Exhibit E _ Contractor Affidavit.docx
DOCX document 14 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000123
- Issued by
- Candler County, Georgia
About this file
This is a Contractor Affidavit document for the J-463 TLC Lecture Hall Renovation and Systems Renewal project at the University of West Georgia, administered by the Board of Regents of the University System of Georgia. The affidavit serves as a compliance verification document requiring contractors engaged in the physical performance of services to confirm their registration with and authorization to use the E-Verify federal work authorization program in accordance with O.C.G.A. 13-10-91. Contractors must provide their federal work authorization user identification number and date of authorization and commit to continued use of E-Verify throughout the contract period. Additionally, contractors are required to ensure that any subcontractors hired for services also submit affidavits demonstrating their E-Verify compliance under the same statutory requirements.
The document functions as a sworn statement executed under penalty of perjury, requiring the signature of an authorized officer or agent of the contractor and notarization. The affidavit includes blank fields for the contractor's federal work authorization identification number, authorization date, contractor name, project name, public employer designation, execution date, location, notary information, and commission expiration date. No pricing terms, set-asides, funding amounts, or other financial information is contained within this compliance document.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit A _ Certification Form.docx | DOCX document | |
| _J_463_TLC Reno _ Renewal_DP_RFQ.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.pdf |
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Text version
Exhibit E J-463, TLC Lecture Hall Renovation and Systems Renewal University of West Georgia, Carrollton, Georgia
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 University of West Georgia, 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
J-463 TLC Lecture Hall Renovation and Systems Renewal Name of Project
Board of Regents of the University System of Georgia For the use and benefit of University of West Georgia
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:
File details come from the government source that posted it. Updated .