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DocuSign Envelope ID: E53DCC3C-B8E8-410C-BB50-A039C27BD393 <br /> ATTACHMENT B- ELECTRONIC VERIFICATION FORM <br /> STATE OF NORTH CAROLINA <br /> AFFiDAViT <br /> ORANGE COUNTY <br /> I, (the individual attesting below), being duly 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-Verifyis 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 /> Th is day of , 2013. <br /> Signature of Affiant <br /> Print or Type Name: <br /> State of North Carolina Orange County 3 <br /> Signed and sworn to(or affirmed) before me,this the <br /> n <br /> day of 12013. v <br /> z <br /> My Commission Expires: <br /> Notary Public ; <br /> 20 <br /> RFP No.xxxx <br />