E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- FY2026 Airfield Pavement Rehabilitation
- Solicitation number
- 26-0722-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This is an E-Verify Affidavit form required by Pinellas County, Florida for contractors bidding on the FY2026 Airfield Pavement Rehabilitation project. 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 E-Verify system registration proof as an attachment to the affidavit and complete all required signature lines, including their Federal Work Authorization User Identification Number and the relevant Pinellas County contract name and number.
The affidavit must be notarized before a Notary Public, with the notary certifying acknowledgment either through physical presence or online notarization. The notary must record the date of acknowledgment, identify the signing officer or agent and their title, specify the contractor company name and state or place of incorporation, document the identification provided, and affix their notary seal. This document serves as a mandatory compliance requirement for contract award and execution in Pinellas County procurement processes.
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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 .