3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Stevens ROOF
- Solicitation number
- RFP 087-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by the Springfield-Greene County Public Schools (SLPS) for the Tornado: Stevens ROOF project in Missouri. The affidavit serves as a compliance document to verify that contractors and their employees meet federal work authorization requirements. The form requires authorized company representatives to attest under oath that their company is enrolled in the E-Verify program and does not knowingly employ unauthorized aliens in connection with services provided to the school district. The affidavit must be notarized and signed by an individual with authority to execute the document on behalf of the company, with completion required prior to contract award or performance of services.
The affidavit is a mandatory compliance requirement rather than a pricing or commercial document. It contains no pricing terms, set-asides, or funding information, as it functions solely to establish federal work authorization compliance. Contractors must complete the form with specific company and individual information, obtain notarization from a Missouri notary public, and submit it as part of their bid package or contractual documentation. Non-compliance with E-Verify enrollment and the execution of this affidavit may result in bid rejection or contract termination. The form is applicable to all contractors and subcontractors engaged in work for SLPS regardless of contract value or scope.
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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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