Common_Carrier_Attestation_02.05.2025.pdf
PDF 112 KB Posted
- Attached to
- 26-0408-RFP Pharmacy Benefit Manager Services
- Solicitation number
- 26-0408-REQ
- Issued by
- Pinellas County, Florida
About this file
This is a Common Carrier Attestation form required by Pinellas County, Florida for the RFP 26-0408 Pharmacy Benefit Manager Services procurement. The attestation requires contractors to confirm compliance with Florida Statute 92.525 and Section 908.111, certifying that they will not knowingly transport unauthorized aliens into Florida during the contract term, except to facilitate detention, removal, or departure. An authorized representative of the contractor must execute the attestation under penalty of perjury, providing their signature, printed name, date, Federal Work Authorization User Identification Number, and the contract name and number. The form applies to any entity defined as a "common carrier"—a person, firm, or corporation that transports persons or commodities for hire as a regular business, offering services to all customers at stated charges.
Pinellas County reserves the right to terminate the associated Pharmacy Benefit Manager Services agreement for cause if the contractor is found in violation of the common carrier attestation. This compliance requirement is one of several mandatory affidavits and attestations that all proposing firms must complete and submit as part of their proposal response, along with human trafficking law compliance affidavits, foreign country of concern ownership restrictions documentation, and other statutory certifications. The attestation form must be completed and submitted as part of the comprehensive proposal package by the March 31, 2026 deadline to be considered for award of the five-year PBM services contract with two optional one-year renewal periods commencing January 1, 2027.
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Text version
COMMON CARRIER ATTESTATION
In accordance with section 908.111, Florida Statutes, the undersigned, on behalf of ___________________________ (the “Contractor”), attests and agrees they are in conformity with Florida Statute § 92.525 and is not willfully providing and will not willfully provide any service during the contract term in furtherance of transporting a person into this state knowing that the person is an unauthorized alien, except to facilitate the detention, removal, or departure of the person from this state or the United States.
For purposes of this Attestation, the Contractor is a “Common carrier” if it is a person, firm, or corporation that undertakes for hire, as a regular business, to transport persons or commodities from place to place, offering his or her services to all such as may choose to employ the common carrier and pay his or her charges.
The undersigned must be an authorized representative of the Contractor who can execute this Attestation on the Contractor’s behalf.
Under penalties of perjury, I _________________, declare that I have read the foregoing Common Carrier Attestation and that the facts stated in it are true.
Signature:______________________________
Print Name:______________________________
Date:______________________________
Federal Work Authorization User Identification No.:_____________________________
Name of Pinellas County Contract and Contract No.:____________________________
COMMON CARRIER TERMINATION
The County reserves the right to terminate the associated agreement, for cause, if the Contractor is found in violation of its attestation above.
https://www.lawinsider.com/clause/attestation https://www.lawinsider.com/clause/attestation
| Print Name: |
| Date: |
| Federal Work Authorization User Identification No: |
| Name of Pinellas County Contract and Contract No: |
| Contractor: |
| Name: |
| Contractor Signature_es_:signer:signature: |
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