E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- Infrastructure Repair Work Order Contract
- Solicitation number
- 26-0208-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This is an E-Verify Affidavit required for contractors bidding on an Infrastructure Repair Work Order Contract with Pinellas County, Florida. 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. The contractor must provide a true and correct copy of their proof of registration in the E-Verify system with the affidavit submission.
The affidavit requires the contractor's authorized representative to sign and print their name, provide the date of execution, and include their Federal Work Authorization User Identification Number. The document must be notarized in Florida with identification of the notary public, their commission expiration date, and confirmation of the notarization method (physical presence or online). The affidavit must reference the specific Pinellas County contract name and contract number. This document serves as a mandatory compliance requirement for participation in the county's infrastructure repair work orders, which encompass concrete repairs, site cleanup, milling and resurfacing, landscape work, fencing, sidewalk repairs, ADA ramps, sheet pile installation, and related incidental items.
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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 .