HomeMy Public PortalAboutE Verify contractor aff OCGA_13-10-91xbx3x_Affidavit_for_hb_87_1.docx Contractor Affidavit under O.C.G.A. § 13-10-91(b)(3)
By executing this affidavit, the undersigned contractor 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 the City of Tybee Island, Georgia 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
contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services
in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Additionally, the undersigned
contractor will forward notice of the receipt of an affidavit from a subcontractor to the City of Tybee Island within five business days of receipt. If the undersigned contractor receives
notice of receipt of an affidavit from any sub-subcontractor that has contracted with a subcontractor to forward, within five business days of receipt, a copy of such notice to the
City of Tybee Island. Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:
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Federal Work Authorization User Identification Number
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Date of Authorization
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Name of Subcontractor
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Name of Project
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Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on ______, ___, 201__ in _____(city), ______(state).
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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__.
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NOTARY PUBLIC
My Commission Expires:
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