Exhibit E _ Contractor Affidavit.docx
DOCX document 14 KB Posted
- Solicitation number
- PE-47200-RFQ-2027-000000150
- Issued by
- Douglas County, Georgia
About this file
This is a Contractor Affidavit document required for Project No. J-474, Campuswide HVAC Renewal at Georgia Southern University's Swainsboro Campus, involving the Board of Regents of the University System of Georgia. The affidavit serves as verification of contractor compliance with O.C.G.A. 13-10-91(b)(1), which mandates federal work authorization program participation. The contractor must attest that it is registered with, authorized to use, and actively uses E-Verify or any subsequent replacement program in accordance with applicable state provisions and deadlines. The contractor commits to continued E-Verify usage throughout the entire contract period and agrees to contract only with subcontractors who provide equivalent affidavits demonstrating their own E-Verify compliance and authorization.
The affidavit requires the contractor to provide its federal work authorization user identification number and date of authorization. The document must be executed by an authorized officer or agent of the contracting firm and notarized, with the notary public providing their commission expiration date. This affidavit is a mandatory compliance document for all contractors performing work on this project and serves as a binding attestation made under penalty of perjury regarding employment eligibility verification procedures.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| _GSOU J_474 HVAC_DP RFQ.pdf | ||
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit A _ Certification Form.docx | DOCX document |
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Text version
Exhibit E J-474 Campuswide HVAC Renewal, Swainsboro Campus Georgia Southern University, Swainsboro, 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-474 Campuswide HVAC Renewal, Swainsboro Campus 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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