2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 102-2026
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form for the St. Louis Public Schools District in Missouri, designed to verify contractor compliance with federal employment authorization requirements. The affidavit requires authorized company representatives to confirm that their firm is enrolled and actively participating in the U.S. E-Verify program for employees working on district services and that no unauthorized aliens are knowingly employed in connection with the services being provided to the district. The document is a notarized declaration that must be executed by an individual with authority to bind the company, with signature and acknowledgment before a notary public in Missouri.
The affidavit serves as a mandatory compliance document for vendors bidding on or executing contracts with the St. Louis Public Schools, specifically in connection with the Gundlach demolition and site restoration project. The form includes fillable fields for contractor information, notarization details, and expiration of notary commission, ensuring that employment authorization verification is current and properly documented. Submission of this completed and notarized affidavit is a prerequisite requirement for contract award and performance on district projects.
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Text version
FEDERAL WORK AUTHORIZATION PROGRAM AFFIDAVIT
I, __________________________________________, being of legal age and having been duly sworn upon my oath, state the following facts are true:
1. I am more than twenty-one years of age; and have first-hand knowledge of the matters set forth herein.
2. I am employed by ____________________________________ (hereinafter “Company”) and have authority to issue this affidavit on its behalf.
3. Company is enrolled in and participating in the United States E-Verify (formerly known as “Basic Pilot”) federal work authorization program with respect to Company’s employees working in connection with the services Company is providing to, or will provide to, the district, to the extent allowed by E-Verify.
4. Company does not knowingly employ any person who is an unauthorized alien in connection with the services Company is providing to, or will provide to, the district.
FURTHER AFFIANT SAYETH NOT.
By: _________________________________________________ (individual signature)
For: ________________________________________________ (company name)
Title: _______________________________________________
STATE OF MISSOURI)
) ss.
COUNTY OF __________________________)
On this _______ day of ______________, 20____, before me, _______________________, a Notary Public in and for such County and State, personally appeared _______________________________________ of
___________________________________________, known to me to be the person who executed the affidavit on behalf of said ________________________ and acknowledged to me that he or she executed the same for the purposes therein stated. Subscribed and affirmed before me this _______ day of
_________________, 20______.
Notary Public My commission expires on: _________________________
| I: |
| 2 I am employed by: |
| By: |
| For: |
| Title: |
| COUNTY OF: |
| On this: |
| day of: |
| 20: |
| before me: |
| and for such County and State personally appeared: |
| known to me to be the person who executed the: |
| affidavit on behalf of said: |
| same for the purposes therein stated Subscribed and affirmed before me this 1: |
| same for the purposes therein stated Subscribed and affirmed before me this 2: |
| 20_2: |
| Notary Public: |
| My commission expires on: |
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