WORK_AUTHORIZATION_AFFIDAVIT_FOR_BUSINESS_ENTITIES.pdf
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- Solicitation number
- 25-0266-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, relating to the Mullanphy Road Resurfacing project (Federal Project No. STP-4901(650) in St. Louis County). The affidavit is a sworn statement that must be completed by an authorized representative of the contractor entity and notarized. The contractor must attest to enrollment and participation in a federal work authorization program for all employees working on goods or services provided to the City of Florissant and affirm that the contractor does not knowingly employ unauthorized aliens in connection with the services being provided.
The affidavit additionally requires that all subcontractors working on the City of Florissant contract include written statements in their subcontracts confirming compliance with Missouri Statute 285.530, or alternatively submit their own sworn affidavits under penalty of perjury attesting that all employees are lawfully present in the United States. This documentation of federal work authorization program participation must be attached to the executed affidavit. The affidavit must be subscribed and sworn before a notary public and serves as a compliance mechanism to ensure the contractor and all subcontractors maintain legal workforce authorization throughout the contract term.
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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 .