E-Verify_Affidavit.pdf
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- Solicitation number
- 23-0440-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an E-Verify Affidavit for a Pinellas County contract, specifically related to the Mullet Creek Channel B Erosion Control project. The affidavit certifies that the contractor does not employ unauthorized aliens and is in full compliance with Section 448.095 of Florida Statutes. The document requires the contractor to confirm that all employees hired on or after January 1, 2021, have had their work authorization status verified 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 compliance document that must be completed and notarized, with space for the contractor's signature, printed name, date, Federal Work Authorization User Identification Number, and the specific Pinellas County contract details. The notarization section allows for either physical presence or online notarization, requiring the representative to be personally known to the notary or provide acceptable identification. This document serves as a legal attestation of the contractor's adherence to employment authorization regulations for the Mullet Creek Channel B Erosion Control project, which aims to provide bank stabilization, prevent erosion, and improve the creek's ecosystem.
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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 .