E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- FY25 Pavement Preservation Package No 1
- Solicitation number
- 24-0757-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is an E-Verify Affidavit for a contractor seeking to participate in the Pinellas County FY25 Pavement Preservation Package No. 1 contract opportunity. The affidavit certifies that the contractor does not employ unauthorized aliens and is in full compliance with Section 448.095 of Florida Statutes, with all employees hired after January 1, 2021 having their work authorization status verified through the E-Verify system. The affidavit requires the contractor to attach proof of E-Verify system registration and provide details such as the Federal Work Authorization User Identification Number and the specific Pinellas County contract information.
The document is a standard notarization form that requires the contractor's authorized representative to sign and have the document acknowledged before a notary public. It provides options for physical presence or online notarization, with spaces for the notary to record identification details, commission expiration, and to apply an official notary seal. While the affidavit itself does not contain pricing or funding specifics, it is a mandatory compliance document for contractors bidding on the Pinellas County roadway preservation project, which involves approximately 34.98 lane miles of roadway improvements across four paving locations including one collector and three local neighborhood projects.
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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 .