Exhibit E _ Contractor Affidavit.docx
DOCX document 14 KB Posted
- Attached to
- GSOU J-460-DP School of Optometry
- Solicitation number
- PE-47200-RFQ-2026-000000127
- Issued by
- Brooks County, Georgia
About this file
This is a Contractor Affidavit form required under Georgia Code Section 13-10-91(b)(1) for the Board of Regents of the University System of Georgia, specifically for Georgia Southern University's School of Optometry project (J-460) located in Statesboro, Georgia. The affidavit serves as verification that contractors performing services on behalf of the university have registered with and are authorized to use the federal E-Verify work authorization program. Contractors executing this document affirm their compliance with applicable state law and commit to maintaining E-Verify authorization throughout the contract period. Additionally, contractors agree to contract only with subcontractors who submit comparable affidavits demonstrating their own E-Verify compliance.
The affidavit requires the contractor to provide their federal work authorization user identification number and date of authorization, along with an authorized officer's signature and notarization. This document establishes the contractor's legal commitment under penalty of perjury to comply with Georgia's workforce verification requirements and serves as a mandatory compliance document for the School of Optometry design professional services project. No pricing, payment terms, or financial information is contained in this affidavit form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| _J_460 GSOU_DP RFQ_RFP.pdf | ||
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit A _ Certification Form.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Exhibit E J-460, School of Optometry Georgia Southern University, Statesboro, 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 (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:
File details come from the government source that posted it. Updated .