3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Patrick Henry ROOF
- Solicitation number
- RFP 085-2025
- Issued by
- St. Louis City, Missouri
About this file
This document is a Federal Work Authorization Program Affidavit required for vendors contracting with Saint Louis Public Schools (SLPS) in Missouri, specifically for the Patrick Henry Roof project. The affidavit serves as a compliance verification tool requiring authorized company representatives to confirm their organization's enrollment and participation in the E-Verify federal work authorization program and to attest that the company does not knowingly employ unauthorized aliens in connection with services provided to the district. The form must be notarized and executed by an individual with authority to bind the company, including the affiant's signature, company name, title, and the notary public's certification with commission expiration date.
The affidavit contains no pricing information, set-aside provisions, or contract term details, as it functions solely as a compliance certification requirement. The document is a fillable PDF template designed to be completed and submitted as part of the bidding process to demonstrate adherence to federal work authorization requirements. Vendors must complete this form and have it properly notarized before submitting their bid for the roof replacement project at Patrick Henry, with the notarization occurring in Missouri in the county where the authorized representative executes the document.
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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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