Attachment 3 - Contractor Affirmation- SCO Form- 2008.pdf
PDF 34 KB Posted
- 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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Other files
| File | Type | Posted |
|---|---|---|
| DQ1-AADA-2015000107 Truck Toppers.doc | DOC document | |
| Attachment 2 - Notice to Participate- SCO Form- 2008.pdf | ||
| Attachment 6 - Insurance Requirements.doc | DOC document | |
| Attachment 5_ W-9.pdf | ||
| Exhibit B - State Purchase Order Terms and Conditions.pdf | ||
| Attachment 4 - Vendor Disclosure Statement.doc | DOC document | |
| Addendum_1.doc | DOC document | |
| Attachment 1- Process Guide for Contractors- Agencies- SCO Form- 2008.pdf |
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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)
(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 .