E-Verify_Affidavit.pdf
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- Solicitation number
- 26-0364-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 the Fiscal Year 2027 Pavement Preservation - Package 4 contract opportunity. The affidavit serves as a compliance certification document that contractors must complete and submit as part of the bidding process. The form requires the contractor company to certify that it 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 their work authorization status verified through the E-Verify system, and contractors must provide a copy of their E-Verify registration proof with the affidavit.
The affidavit must be signed by an authorized representative of the contractor company and notarized before a Florida notary public, with the notarization performed either through physical presence or online. The signatory must provide their name, signature, date, and Federal Work Authorization User Identification Number, along with the name and contract number of the Pinellas County contract. This document is a mandatory compliance requirement for contractors bidding on Pinellas County infrastructure projects and serves as verification of the contractor's adherence to Florida's employment authorization verification statutes.
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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 .