Common_Carrier_Attestation_02.05.2025.pdf
PDF 112 KB Posted
- Solicitation number
- 26-0251-REQ
- Issued by
- Pinellas County, Florida
About this file
This Common Carrier Attestation form is required by Pinellas County, Florida for Request for Proposal 26-0251 regarding employee benefits concierge and health navigation services. The attestation requires contractors to confirm compliance with Florida Statute 92.525 and certify 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 County reserves the right to terminate any agreement for cause if a contractor is found in violation of this attestation.
This attestation is one of several mandatory certifications required from all contractors responding to the RFP for health navigation services for approximately 3,250 County employees and their families. Additional required certifications include the Foreign Countries of Concern Affidavit, Human Trafficking Affidavit, HIPAA Business Associate Agreement, E-Verify compliance documentation, and proof of required insurance coverage. The initial contract term is five years effective August 1, 2026, with options for two additional twelve-month renewal periods. Proposals are due March 5, 2026, at 3:00 p.m. via the OpenGov procurement portal, with the question submission deadline of February 19, 2026, at 10:00 a.m. No bidder's conferences or site visits are scheduled for this procurement.
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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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