Declaration of Employee-Number Categories. Proposer shall complete and submit Form E, which requests the employee-number category applicable to your company.
Declaration of Employee-Number Categories. Please affirmatively indicate by checking the appropriate box the employee- number category applicable to your organization: □ 500 or more employees □ 100 or more employees □ fewer than 100 employees Organization Name: I certify that the above information is true and correct and that the classification noted is applicable for this Project. Signed: Printed: Title: Date: FORM F: GEORGIA SECURITY AND IMMIGRATION CONTRACTOR AFFIDAVIT Instructions: Contractors must attest to compliance with the requirements of O.C.G.A 13-10- 91 and the Georgia Department of Labor Rule 300-10-01-.02 by executing the Contractor Affidavit. The affidavit should be executed by Contractors with 100 or more employees. STATE OF GEORGIA COUNTY OF XXXXXX FORM F: GEORGIA SECURITY AND IMMIGRATION CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with [insert name of Prime Contractor] on behalf of Xxxxxx County Government has registered with and is participating in a federal work authorization program* [any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603], in accordance with the applicability provisions and deadlines established in O.C.G.A. 13- 10-91. The undersigned further agrees that, should it employ or contract with any Sub- Contractor(s) in connection with the physical performance of services to this contract with Xxxxxx County Government, contractor will secure from such Sub-Contractor(s) similar verification of compliance with O.C.G.A. 13-10-91 on the Sub-Contractor Affidavit provided in Rule 300-10-01-.08 or a substantially similar form. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the Xxxxxx County Government at the time the Sub-Contractor(s) is retained to perform such service. EEV/Basic Pilot Program* User Identification Number
