Ga. Comp. R. & Regs. R. 300-10-1-.07 - Contractor Affidavit and Agreement

Public employers shall use the following affidavit and agreement form, or an affidavit and agreement form that is substantially similar to that provided below, to document a contractor's compliance with the requirements of O.C.G.A. 13-10-91:

Contractor Affidavit and Agreement (Example):


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 contracting with (name of public employer) 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 subcontractor(s) in connection with the physical performance of services pursuant to this contract with (name of public employer), contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. 13-10-91 on the Subcontractor 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 (name of the public employer) at the time the subcontractor(s) is retained to perform such service.


EEV/Basic Pilot Program* User Identification Number

________________________________________ __________

BY: Authorized Officer or Agent Date

(Contractor Name)


Title of Authorized Officer or Agent of Contractor


Printed Name of Authorized Officer or Agent



_____ DAY OF ______________________, 200_


Notary Public

My Commission Expires:


* As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is the "EEV/Basic Pilot Program" operated by the U. S. Citizenship and Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA).

(End of Form)


Ga. Comp. R. & Regs. R. 300-10-1-.07
O.C.G.A. Sec. 13-10-91.
Original Rule entitled "Contractor Affidavit and Agreement" adopted. F. May 25, 2007; eff. June 18, 2007, as specified by the Agency.

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