7-Contractor Affidavit.pdf
PDF 193 KB Posted
- Attached to
- P26-05 Concrete & Asphalt Services
- Solicitation number
- P26-05
- Issued by
- Fayette County, Georgia
About this file
This is a Contractor Affidavit form required by Forsyth County Schools in Georgia for compliance with O.C.G.A. § 13-10-91, a state employment eligibility verification statute. The form must be completed and submitted by any contractor bidding on or entering into a contract with Forsyth County Schools for the P26-05 Concrete & Asphalt Services project. Contractors are required to register with and utilize the federal E-Verify work authorization program throughout the entire contract period, including any renewals or extensions, and must notify the school district immediately if they cease using the program during contract performance. Contractors must also ensure that all subcontractors comply with the same E-Verify requirements by obtaining affidavits from them prior to contract execution.
The affidavit requires contractors to provide their E-Verify User Identification Number, the date of E-Verify authorization, and project identification details. Contractors must submit copies of required affidavits, driver's licenses, and identification cards to Forsyth County Schools within five business days of receipt. Failure to maintain E-Verify compliance constitutes a material breach of contract. For contractors with no employees, Section B of the form allows exemption with submission of a driver's license or alternative state-issued identification. The affidavit must be notarized and executed by an authorized representative of the contractor, with all documentation incorporated into any resulting contract without further action required from the contractor.
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Text version
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
| Federal Work Authorization User Identification Number: |
| Date of EVerify Authorization: |
| Name of Contractor: |
| Name of ProjectContract Number: |
| Printed Name and Title of Authorized Officer or Agent: |
| Month: |
| Day: |
| Year: |
| City: |
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| Check Box1: Off |
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