NORCROSS E_Verify Contractor Affidavit_1.pdf
PDF 895 KB Posted
- Attached to
- 2026 Road Resurfacing (ITB PW 26-08)
- Solicitation number
- PE-66780-NONST-2026-000000042
- Issued by
- Gwinnett County, Georgia
About this file
This is an E-Verify Contractor Affidavit document issued by the City of Norcross, Georgia, establishing compliance requirements for contractors performing services valued over $2,499.99. The affidavit pertains to all contracts with the City involving physical labor and services. Contractors are required to register with and utilize the federal E-Verify work authorization program in accordance with O.C.G.A. 13-10-91. The document mandates that contractors maintain E-Verify authorization throughout the entire contract period and verify their federal work authorization user identification number and authorization date. Contractors bear the responsibility of obtaining and submitting E-Verify affidavits from all subcontractors performing work on the project.
The affidavit requires completion of contractor information including legal name, address, federal work authorization user identification number, and authorization date. Contractors without employees who do not hire or intend to hire may satisfy compliance by submission of a state-issued driver's license or identification card. The document must be executed by an authorized officer or agent and notarized before submission. The affidavit includes an attestation made under penalty of perjury regarding the contractor's E-Verify status and compliance with Georgia law. Additional information and registration details for the E-Verify program are available at www.uscis.gov.
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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 .