E-Verify_Affidavit.pdf
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- Solicitation number
- 26-0363-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 3 contract opportunity. The affidavit serves as a compliance certification document that contractors must complete and notarize as part of the bidding process. Contractors are required to certify that their 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 had their work authorization status verified through the E-Verify system. The form requires the contractor to provide a true and correct copy of their proof of registration in the E-Verify system along with their Federal Work Authorization User Identification Number.
The affidavit must be notarized by a Florida notary public, with the notary verifying the identity of the authorized officer or agent of the contractor company through either physical presence or online notarization. The completed and notarized form must include the contractor's company name, the Pinellas County contract name and contract number, the notary's commission expiration date, and the date of acknowledgment. This document is a mandatory compliance requirement for all bidders on this Pinellas County pavement preservation project and must be submitted as part of the bid package to demonstrate adherence to Florida's work authorization verification requirements.
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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 .