E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- FY 2026 Pavement Preservation Package 2-STEP 2
- Solicitation number
- 25-0071-ITB-C STEP 2
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is an E-Verify Affidavit related to Pinellas County contract requirements. The affidavit certifies that a contractor does not employ, contract with, or subcontract with unauthorized aliens, and is in full compliance with Section 448.095 of Florida Statutes. Specifically, the document requires that all employees hired on or after January 1, 2021, have had their work authorization status verified through the E-Verify system, with the contractor required to attach proof of registration in the E-Verify system to the affidavit.
The affidavit includes spaces for the contractor's signature, printed name, date, Federal Work Authorization User Identification Number, and the specific Pinellas County contract details. The document also includes a notarization section where a notary public can acknowledge the contractor's signature, with options for physical presence or online notarization. The form must be completed with the contractor's company information, and the signatory must be identified or provide acceptable identification.
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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 .