Exhibit_D_-_Human_Trafficking_Affidavit_FINAL.pdf
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- Attached to
- Benefit Administrative Services
- Solicitation number
- 26-P-66TF
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by the County of Volusia, Florida, in conjunction with the execution, renewal, or extension of a contract for benefit administrative services. Pursuant to Section 787.06(14) of the Florida Statutes, any nongovernmental entity entering into a contract with Volusia County must provide a signed affidavit under penalty of perjury certifying that the entity does not use coercion to employ persons for labor or services. The attestation applies to all contracted benefit administrative services, including third-party administration of Flexible Spending Accounts (Medical and Dependent Care FSA), Health Reimbursement Arrangements (HRA), COBRA administration, and retiree billing services. The form requires completion and signature by a duly authorized officer or representative of the contracting entity prior to contract execution, renewal, or extension.
The affidavit defines coercion comprehensively to include physical force, restraint, debt bondage, document confiscation, financial harm, fraud, and provision of controlled substances for exploitation purposes. The nongovernmental entity must attest that it does not engage in these practices and commits to immediately notifying the County should any coercive labor practices occur in the future. The signed attestation becomes binding documentation provided for the County's reliance and compliance verification. Failure to maintain this commitment or subsequent discovery of coercive practices may result in termination of contract execution, renewal, or extension between the parties.
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Text version
26-P-66TF Exhibit D
P:\TABATHA\2026 Solicitations\26-P-66TF Benefit Administrative Services (COBRA, FSA & Retiree Billing)\1 SOLICITATION\Exhibit D - Human Trafficking Affidavit FINAL.docx
HUMAN TRAFFICKING ATTESTATION
PURSUANT TO SECTION 787.06, FLORIDA STATUTES
Name of Entity/Contractor: __________________________________ ("Nongovernmental Entity")
This form has been completed by a duly authorized officer or representative of the Nongovernmental Entity in conjunction with the execution, renewal, or extension of a contract with County of Volusia, a governmental entity and political subdivision of the State of Florida, ("Governmental Entity") in compliance with Section 787.06(14), Florida Statutes, (2025).
The Nongovernmental Entity acknowledges that Section 787.06(14), Florida Statutes, provides that when a contract is executed, renewed, or extended between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services. For purposes of this requirement, “labor” means work of economic or financial value and “services” means any act committed at the behest of, under the supervision of, or for the benefit of another.
The term, “services” includes, but is not limited to, forced marriage, servitude, or the removal of organs.
Pursuant to Section 787.06, Florida Statutes, when a contract is executed, renewed, or extended between you, a nongovernmental entity, and Volusia County, a governmental entity in the State of Florida, you are hereby providing this affidavit under penalties of perjury that you do not use coercion to employ any person for labor or services. Coercion includes, without limitation, using or threatening to use physical force against any person; restraining, isolating, or confining or threatening to restrain, isolate, or confine any person without lawful authority and against her or his will; using lending or other credit methods to establish a debt by any person when labor or services are pledged as a security for the debt, if the value of the labor or services as reasonably assessed is not applied toward the liquidation of the debt, the length and nature of the labor or services are not respectively limited and defined; destroying, concealing, removing, confiscating, withholding, or possessing any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification document, of any person; causing or threatening to cause financial harm to any person; enticing or luring any person by fraud or deceit;
or providing a controlled substance as outlined in Schedule I or Schedule II of Section 893.03, Florida Statutes, to any person for the purpose of exploitation of that person.
This signed attestation is provided to the Governmental Entity to comply with the statutory requirement. If, at any time in the future, the Nongovernmental Entity does use coercion for labor or services, the Nongovernmental Entity will immediately notify the Governmental Entity and no contracts may be executed, renewed, or extended between the parties.
This attestation is made for the benefit of, and reliance by, the Governmental Entity.
Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.
Printed Name: Title:
Signature: Date:
File details come from the government source that posted it. Updated .