E-Verify_Affidavit.pdf
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- Solicitation number
- 26-0361-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an E-Verify Affidavit form required by Pinellas County, Florida for contractors bidding on the Fiscal Year 2027 Pavement Preservation - Package 1 project. The affidavit serves as a compliance certification document whereby contractors must attest that they do not employ, contract with, or subcontract with unauthorized aliens and are in full compliance with Section 448.095, Florida Statutes. Contractors must verify the work authorization status of all employees hired on or after January 1, 2021 through the E-Verify system and provide proof of registration with the system as an attachment to the affidavit. The completed affidavit requires the contractor's signature, printed name, date, Federal Work Authorization User Identification Number, and reference to the specific Pinellas County contract name and number.
The affidavit must be notarized before a notary public, with the notary certifying that acknowledgment was made either through physical presence or online notarization. The notary must identify the contractor company representative by name and title, note the state or place of incorporation, and document the form of identification presented. The notary must then affix their seal, print or stamp their name, and indicate when their commission expires. This document is a mandatory requirement for contract award and demonstrates the contractor's commitment to employing only legally authorized workers on county-funded projects.
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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 .