E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- FY 2024 Pavement Preservation Package 1
- Solicitation number
- 23-0831-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is an E-Verify Affidavit for a Pinellas County contract, specifically related to the FY 2024 Pavement Preservation Package 1 project. The affidavit certifies that the contractor does not employ, contract with, or subcontract with unauthorized aliens, and is in full compliance with Section 448.095 of Florida Statutes. The document requires the contractor to verify that all employees hired on or after January 1, 2021, have had their work authorization status confirmed through the E-Verify system, and mandates attaching a true and correct copy of the company's E-Verify system registration proof.
The affidavit is a standard legal document that must be completed with the contractor's company name, signature, printed name, date, and Federal Work Authorization User Identification Number. It requires notarization, with options for physical presence or online notarization, and includes spaces for the notary to confirm the identity of the signing officer and document the acknowledgment. While the document does not provide specific pricing or funding details, it is a critical compliance document for contractors participating in the Pinellas County FY 2024 Pavement Preservation Package 1 project, which involves approximately 25 miles of roadway improvements across four paving locations.
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Text version
E-VERIFY AFFIDAVIT
E-VERIFY AFFIDAVIT
I hereby certify that ___________________________ [insert contractor company name] does not employ, contract with, or subcontract with an unauthorized alien, and is otherwise in full compliance with Section 448.095, Florida Statutes.
All employees hired on or after January 1, 2021 have had their work authorization status verified through the E-Verify system.
A true and correct copy of _______________________________ [insert contractor company name] proof of registration in the E-Verify system is attached to this Affidavit.
Signature:______________________________
Print Name:______________________________
Date:______________________________
Federal Work Authorization User Identification No.:_____________________________
Name of Pinellas County Contract and Contract No.:____________________________
STATE OF FLORIDA COUNTY OF ________________
The foregoing instrument was acknowledged before me by means of 1) physical presence __ or 2) online notarization ___, this __________________________ (date) by ____________________________ (name of officer or agent, title of officer or agent) of _____________________________________ (name of contractor company acknowledging), a __________________________________ (state or place of incorporation) corporation, on behalf of the corporation.
He/she is personally known to me or has produced __________________________________ (type of identification) as identification.
[Notary Seal]
Notary Public:_________________________________________
Name typed, printed, or stamped:_________________________________________
My Commission Expires:_________________________________________
File details come from the government source that posted it. Updated .