Exhibit E _ Contractor Affidavit.docx
DOCX document 14 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000118
- Issued by
- Douglas County, Georgia
About this file
This is a Contractor Affidavit form for the Board of Regents of the University System of Georgia on behalf of Albany State University related to Project J-462, a renovation project for the Criminal Justice Learning Lab and Public Safety facility. The affidavit document serves as a compliance verification instrument requiring the contractor to confirm registration with and authorized use of the federal E-Verify work authorization program in accordance with O.C.G.A. 13-10-91. The contractor must attest to continuous use of E-Verify throughout the contract period and ensure that all subcontractors similarly provide affidavits demonstrating compliance with state work authorization requirements.
The affidavit requires the contractor to provide its federal work authorization user identification number and date of authorization, with the document executed under penalty of perjury before a notary public. The form includes signature lines for an authorized officer or agent of the contractor, with printed name and title required, and must be notarized with specification of the notary's commission expiration date. This affidavit is a mandatory compliance document that must be completed and submitted as part of the contractual requirements for Project J-462.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| J_462 ALSU CJLL _ PS Reno DP RFQ.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| J_462 CJLL PS DP RFQ _ ADDENDUM 1.pdf | ||
| Exhibit A _ Certification Form.docx | DOCX document |
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Text version
Exhibit E J-462 Renovation for the Criminal Justice Learning Lab and Public Safety Albany State University, Albany, 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 Albany 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
J-462 Renovation for the Criminal Justice Learning Lab and Public Safety Name of Project
Board of Regents of the University System of Georgia For the use and benefit of Albany 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:
File details come from the government source that posted it. Updated .