E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Solicitation number
- 26-0144-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This is an E-Verify Affidavit form required by Pinellas County, Florida for contractors bidding on the Light Electrical Commercial Repairs and Equipment contract. The affidavit certifies that the contractor company does not employ, contract with, or subcontract with unauthorized aliens and maintains full compliance with Section 448.095, Florida Statutes. All employees hired on or after January 1, 2021 must have their work authorization status verified through the E-Verify system, with proof of registration in the system attached to the affidavit. The form requires the contractor's signature, printed name, date, Federal Work Authorization User Identification Number, and reference to the Pinellas County contract name and contract number.
The affidavit must be notarized before a notary public, with the notarization conducted either through physical presence or online notarization. The notary section requires certification of the contractor's identity through either personal knowledge or acceptable identification, along with the notary's signature, printed name, and commission expiration date. This document serves as a mandatory compliance requirement for contractors seeking to work with Pinellas County on electrical repair and maintenance services for county-owned and leased facilities.
View the file
Other files
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 .