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DocuSign Envelope ID: 7796CD94- 342E- 40D0- B7C3- A2B604F926B4 <br />f <br />ORANGE COUNTY <br />ATTACHMENT B- ELECTRONIC VERIFICATION FORM <br />STATE OF NORTH CAROLINA <br />AFFIDAVIT <br />ORANGE COUNTY <br />WWA Rikl kA kA•kA!!Al AA lA lRAR <br />Department of Solid Waste Management <br />I, (the individual attesting below), being duty authorized by and on behalf of <br />(the entity bidding on project hereinafter "Employer") after first being <br />duly sworn hereby swears or affirms as follows: <br />1. Employer understands that E -Verify is the federal E- Verify program operated by the United States <br />Department of Homeland Security and other federal agencies, or any successor or equivalent program used to <br />verify the work authorization of newly hired employees pursuant to federal law in accordance with NCGS §64- <br />25(5 ). <br />2. Employer understands that Employers Must Use E- Verify. Each employer, after hiring an employee to <br />work in the United States, shall verify the work authorization of the employee through E- Verify in accordance <br />with NCGS §64- 26(a). <br />3. Employer is a person, business entity, or other organization that transacts business in this State and <br />that employs 25 or more employees in this State. (mark Yes or No) <br />a. YES , or <br />b. NO <br />4. Employer's subcontractors comply with E- Verify, and if Employer is the winning bidder on this project <br />Employer will ensure compliance with E- Verify by any subcontractors subsequently hired by Employer. <br />This day of , 2011 <br />Signature of Affiant <br />Print or Type Name: <br />State of North Carolina Orange County <br />Signed and sworn to (or affirmed) before me, this the <br />day of .2013. <br />My Commission Expires: <br />Notary Public <br />20 <br />RFP No. 5427 <br />D <br />n <br />iv <br />Z <br />v <br />m <br />;y <br />U) <br />ro <br />w <br />