E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- FY 2026 Pavement Preservation Package 1
- Solicitation number
- 25-0070-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an E-Verify Affidavit for a Pinellas County contract related to the FY 2026 Pavement Preservation Package 1, which involves roadway milling and resurfacing. The affidavit certifies that the contractor does not employ unauthorized aliens and is in full compliance with Section 448.095 of Florida Statutes. The affidavit requires the contractor to verify work authorization status for all employees hired on or after January 1, 2021 through the E-Verify system, and mandates attaching proof of registration in the E-Verify system.
The document is a standard legal form that must be completed, signed, and notarized by the contractor, with spaces to include the contractor's company name, signature, printed name, date, Federal Work Authorization User Identification Number, and specific contract details. The form includes a notary section to validate the authenticity of the document, with options for physical presence or online notarization. This affidavit is a standard compliance document ensuring that contractors participating in Pinellas County's roadway improvement projects adhere to legal requirements regarding employee work authorization.
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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 .