STATE OF COLORADO
CERTIFICATION AND AFFIDAVIT
REGARDING ILLEGAL ALIENS
The Vendor, whose name and signature appear below, certifies and agrees as follows:
1.
The Vendor shall comply with the provisions of CRS 8-17.5-101 et seq. The Vendor shall not
knowingly employ or contract with an illegal alien to perform work for the State or enter into a contract
with a subcontractor that knowingly employs or contracts with an illegal alien.
3.
The Vendor represents, warrants, and agrees that it (i) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (ii) otherwise shall comply
with the requirements of CRS 8-17.5-102(2)(b).
4.
The Vendor shall comply with all reasonable requests made in the course of an investigation
under CRS 8-17.5-102 by the Colorado Department of Labor and Employment. If the Vendor fails to
comply with any requirement of this provision or CRS 8-17.5-101 et seq., the State may terminate work
for breach and the Vendor shall be liable for actual and consequential damages to the State.
5.
If the Vendor is a sole proprietor, the undersigned hereby swears or affirms under penalty of
perjury under the laws of the State of Colorado that (check one):
___
I am a United States citizen, or
___
I am a Permanent Resident of the United States, or
___
I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I am a sole proprietor entering into a
contract to perform work for the State of Colorado. I understand that state law requires me to provide
proof that I am lawfully present in the United States prior to starting work for the State. I further
acknowledge that I will comply with the requirements of CRS 24-76.5-101 et seq. and will produce the
required form of identification prior to starting work. I acknowledge that making a false, fictitious, or
fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of
Colorado as perjury in the second degree under CRS 18-8-503 and it shall constitute a separate criminal
offense each time a public benefit is fraudulently received.
CERTIFIED and AGREED to this ______ day of _________________, 20___.
VENDOR:
________________________________________
_________________________
(Vendor Full Legal Name)
FEIN or Social Security Number
BY: _______________________________________
__________________________
Signature of Authorized Representative
Title
To be filled by State of Colorado
Type of ID: _________________________
Issuing State: _________________________
Verified by: _________________________
Viewed in person: _________
Date: __________________