Common_Carrier_Attestation_02.05.2025.pdf
PDF 112 KB Posted
- Attached to
- 26-0408-RFP Pharmacy Benefit Manager Services
- Solicitation number
- 26-0408-REQ
- Issued by
- Pinellas County, Florida
About this file
This document is a Common Carrier Attestation form required by Pinellas County, Florida, in connection with the 26-0408-RFP Pharmacy Benefit Manager Services contract opportunity. The attestation form serves as a compliance document that contractors must complete and sign to affirm their adherence to Florida Statute 908.111 and Florida Statute 92.525. The contractor's authorized representative must attest under penalties of perjury that the contractor will not knowingly transport unauthorized aliens into Florida during the contract term, except to facilitate their detention, removal, or departure from the state or United States. The form requires the contractor to provide identifying information including the signatory's printed name, signature, date, Federal Work Authorization User Identification Number, and the name and contract number of the Pinellas County contract.
The attestation defines "common carrier" as any person, firm, or corporation that undertakes transportation of persons or commodities for hire as a regular business, offering services to the public for specified charges. Pinellas County reserves the right to terminate the associated agreement for cause if the contractor is found in violation of the attestation. Execution of this form is mandatory for all contractors bidding on Pinellas County contracts and represents a material compliance requirement in the procurement process.
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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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