Form_7.12_-_E-Verify_Affidavit.pdf
PDF 191 KB Posted
- Attached to
- City Center Sport Complex Ballfields Restoration
- Solicitation number
- ITB-26-22-CW
- Issued by
- Volusia County, Florida
About this file
This is an E-Verify Affidavit form required by the City of Port Orange, Florida for the City Center Sport Complex Ballfields Restoration project. The affidavit serves as a contractual compliance document wherein contractors must certify their enrollment and participation in the E-Verify system in accordance with Section 448.095, Florida Statutes. Contractors are required to attest that they do not employ, contract with, or subcontract with unauthorized aliens and that they maintain full compliance with state employment verification requirements. The completed affidavit must be notarized and submitted with the contractor's bid or proposal response, accompanied by proof of E-Verify system registration.
The form requires contractors to provide their company name, Federal Employer ID Number (FEIN), and E-Verify registration number. The affiant must be duly authorized to bind the company and sign under penalty of perjury. Notarization must be executed before a notary public with physical presence or online notarization capability, and the notary must verify the affiant's identity through personal knowledge or acceptable identification. This document is a mandatory compliance requirement for all contractors bidding on the City of Port Orange's ballfields restoration project and must be returned with the proposal submittal. Enrollment in the E-Verify system can be completed at www.e-verify.gov.
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Text version
FORM 7.12 – E-VERIFY AFFIDAVIT
CITY OF PORT ORANGE
CONTRACTOR E-VERIFY AFFIDAVIT
IN ACCORDANCE WITH SECTION 448.095, FLORIDA STATUTES
Project Name: _________________________________________________________________________________________
Solicitation Number: _______________________________________
I, the undersigned hereby certify that _______________________________________________ (insert contractor company name) does not employ, contract with or subcontract with an unauthorized alien, and is otherwise in full compliance with Section 448.095, Florida Statutes.
I acknowledge that it is my responsibility to ensure full compliance with Section 448.095, Florida Statutes. I am aware enrollment in the E-Verify system for employers can be done at www.e-verify.gov.
A true and correct copy of ___________________________________________________ (insert contractor company name) proof of registration in the E-Verify system is attached to this Affidavit.
By affixing my signature below, I hereby affirm that I am duly authorized to bind the company reference herein and I will comply with all applicable E-Verify requirements.
Print or Type Name, Title Signature of Affiant
Federal Employer ID Number (FEIN) E-Verify Number
STATE OF FLORIDA
COUNTY OF: _______________________
The foregoing instrument was acknowledged before me by means of ☐physical presence or ☐online notarization, this _______ day of _______________________, 2026, by____________________________________________________________ and who:
☐Is personally known to me; or ☐ has produced __________________ as identification.
______________________________________________ Notary Public, State of ______________________________________ Printed, typed or stamped name, commission and expiration:
This document to be completed and returned with your Submittal http://www.e-verify.gov/
File details come from the government source that posted it. Updated .