E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- FY 2025 - Pavement Preservation - Package 4
- Solicitation number
- 25-0669-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is an E-Verify Affidavit form for a Pinellas County, Florida contract opportunity related to the FY 2025 Pavement Preservation Package 4 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 form 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 must attach proof of registration in the E-Verify system.
The affidavit is a standard compliance document that must be completed and notarized for the contractor to be eligible to bid on or perform work for the Pinellas County roadway project. The document includes spaces for the contractor's signature, Federal Work Authorization User Identification Number, and specific contract details. It also provides a notary section for official acknowledgment, requiring the signatory to be either personally known to the notary or to provide acceptable identification. This form is a critical component of the county's efforts to ensure legal workforce practices for the pavement preservation project, which involves milling and resurfacing approximately 34.98 lane miles of roadway across four 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 .