E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- Palm Harbor Recreation Center Addition State and local contract opportunity
- Solicitation number
- 26-0011-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an E-Verify Affidavit for a Pinellas County contract, designed to certify a contractor's compliance with Florida Statute 448.095 regarding employment authorization. The affidavit requires the contractor to verify that they do not employ, contract with, or subcontract with unauthorized aliens, and that all employees hired on or after January 1, 2021, have had their work authorization status verified through the E-Verify system.
The form requires the contractor to attach a true and correct copy of their E-Verify system registration proof, provide their Federal Work Authorization User Identification Number, and have the document notarized. The affidavit includes spaces for the contractor's signature, printed name, date, and specific details about the Pinellas County contract. The notarization section allows for either physical presence or online notarization, with spaces for the notary's details, including their name and commission expiration date.
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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 .