2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 106-2026
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form for the Board of Education of the City of St. Louis (St. Louis Public Schools) related to the "Walnut Park" Demolition Existing Structures and Site Restoration contract opportunity in Missouri. The affidavit requires company representatives to certify under oath that they are authorized to execute the document on behalf of their employer, that the company is enrolled and participating in the E-Verify federal work authorization program for all employees working on district services, and that the company does not knowingly employ any unauthorized aliens in connection with services provided to the district. The affidavit must be notarized by a Notary Public in the State of Missouri and includes spaces for the affiant's signature, company name, title, date, and the notary's commission expiration date.
The document serves as a compliance requirement for bidders on the demolition and site restoration project, ensuring that all contractors and subcontractors maintain federal work authorization compliance. Completion and submission of this notarized affidavit is a prerequisite for bid consideration and contract award. There are no pricing terms, set-asides, or funding information contained within this form, as it functions solely as a verification and compliance document rather than a solicitation or pricing instrument.
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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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