Exhibit_D_-_Human_Trafficking_Affidavit_FINAL.pdf
PDF 125 KB Posted
- Attached to
- EMS Invoicing Services
- Solicitation number
- 26-B-68TF
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by County of Volusia, Florida, for contractors entering into, renewing, or extending contracts with the county. The form mandates that nongovernmental entities provide a signed affidavit under penalty of perjury attesting compliance with Section 787.06 of the Florida Statutes, which prohibits the use of coercion for labor or services. The attestation applies to the EMS Invoicing Services contract, which involves the County of Volusia's Emergency Medical Services Division and requires contractor compliance with HIPAA and HITECH Act requirements. Contractors must declare that they do not engage in coercion, including practices such as physical force, unlawful restraint, debt bondage, document confiscation, financial harm, fraud, or provision of controlled substances for exploitation purposes.
Contractors are required to complete and sign the form with their printed name, title, signature, and date prior to contract execution, renewal, or extension. Should a contractor subsequently engage in coercive labor practices at any time during the contract period, they must immediately notify the County of Volusia, and the parties may not execute, renew, or extend any future contracts. The attestation serves as a statutory compliance requirement and is made under the penalties of perjury, with the contractor certifying the truthfulness of the declaration.
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Text version
26-B-68TF Exhibit D
P:\TABATHA\2026 Solicitations\26-B-68TF EMS Invoicing Services\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(13), Florida Statutes, (2024).
The Nongovernmental Entity acknowledges that Section 787.06(13), 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 .