WORK_AUTHORIZATION_AFFIDAVIT_FOR_BUSINESS_ENTITIES.pdf
PDF 124 KB Posted
- Attached to
- PCC Sidewalk Slab Removal & Replacement FY 2026
- Solicitation number
- 25-0248-PW
- Issued by
- St. Louis County, Missouri
About this file
This is a Work Authorization Affidavit for Business Entities required by the City of Florissant, Missouri for all contracts exceeding $5,000.00. The affidavit pertains to the PCC Sidewalk Slab Removal & Replacement FY 2026 project, which involves sidewalk repair and replacement of Portland Cement Concrete slabs within the Willow Creek subdivision. The project includes tree removal and stump grinding to address damage caused by tree roots, with all work required to comply with Americans with Disabilities Act standards. The contractor and all subcontractors must complete this affidavit as a condition of contract award and performance.
The affidavit requires the contractor's authorized agent to attest under penalty of perjury that the contractor participates in a federal work authorization program and does not knowingly employ unauthorized aliens. Documentation of participation in a federal work authorization program must be attached to the affidavit. All subcontractors must similarly affirm in writing that they comply with Missouri Revised Statute 285.530 regarding work authorization, or submit their own sworn affidavits attesting that all employees are lawfully present in the United States. The affidavit must be notarized before a notary public and includes subscription and swearing provisions.
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Text version
WORK AUTHORIZATION AFFIDAVIT FOR BUSINESS ENTITIES
PURSUANT TO 285.530 R.S. Mo.
(FOR ALL CONTRACTS IN EXCESS OF $5,000.00)
I, , being duly sworn, attest and state, under penalty of perjury, as follows:
[Contractor Agent]
1. I am employed by and serve as the [Contractor] [Position with Contractor].
2. I hereby affirm enrollment and participation in a federal work authorization [Contractor's] program with respect to all employees working in connection with any goods or services provided to the City of
Florissant. Documentation of participation in a federal work authorization program is attached to this affidavit.
3. does not knowingly employ, hire for employment, or continue to employ an [Contractor] unauthorized alien in connection with the services being provided to the City of Florissant.
4. Furthermore, all subcontractors working on this contract for services to the City of Florissant shall affirmatively state in writing in their contracts with that they are not in violation of Section [Contractor]
285.530 1, R.S. Mo., and shall not thereafter be in violation. Alternatively, the subcontractor shall submit a sworn affidavit under penalty of perjury attesting that all employees are lawfully present in the United States.
Further Affiant Sayeth Not.
[Contractor Agent]
STATE OF MISSOURI
) ss.
COUNTY )
Subscribed and sworn to me, a notary public, this_ _day of _, 20 .
Notary Public
My commission expires:
File details come from the government source that posted it. Updated .