4-Attachment C-Human Trafficking (1).pdf
PDF 333 KB Posted
- Attached to
- Ophthalmology Practice Equipment
- Solicitation number
- PROJ-25-160
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by Halifax Health for any nongovernmental entity executing, renewing, or extending a contract with the organization. The attestation pertains to the Ophthalmology Practice Equipment procurement (PROJ-25-160), a competitive bid process for qualified suppliers to provide various ophthalmology equipment. The Invitation for Bid packet became available on December 4, 2025, at 12:00 PM EST through the Halifax Health Procurement Portal at http://halifaxhealth.bonfirehub.com. Suppliers interested in submitting bids must demonstrate expertise on similar projects. The deadline for submitting questions regarding the ITB is 12:00 PM EST on December 15, 2025, with responses provided via addendum. All bids must be submitted electronically through the procurement portal, with final bid submissions due by 2:00 PM EST on December 17, 2025. The general conditions contained in the bid instructions and conditions are binding upon each bidder.
The attestation form requires an authorized officer or representative of the nongovernmental entity to certify under penalty of perjury that the entity does not use coercion for labor or services as defined in Florida Statutes Section 787.06. Signatories understand that any false statement in the attestation must be immediately disclosed to Halifax Health, and failure to comply will result in the entity's ineligibility to enter into future contracts with Halifax Health or renew existing contracts. The form requires completion of standard fields including the nongovernmental entity name, authorized representative signature, printed name, and title.
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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 .