E-Verify_Affidavit.pdf

77 KB Posted

Attached to
CONCRETE MIX MATERIALS, BATCH MIX - DELIVERED (CO-OP)
Solicitation number
23-0285-ITB
Issued by
Pinellas County, Florida

About this file

Written by GovTribe AI ·

This document is an E-Verify Affidavit related to a Pinellas County contract opportunity for concrete mix materials and batch delivery services. The affidavit certifies that the contractor does not employ unauthorized aliens and is in full compliance with Section 448.095 of Florida Statutes. All employees hired on or after January 1, 2021, have had their work authorization status verified through the E-Verify system, and the contractor must attach proof of registration in the E-Verify system to this affidavit.

The document requires a notarized signature from an authorized representative of the contracting company, including spaces for the company name, signature, printed name, date, and Federal Work Authorization User Identification Number. The affidavit must be completed for the specific Pinellas County contract, with provisions for notarization either through physical presence or online notarization. This form serves as a legal confirmation of the contractor's compliance with employment verification requirements for the concrete mix materials and delivery contract.

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Other files

File Type Posted
CONCRETE_MIX_MATERIALS,_BATCH_MIX_-_DELIVERED_(CO-OP).pdf PDF
23-0285-ITB-Goods_-_Concrete_Mix_Materials_-_Batch_Mix_Delivered_(Co-Op).pdf PDF
Vendor_References.pdf PDF
Electronic_Payment_(EPAYABLES).pdf PDF
VENDORS_MUST_COMPLETE_THE_FOLLOWING.pdf PDF

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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 .