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TROUP COUNTY, GEORGIA VE NDOR/CONTRACTOR (E-VERIFY) AFFIDAVIT AND AGREEMENT Please initial the appropriate statement for your current and future business relations with Columbia County, GA, (one of items A thru E must be initialed) and sign and have notarized, if applicable: A) I and/or my organization provide(s) products only for the County (no physical labor or services). B) I and/or my organization have/has no employees, or plans to hire employees, and cannot apply for an E-verify number (attach a copy of a valid driver's license instead). C) am an individual exempt as a professional licensed under Title 26 (“Food, Drugs and Cosmetics”) or Title 43 (“Professions and Businesses”) or by the State Bar of Georgia. (attach copy of current professional license) D) I and/or my organization am/is providing labor or services that will not exceed $2,499.99. E) I and/or my organization provide(s) labor or services to the County and I have supplied the EV number below (notarization below is required). Signature of Authorized Officer or Agent Printed Name Date Company / Contractor Name Title of Authorized Officer or Agent NOTARIZATION REQUIRED FOR E-VERIFY NUMBER SUBMISSIONS: COMES NOW before me, the undersigned officer duly authorized to administer oaths, the undersigned contractor, who, after being duly sworn, states as follows: By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91 and Georgia Department of Labor Rule 300-10-1-.02, stating affirmatively that the individual, firm, or corporation which is contracting with the County has registered with and is participating in a federal work authorization program in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91 and Georgia Department of Labor Rule 300-10-1- .02. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period. The undersigned contractor further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to the contract with Columbia County, Georgia, of which this affidavit is a part, the undersigned contractor will secure from such subcontractor( s) similar verification of compliance with O.C.G.A. § 13-10-91 and Georgia Department of Labor Rule 300-10-1-.02 through the subcontractor's execution of the subcontractor affidavit required by Georgia Department of Labor Rule 300-10-1-.08 or a substantially similar subcontractor affidavit. The undersigned contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the County at the time the subcontractor(s) is retained to perform such service. EEV (E-Verify Number) Issued by DOHS Sworn to and subscribed before me day , Notary Public Visit www.e-verify.gov for more information or to obtain a number. COLUMBIA COUNTY BOARD OF COMMISSIONERS, GEORGIA VENDOR/ CONTRACTOR (E-VERIFY) AFFIDAVIT AND AGREEMENT F) I and/or my organization is a foreign company with no employees working in the United States and therefore exempt from E-Verify requirements).