6-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- South Machine Room Booster Pump
- Solicitation number
- PROJ-26-068
- 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. The attestation is mandated pursuant to Florida Statutes Section 787.06(13) and must be completed and signed by an authorized representative or officer of the contracting entity. The form applies to the South Machine Room Booster Pump project, which involves the removal and replacement of existing booster pumps in the South Machine Room at Halifax Health's facility in Florida.
The attestation 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 signing representative must provide the entity name, signature, printed name, and title on the form. The entity acknowledges that if the attestation becomes untrue at any time, it must immediately notify Halifax Health and will be ineligible to enter into any future contracts, renewals, or extensions with Halifax Health. This document serves as Halifax Health's compliance mechanism with state human trafficking prevention requirements and must be submitted as part of the contract execution process.
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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 .