E-Verify_Affidavit.pdf
PDF 69 KB Posted
- Attached to
- Dunn Exploratory Well (PID 004365A)
- Solicitation number
- 23-1141-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an E-Verify Affidavit form for a Pinellas County contract, specifically related to the Dunn Exploratory Well project. The affidavit requires the contractor to certify compliance with Section 448.095 of Florida Statutes, confirming that they do not employ unauthorized aliens and have verified the work authorization status of all employees hired on or after January 1, 2021 through the E-Verify system. The form requires the contractor to attach proof of E-Verify system registration and provide details such as the Federal Work Authorization User Identification Number.
The affidavit is a mandatory document for the contractor to complete, which involves notarization to validate the contractor's compliance with employment verification requirements. While the form itself does not specify pricing or funding details, it is connected to the Dunn Exploratory Well project, which aims to provide Pinellas County with a reclaimed water disposal option through an injection well at the W.E. Dunn Water Reclamation Facility. The project's goal is to create an injection well with a potential capacity of up to 12.7 million gallons per day, contingent on favorable hydrogeologic conditions.
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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 .