2-Contractor Affidavit.pdf
PDF 193 KB Posted
- Attached to
- P26-01 Interpretation & Translation Services
- Solicitation number
- P26-01
- Issued by
- Fayette County, Georgia
About this file
This is a Contractor Affidavit form required by Forsyth County Schools in Georgia for compliance with O.C.G.A. 13-10-91, the state's public works contractor verification statute. The affidavit pertains to the P26-01 Interpretation & Translation Services contract opportunity. Contractors responding to this solicitation must complete and submit this affidavit to verify their registration with and authorization to use E-Verify, the federal work authorization program. The form requires contractors to confirm their continued use of E-Verify throughout the contract period and any renewals or extensions, and to notify Forsyth County Schools should they cease participation in the program at any time.
Contractors must acknowledge that discontinuation of E-Verify usage constitutes material breach of contract and that they will require all subcontractors to submit compliant affidavits under the same state statute. Contractors are responsible for submitting copies of required affidavits, driver's licenses, and identification cards to the public employer within five business days of receipt. The form requires completion of contractor information, project details, the federal work authorization user identification number, and notarization by an authorized officer or agent. Alternatively, contractors without employees may submit Section B of the affidavit along with a copy of a driver's license or state-issued identification card to claim exemption from the E-Verify requirement.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-P26 -01 Bid Form.pdf | ||
| 3-Contract Agreement P26-01.pdf | ||
| 5-P26-01 Special TC and SOW.pdf | ||
| 4-P26-01 Invitation.pdf |
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Text version
Forsyth County Schools Dr. Mitch Young, Superintendent. 1120 Dahlonega Hwy. Cumming, GA 30040. Telephone 770-887-2461
Section A Contractor Affidavit under O.C.G.A. § 13-10-91(b)(l)
The undersigned contractor ("Contractor") executes this Affidavit to comply with O.C.G.A § 13-10-91 related to any contract to which Contractor is a party that is subject to O.C.G.A. § 13-10-91 and hereby verifies its compliance with O.C.G.A. § 13-10-91, attesting as follows:
a) The Contractor has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program;
b) The Contractor will continue to use the federal work authorization program throughout the contract period, including any renewal or extension thereof;
c) The Contractor will notify the public employer in the event the Contractor ceases to utilize the federal work authorization program during the contract period, including renewals or extensions thereof;
d) The Contractor understands that ceasing to utilize the federal work authorization program constitutes a material breach of Contract;
e) The Contractor will contract for the performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the Contractor with the information required by O.C.G.A. § 13-10-91(a), (b), and (c);
f) The Contractor acknowledges and agrees that this Affidavit shall be incorporated into any contract(s) subject to the provisions of O.C.G.A. § 13-10- 91 for the project listed below to which Contractor is a party after the date hereof without further action or consent by Contractor; and
g) Contractor acknowledges its responsibility to submit copies of any affidavits, drivers' licenses, and identification cards required pursuant to O.C.G.A. § 13-10-91 to the public employer within five business days of receipt.
Date of E-Verify Authorization
Name of Project/Contract Number/ Purchase Order Number
Federal Work Authorization User Identification Number
(4-7 Digits, No Letters)
Name of Contractor
Forsyth County Schools Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on ______________, _____, 20_____ in ______________________________ (city), __________ (state).
Printed Name and Title of Authorized Officer or Agent Signature of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE _______ DAY OF _________________, 20______.
__________________________________________________ My Commission Expires: ___________________
NOTARY PUBLIC
Section B
I hereby certify that I do not have and do not intend to hire any employees. Therefore, I am attaching a copy of my driver’s license or an alternative ID card issued by the State.
Name of Contractor Signature of Contractor Date
Exempt; licensed under Title 26, Title 43 or by State Bar of Georgia tridings Underline
| Federal Work Authorization User Identification Number: |
| Date of EVerify Authorization: |
| Name of Contractor: |
| Name of ProjectContract Number: |
| Printed Name and Title of Authorized Officer or Agent: |
| Month: |
| Day: |
| Year: |
| City: |
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| Year 1: |
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| Check Box1: Off |
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