Form Gs-1078 - Attestation Regarding Personnel Used In Contract Performance

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State of Tennessee
Department of General Services
Central Procurement Office
312 Rosa L. Parks Avenue
rd
William R. Snodgrass TN Tower, 3
Floor
Nashville, TN 37243-1102
Phone: 615-741-1035 Fax: 615-741-0684
Attestation Regarding Personnel Used in Contract Performance
Company Name:
Contract No:
Company Mailing Address:
Buyer:
Edison Vendor ID Number:
Company Contact Name:
Telephone Number of Contact:
Company Email Address:
The Contractor, identified above, does hereby attest, certify, warrant, and assure that the Contractor shall
not knowingly utilize the services of an illegal immigrant in the performance of this Contract and shall
not knowingly utilize services of any subcontractor who will utilize the services of an illegal immigrant
in the performance of this Contract.
Affirmation: The Contractor acknowledges by signature that all information stated above is true
and accurate and is no way misleading.
Authorized Signatory: I, ____________________________ (print name), as a Principal or Officer
of the Company, do certify, warrant and assure that I am empowered to contractually bind the
Contractor.
________________________________________
_______________
Officer’s Signature
Date
_____________________________________________________________________
Title of Signatory
GS-1078 (Rev. 12-12)

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