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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 contracting with the Greene County Board of Commissioners 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 the Greene County Board of Commissioners, 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 and provide copies to the Greene County Board of Commissioners within five business days of entering into a contract with such subcontractor. E-Verify * Company Identification Number Date Authorized to Use e-Verify Company Name Authorized Officer/Agent Date (Contractor Signature) Printed Name of Authorized Officer/Agent Title of Authorized Officer/Agent of Contractor SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 20__. Notary Public My Commission Expires: