Subcontractor's E-Verify Affidavit.pdf
PDF 177 KB Posted
- Attached to
- 5th District Court of Appeal Security Upgrades
- Solicitation number
- ITN-14562
- Issued by
- Leon County, Florida
About this file
This is a Subcontractor's E-Verify Registration Affidavit required by the Florida State Courts System for the 5th District Court of Appeal Security Upgrades project. The affidavit document establishes compliance requirements under Florida Statute section 448.095(2)(a), mandating that all private employers with more than 25 employees and public employers, contractors, and subcontractors register with and utilize the Department of Homeland Security's E-Verify system to verify work authorization status of newly hired employees within three business days of employment. The form requires the business entity's authorized representative to certify registration with DHS E-Verify, provide the business legal name, address, and taxpayer identification number, and acknowledge the requirement to maintain active E-Verify registration throughout contract performance. Subcontractors must notify the Contract Manager within ten calendar days of any change in employer status. The affidavit must be notarized and executed before a notary public, with identification required from the signer.
Non-compliance with E-Verify requirements carries significant penalties, including fines of $1,000 per day, prohibition from entering into any contracts with Florida government entities for one year, suspension or revocation of any state-issued business or professional licenses, and immediate contract termination. Alternatively, subcontractors with five or fewer employees who do not hire more than five employees in a calendar year may qualify for exemption from E-Verify registration requirements. All subcontractors must certify compliance on the first unemployment tax return submitted to the Department of Commerce as required by statute. This affidavit serves as a mandatory compliance document for all subcontractors participating in the security assessment and design services contract for the 5th District Court of Appeal.
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Text version
SCS-E-Verify Registration Affidavit v.8.0 Page | 1 rev 4/16/2024
FLORIDA STATE COURTS SYSTEM
SUBCONTRACTOR’S E-VERIFY REGISTRATION AFFIDAVIT
I, _____________________________________, am the owner or authorized representative of the business entity shown below. I hereby acknowledge on behalf of my business or business entity that I am aware of the requirement in section 448.095(2)(a), Florida Statutes, that every private employer with more than 25 employees and every public employer, contractor, and subcontractor must be registered with and use the Department of Homeland Security’s (DHS) E-Verify system to verify the work authorization status of all newly hired employees.
Business or Business Entity Legal Name:
Business or Business Entity Legal Address:
Business or Business Entity Taxpayer Identification Number (TIN):
I hereby certify that my business or business entity:
Is registered with the DHS E-Verify system (https://www.e-verify.gov/) to verify the employment eligibility of each new employee hired within three (3) business days after the employee begins working for pay, as required by 8 C.F.R s. 274a for contract\agreement eligibility purposes.
Does not have more than five (5) employees at any given time and does not hire more than five
(5) employees in a calendar year and is not eligible to register to use the DHS E-Verify system.
Does not hire and agrees not to hire employees who are not authorized to be employed in the United States pursuant to 8 U.S.C. s. 1324a(h)(3).
By signing this affidavit, I agree to maintain an active E-Verify registration and that I will notify the Contract Manager within ten (10) calendar days of any change in business entity status as an employer. I further acknowledge that the failure to comply with section 448.095, Florida Statutes, can result in fines of $1,000 per day, prohibition of my business from entering into any contracts with any government entity in the State of Florida for a period of 1-year, suspension or revocation of any business or professional license issued to my business by any agency of the State of Florida and the immediate termination of my contract.
Will certify compliance on the first unemployment tax return submitted to the Department of Commerce, as required by section 448.095(3), Florida Statues.
SCS-E-Verify Registration Affidavit v.8.0 Page | 2 rev 4/16/2024
I HEREBY AFFIRM AND VERIFY THAT THE FOREGOING IS TRUE AND CORRECT.
Sole Proprietor/Authorized Representative
Printed Name
STATE OF _______________________
COUNTY OF _____________________
Sworn to (or Affirmed) and Subscribed Before Me By Means of ☐ Physical Presence or ☐ Online Notarization this ___________ day of __________________, 202__, by ________________________________________, Who ☐ Is Personally Known to Me or ☐ Produced Identification.
Type of Identification Produced: _________________________
Signature of Notary Public
Printed Name of Notary Public Administering Oath Pursuant to §117.03, Florida Statutes
| am the owner or authorized representative of the: |
| Business or Business Entity Legal Name: |
| Business or Business Entity Legal Address: |
| Business or Business Entity Legal Address_2: |
| Business or Business Entity Legal Address_3: |
| Business or Business Entity Taxpayer Identification Number TIN: |
| Printed Name: |
| STATE OF: |
| COUNTY OF: |
| Physical Presence or: Off |
| Online Notarization: Off |
| this: |
| 202: |
| by: Off |
| Produced Identification: Off |
| Is Personally Known to Me or: |
| Type of Identification Produced: |
| Printed Name of Notary Public Administering Oath Pursuant to 11710 Florida Statutes: |
| Check Box8: Off |
| Check Box9: Off |
| Check Box10: Off |
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