Attachment 3 - Contractor Affirmation- SCO Form- 2008.pdf

PDF 34 KB Posted

Attached to
Purchase & installation - 10 truck toppers for pickup trucks
Solicitation number
DQ1 AADA 2015000107 2
Issued by
Denver County, Denver City, Colorado

About this file

This is a Contractor Affirmation form issued by the Colorado Division of Labor for use by contractors participating in the Department Program for public contracts for services under Colorado Revised Statutes sections 8-17.5-101 and 8-17.5-102. The form applies to contractors bidding on the purchase and installation of 10 truck toppers for pickup trucks in Colorado. Contractors must complete and submit a notarized affirmation within twenty days after hiring any employee newly assigned to perform work under the public contract. The form requires the contractor to confirm examination of the employee's legal work status, retention of identification documents as required by 8 U.S.C. section 1324a, and that no identification documents have been altered or falsified.

The affirmation must be submitted to the contracting state agency or political subdivision in written, notarized form and should not be submitted to the Colorado Division of Labor unless specifically requested. Contractors are required to retain the affirmation and all supporting documentation for the duration of the employee's employment on the contract. The form provides space for employee information, contractor details, notary certification, and multiple signature lines. An alternative substantially similar affirmation may be used provided it contains all necessary elements required by Colorado law.

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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)

(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.

Notary Seal

File details come from the government source that posted it. Updated .