6-FCS ContractorAffidavit.pdf
PDF 51 KB Posted
- Attached to
- Track Resurfacing
- Solicitation number
- P26-08
- Issued by
- Fayette County, Georgia
About this file
This is a Contractor Affidavit form issued by the Forsyth County School System in Georgia, administered by Superintendent Mitch Young, for use in connection with track resurfacing projects at West Forsyth High School and Lambert High School. The affidavit serves as a compliance verification document whereby contractors confirm their registration with and authorized use of the E-Verify federal work authorization program in accordance with O.C.G.A. 13-10-91. Contractors executing this affidavit must provide their federal work authorization user identification number and date of E-Verify authorization, along with the relevant project and contract information.
The affidavit requires contractors to maintain E-Verify compliance throughout the entire contract period and obligates them to contract only with subcontractors who have similarly provided compliant affidavits. The document must be executed under penalty of perjury and notarized before a notary public. This affidavit is a mandatory compliance requirement for all contractors performing physical services on behalf of the Forsyth County School System and represents the school district's commitment to ensuring authorized workforce participation on its projects.
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Text version
Mr. Mitch Young, Superintendent • 1120 Dahlonega Highway • Cumming, Georgia 30040 • Telephone 770.887.2461 • Fax 770.781.6632
Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)
By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of (Forsyth County
School System) has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in
O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical 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(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:
Federal Work Authorization User Identification Number (4-6 Digits, no letters)
Date of Authorization (of E-Verify authorization)
Name of Contractor
Name of Project/Contract Number/Purchase Order Number
Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on ______, ___, 202__ 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 ______________,202__.
NOTARY PUBLIC
My Commission Expires:
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