2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 103-2026
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by the St. Louis Public Schools for the "Scullin" Demolition Existing Structures and Site Restoration project in Missouri. The affidavit serves as a compliance document wherein company representatives certify 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 of legal age, possess firsthand knowledge of the company's E-Verify participation, and have authority to execute the affidavit on behalf of the employer. The document must be notarized by a Missouri notary public, with specific fields for the affiant's signature, company name, title, and the notary's commission expiration date.
This affidavit is a mandatory prerequisite document for bidders responding to the St. Louis Public Schools' invitation for comprehensive demolition and site restoration services at a former school site. The requirement ensures that all contractors and subcontractors comply with federal work authorization regulations prior to contract award. No pricing information, specific contract terms, or award dates are contained within this affidavit form itself; rather, it represents a compliance and verification requirement that must be submitted as part of the bidding process to demonstrate the contractor's commitment to employing only legally authorized workers.
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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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