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 contractors participating in the Health Program Evaluation Services procurement. The attestation document requires authorized contractor representatives to certify compliance with Florida Statute 92.525 and section 908.111, confirming that the contractor will not knowingly transport unauthorized aliens into Florida during the contract term, except to facilitate detention, removal, or departure from the state or United States. The form defines "common carrier" as any person, firm, or corporation that transports persons or commodities for hire as a regular business to all customers willing to pay applicable charges. Contractors must complete the attestation by providing the contractor name, authorized representative signature, printed name, execution date, Federal Work Authorization User Identification Number, and the associated Pinellas County contract name and number. The County reserves the right to terminate the contract for cause if the contractor violates the attestation requirements.
This attestation is one of several compliance documents required for the Pinellas County Health Program Evaluation Services RFP, alongside a Human Trafficking Affidavit, HIPAA Business Associate Agreement, and Foreign Countries of Concern Affidavit. The six-month evaluation contract, with no renewal options, requires selected firms to assess the County's indigent healthcare programs serving residents at 100%, 200%, and 300% of the Federal Poverty Level. While the RFP was released September 10, 2025, with questions due September 25, 2025, and proposals due October 2, 2025, at 3:00 p.m., this attestation represents a standard pre-award compliance requirement that prospective vendors must satisfy prior to contract execution.
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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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