Human_Trafficking_Affidavit_11.20.25.pdf

This is a Human Trafficking Affidavit form required by Pinellas County, Florida for contractors bidding on RFP 26-0408 for Pharmacy Benefit Manager Services. The affidavit requires an authorized representative of the bidding contractor to attest under penalties of perjury that the firm does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The document must be notarized and include the contractor's name, the authorized representative's signature and printed name, date of execution, Federal Work Authorization User Identification Number, the Pinellas County contract name and number, and the notary public's seal and commission expiration date. This affidavit is a mandatory compliance document for all proposers responding to the RFP, which seeks comprehensive Pharmacy Benefit Manager services for approximately 3,200 county employees with a contract term of five years plus two optional one-year renewal periods, commencing January 1, 2027. Proposals must be submitted electronically through OpenGov by March 31, 2026 at 3:00 p.m., with a question submission deadline of March 19, 2026.

In addition to the Human Trafficking Affidavit, all proposing firms must also complete and submit notarized affidavits addressing foreign country of concern ownership restrictions and common carrier attestations regarding unauthorized alien transportation. The RFP requires qualified vendors to be licensed as a PBM in all 50 states, manage at least one million Rx lives, possess a minimum of eight years of experience as a full-service PBM or health plan carrier, and maintain business relationships with 3-5 government or public sector clients in Florida or neighboring states. Pricing must be submitted as a five-year lump sum total on a per employee per month (PEPM) basis with detailed pricing for retail, mail order, retail 90-day, and specialty pharmacy claims. Annual pricing adjustments after the initial twelve months are capped at the Consumer Price Index or 3 percent, whichever is less, with vendors assuming dollar-for-dollar risk on pricing shortfalls. The incumbent vendor is Express Scripts Inc., and the County reserves the right to terminate the agreement with 90 days' notice without cause and to reject any or all proposals.