Attachment J "Immigration and Security Independent Contractor Affidavit" - Georgia (United States)

What Is Attachment J?

This is a legal form that was released by the Georgia Department of Juvenile Justice - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Georgia Department of Juvenile Justice;
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Download a printable version of Attachment J by clicking the link below or browse more documents and templates provided by the Georgia Department of Juvenile Justice.

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Download Attachment J "Immigration and Security Independent Contractor Affidavit" - Georgia (United States)

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Avery D. Niles, Commissioner
D
J
J
EPARTMENT OF
UVENILE
USTICE
3408 Covington Highway  Decatur, Georgia  30032
Telephone: (404) 508-7200, Fax: (404) 508-7340
IMMIGRATION AND SECURITY INDEPENDENT CONTRACTOR AFFIDAVIT
Department of Juvenille Justice
Solicitation/Contract/Purchase Order No.: ______________________________
CONTRACTOR AFFIDAVIT
By executing this affidavit, the undersigned Contractor verifies its compliance with
O.C.G.A. §13-10-91, stating affirmatively that the contractor has no employees
and does not hire or intend to hire employees for purposes of satisfying or
completing the terms and conditions of any part or all of the original contract with
the Department of Juvenille Justice, in accordance with the applicability provisions
and deadlines established in O.C.G.A. 13-10-91.
_______________________________________
Georgia Drivers License or State Issued Identification Number
_____________________________________________
_______________
BY: Authorized Officer or Agent
Date
(Contractor Name)
_______________________________________
Title of Authorized Officer or Agent of Contractor
_______________________________________
Printed Name of Authorized Officer or Agent
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
_____ DAY OF ______________________, 20__
________________________________________
[NOTARY SEAL]
Notary Public
My Commission Expires:
DJJ 2.2, Attachment J
Avery D. Niles, Commissioner
D
J
J
EPARTMENT OF
UVENILE
USTICE
3408 Covington Highway  Decatur, Georgia  30032
Telephone: (404) 508-7200, Fax: (404) 508-7340
IMMIGRATION AND SECURITY INDEPENDENT CONTRACTOR AFFIDAVIT
Department of Juvenille Justice
Solicitation/Contract/Purchase Order No.: ______________________________
CONTRACTOR AFFIDAVIT
By executing this affidavit, the undersigned Contractor verifies its compliance with
O.C.G.A. §13-10-91, stating affirmatively that the contractor has no employees
and does not hire or intend to hire employees for purposes of satisfying or
completing the terms and conditions of any part or all of the original contract with
the Department of Juvenille Justice, in accordance with the applicability provisions
and deadlines established in O.C.G.A. 13-10-91.
_______________________________________
Georgia Drivers License or State Issued Identification Number
_____________________________________________
_______________
BY: Authorized Officer or Agent
Date
(Contractor Name)
_______________________________________
Title of Authorized Officer or Agent of Contractor
_______________________________________
Printed Name of Authorized Officer or Agent
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
_____ DAY OF ______________________, 20__
________________________________________
[NOTARY SEAL]
Notary Public
My Commission Expires:
DJJ 2.2, Attachment J