3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Hickey Mitigation and Restoration
- Solicitation number
- RFP 089-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit required by the State of Missouri for the Tornado: Hickey Mitigation and Restoration project. The document is a notarized attestation form that contractors and their authorized representatives must complete to certify compliance with federal work authorization requirements. The affiant must confirm that they are employed by the contracting company with authority to execute the affidavit, that the company is enrolled in and actively participating in the E-Verify federal work authorization program for all employees working on the project, and that the company does not knowingly employ any unauthorized aliens in connection with services provided to the district. The form requires the individual's signature, company name, title, and must be notarized by a Missouri notary public with specified commission expiration date.
This affidavit serves as a mandatory compliance document establishing the contractor's commitment to employment eligibility verification through the E-Verify system. The form is fillable and follows Missouri notarization requirements, including identification of the notary public, the county where notarization occurs, and the date of execution. There are no pricing terms, set-asides, or funding information contained within this document, as it functions solely as a pre-qualification and compliance verification instrument for contractors bidding on or performing work related to tornado mitigation and restoration services for Springfield-area school districts or municipalities.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .