8-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- PHARMACY IV ROOM REMODEL FOR HHPO
- Solicitation number
- PROJ-25-099
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by Halifax Health, a healthcare organization, for any nongovernmental entity executing, renewing, or extending contracts with the organization. The attestation is mandated under Florida Statutes Section 787.06(13) and requires completion by an authorized officer or representative of the contracting entity. The form serves as a compliance document to ensure adherence to state anti-human trafficking laws and includes signature fields for the nongovernmental entity name, authorized signature, printed name, and title of the signing official.
The attestation requires the signatory to attest under penalty of perjury that their organization does not use coercion for labor or services as defined in Florida Statutes Section 787.06. Additionally, the form establishes that if the attestation becomes untrue at any time, the nongovernmental entity must immediately notify Halifax Health and agrees not to enter into future contracts or renew/extend existing contracts with the healthcare organization. The document is dated July 2024 and is designated as "Attachment C" in what appears to be a larger contract package or procurement document.
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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 .