RFQF _ ABC RIBBONS and LABELS Page 51
ATTACHMENT B
EEV CERTIFICATION AND AGREEMENT
By executing this Certification and Agreement, the undersigned verifies its compliance
with the Mississippi Employment Protection Act, Section 71-11-3 of the Mississippi Code
of 1972, as amended, and any rules or regulations promulgated by Mississippi
Transportation Commission, Department of Employment Security, Department of
Revenue [DOR], Secretary of State, Department of Human Services in accordance with
the Mississippi Administrative Procedures Law (Section 25-43-1 et seq., Mississippi Code
of 1972, as amended), stating affirmatively that the individual, firm, or corporation which
is contracting with DOR has registered with and is participating in a federal work
authorization program* operated by the United States Department of Homeland Security
to electronically verify information of newly hired employees pursuant to the Immigration
Reform and Control Act of 1986, Pub.L. 99-603, 100 Stat 3359, as amended. The
undersigned agrees to inform the DOR if the undersigned is no longer registered or
participating in the program.
The undersigned agrees that, should it employ or contract with any subconsultant(s) and/or
subcontractor(s) in connection with the performance of this Contract, the undersigned will
secure from such subconsultant(s) and/or subcontractor(s) verification of compliance with
the Mississippi Employment Protection Act. The undersigned further agrees to maintain
records of such compliance and provide a copy of each such verification to DOR, if
requested, for the benefit of the DOR or this Contract.
_____________________________________
EEV* Company Identification Number [Required]
The undersigned certifies that the above information is complete, true and correct to
the best of my knowledge and belief. The undersigned acknowledges that any
violation may be subject to the cancellation of the contract, ineligibility for any state
or public contract for up to three (3) years, the loss of any license, permit, certificate
or other document granted by any agency, department or government entity for the
right to do business in Mississippi for up to one (1) year, or both, any and all
additional costs incurred because of the contract cancellation or the loss of any license
or permit, and may be subject to additional felony prosecution for knowingly or
recklessly accepting employment for compensation from an unauthorized alien as
defined by 8 U.S.C §1324a(h)(3), said action punishable by imprisonment for not less
than one (1) year nor more than five (5) years, a fine of not less than One Thousand
Dollars ($1,000.00) nor more than Ten Thousand Dollars ($10,000.00), or both, in
addition to such prosecution and penalties as provided by Federal law.
BY: ____________________________________ ____________________________
Authorized Officer or Agent Date
________________________________________ _____________________________