E-Verify.pdf

PDF 476 KB Posted

Attached to
Invitation to Bid Parking Lot Rehabilitation (3)
Solicitation number
2025-PWP-014
Issued by
Marion County, Indiana

About this file

This is an E-Verify Affidavit form required by the City of Bloomington, Indiana, for contractors and subcontractors seeking to provide services to the municipality. The affidavit serves as a compliance document in which company representatives must attest under oath that their organization does not knowingly employ unauthorized aliens as defined under 8 United States Code 1324a(h)(3) and that the company is enrolled in and actively participates in the E-Verify program. The document requires notarization and must be completed by an authorized company representative, such as an officer or manager, who signs and provides their printed name along with the signature and details of a notary public.

This affidavit is a mandatory employment eligibility compliance requirement for any entity contracting with the City of Bloomington or serving as a subcontractor on city contracts. The form does not establish pricing terms, set-asides, or funding requirements but rather functions as a prerequisite eligibility document to ensure contractor compliance with federal immigration employment verification mandates. Bidders responding to opportunities such as the Invitation to Bid for Parking Lot Rehabilitation must execute and submit this affidavit as part of their bid package to demonstrate adherence to applicable federal and local employment verification regulations.

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Text version

“AFFIDAVIT”

STATE OF _______________ )

) SS:

COUNTY OF _____________ )

E-VERIFY AFFIDAVIT

The undersigned, being duly sworn, hereby affirms and says that:

1. The undersigned is the ___________________ of _______________________________.

(job title) (company name)

2. The company named herein that employs the undersigned:

i. has contracted with or seeking to contract with the City of Bloomington to provide services; OR

ii. is a subcontractor on a contract to provide services to the City of Bloomington.

3. The undersigned hereby states that, to the best of his/her knowledge and belief, the company named herein does not knowingly employ an “unauthorized alien,” as defined at 8 United States Code

1324a(h)(3).

4. The undersigned herby states that, to the best of his/her belief, the company named herein is enrolled in and participates in the E-verify program.

Signature Printed Name

STATE OF _______________ )

) SS:

COUNTY OF _____________ )

Before me, a Notary Public in and for said County and State, personally appeared ___________________ and acknowledged the execution of the foregoing this _____ day of _____________________, 20____.

Notary Public’s Signature

Printed Name of Notary Public

My Commission Expires: __________________

County of Residence: _____________________

File details come from the government source that posted it. Updated .