7-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- CHILLER REPLACEMENT FOR HHPO
- Solicitation number
- PROJ-25-131
- Issued by
- Volusia County, Florida
About this file
This document is a Human Trafficking Attestation form issued by Halifax Health, requiring completion by nongovernmental entities executing, renewing, or extending a contract with the organization. The form is based on Florida Statutes Section 787.06(13) and requires an authorized representative to attest, under penalty of perjury, that their organization does not use coercion for labor or services as defined in the referenced statute.
The attestation mandates that the nongovernmental entity commit to immediately notifying Halifax Health if the attestation becomes untrue, and agrees to refrain from entering into future contracts or renewing existing contracts with Halifax Health under such circumstances. The document is dated July 2024 and provides blank spaces for the nongovernmental entity's name, signature, printed name, and title of the authorized representative completing the form.
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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 .