Exhibit_B___Contractor_Affidavit (2).pdf
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- Solicitation number
- PE-51200-RFQ-2027-000000040
- Issued by
- Richmond County, Atlanta City, Georgia
About this file
This is a Contractor Affidavit document required by the Board of Regents of the University System of Georgia for the Interdisciplinary Research Building Fire Alarm System replacement project in Georgia. The affidavit verifies that the contractor performing services is registered with and authorized to use E-Verify, the federal work authorization program, in compliance with O.C.G.A. 13-10-91(b)(1). Contractors must provide their federal work authorization user identification number and date of authorization and certify that they will maintain E-Verify compliance throughout the contract period. Additionally, contractors are required to ensure that all subcontractors also present affidavits demonstrating E-Verify compliance in accordance with applicable state provisions.
The affidavit must be executed under penalty of perjury and notarized before a notary public. The document serves as a mandatory compliance verification tool for the replacement of the fire alarm system in the 211,000 gross square foot Interdisciplinary Research Building on the Health Science campus, which includes replacement of the existing fire alarm panel, sensors, horns, strobes, detectors, and communication backbone, with connection to the existing campus fire alarm mesh network. No pricing terms, award dates, or contract term information is contained within this affidavit document, as it functions solely as a pre-award compliance certification requirement.
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Text version
Exhibit B Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)
By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Board of Regents of the University System of Georgia for the use and benefit of Institution Name, Using Agency (public employer) has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10- 91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:
Federal Work Authorization User Identification Number
Date of Authorization
Name of Contractor
Project Number and Description Name of Project
Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on ______, ___, 20__ in _____(city), ______(state).
Signature of Authorized Officer or Agent
Printed Name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE ______ DAY OF ______________,20__.
NOTARY PUBLIC
My Commission Expires:
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