E-Verify_Affidavit.pdf
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- Attached to
- Chesnut Park Managed Aquifer Recharge Well Drilling And Completion Of Subsurface Testing
- Solicitation number
- 26-0046-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an E-Verify Affidavit form required by Pinellas County Utilities for the Chesnut Park Managed Aquifer Recharge Well Drilling and Completion of Subsurface Testing project in Florida. The affidavit certifies contractor compliance with Florida Statutes Section 448.095 regarding employment of unauthorized aliens and confirms that all employees hired on or after January 1, 2021, have had their work authorization status verified through the E-Verify system. The contractor must provide a true and correct copy of proof of registration in the E-Verify system attached to the executed affidavit. The document requires the contractor company name, authorized representative signature, printed name, date, and Federal Work Authorization User Identification Number, along with the Pinellas County contract name and number. The affidavit must be notarized either through physical presence or online notarization, with the notary public providing seal, printed name, and commission expiration date.
This affidavit represents a mandatory compliance requirement for all contractors and subcontractors bidding on the Chesnut Park MAR well project. Contractors must execute the affidavit prior to contract award to demonstrate adherence to Florida's employment authorization verification requirements. The document serves as a binding certification of the contractor's legal compliance status and workforce eligibility, establishing accountability for maintaining authorized employment practices throughout the contract performance period of 540 consecutive calendar days, including a 12-month guarantee period.
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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 .