Common use of AFFIDAVIT OF WORK AUTHORIZATION Clause in Contracts

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (NAME OF COUNTY) , and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.)

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , (NAME OF COUNTY) , (NAME OF STATE) and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date Exhibit 1 (continued) (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.) BOX C – Affidavit on File - Current Business Entity Status 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-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date FOR STATE USE ONLY Documentation Verification Completed By: Buyer Date Exhibit 2: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by 2 CFR Part 180.

AFFIDAVIT OF WORK AUTHORIZATION. The contractor Employer 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(sagreement(s) with the State of Missouri for the duration of the contract(sagreement(s), if awarded in accordance with subsection 2 of section 285.530, 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 agreed services provided under the contract(sagreement(s) for the duration of the contract(sagreement(s), if awarded. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, 575.040 RSMo.) Authorized Business Entity Authorized Business Entity Representative’s 's Name (Please Print) Representative's Signature Printed Name Position/Title (Please Print) Date Email Address (Please Print) E-Mail Address E-Verify verify Company ID Number NOTARY Subscribed and sworn to before me this of . I am commissioned as a Notary (DAY) (MONTH, YEAR) commissioned as a notary public Public within the County of , State of (NAME OF COUNTY) , and my commission expires on . (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) (DATE) Signature of Notary Date Seal/Stamp (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not DO NOT complete Box B.) BOX C — AFFIDAVIT ON FILE — CURRENT BUSINESS ENTITY STATUS 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 has 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 agreements(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or 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 Employer's name and the MOU signature page completed and signed by the Employer and the U.S. Department of Homeland Security—Verification Division. A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, or Public University* to which previous E-Verify Documentation was submitted:

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , (NAME OF COUNTY) , (NAME OF STATE) and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date Exhibit 1 (continued) (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.) BOX C – Affidavit on File - Current Business Entity Status 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-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date FOR STATE USE ONLY Documentation Verification Completed By: Buyer Date Exhibit 2: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by 2 CFR Part 180.

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , (NAME OF COUNTY) , (NAME OF STATE) and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date Exhibit 1 (continued) (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.) BOX C – Affidavit on File - Current Business Entity Status 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-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date FOR STATE USE ONLY Documentation Verification Completed By: Buyer Date Exhibit # 2: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by 2 CFR Part 180.

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (DAY) (MONTH, YEAR) public commissioned as a notary public within the County of , State of , (NAME OF COUNTY) , (NAME OF STATE) and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date Exhibit # 1: (continued) (Complete the following if you have the E-Verify E‐Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.) BOX C – Affidavit on File ‐ Current Business Entity Status 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 contractor’s name and the MOU signature page completed and signed by the 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-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Authorized Business Entity Name (Please Print) Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date FOR STATE USE ONLY Documentation Verification Completed By: Buyer Date Exhibit # 2: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by 2 CFR Part 180.

AFFIDAVIT OF WORK AUTHORIZATION. The contractor contracting agency 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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (NAME OF COUNTY) , and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.)

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (NAME OF COUNTY) , and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date EXHIBIT 1, continued (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.)

AFFIDAVIT OF WORK AUTHORIZATION. The contractor Employer 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, 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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, 575.040 RSMo.) Authorized Business Entity Authorized Business Entity Representative’s 's Name (Please Print) Representative's Signature Printed Name Position/Title (Please Print) Date Email Address (Please Print) E-Mail Address E-Verify verify Company ID Number NOTARY Subscribed and sworn to before me this of . I am commissioned as a Notary (DAY) (MONTH, YEAR) commissioned as a notary public Public within the County of , State of (NAME OF COUNTY) , and my commission expires on . (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) (DATE) Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not DO NOT complete Box B.) BOX C — AFFIDAVIT ON FILE — CURRENT BUSINESS ENTITY STATUS 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 has 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, Missouri Job Center, Local Workforce Development Board, or 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 Employer's name and the MOU signature page completed and signed by the Employer and the U.S. Department of Homeland Security—Verification Division. A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, or Public University* to which previous E-Verify Documentation was submitted:

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , (NAME OF COUNTY) , (NAME OF STATE) and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date Exhibit 1 (continued) (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.) BOX C – Affidavit on File - Current Business Entity Status 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-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Authorized Business Entity Name (Please Print) Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date FOR STATE USE ONLY Documentation Verification Completed By: Buyer Date Exhibit # 2: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by 2 CFR Part 180. (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION)

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. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.) 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 (DAY) (MONTH, YEAR) commissioned as a notary public within the County of , State of , (NAME OF COUNTY) , (NAME OF STATE) and my commission expires on . (NAME OF STATE) (DATE) Signature of Notary Date Exhibit 1 (continued) (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.) BOX C – Affidavit on File - Current Business Entity Status 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-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date FOR STATE USE ONLY Documentation Verification Completed By: Buyer Date Exhibit 2: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by 2 CFR Part 180.