6-E-Verify Affidavit-Contractor.pdf
PDF 65 KB Posted
- Attached to
- On-Call Pipe Lining Services
- Solicitation number
- 26-115
- Issued by
- Fulton County, Georgia
About this file
This is an E-Verify Affidavit for Contractor Participation in Federal Work Authorization Program, required by the City of Alpharetta, Georgia for contractors bidding on the On-Call Pipe Lining Services contract (RFP 26-115). The affidavit verifies contractor compliance with O.C.G.A. § 13-10-91 regarding federal work authorization. Contractors must attest that they have registered with and are authorized to use E-Verify, will continue using the program throughout the contract period and any renewals or extensions, and will immediately notify the City if they cease participation. The document must be notarized and submitted by the contractor's authorized officer or agent. Contractors are responsible for submitting copies of affidavits, drivers' licenses, and identification cards required under O.C.G.A. § 13-10-91 to the City of Alpharetta within five business days of receipt.
Contractors must ensure all subcontractors also comply with E-Verify requirements by presenting affidavits containing the information specified in O.C.G.A. § 13-10-91(a), (b), and (c). Failure to maintain E-Verify participation constitutes a material breach of contract. The affidavit is incorporated into all contracts subject to O.C.G.A. § 13-10-91 without further action or consent by the contractor. This mandatory requirement applies to all contractors and subcontractors participating in the pipe lining services procurement, regardless of contract value or award status.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 8-RFP 26-115 Scope of Work-Submittal Info.pdf | ||
| 1-Alpharetta LVP Form.pdf | ||
| 2-IRS Form W-9 March 2024.pdf | ||
| 4-26-115 Spin-Cast Rate Sheet-Sample Cost.xlsx | XLSX spreadsheet | |
| 5-Disclosure-Debarment Required Form.pdf | ||
| 7-RFP 26-115 Information and Contract TC.pdf | ||
| 3-26-115 CIPP Rate Sheet-Sample Cost.xlsx | XLSX spreadsheet |
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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: On-Call Pipe Lining Services |
| Executed date: |
| in: |
| state: |
| Printed Name and Title of Authorized Officer or Agent: |
| My Commission Expires: |
| Year: |
| Month: |
| Day: |
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