Attachment 3 - Contractor Affirmation- SCO Form- 2008.pdf
PDF 34 KB Posted
- Attached to
- Truck Toppers, Bed Slides and Running Boards
- Solicitation number
- DQ1 AADA 2015001378 1
- 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 8-17.5-102. The form applies to the State of Colorado and is used for contracts involving truck toppers, bed slides, and running boards. Contractors must complete this affirmation form for each newly hired employee assigned to perform work under a public contract for services within twenty days of the employee's hire date. The form documents the contractor's examination of the employee's legal work status, retention of required identification documentation per 8 U.S.C. Section 1324a, and confirmation that no identification documents have been altered or falsified.
The affirmation must be provided as a written, notarized copy to the contracting state agency or political subdivision and should not be submitted to the Colorado Division of Labor unless specifically requested. The contractor must retain this affirmation and all supporting documents required by federal immigration law for the duration of the employee's employment. The form requires the employee's name, date of birth, and date of hire, along with the contract number, contractor business name, phone number, and the signature of an authorized contractor representative or the contractor themselves. A notary public must execute the affirmation by providing their official signature and commission expiration date. Alternative substantially similar affirmations may be used provided they contain all necessary elements and information required by law.
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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 .