4-Contractor Affidavit.pdf

Forsyth County Schools Dr. Mitch Young, Superintendent. 1120 Dahlonega Hwy. Cumming, GA 30040. Telephone 770-887-2461

Section A Contractor Affidavit under O.C.G.A. § 13-10-91(b)(l)

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 public employer 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) 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 public employer within five business days of receipt.

Date of E-Verify Authorization

Name of Project/Contract Number/ Purchase Order Number

Federal Work Authorization User Identification Number

(4-7 Digits, No Letters)

Name of Contractor

Forsyth County Schools Name of Public Employer

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

Executed on ______________, _____, 20_____ in ______________________________ (city), __________ (state).

Printed Name and Title of Authorized Officer or Agent Signature of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE _______ DAY OF _________________, 20______.

__________________________________________________ My Commission Expires: ___________________

NOTARY PUBLIC

Section B

I hereby certify that I do not have and do not intend to hire any employees. Therefore, I am attaching a copy of my driver’s license or an alternative ID card issued by the State.

Name of Contractor Signature of Contractor Date

Exempt; licensed under Title 26, Title 43 or by State Bar of Georgia tridings Underline