E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- High Point Community Park (PID 002998A) ARPA
- Solicitation number
- 24-0281-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is an E-Verify Affidavit for a Pinellas County contract related to the High Point Community Park project, requiring contractor certification of compliance with Florida Statute 448.095. The affidavit mandates that the contractor does not employ unauthorized aliens and has verified work authorization through the E-Verify system for all employees hired on or after January 1, 2021. The document provides a template for a contractor to affirm their compliance, including spaces for company name, signature, date, and Federal Work Authorization User Identification Number.
The affidavit is a standard legal document designed to ensure employment eligibility verification for contractors working on the Pinellas County project. It requires notarization, with provisions for either physical presence or online notarization, and includes space for the notary to confirm the identity of the signing officer. The form is specifically tied to the High Point Community Park project, which is being constructed using ARPA (American Rescue Plan Act) funds and will feature multi-purpose fields, basketball courts, lighting, playground, walking trail, picnic shelter, and restroom facilities.
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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 .