4-TOH-200 - E-Verification Use and Registration Certification - 3.18.24.pdf

FORM

TOH-200

v: 03/2024

E-Verify Registration and Use Certification Form Page

Instructions: “Vendor(s)”, defined as any person or entity seeking to engage in business with the Tohopekaliga Water Authority (“Toho”), must certify that they are registered and use the U.S.

Department of Homeland Security’s E-Verify system using this form. The terms “Contract” and “Agreement” may be interchangeably used.

Vendor Name (as on Sunbiz.org):

Solicitation/Contract Number:

Section 448.095, Florida Statutes, Compliance Certification

Employment Eligibility

The undersigned, on behalf of the Vendor, hereby certifies as follows:

A. Vendor acknowledges that Section 448.09, Florida Statutes, makes it unlawful for any person to knowingly employ, hire, recruit, or refer, for private or public employment, an alien who is not duly authorized to work in the United States.

B. Vendor acknowledges that, in accordance with Section 448.095(5), Florida Statutes: (1) the Vendor, and any subcontractor thereof, are required register with and use the U.S. Department of Homeland Security’s E-Verify system to verify the work authorization status of all new employees of the Vendor or subcontractor; and (2) Toho may not enter into a contract unless each party to the contract registers with and uses the E-Verify system.

C. Vendor hereby certifies that the Vendor is registered with the U.S. Department of Homeland Security’s E-Verify system to verify the work authorization status of all employees hired during the term of the Contract.

D. Vendor hereby certifies that it does not and shall not employ, contract, or subcontract with an unauthorized alien, pursuant to Section 448.095, Florida Statutes, is otherwise in compliance with the requirements of Sections 448.09 and 448.095, Florida Statutes, and shall remain in compliance with such sections of Florida law during the term of any contract with Toho.

E. Vendor hereby acknowledges that the language of the Solicitation and/or Contract notwithstanding, a contract terminated under Section 448.095(5), Florida Statutes, is not a breach of contract and may not be considered as such.

F. Vendor hereby acknowledges and agrees that in the event that Vendor, or any subcontractor thereof, fails to comply with all applicable provisions of Sections 448.09 and 448.095, Florida Statutes, Toho reserves the right to exercise all remedies available to it at law and in equity, including without limitation recovery from the Vendor of the costs incurred by Toho as a result of termination of the Agreement under the aforementioned Florida statutes.

G. Attached to this form is a true and correct copy of the Vendor’s proof of registration in the E- Verify system.

H. Vendor shall ensure compliance with the requirements of Sections 448.09 and 449.095, Florida Statutes, by any and all of its subcontractors, and shall require all subcontractors performing work under the Contract to provide this same certification form, with party names changed as applicable.

Toho reserves the right to request copies of each such subcontractor’s form.

Initials: _____

FORM

TOH-200

v: 03/2024

E-Verify Registration and Use Certification Form Page

EXECUTION OF ABOVE CERTIFICATION

The undersigned hereby represents that they: make the above certification based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certification; and are authorized to legally bind and make the above certification on behalf of the Vendor.

Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the certification provided above on behalf of Vendor.

By:

Authorized Representative on behalf of Vendor

Printed Name:

Official Title:

Date:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as

__________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.

(Seal)

Signature of Notary Public

Name of Notary Typed, Printed or Stamped