E-Verify_Affidavit.pdf
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- Solicitation number
- 25-0073-ITB-C STEP 2
- Issued by
- Pinellas County, Florida
About this file
This document is an E-Verify Affidavit for a Pinellas County contract that requires contractors to certify compliance with Florida Statutes Section 448.095 regarding employment authorization. The affidavit mandates that all employees hired on or after January 1, 2021, must have their work authorization status verified through the E-Verify system. Contractors must attach proof of their E-Verify system registration and complete the document with their company details, signature, and date.
The affidavit includes a notarization section where the document must be acknowledged before a notary public, either through physical presence or online notarization. The contractor must provide their Federal Work Authorization User Identification Number and the specific Pinellas County contract details. This document serves as a legal certification of the contractor's commitment to employing only authorized workers and adherence to state employment 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 .