Exhibit 2 - Annual Worker Eligibility Verification Affidavit.pdf
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- Attached to
- Automated Data Collection Van
- Solicitation number
- 300000117765804
- Issued by
- Missouri
About this file
This is an Annual Worker Eligibility Verification Affidavit required by the Missouri Highways and Transportation Commission (MHTC) for state contract work. The affidavit applies to any business entity entering into a contract agreement with the state to perform jobs, tasks, employment, labor, personal services, or other activities for compensation. For joint ventures, separate affidavits are required for each business entity involved. The document must be notarized and signed by an authorized representative of the business entity who can personally certify the facts stated in the affidavit.
The affidavit requires the business entity to affirm enrollment and participation in a federal work authorization program operated by the United States Department of Homeland Security and to verify employment eligibility for all newly hired employees working on MHTC-contracted services. The business entity must warrant that it does not and will not knowingly employ any alien without legal authorization to work in the United States as defined under 8 U.S.C. 1324a(h)(3). The affiant must acknowledge awareness that failure to satisfy the conditions outlined in Section 285.530, RSMo, may result in liability under Sections 285.525 through 285.550, RSMo, for subcontractors that knowingly employ unauthorized aliens. Documentation evidencing enrollment and participation in a federal work authorization program must be attached to the affidavit at the time of submission.
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Text version
EXHIBIT 2
ANNUAL WORKER ELIGIBILITY VERIFICATION AFFIDAVIT
(for joint ventures, a separate affidavit is required for each business entity)
STATE OF ________________ )
) ss
COUNTY OF ________________ )
On the _____ day of _______________, 20____, before me appeared
________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be a person whose name is subscribed to this affidavit, who being by me duly sworn, stated as follows:
I, the Affiant, am of sound mind, capable of making this affidavit, and personally certify the facts herein stated, as required by Section 285.530, RSMo, to enter into any contract agreement with the state to perform any job, task, employment, labor, personal services, or any other activity for which compensation is provided, expected, or due, including but not limited to all activities conducted by business entities.
I, the Affiant, am the _______________ of ______________________________, and I am duly authorized, directed, and/or empowered to act officially and properly on behalf of this business entity.
I, the Affiant, hereby affirm and warrant that the aforementioned business entity is enrolled in a federal work authorization program operated by the United States Department of Homeland Security, and the aforementioned business entity shall participate in said program to verify the employment eligibility of newly hired employees working in connection with any services contracted by the Missouri Highways and Transportation
Commission (MHTC). I have attached documentation to this affidavit to evidence enrollment/participation by the aforementioned business entity in a federal work authorization program, as required by Section 285.530, RSMo.
I, the Affiant, also hereby affirm and warrant that the aforementioned business entity does not and shall not knowingly employ, in connection with any services contracted by MHTC, any alien who does not have the legal right or authorization under federal law to work in the United States, as defined in 8 U.S.C. § 1324a(h)(3).
I, the Affiant, am aware and recognize that, unless certain contract and affidavit conditions are satisfied pursuant to Section 285.530, RSMo, the aforementioned business entity may be held liable under Sections
285.525 through 285.550, RSMo, for subcontractors that knowingly employ or continue to employ any unauthorized alien to work within the state of Missouri.
I, the Affiant, acknowledge that I am signing this affidavit as a free act and deed of the aforementioned business entity and not under duress.
Affiant Signature
Subscribed and sworn to before me in ______________________, _____, the day and year first above-written.
Notary Public
My commission expires:
[attach documentation of enrollment/participation in a federal work authorization program] title business name state
Affiant name tackel1 Cross-Out
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