E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Solicitation number
- 23-0394-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an E-Verify Affidavit for a Pinellas County contract related to the Open Conveyance Contract Maintenance project (PID 001922B). The affidavit certifies that the contractor does not employ unauthorized aliens and is in full compliance with Section 448.095 of Florida Statutes. Specifically, the document confirms that all employees hired on or after January 1, 2021, have had their work authorization status verified through the E-Verify system, and requires the contractor to attach proof of registration in the E-Verify system.
The affidavit is a standard compliance document that must be notarized, with space provided for the contractor's signature, printed name, date, and Federal Work Authorization User Identification Number. The form includes a notary section to formally acknowledge the document, with options for physical presence or online notarization. While the affidavit itself does not provide details about the contract's financial terms or specific scope, it is associated with a stormwater management maintenance project in Pinellas County, Florida, which will involve activities such as vegetation removal, sediment management, bank restoration, and potential infrastructure replacements in open ditches and related water management systems.
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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 .