9-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- HBS RTU REPLACEMENTS
- Solicitation number
- PROJ-26-073
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by Halifax Health, a Florida healthcare organization, for any nongovernmental entity executing, renewing, or extending a contract with the agency. The attestation pertains to the HBS RTU Replacements project, which involves replacing four rooftop units (Unit 11, 12, 13, and 14) at Halifax Health Behavioral Services. The form requires an authorized representative or officer of the nongovernmental entity to certify under penalty of perjury that the entity does not use coercion for labor or services as defined in Florida Statutes Section 787.06.
The attestation serves as Halifax Health's compliance mechanism with Florida Statutes Section 787.06 regarding human trafficking prevention. Nongovernmental entities must complete the form by providing their organization name, authorized representative signature, printed name, and title. The entity acknowledges that if the attestation becomes untrue at any point, it must immediately notify Halifax Health and will be ineligible to enter into any future contracts or renew or extend existing contracts with the organization. This requirement applies to all contractors bidding on or currently engaged with Halifax Health contracts.
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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 .