Lease of Robotic Field Line Marking System with Maintenance and Paint Program

Contractor Affidavit under O.C.G.A. 13-10-91(b)(1)
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, has registered with City of
Kingsland, and is authorized to use and uses the federal work authorization program
commonly known as E-Verify, or any subsequent replacement program, in accordance
with the applicable provisions and deadlines established in O.C.G.A. 13-10-91.
Furthermore, the undersigned contractor will continue to use the federal work
authorization program throughout the contract period and the undersigned contractor
will contract for the physical performance of services in satisfaction of such contract
only with subcontractors who present an affidavit to the contractor with the information
required by O.C.G.A. 13-10-91(b). Contractor hereby attests that its federal work
authorization user identification number and date of authorization are as follows:
_______________________________
Federal Work Authorization User Identification Number
_________________________________
Date of Authorization
_________________________________
Name of Contractor
_________________________________
Name of Project
_________________________________
Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on ______, ___, 202__ in _______________________(city), _______(state).
_________________________________
Signature of Authorized Officer or Agent
_______________________________
Printed Name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE ______ DAY OF ______________,202__.
_________________________________
NOTARY PUBLIC
My Commission Expires: _________________________________