ATTACHMENT D EEV CERTIFICATION.pdf

ATTACHMENTI)

EEV CERTIFICATION

ATTACHMENT D

EEV CERTIFICATION AND AGREEMFNT

By executing this Certification and Agreement, the undersigned verifies its compliance with the "Mississippi Employment Protection Act," Section 71-11-g of the MississippiCode o{1972, as amended, and any rules or regulatidr.is promu[gateO by MiTissippi Transportation Commission, Department of Employment Security, Staie Tax Cominission, becretjry ot State, Department of Human Services in accordance with the Miisiisippindminisirative Procedures Law (Section 2S-43-1 et seq., Mississippi Code of 1972, as amended), stating affirmatively that the individual, firm, or corporation which is contracting with Mississippi Transportation C_ommission has registtired with and is participating in a federal work authorization program' operated by the United States Department of Homeland Security td e6cironicily verify information of newly hired employees pursuant to the lmmigration Reform and Control Act of 1986; Pub.L. g9€0S, 100 Stat 3339, as amended. The undersigned. agrees to inform the Mississippi Transportation Commission if the undersigned is no longer registered or participating in the program.

The undersigned agrees that, should it employ or contract with any subcontractor(s) in connection with the performance of this Contract, the undersigned will secure from such subcontricto(s) verificaiidn of comptiance with ihe Mississippi Employment Protection Ac! on the provided MDoT-approved form. Thi irndersigned further agrees to maintain records of such compliance and provide a copy of each such verification to MississippiTrinsportation C-ommission at the time such subcontractor(s) is retained for the benefit of the Mississippi Transportation Commisiion or this Contract.

Vendor Name

EE\tr Company tdentification Number [Required]

The undersigned certifies that the above information is complete, true and correct to the best of my knowledge and belief.

The undersigned acknowledges that any violatlon may be subJect to the cancellation of the contract, ineligibilitifor any etate or public contract for up to three (3) years, the loss of any license, permi( certiflcate or other documint granted uy any aq9l9y' department or gov€mment entlty for the right to do business in Mississlppl for up to one (l) year, or b6th, any ana ail additional costs lncurred because of the contract cancellation or the loss of ahy ttcenie or perinit, and may be subject to additional felony prosegulign for knowingly or recklessly acceptlng emptoyment for compensation from an unauthorized alien as defined by I U.S.C Sr324a(hx3), sald action punishable by imprisonment for not lesi than one (l) year nor more than five (5) ysan, a fine of not tess than One Thousand Dottars ($1,OOO.OO) nor mor:e tlran Ten Thousand Ooifirs ($i0,000.00), or both, in addltion to such prosecution and penaltieo as provided by Federal law.

BY:

Authorized Offtcer or Agent Date

Printed Name of Authorized Officer or Agent Title of Authorized Oflicer or Agent of Contractor

SWORN TO AND SUBSCRTBED before me on this the day of

NOTARY PUBLIC

My Commission Expires:

* As of the effective date oI the l\4ississippi Employmerrt Protection Act, the applicable federal work authorization program is E-Veriffru qperate-d bv the U' S. Citizenship and lmmigration Services of the ti.S. Diiartment oi iomelanO g!||Jrily, i;'#j;;;i;" wirh rheSocial Security Administration