3-Attachment C-Human Trafficking.pdf

This is a Human Trafficking Attestation form required by Halifax Health, a healthcare organization, for any nongovernmental entity executing, renewing, or extending contracts with the organization. The document serves as Attachment C to contracting documentation and mandates compliance with Florida Statutes Section 787.06(13), requiring completion by an authorized officer or representative of the contracting entity. The form requires attestation under penalty of perjury that the nongovernmental entity does not use coercion for labor or services as defined in Florida Statutes Section 787.06, and includes an understanding that if the attestation becomes untrue at any time, the entity must immediately notify Halifax Health and will be prohibited from entering into future contracts or renewing existing ones.

The attestation form includes signature fields for the nongovernmental entity name, authorized representative signature, printed name, and title, with references to the governing Florida statute and a July 2024 date. This document appears to be a mandatory compliance requirement rather than a procurement opportunity, serving as a legal safeguard for Halifax Health to ensure their contracting partners adhere to anti-human trafficking regulations. The form does not specify contract values, terms, or specific services, as it functions as a universal attestation document applicable to all nongovernmental contracts with Halifax Health.