Common_Carrier_Attestation_02.05.2025.pdf
PDF 112 KB Posted
- Solicitation number
- 26-0137-REQ
- Issued by
- Pinellas County, Florida
About this file
This is a Common Carrier Attestation form required by Pinellas County, Florida for the Workers Compensation Third-Party Administrator Services contract (RFP 26-0137). The attestation mandates that the contractor comply with Florida Statute 92.525 and confirms that the contractor will not willfully provide services to transport unauthorized aliens into Florida, except to facilitate their detention, removal, or departure from the state or United States. The form applies to any "common carrier"—defined as a person, firm, or corporation that transports persons or commodities for hire as a regular business—and must be executed by an authorized representative of the contractor under penalties of perjury. The signatory must provide their printed name, date, Federal Work Authorization User Identification Number, and the name and contract number of the Pinellas County contract. Pinellas County reserves the right to terminate the associated agreement for cause if the contractor is found in violation of this attestation.
This attestation form is a compliance requirement that must be completed as part of the proposal submission process for RFP 26-0137. While the Workers Compensation Third-Party Administrator Services contract itself does not involve transportation services, the attestation reflects Florida's statutory requirements for contractors working with the state and local government. All prospective vendors responding to this RFP must complete and submit this form with their proposals to demonstrate compliance with state immigration and transportation regulations.
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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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