E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- Ridgecrest YMCA Elevator Modernization
- Solicitation number
- 26-0529-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This is an E-Verify Affidavit required for state and local contract opportunities in Florida, specifically for a Ridgecrest YMCA Elevator Modernization project in Largo, Florida. 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 their work authorization status verified through the E-Verify system, with proof of the contractor's registration in the E-Verify system attached to the affidavit. The document requires the contractor to provide their Federal Work Authorization User Identification Number and the name and contract number of the Pinellas County contract.
The affidavit must be notarized before a notary public, with the notary certifying acknowledgment through either physical presence or online notarization. The document requires signature, printed name, and date from an authorized officer or agent of the contractor company, along with identification verification and the notary's seal, commission information, and expiration date. This affidavit serves as a mandatory compliance document for contractors bidding on Florida state and local contracts, ensuring adherence to federal work authorization requirements under E-Verify regulations.
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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 .