Exhibit E

13 KB Posted

Attached to
25-27 Auburn Avenue Renovation for Student Success
Solicitation number
BR-50-2201CxA
Issued by
Fulton County, Georgia

About this file

This is a Contractor Affidavit document executed under O.C.G.A. § 13-10-91(b)(1) for the Board of Regents of the University System of Georgia on behalf of Georgia State University. The affidavit pertains to Project No. BR-50-2201, the "25-27 Auburn Avenue Renovation for Student Success Center" located in Atlanta, Georgia. The document requires the contractor performing physical services to verify compliance with federal work authorization requirements, specifically confirming registration with and authorized use of the E-Verify program or any subsequent replacement program throughout the contract period.

The contractor must attest to its federal work authorization user identification number and date of authorization, and must ensure that all subcontractors engaged for physical performance of services also present compliant affidavits. The affidavit requires execution before a notary public, with the contractor declaring under penalty of perjury that the information provided is true and correct. This document serves as a mandatory compliance verification for contractors performing services on University System of Georgia projects and establishes the framework for ongoing E-Verify utilization throughout the contract term.

Text of this file

Exhibit E 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 Georgia State University, 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

BR-50-2201 25-27 Auburn Avenue Renovation for Student Success Center Name of Project

Board of Regents of the University System of Georgia For the use and benefit of Georgia State University 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:

s

Other files

File Type Posted
GSU BR-50-2201-CxA RFQ-RFP —
Exhibit F —
Egnyte Upload Instructions —
Exhibit B —
Exhibit A —
Award Information —
GSU BR-50-2201-CxA Addn. No. 1 —

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