3-E-Verify Affidavit-Contractor.pdf

65 KB Posted

Attached to
North Park Lighting Project
Solicitation number
26-109
Issued by
Fulton County, Georgia

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This is an E-Verify Affidavit document required by the City of Alpharetta, Georgia for the North Park Lighting Project. The affidavit verifies that contractors participating in contracts subject to O.C.G.A. § 13-10-91 are registered with and actively use the federal E-Verify work authorization program. The document outlines contractor obligations including continuous E-Verify participation throughout the contract period and any renewals or extensions, immediate notification to the City if E-Verify usage ceases, and a requirement to ensure all subcontractors submit compliant affidavits. The project involves lighting upgrades to North Park facilities located at 13450 Cogburn Road, Alpharetta, Georgia, including replacement of wooden light poles with concrete poles and upgrades to LED lighting fixtures at four softball fields, one turf field, the Miracle League Adaptive Field, and tennis/pickleball courts. The project is funded in part with Land & Water Conservation Fund (LWCF) grant funds, which impose specific compliance requirements throughout project duration.

Contractors must acknowledge that ceasing E-Verify participation constitutes material breach of contract and that failure to submit required affidavits, driver's licenses, and identification cards within five business days of receipt is a violation of the contract terms. The affidavit is incorporated into any resulting contract without further action or consent required by the contractor. The scope of work includes removal and disposal of existing wooden poles, installation of new concrete poles, upgrade of lighting fixtures to LED providing no less than Class IV lighting levels, and all required design and permitting services. Proposers must comply with all bonding, insurance, and licensing requirements as specified in the project documentation.

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Other files

File Type Posted
2-Disclosure-Debarment Required Form.pdf PDF
5-North Park Fields Lighting Placement.pdf PDF
4-RFP 26-109 Bid Bond Form.pdf PDF
7-RFP 26-109 Scope of Work-Submittal Info.pdf PDF
1-IRS Form W-9 March 2024.pdf PDF
6-RFP 26-109 Information and Contract TC.pdf PDF

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City of Alpharetta, GA Procurement Required Document Affidavit Verifying Contractor Participation in Federal Work Authorization Program (E-Verify)

AFFIDAVIT VERIFYING CONTRACTOR PARTICIPATION IN

FEDERAL WORK AUTHORIZATION PROGRAM (E-Verify)

The undersigned contractor ("Contractor") executes this Affidavit to comply with O.C.G.A § 13-10-91 related to any contract to which Contractor is a party that is subject to O.C.G.A. § 13-10-91 and hereby verifies its compliance with O.C.G.A. § 13-10-91, attesting as follows:

a) The Contractor has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program;

b) The Contractor will continue to use the federal work authorization program throughout the contract period, including any renewal or extension thereof;

c) The Contractor will notify the City of Alpharetta in the event the Contractor ceases to utilize the federal work authorization program during the contract period, including renewals or extensions thereof;

d) The Contractor understands that ceasing to utilize the federal work authorization program constitutes a material breach of Contract;

e) The Contractor will contract for the performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the Contractor with the information required by O.C.G.A. § 13-10-91(a), (b), and (c);

f) The Contractor acknowledges and agrees that this Affidavit shall be incorporated into any contract(s) subject to the provisions of O.C.G.A. § 13-10- 91 for the project listed below to which Contractor is a party after the date hereof without further action or consent by Contractor; and

g) The Contractor acknowledges its responsibility to submit copies of any affidavits, drivers' licenses, and identification cards required pursuant to O.C.G.A. § 13-10-91 to the City of Alpharetta within five business days of receipt.

Federal Work Authorization User Identification Number Date of Authorization

Name of Contractor Name of Project

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed date ___________________ in _______________ (city), __________ (state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE _______ DAY OF _____________, 20______.

NOTARY PUBLIC

My Commission Expires: _____________________________

(Notary Stamp)

AFFIDAVIT VERIFYING CONTRACTOR PARTICIPATION IN FEDERAL WORK AUTHORIZATION PROGRAM (E-Verify)

Federal Work Authorization User Identification Number:
Date of Authorization:
Name of Contractor:
Name of Project: North Park Lighting Project
Executed date:
in:
state:
Printed Name and Title of Authorized Officer or Agent:
My Commission Expires:
Year:
Month:
Day:

File details come from the government source that posted it. Updated .