3-E-Verify Affidavit-Contractor.pdf
PDF 65 KB Posted
- Solicitation number
- 26-114
- Issued by
- Fulton County, Georgia
About this file
This is an E-Verify Affidavit document required by the City of Alpharetta, Georgia for contractor participation in the Alpha Loop Design project covering Northwinds Parkway, Haynes Bridge Road, and Morrison Parkway. The affidavit serves as a mandatory compliance document under O.C.G.A. § 13-10-91, requiring contractors to verify their registration with and authorization to use the federal E-Verify work authorization program. Contractors executing this affidavit commit to maintaining continuous E-Verify participation throughout the contract period, including any renewals or extensions, and must notify the City of Alpharetta immediately if participation ceases. The document must be notarized and submitted by the authorized officer or agent of the contracting entity. Contractors are responsible for ensuring all subcontractors also provide compliant E-Verify affidavits prior to engagement, and must submit copies of affidavits, driver's licenses, and identification cards to the City within five business days of receipt.
Failure to maintain E-Verify participation constitutes a material breach of contract. The affidavit becomes automatically incorporated into any resulting contract without further action or consent from the contractor. This requirement applies to all contractors bidding on the Alpha Loop Design project and represents a mandatory compliance element for contract award and performance. The document requires completion of specific fields including the Federal Work Authorization User Identification Number, date of authorization, contractor name, and project name, along with notarization before an official notary public.
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Text version
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: Alpha Loop Design: Northwinds Pkwy, Haynes Bridge Rd, Morrison Pkwy |
| 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 .