Exhibit E _ Contractor Affidavit.docx
DOCX document 14 KB Posted
- Attached to
- GSOU J-460-PM School of Optometry
- Solicitation number
- PE-47200-RFQ-2026-000000126
- Issued by
- Brooks County, Georgia
About this file
This is a Contractor Affidavit document required under O.C.G.A. 13-10-91(b)(1) for the Board of Regents of the University System of Georgia in connection with program management services for Project No. J-460-PM, School of Optometry at Georgia Southern University in Statesboro, Georgia. The affidavit serves as verification of the contractor's compliance with Georgia's federal work authorization requirements and must be executed by an authorized officer or agent of the contracting firm. The document requires the contractor to provide its federal work authorization user identification number and date of authorization, along with the contractor's signature, printed name, and title, all notarized before a notary public.
The affidavit establishes that the contractor has registered with, is authorized to use, and actively uses E-Verify or any subsequent federal work authorization program replacement in accordance with applicable provisions and deadlines established under O.C.G.A. 13-10-91. The contractor commits to continued use of the federal work authorization program throughout the entire contract period and agrees to contract only with subcontractors who submit equivalent affidavits containing the information required by O.C.G.A. 13-10-91(b). This document is a mandatory compliance requirement and does not contain information regarding pricing, contract duration, or award amounts.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit D _ PM Fee Proposal Form.xlsx | XLSX spreadsheet | |
| Exhibit F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit A _ RFQ Certification Form.docx | DOCX document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| J_460 GSOU School of Optometry PM RFQ_RFP_djh.pdf | ||
| Exhibit C _ Project Team Composition Form.docx | DOCX document |
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Text version
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 Southern 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-460, School of Optometry Name of Project
Board of Regents of the University System of Georgia For the use and benefit of Georgia Southern 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:
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