Aff C Prime E_verify.docx

AFFIDAVIT “C”

STATE OF ____________ COUNTY OF ___________ CONTRACTOR AFFIDAVIT AND AGREEMENT

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 Spalding County Water & Sewerage Facilities Authority (“Authority”) in Spalding County, Georgia 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). Additionally, the undersigned contractor will forward notice of the receipt of an affidavit from a subcontractor to the Authority within five (5) business days of receipt.

Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization Name of Contractor Name of Project

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

Executed on _________, 2024 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 ______________, 2024.

_________________________________ NOTARY PUBLIC [NOTARY SEAL]

My Commission Expires: _________________________________