E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- Ridgemoor Blvd and Brooker Creek at Brooker Creek Bridge #154153 Bridge Replacement Project (PID 005749A)
- Solicitation number
- 26-0506-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an E-Verify Affidavit required by Pinellas County, Florida for contractors bidding on the Ridgemoor Boulevard Bridge over Brooker Creek replacement project. The affidavit certifies that the contractor company does not employ, contract with, or subcontract with unauthorized aliens and is in full compliance with Section 448.095, Florida Statutes. All employees hired on or after January 1, 2021 must 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 along with the completed and notarized affidavit, which includes the contractor company name, signature of an authorized representative, Federal Work Authorization User Identification Number, and the name and number of the Pinellas County contract.
The affidavit must be notarized before a notary public in Florida, with the notary certifying acknowledgment through either physical presence or online notarization. The document requires identification of the notary public, commission expiration date, and the state or place of incorporation of the contractor company. This documentation is a mandatory compliance requirement for contractors seeking to work on federally funded projects administered through the Florida Department of Transportation, including the Local Agency Program project for the bridge replacement on Ridgemoor Boulevard.
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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 .