3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 081-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit required by the State of Missouri and applicable to the Tornado: Yeatman Liddell Mitigation & Restoration contract opportunity with Saint Louis Public Schools (SLPS). The affidavit mandates that vendors and their authorized representatives certify under oath their enrollment in and participation with the United States E-Verify federal work authorization program for all employees working on services provided to the district. The affidavit further requires certification that the company does not knowingly employ any unauthorized aliens in connection with the services being provided or to be provided to the district.
The affidavit must be completed by an individual employed by the bidding company with authority to execute the document on the company's behalf and must be notarized before a Missouri Notary Public. The affiant must declare they are over twenty-one years of age and have firsthand knowledge of the facts stated. The notarized document serves as a compliance verification tool to ensure that all contractors meet federal work authorization requirements as a condition of contract award and performance on SLPS projects.
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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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