NORCROSS E_Verify Contractor Affidavit_1.pdf
PDF 895 KB Posted
- Attached to
- On-Call CIPP Relining Services (RFQ PW 26-05)
- Solicitation number
- PE-66780-NONST-2026-000000037
- Issued by
- Gwinnett County, Georgia
About this file
This is an E-Verify Contractor Affidavit issued by the City of Norcross, Georgia, pursuant to O.C.G.A. § 13-10-91. The affidavit applies to all contracts with the City of Norcross involving physical labor and services valued at $2,499.99 or greater. Contractors must register with and utilize the federal E-Verify program throughout the entire contract period. The affidavit requires contractors to provide their federal work authorization user identification number and date of authorization. Contractors are responsible for obtaining E-Verify affidavits from all subcontractors performing physical services on the project. Alternatively, contractors with no employees and no intention to hire employees may satisfy the requirement by submitting a state driver's license or state identification number.
The affidavit must be executed and notarized by an authorized officer or agent of the contractor, with the notary public signature and commission expiration date included. Contractors certify under penalty of perjury that they are registered with E-Verify and will maintain compliance throughout the contract term. The City of Norcross is located at 65 Lawrenceville Street, Norcross, Georgia 30071. No pricing information, contract term length, set-asides, or incumbent information is specified in this compliance document.
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Text version
Physical performance of services: Contracts with the City involving both physical labor and any services over $2499.99 in value.
Contractors must be registered with and use the E-Verify program. If you have not registered, you can find the information at www.uscis.gov(click on E-verify Homepage, see start here directions.)
It is the responsibility of the Contractor to submit additional E-Verify Affidavits on every Sub-Contractor for this project.
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 the City of Norcross 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:
Project Name: Date of Project: _
Legal Name of Contractor:
Address: City: _________________ State: _____ Zip Code: _________________
Federal Work Authorization User Identification Number (E-Verify Number): __________(4-6 digit numeric #)
Date of Authorization:
*If a contractor has no employees and does not hire or intend to hire they may satisfy the law by submission of (State DL or State ID) Drivers’ License Number: _____________________________________
I hereby declare under penalty of perjury that the foregoing is true and correct
Signature of Authorized Officer/Agent Date Printed Name and Title of Authorized Officer/Agent
MUST BE COMPLETED BY NOTARY
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20
Executed in (City), (State)
NOTARY PUBLIC Signature My Commission Expires
65 Lawrenceville St. Norcross, GA 30071 [P] 770.448.2122 [F] 770.448.5945 www.norcrossga.net
E-Verify Contractor Affidavit O.C.G.A. § 13-10-91 (b)(1)
EXEMPT: YES OR NO
http://www.uscis.gov/
File details come from the government source that posted it. Updated .