E-Verify_Affidavit.pdf
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- Solicitation number
- 23-1234-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 Stormwater Starkey Facility M10 Modification project. The affidavit requires the contractor to certify compliance with Section 448.095 of Florida Statutes, specifically confirming that the company does not employ unauthorized aliens and has verified the work authorization status of all employees hired on or after January 1, 2021 through the E-Verify system.
The affidavit is a standard compliance document that must be completed and notarized, with the contractor required to attach proof of E-Verify system registration. The form is specifically tied to a Pinellas County contract and must be signed by an authorized company representative, with space for notarization and documentation of the federal work authorization user identification number. This document appears to be a mandatory prerequisite for participating in the Stormwater Starkey Facility M10 Modification project, which is funded through Penny for Pinellas, SWFWMD, and ARPA sources, and involves retrofitting and enhancing an existing stormwater management facility to improve water quality treatment and maintain flood protection levels.
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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 .