Common_Carrier_Attestation_02.05.2025.pdf
PDF 112 KB Posted
- Attached to
- Pinellas County Health Program Evaluation Services State and local contract opportunity
- Solicitation number
- 25-0913-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Common Carrier Attestation form required by Pinellas County, Florida for the Health Program Evaluation Services procurement. The attestation is a compliance document that contractors must complete and execute as part of their proposal submission for the evaluation services contract. The form requires authorized representatives of contracting firms to attest, under penalty of perjury, that they are in conformity with Florida Statute 92.525 and will not knowingly transport unauthorized aliens into Florida during the contract term, except to facilitate detention, removal, or departure. The attestation must be signed by an authorized company representative and include the signer's printed name, date, Federal Work Authorization User Identification Number, and the name and number of the associated Pinellas County contract.
The County reserves the right to terminate the associated agreement for cause if the Contractor is found in violation of the Common Carrier Attestation. This document is one of several required compliance submissions for vendors responding to the Pinellas County Health Program Evaluation Services RFP, alongside a Human Trafficking Affidavit, HIPAA Business Associate Agreement, and Foreign Countries of Concern Affidavit. The Common Carrier Attestation applies to any person, firm, or corporation that undertakes for hire as a regular business to transport persons or commodities from place to place and offers services to those willing to employ them and pay applicable charges.
View the file
Other files for this state and local contract opportunity
Show all 34
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .