7-Attachment C-Human Trafficking.pdf

333 KB Posted

Attached to
FIRE PUMP
Solicitation number
PROJ-26-010
Issued by
Volusia County, Florida

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This document is a Human Trafficking Attestation form from Halifax Health, pursuant to Florida Statutes Section 787.06(13). The form is designed to be completed by an officer or representative of any nongovernmental entity that is executing, renewing, or extending a contract with Halifax Health. The attestation requires the nongovernmental entity to confirm that they do not use coercion for labor or services as defined in the referenced Florida statute.

The form includes a critical compliance statement where the signatory acknowledges that the statements are made for Halifax Health's benefit and that if the attestation is found to be untrue, the nongovernmental entity will immediately notify Halifax Health. Furthermore, the entity agrees not to enter into any future contracts or renew existing contracts with Halifax Health if the attestation is proven false. The document is dated July 2024 and is marked as Attachment C, indicating it is part of a larger contract or procurement package.

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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 .