AFFIDAVIT OF WORK AUTHORIZATION. The bidder/contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now _ (Name of Business Entity Authorized Representative) as (Position/Title) first being duly sworn on my oath, affirm (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that _ (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the contracted services provided under the contract(s) for the duration of the contract(s), if awarded. Authorized Representative’s Signature Printed Name Title Date E-Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a notary public within the County of , State of , and my commission expires on . Signature of Notary Date I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, and have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following. The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the bidder’s/contractor’s name and the MOU signature page completed and signed by the bidder/contractor and the Department of Homeland Security – Verification Division A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized within the past twelve months). Name of Missouri State Agency or Public University* to Which Previous E-Verify Documentation Submitted: *Public University includes the following five schools under chapter 34, RSMo: Xxxxxx-Xx...
AFFIDAVIT OF WORK AUTHORIZATION. The contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as (Position/Title) first being duly sworn on my oath, affirm (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the contracted services provided under the contract(s) for the duration of the contract(s), if awarded. Authorized Representative’s Signature Printed Name Title Date E-Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , and my commission expires on . Signature of Notary Date
AFFIDAVIT OF WORK AUTHORIZATION. An Employer who meets the section 285.525 RSMo definition of a business entity must complete, sign in the presence of a notary public, and return the following Affidavit of Work Authorization: Comes now (Name of Business Entity Authorized Representative) as (Position/Title), first being duly sworn on my oath, to affirm that
AFFIDAVIT OF WORK AUTHORIZATION. Pursuant to 285.530 RSMo, the Contractor must affirm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein by Having on file an AFFIDAVIT OF WORK AUTHORIZATION and DocuSign Envelope ID: 9E326740-01B6-426D-BF04-E8018FDF0FD4 Providing documentation as requested affirming the bidder’s enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein.
AFFIDAVIT OF WORK AUTHORIZATION. The contractor who meets the section 285.525, RSMo definition of a business entity must complete and return the following Affidavit of Work Authorization.
AFFIDAVIT OF WORK AUTHORIZATION. The contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as Authorized Representative’s Signature Printed Name Title Date E-Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a notary public within the County of , State of , and my commission expires on . Signature of Notary Date
AFFIDAVIT OF WORK AUTHORIZATION. The grantee, subgrantee, contractor or subcontractor who meets the section 285.525, RSMo definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as (Position/Title) first being duly sworn on my oath, affirm (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to (Bid/Grant/Subgrant/Contract/Subcontract) for the duration of the grant, subgrant, contractor, or subcontract, if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the contracted services related to Authorized Representative’s Signature Printed Name Title Date Subscribed and sworn to before me this of . I am (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , and my commission expires on . Signature of Notary Date Sub-grantee: Grant Number: Date of Request: Requested Reimbursement 1. Payee 2. Budget Category 3. Grant Funds Requested 4. Match Funds Provided 5. Total (sum of 3 + 4) Total The Sub-grantee will be reimbursed for all allowable expenses and/or expenditures incurred or created in completion of the approved grant project. All requests for reimbursement and/or payment must be fully completed and signed by the Sub- grantee, identifying the amount or amounts of grant funds requested through MMSWMD and providing proof of all expenditures, such as invoices and canceled checks. This request must identify the Sub-grantee's share of matching funds and must provide proof of the Sub-grantee's payment of such matching funds before grant funds may be advanced.* Indicates payee qualifies as MBE/WBE as per Sec. 11 of the Financial Assistance Agreement. Grant Sub-grantee(s) I certify that to the best of my knowledge and belief the data above are correct and that all outlays were made or will be made in accordance with the sub-grant and that payment is due and has not been previously requested. Name Title