E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- STAR Center Chiller 2 Replacement STEP 2
- Solicitation number
- 23-1128-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, Florida, which requires contractors to certify compliance with state employment verification regulations. The affidavit mandates that the contractor does not employ unauthorized aliens and has verified the work authorization status of all employees hired on or after January 1, 2021, through the E-Verify system. The document requires the contractor to attach proof of E-Verify system registration and provide details such as the Federal Work Authorization User Identification Number.
The affidavit is a formal legal document that must be signed by a company representative and notarized, with options for either physical presence or online notarization. It is specifically designed to ensure compliance with Section 448.095 of Florida Statutes, requiring contractors to confirm the legal work status of their employees. The form includes spaces for the contractor's company name, signature, date, and identification of the specific Pinellas County contract, with a section for the notary public to complete and validate the document's execution.
View the file
Other files
Show all 16
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .