E-Verify_Affidavit.pdf

69 KB Posted

Attached to
U. S. 19 Fuel Site Renovation
Solicitation number
23-1167-ITB-C
Issued by
Pinellas County, Florida

About this file

Written by GovTribe AI ·

The document is an E-Verify Affidavit for a Pinellas County contract related to the U.S. 19 Fuel Site Renovation project in Florida. The affidavit certifies that the contractor does not employ unauthorized aliens and is in full compliance with Section 448.095 of Florida Statutes. Specifically, the document confirms that all employees hired on or after January 1, 2021, have had their work authorization status verified through the E-Verify system, and requires the contractor to attach proof of registration in the E-Verify system.

The affidavit is a standard compliance document that must be completed, signed, and notarized for the U.S. 19 Fuel Site Renovation project. It includes fields for the contractor's company name, signature, printed name, date, Federal Work Authorization User Identification Number, and the specific Pinellas County contract details. The document provides a template for the contractor to affirm their legal compliance with employment verification requirements, which is likely a mandatory submission for bidding on or executing the fuel site renovation contract.

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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 .