2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 108-2026
- Issued by
- St. Louis County, Missouri
About this file
This is a Federal Work Authorization Program Affidavit required by the St. Louis Board of Education (St. Louis Public Schools) for the Clyde C. Miller High School Cosmetology and Barber instructional space renovation project in Missouri. The affidavit serves as a compliance document whereby authorized company representatives certify, under oath and notarization, that their firm is enrolled in and actively participating in the U.S. E-Verify federal work authorization program for all employees working on the district contract. The affiant must also confirm that the company does not knowingly employ any unauthorized aliens in connection with services provided to the district. Project documents are available through Custom Blueprint, located at 1632 South Broadway, St. Louis, Missouri 63104, with contact information available at 314-231-4400 or customblueprint-supply.com.
This affidavit is a mandatory compliance requirement and does not contain pricing, set-asides, funding information, or contract terms. All bidders and contractors seeking to work on this renovation project for new and expanded CTE program facilities at Clyde C. Miller High School must complete and notarize this form as part of their bid submission or contract execution requirements. The document requires the authorized representative's signature, company name, title, and notary public acknowledgment with commission expiration date, establishing legal accountability for the contractor's E-Verify compliance and employment authorization practices.
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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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