E-Verify_Affidavit.pdf
PDF 77 KB Posted
- Attached to
- Sign Fabrication Services
- Solicitation number
- 23-0203-ITB - Services
- Issued by
- Pinellas County, Florida
About this file
This is an E-Verify Affidavit form required by Pinellas County, Florida for vendors responding to Invitation to Bid (ITB) No. 23-0203-ITB-Services for Sign Fabrication Services. The affidavit serves as a certification document that contractors must complete and notarize as part of their bid submission. The form requires the contractor company name, contractor signature, printed name, date, and Federal Work Authorization User Identification Number. Contractors must certify compliance with Section 448.095, Florida Statutes, confirming they do not employ, contract with, or subcontract with unauthorized aliens. All employees hired on or after January 1, 2021, must have had their work authorization status verified through the E-Verify system, with proof of registration attached to the affidavit.
The affidavit must be notarized before a Florida notary public, with the notary required to verify the contractor's identity either through physical presence or online notarization. The notarization section requires identification of the notary public, commission expiration date, and notary seal. This document is a mandatory compliance requirement for the sign fabrication services solicitation and must be submitted as part of the comprehensive bid package that includes Certificate of Insurance, Vendor References, ePayables Form, and W-9 documentation. The E-Verify requirement ensures that all contractors and subcontractors maintain a compliant workforce with verified work authorization status throughout the contract term.
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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 .