Safe Streets and Roads for All (SS4A) Planning Services – Revised Appendix E

Description

APPENDIX E: Subcontractor Affidavit By executing this 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 (name of public employer) 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 subsubcontractor to the contractor within five business days of receipt. If the undersigned subcontractor receives notice that a sub-subcontractor has received an affidavit from any other contracted sub-subcontractor, the undersigned sub-subcontractor must forward, within five business days of receipt, a copy of the 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 I hereby declare under penalty of perjury that the foregoing is true and correct. _________________________________ AUTHORIZED OFFICER/AGENT SIGNATURE _________________________________ AUTHORIZED OFFICER/AGENT PRINT NAME _________________________________ AUTHORIZED OFFICER/AGENT TITLE _________________________________ DATE NOTARY SEAL: SUBSCRIBED AND SWORN BEFORE ME ON THIS, THE DAY OF _________________________________ DATE _________________________________ NOTARY PUBLIC SIGNATURE _________________________________ NOTARY PUBLIC COMMISSION EXPIRATION 10