2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 105-2026
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by the Board of Education of the City of St. Louis (d/b/a St. Louis Public Schools) for the "Hempstead" Demolition Existing Structures and Site Restoration contract opportunity in Missouri. The affidavit serves as a compliance document whereby authorized company representatives confirm under oath that their firm is enrolled in the E-Verify federal work authorization program and does not knowingly employ unauthorized aliens in connection with services provided to the district. The form requires the affiant to be over twenty-one years of age with firsthand knowledge of the company's E-Verify participation and employment practices, and must be signed by an individual with authority to execute the affidavit on the company's behalf.
The affidavit must be notarized in the State of Missouri before submission as part of the bid process. The document includes designated spaces for the affiant's signature, company name, title, notary public signature, notary commission expiration date, and county information. This requirement ensures that all contractors bidding on the demolition and site restoration services comply with federal work authorization regulations prior to award and performance of the contract.
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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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