5-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- Vein Finder for HMC Oncology
- Solicitation number
- PROJ-26-045
- 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 procurement of a Vein Finder for HMC Oncology in Florida and must be completed and signed by an authorized officer or representative of the vendor organization. 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 attestation mandates that if the statements made are found to be untrue at any point, the nongovernmental entity must immediately notify Halifax Health and will be prohibited from entering into any future contracts with Halifax Health and will not be permitted to renew or extend any existing contracts. The form requires completion of standard identification fields including the nongovernmental entity name, authorized signature, printed name, and title of the signatory. This attestation is a compliance requirement under Florida Statutes Section 787.06(13) and was current as of July 2024.
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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 .