Exhibit E _ Contractor Affidavit.docx
DOCX document 14 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000147
- Issued by
- Brantley County, Colquitt City, Georgia
About this file
This is a Contractor Affidavit document required under Georgia law (O.C.G.A. 13-10-91(b)(1)) for Project J-469, Cochran Campus Domestic Water System Replacement at Middle Georgia State University in Cochran, Georgia, administered by the Board of Regents of the University System of Georgia. The affidavit verifies that contractors engaged in the physical performance of services on this project are registered with and authorized to use the federal E-Verify work authorization program, or any subsequent replacement program, in accordance with applicable Georgia provisions and deadlines. Contractors must continue E-Verify usage throughout the entire contract period and may only subcontract with entities that have submitted the required affidavit documenting their E-Verify authorization.
The affidavit requires the contractor to provide their federal work authorization user identification number and date of authorization, along with the signature of an authorized officer or agent executed before a notary public. This document serves as a compliance verification mechanism rather than a pricing or service specification document, establishing the contractor's legal eligibility to perform work on the project under Georgia's employment eligibility requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit A _ Certification Form.docx | DOCX document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| _MGSU J_469 DP RFQ_RFP.pdf | ||
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document |
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Text version
Exhibit E J-469 Cochran Campus Domestic Water System Replacement Middle Georgia State University, Cochran, 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 Middle 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
J-469 Cochran Campus Domestic Water System Replacement Name of Project
Board of Regents of the University System of Georgia For the use and benefit of Middle 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:_________________________________
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