9-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Solicitation number
- PROJ-26-022
- 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 Halifax Behavioral Services – Unit 200 Remediation project in Florida, which involves remediation work including containment, demolition, disposal, HVAC isolation, finish repairs, and sanitization. The form must be completed and signed by an authorized representative or officer of the bidding nongovernmental entity under penalty of perjury.
The attestation requires the bidding entity to confirm that it does not use coercion for labor or services as defined in Florida Statutes Section 787.06. By executing the form, the entity acknowledges that any false statements made in the attestation will result in immediate notification to Halifax Health, disqualification from future contract opportunities, and forfeiture of any contract renewal or extension rights. The form includes spaces for the nongovernmental entity name, authorized signature, printed name, and title of the signing official, with the form dated July 2024.
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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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