HomeMy WebLinkAbout112307 E & LL TRUCKING - CONTRACT - BID - 5811 SNOW AND ICE (2)DIS
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EXHIBIT E
AFFIDAVIT PURSUANT TO C.R S. 24-76.5-103
swear or affirm under penalty of perjury under the laws of the
of Colorado that (check one)
x 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 have applied for a
public benefit I understand that state law requires me to provide proof that I am lawfully
present in the United States prior to receipt of this public benefit I further 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 Colorado Revised Statute 18-8-503 and it shall constitute a separate
criminal offense each time a public benefit is fraudulently received
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Signature ✓I /
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Date
INTERNAL USE ONLY Valid forms of identification
T --- current Colorado driver's license, minor driver's license, probationary driver's license,
commercial driver's license, restricted driver's license, instruction permit
T--- current Colorado identification card
q--- U S military card or dependent identification card
T --- U S coast guard merchant manner card
p--- Native American tribal document
The following forms of identification may be accepted through February 28, 2007'
T --- original birth certificate from any state of the United States
T --- certificate verifying naturalized status by U S with photo and raised seal
T --- certificate verifying U S citizenship by U S government, e g, U S passport
T --- order of adoption by a U S court with seal of certification
T--- valid driver's license from any state of the U S or the Dist of Columbia excluding AK, HI, IL,
MD, Ml, NE, NM, NC, OR, TN, TX, UT, VT and WI
T --- valid immigration documents demonstrating lawful presence, e g , current foreign passport with
current 1-551 stamp or visa, current foreign passport with 1-94, 1-94 with asylum status, unexpired
Resident Alien card, Permanent Resident card or Employment Authorization card
"A waiver may be available where no identification exists or can be obtained due to a medical
condition, homelessness, or insufficient documentation to receive a Colorado I D or driver's
license Contact your department director
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