3-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- Haag-Streit BQ 900 LED Slit Lamp with Imaging
- Solicitation number
- PROJ-25-160A
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by Halifax Health for all nongovernmental entities executing, renewing, or extending contracts with the organization in accordance with Florida Statutes Section 787.06(13). The attestation applies to the procurement of a Haag-Streit BQ 900 LED Slit Lamp with Imaging in Florida and must be completed and signed by an authorized officer or representative of any vendor entity seeking to contract with Halifax Health. The form requires the nongovernmental entity to attest, under penalty of perjury, that it does not use coercion for labor or services as defined in Florida Statutes Section 787.06.
The executing party must acknowledge that the statements are made for the benefit of Halifax Health's compliance with human trafficking statutes and agree that any false attestation will result in immediate notification to Halifax Health and prohibition from entering into any future contracts with the organization, as well as termination of any existing contracts. The form requires completion of fields for the nongovernmental entity name, authorized representative signature, printed name, and title. No pricing, set-asides, incumbent information, or other procurement-specific financial terms are addressed in this attestation document.
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Text version
Human Trafficking Attestation
Pursuant to Florida Statutes Section 787.06(13), this attestation must be completed by an officer or representative of any nongovernmental entity that is executing, renewing, or extending a contract with Halifax Health.
The undersigned, as an authorized representative or officer of, and on behalf of, the “Nongovernmental Entity,” by executing below, attests, under penalty of perjury, to the following:
The Nongovernmental Entity does not use coercion for labor or services as such italicized terms are defined in Florida Statutes Section 787.06, as the same may be amended from time to time.
The undersigned understands that the statements made herein are made for the benefit of Halifax Health, and its compliance with Florida Statutes Section 787.06, and if at any time the attestation made herein is untrue, the Nongovernmental Entity will immediately notify Halifax Health of same and will not, thereafter, enter into any future contracts with Halifax Health, and will not renew or extend any existing contracts.
Nongovernmental Entity Name:__________________________________________________________
Signature: ____________________________________________________________________
Printed Name: ________________________________________________________________________
Title: _______________________________________________________________________
s. 787.06, FS July 2024
Attachment C
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File details come from the government source that posted it. Updated .