Sample_E-Verify_Form.pdf
PDF 591 KB Posted
- Attached to
- On-Call Aviation Engineering Services
- Solicitation number
- 2025-RFQ-020
- Issued by
- Greenwood County, Washington
About this file
The document is an E-Verify Declaration form from Pierce County, Washington, designed to ensure contractors participating in county contracts comply with federal employment verification requirements. The form applies to county contracts for public works exceeding $100,000 or other county contracts over $25,000 with a duration longer than 120 days. Contractors must enroll in the E-Verify program, provide certification of enrollment with their bid submittal, and verify enrollment for all applicable subcontractors.
The declaration requires contractors to certify under penalty of perjury that they are currently enrolled in the E-Verify system implemented on March 1, 2010, and will continue using it throughout the project duration. Pierce County reserves the right to request a Memorandum of Understanding between the contractor and the Department of Homeland Security at any time, with failure to provide this document within 10 days potentially resulting in contract suspension. The Federal E-Verify Program can be accessed at www.dhs.gov/everify, and contractors must demonstrate ongoing compliance throughout the contract period.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
E-VERIFY DECLARATION
Firm Name: __________________________________________________
Contract No.____________________________
Pierce County requires that, as a condition for the award of any County contract for public works in excess of $100,000.00 or any other County contract in excess of $25,000.00, and the duration of the contract is greater than 120 days, the business entity or contractor shall enroll in the E Verify program, or its successor, and thereafter shall provide the County documentation affirming its enrollment and participation in the program. The requirement extends to every subcontractor meeting the same criteria. The Prime Contractor must provide certification of enrollment with bid submittal. The Prime Contractor is responsible for verification of every applicable subcontractor.
Pierce County reserves the right to require a copy of a Memorandum of Understanding between the Prime or any Subcontractor and Department of Homeland Security upon request at any time during the project verifying the contractor’s enrollment. Failure to provide this document could result in suspension of the project.
The Federal E-Verify Program is a web-based application that can be accessed at:
www.dhs.gov/everify.
The undersigned declares, under penalty of perjury under the laws of Washington that:
1. That the above named firm is currently enrolled in and using the E-Verify system implemented on March 1, 2010 as outlined in PCC 2.106.022 and will continue to use the E-Verify system for so long as work is being performed on the above named project.
2. I certify that I am duly authorized to sign this declaration on behalf of the above named bidder/proposer.
3. I acknowledge that Pierce County reserves the right to require a copy of the Memorandum of Understanding between the contractor listed above and the Department of Homeland Security certifying enrollment in the E-Verify program at any time. Failure to provide the required Memorandum of Understanding within 10 days of request could lead to suspension of this contract.
Dated at Washington this day of , 20
Signature
Printed Name
Title
END OF FORM
SAMPLE
http://www.dhs.gov/everify
File details come from the government source that posted it. Updated .