2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 100-2026
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit document required by the State of Missouri for the Renovation & Additions project at Central VPA & Collegiate M & B High Schools. The affidavit serves as a compliance certification in which a company representative confirms under oath that the company is enrolled in the E-Verify federal work authorization program and commits to verifying the work authorization status of all employees assigned to the project. The document requires the affiant to declare that they are over twenty-one years of age, possess authority to execute the affidavit on behalf of their employer, and that the company does not knowingly employ any unauthorized aliens in connection with services provided to the school district.
The affidavit must be executed before a notary public in Missouri and includes standard notarization elements such as the notary's signature, commission expiration date, and the date of execution. This documentation is a prerequisite for contractors and subcontractors bidding on or performing work related to the Central VPA and Collegiate High School project, ensuring compliance with federal work authorization requirements applicable to state and local contracts in Missouri.
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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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