3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Dewey ROOF
- Solicitation number
- RFP 092-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by Saint Louis Public Schools (SLPS) for the Tornado: Dewey Roof project in Missouri. The affidavit serves as a compliance document confirming that contractors and their employees meet federal work authorization requirements. The form requires the contractor or authorized company representative to attest under oath that the company is enrolled in the U.S. E-Verify program, maintains compliance with federal work authorization protocols for employees, and does not knowingly employ unauthorized aliens in connection with services provided to the district. The affidavit must be notarized by a Missouri notary public and includes sections for the affiant's signature, company name, title, and notarization details.
This document is a mandatory compliance requirement for participation in the contract opportunity rather than a pricing or service specification document. Contractors bidding on the Dewey roof project must complete and submit this notarized affidavit as part of their proposal package to demonstrate adherence to federal employment verification standards. The form is fillable and standardized, with blanks provided for the affiant's identification, employment information, company details, and notarization information. No pricing, contract terms, or project-specific deliverables are addressed in this affidavit 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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