E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- Pump Station 182 Rehabilitation (PID 005221A)
- Solicitation number
- 25-0422-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an E-Verify Affidavit form for Pinellas County, Florida, which serves as a template document that contractors must complete to certify compliance with federal work authorization requirements. The affidavit requires contractors to certify that they do not employ, contract with, or subcontract with unauthorized aliens and are in full compliance with Section 448.095 of Florida Statutes. The form specifies that all employees hired on or after January 1, 2021 must have their work authorization status verified through the E-Verify system, and contractors must attach proof of their E-Verify system registration to the completed affidavit.
The affidavit must be completed with the contractor's company name, signature, printed name, date, Federal Work Authorization User Identification Number, and the specific Pinellas County contract name and number. The document requires notarization, with options for either physical presence or online notarization, and includes spaces for all required notarial information including the notary's seal, signature, printed name, and commission expiration date. This appears to be a standard compliance document that would be required as part of the contracting process with Pinellas County to ensure adherence to federal employment eligibility verification requirements.
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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 .