3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Hamilton ROOF & Tuckpointing
- Solicitation number
- RFP 093-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by the Saint Louis Public Schools (SLPS) for the Tornado: Hamilton Roof & Tuckpointing project in Missouri. The affidavit serves as a compliance document whereby an authorized company representative confirms under oath that the company is enrolled in the E-Verify federal work authorization program and certifies that no unauthorized aliens are knowingly employed in connection with services provided to the school district. The form requires the affiant to be over twenty-one years of age with firsthand knowledge of the company's employment practices, and must be notarized by a Missouri Notary Public with the county, date, and commission expiration clearly documented.
This document is a mandatory compliance requirement rather than a pricing or service specification document. Contractors bidding on the roofing and tuckpointing project must complete and submit a notarized affidavit as part of their bid package to demonstrate adherence to federal work authorization requirements. The form is fillable and standardized, requiring completion of company name, authorized representative information, notarization details, and confirmation of E-Verify enrollment status.
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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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