Attachment 1 Contractor Affirmation.pdf
PDF 182 KB Posted
- Attached to
- WALL CERTIFICATES/ WALLET CARDS
- Solicitation number
- DQ1 SJAA 2019000532 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Contractor Affirmation form required by the Colorado Division of Labor for contractors participating in the Department Program for public contracts for services under Colorado Revised Statutes 8-17.5-101 and 102. The form serves as a written, notarized certification that contractors must submit to the contracting state agency or political subdivision within twenty days after hiring any employee newly assigned to perform work under a public contract for services. The affirmation requires contractors to confirm three key compliance elements: examination of the employee's legal work status, retention of file copies of documents required by 8 U.S.C. Section 1324a, and verification that employee identification documents have not been altered or falsified. The form requires the employee's name, date of birth, and date of hire, along with the contract number, contractor business name, and contact information.
The affirmation must be notarized and signed by either the contractor or an authorized contractor representative, with the notary's official signature, seal, and commission expiration date required. All documentation related to the affirmation and the I-9 verification documents must be retained by the contractor for the duration of the employee's employment. The Colorado Division of Labor has provided this form as a courtesy, but contractors may use substantially similar affirmations provided they contain all necessary elements required by law. No submission to the Colorado Division of Labor is required unless specifically requested.
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Text version
Contractor Affirmation for the Department Program Required for use by contractors participating in the Department Program for public contracts for services 8-17.5-
101 & 102, C.R.S.
The contractor shall provide a written, notarized copy of this affirmation to the contracting state agency or political subdivision.
DO NOT submit this affirmation to the Colorado Division of Labor unless specifically requested to do so.
Employee Name: Date of Birth : Date of Hire:
Last First M.I.
In accordance with 8-17.5-102, C.R.S., I have:
(Initial after each)
Examined the legal work status of the above named employee:
Retained file copies of documents required by 8 U.S.C. sec. 1324a.:
Not altered or falsified the employee’s identification documents:
Contract Number:
Contractor / Business Name:_
Phone:
Contractor or Contractor Representative Name:
Contractor OR Contractor Representative Signature and Title: Date Signed:
Subscribed and affirmed before me in the county of , State of Colorado, this day of _, 20 .
(Notary’s official signature)
Notary Seal
(Commission expiration date)
8-17.5-102(5)(c)(II), C.R.S. A participating contractor shall, within twenty days after hiring an employee who is newly hired for employment to perform work under the public contract for services, affirm that the contractor has examined the legal work status of such employee, retained file copies of the documents required by
8 U.S.C. sec. 1324a, and not altered or falsified the identification documents for such employees. The contractor shall provide a written, notarized copy of the affirmation to the contracting state agency or political subdivision.
This affirmation and the documents required by 8 U.S.C. sec. 1324a will be retained by the contractor for the duration of the above named individual’s employment.
This affirmation is provided as a courtesy by the Colorado Division of Labor.
Another substantially similar affirmation may be used, provided that it contains the necessary elements and information as required by law.
File details come from the government source that posted it. Updated .