Contractor Affidavit (27).pdf
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- Attached to
- INTERNAL CONTROLS AUDIT
- Solicitation number
- PE-64800-NONST-2025-000000061
- Issued by
- Douglas County, Georgia
About this file
Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)
This document is a Contractor Affidavit required by Douglas County, Georgia for compliance with O.C.G.A. § 13-10-91, a Georgia state law governing federal work authorization verification for public contracts. The affidavit serves as a sworn attestation by contractors that they have registered with and will continue to use E-Verify or any subsequent federal work authorization program replacement throughout the entire contract period, including any renewals or extensions. Contractors must notify the public employer if they cease using E-Verify during the contract term, acknowledge that discontinuation constitutes material breach, and ensure all subcontractors provide equivalent affidavits with required documentation including drivers' licenses and identification cards within five business days of receipt by the public employer.
The affidavit requires completion of specific fields including the Federal Work Authorization User Identification Number, date of authorization, contractor name, project name, and execution details. The document must be executed under penalty of perjury before a notary public, with signature and printed name of an authorized officer or agent. The affidavit is automatically incorporated into any contract subject to O.C.G.A. § 13-10-91 without further action or consent by the contractor, establishing a mandatory compliance framework for all contractors and subcontractors performing services for Douglas County, Georgia projects.
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Text version
Contractor Affidavit under O.C.G.A. § 13-I0-9l(b)(I)
The undersigned contractor ("Contractor") executes this Affidavit to comply with O.C.G.A § 13-10-91 related to any contract to which Contractor is a party that is subject to O.C.G.A. § 13-10-91 and hereby verifies its compliance with O.C.G.A. § 13-10-91, attesting as follows:
a) The Contractor has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program.
b) The Contractor will continue to use the federal work authorization program throughout the contract period, including any renewal or extension thereof.
c) The Contractor will notify the public employer in the event the Contractor ceases to utilize the federal work authorization program during the contract period, including renewals or extensions thereof.
d) The Contractor understands that ceasing to utilize the federal work authorization program constitutes a material breach of Contract.
e) The Contractor will contract for the performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the Contractor with the information required by O.C.G.A. § 13-10-91(a), (b), and (c).
f) The Contractor acknowledges and agrees that this Affidavit shall be incorporated into any contract(s) subject to the provisions of O.C.G.A. § 13-10- 91 for the project listed below to which Contractor is a party after the date hereof without further action or consent by Contractor; and
g) Contractor acknowledges its responsibility to submit copies of any affidavits, drivers' licenses, and identification cards required pursuant to O.C.G.A. § 13-10-91 to the public employer within five business days of receipt.
Federal Work Authorization User Identification Number
Name of Contractor:
Date of Authorization
Name of Project
Douglas County, Georgia Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on _______________, 20 ____ in _____________________(City) ____________(State).
Signature of Authorized Officer or Agent
Printed Name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE _____, DAY OF _____________ , 20 ____
NOTARY PUBLIC
My Commission Expires: _ _ _ _ _ _ _ _ _ _ _ _ lammons Cross-Out
Contractor Affidavit under O.C.G.A. § 13-I0-9l(b)(I)
File details come from the government source that posted it. Updated .