Form_7.12_-_E-Verify_Affidavit.pdf
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- Solicitation number
- ITB-26-18-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 contractors bidding on the Mitigation Reconstruction of a Flood Prone Home Project. The affidavit serves as a compliance certification document in accordance with Section 448.095 of the Florida Statutes. Contractors must complete and submit this form as part of their bid package, certifying that their company does not employ, contract with, or subcontract with unauthorized aliens and maintaining full compliance with state employment verification requirements. The form requires the contractor to provide their company name, project name, solicitation number, Federal Employer ID Number (FEIN), and E-Verify Number, along with a true and correct copy of proof of registration in the E-Verify system attached as supporting documentation.
The affidavit must be signed by an authorized company representative and notarized before a Florida notary public with the notarization dated no later than 2026. The signatory affirms personal authorization to bind the company and commits to compliance with all applicable E-Verify requirements. Contractors can enroll in the E-Verify system through www.e-verify.gov if not already registered. This document must be completed and returned with the bid submittal; failure to provide this affidavit or proof of E-Verify registration may result in bid disqualification. The form establishes no financial terms, pricing conditions, or contract award specifics, functioning solely as a statutory compliance verification mechanism.
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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 .