Common_Carrier_Attestation_02.05.2025.pdf

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 requires the selected contractor to confirm compliance with Florida Statute 92.525 and Section 908.111, Florida Statutes, by attesting that they will not knowingly provide services to transport unauthorized aliens into the state during the contract term, except to facilitate detention, removal, or departure. The form must be executed by an authorized representative of the contractor under penalty of perjury and includes fields for the contractor's name, authorized representative signature, print name, date, Federal Work Authorization User Identification Number, and the specific Pinellas County contract name and number. The contract term is three years with two optional one-year renewal periods, with a question submission deadline of January 13, 2026, and proposal submissions due January 22, 2026, at 3:00 p.m.

Pinellas County reserves the right to terminate the associated workers compensation TPA agreement for cause if the contractor is found in violation of this attestation. The county is transitioning from its current self-administered workers compensation program to engage a Florida-licensed TPA provider with a minimum of seven years' experience administering workers' compensation claims for municipalities. The selected TPA will manage approximately 200-300 open workers compensation files, 70 closed files requiring annual maintenance, and 30 files in litigation for approximately 5,359 employees. Proposers must submit comprehensive annual pricing for third-party claims administration, claim intake, EDI reporting, system access, and check writing services, along with a separate one-time transition fee for migrating existing claims, with the county maintaining a $2 million self-insured retention per occurrence.