Subcontractor affidavit (19).pdf
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- Attached to
- Emergency Medical Services Billing
- Solicitation number
- PE-64800-NONST-2026-000000054
- Issued by
- Douglas County, Georgia
About this file
This document is a Subcontractor Affidavit for the Douglas County Board of Commissioners, specifically addressing compliance with O.C.G.A. § 13-10-91(b)(3). The affidavit requires a subcontractor to verify its use of the federal work authorization program known as E-Verify for employees working on a contract with the county. The subcontractor must affirm that they are registered with E-Verify, will continue to use the program throughout the contract period, and will only contract with sub-subcontractors who provide similar affidavits.
The document mandates that the subcontractor forward notices of affidavit receipts to the primary contractor within five business days and attest to their federal work authorization user identification number and date of authorization. The affidavit must be signed by an authorized officer or agent, sworn before a notary public, and declares compliance under penalty of perjury. While no specific project details, contract value, or scope are provided in this document, it serves as a legal verification of workforce authorization compliance for contractors working with Douglas County.
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Text version
Subcontractor Affidavit
O.C.G.A. § 13‐10‐91(b)(3)
By executing this Subcontractor Affidavit, the undersigned subcontractor 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 under a contract with ___________________________________ (name of contractor) on behalf of Douglas County Board of Commissioners 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 subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub‐ subcontractors who present an affidavit to the subcontractor with the information required by O.C.G.A. § 13‐10‐91(b). Additionally, the undersigned subcontractor will forward notice of the receipt of an affidavit from a sub‐subcontractor to the contractor within five business days of receipt. If the undersigned subcontractor receives notice of receipt of an affidavit from any sub‐subcontractor that has contracted with a sub‐subcontractor, subcontractor shall forward, within five business days of receipt, a copy of such notice to the contractor. Subcontractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:
Federal Work Authorization User Identification Number Date of Authorization
Name of Subcontractor: ____________________________________________________
Name of Project: ____________________________________________________
Name of Public Employer: Douglas County Board of Commissioners
I hereby declare under penalty of perjury that the forgoing is true and correct.
Executed on _____________, 20__ in _________________ (city), __________ (state)
Signature of Authorized Officer or Agent
Printed name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE ____ DAY OF _________, 201____
NOTARY PUBLIC
My Commission Expires:
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