Orange County NC Website
Browse       Search
DocuSign Envelope ID: 7796CD94- 342E- 40D0- B7C3- A2B604F926B4 <br />ORANGE COUNTY C3UNTY <br />ATTACHMENT B- ELECTRONIC VERIFICATJON FORM <br />STATE OF NORTH CAROLINA <br />ORANGE COUNTY <br />AFFIDAVIT <br />Department of Solid Waste Management <br />I,` iCsD (the individual attesting below), being duly authorized by and on behalf of <br />ZQ S Ornc r $ 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-Vsrifv is the federal E- Verify program operated by the United States <br />Department of Homeland securlty and other federal agencies, or any successor or equivalent program used to <br />verity 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 -VeriF . 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. Cmnloyer is a person, business entity, or tither 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 t►� <br />4. Employer's sub<mnfractoss comply with E- Verify, and if Employer is the +,+Tinning bidder on this project <br />Employerwill ensure compliance; with E- Verify by any subcontractors subsequently hired by Employer. <br />This Z day of --t t — , 2a4-S X91 � W <br />i <br />Phil <br />Signature of Affix it <br />Print car Type Name; —PrEg <br />State of NQr1h_Carolina Orange County <br />Signed and sworn to (or affirmed) before me, this the I <br />day of ZQ<— 0 j , -00 tip t <br />z <br />My Commission Explres; <br />otary Public <br />L' <br />20 <br />RFP No. 5427 <br />