Attachment 3 - Contractor Affirmation- SCO Form- 2008.pdf
PDF 34 KB Posted
- Attached to
- Truck Toppers and Bed Slides
- Solicitation number
- DQ1 AADA 2016001682 6
- 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 8-17.5-101 and 102. The form requires contractors to affirm compliance with employment eligibility verification requirements for newly hired employees performing work under public contracts for services. Contractors must complete the affirmation within twenty days after hiring an employee and submit a written, notarized copy to the contracting state agency or political subdivision. The form collects information regarding the employee's name, date of birth, and date of hire, along with the contract number and contractor business information.
The contractor or contractor representative must initial three specific requirements: examination of the employee's legal work status, retention of file copies of documents required by 8 U.S.C. Section 1324a, and confirmation that no identification documents were altered or falsified. The affirmation must be notarized and includes fields for the notary's official signature and commission expiration date. Contractors are required to retain the completed affirmation and supporting documentation for the duration of the employee's employment. The form notes that substantially similar affirmations may be used provided they contain all necessary elements and information required by law, and contractors should not submit the affirmation to the Colorado Division of Labor 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)
(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 .