CC&T Contruction/Street/81,020/Rangeline Road Sidewalk and ADA ImprovementsCC & T Construction Company, Inc.
Street Department - 2016
Appropriation #43-509.00; P.O. #33481
Contract Not To Exceed $81,020.00
Q1�OL�
��AO
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES
THIS AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ("Agreement") is
hereby entered into by and between the City of Carmel, Indiana, acting by and through its Board
of Public Works and Safety ("City"), and CC & T Construction Company, Inc. an entity duly
authorized to do business in the State of Indiana ("Vendor").
TERMS AND CONDITIONS
ACKNOWLEDGMENT, ACCEPTANCE:
Vendor acknowledges that it has read and understands this Agreement, and agrees that its execution of
same constitutes its acceptance of all of the Agreement's terms and conditions.
2. PERFORMANCE:
City agrees to purchase the goods and/or services (the "Goods and Services") from Vendor using City
budget appropriation number 43-509.00 funds. Vendor agrees to provide the Goods and Services and to
otherwise perform the requirements of this Agreement by applying at all times the highest technical and
industry standards.
3. PRICE AND PAYMENT TERMS:
3.1 Vendor estimates that the total price for the Goods and Services to be provided to City hereunder
shall be no more than Eighty One Thousand Twenty Dollars ($81,020.00) (the "Estimate"). Vendor
shall submit an invoice to City no more than once every thirty (30) days detailing the Goods and
Services provided to City within such time period. City shall pay Vendor for such Goods and
Services within sixty (60) days after the date of City's receipt of Vendor's invoice detailing same, so
long as and to the extent such Goods and Services are not disputed, are in conformance with the
specifications set forth in Exhibit A, are submitted on an invoice that contains the information
contained on attached Exhibit B, and Vendor has otherwise performed and satisfied all the terms
and conditions of this Agreement.
3.2 Vendor agrees not to provide any Goods and Services to City that would cause the total cost of the
Goods and Services provided by Vendor to City hereunder to exceed the Estimate, unless City has
previously agreed, in writing, to pay an amount in excess thereof.
4. WARRANTY:
Vendor expressly warrants that the Goods and Services covered by this Agreement will conform to
those certain specifications, descriptions and/or quotations regarding same as were provided to
Vendor by City and/or by Vendor to and accepted by City, all of which documents are incorporated
herein by reference, and that the Goods and Services will be delivered in a timely, good and
workmanlike manner and free from defect. Vendor acknowledges that it knows of City's intended use
and expressly warrants that the Goods and Services provided to City pursuant to this Agreement
have been selected by Vendor based upon City's stated use and are fit and sufficient for their
particular purpose.
(S:\Conlracts\Pfof.SvC & Goals Sv4�'Slrccl@016\CC & T C—nclion Co.. Inc. Grads & Serviec FORM - WITH E-Vcrify Lmguage.d=11112016 12:13 PMI
CC & T Construction Company, Inc.
Street Department - 2016
Appropriation #43-509.00; P.O. #33481
Contract Not To Exceed $81,020.00
5. TIME AND PERFORMANCE:
This Agreement shall become effective as of the last date on which a party hereto executes same ("Effective
Date"), and both parties shall thereafter perform their obligations hereunder in a timely manner. Time is of the
essence of this Agreement.
DISCLOSURE AND WARNINGS:
If requested by City, Vendor shall promptly furnish to City, in such form and detail as City may direct, a list of
all chemicals, materials, -substances and items used in or during the provision of the Goods and Services
provided hereunder, including the quantity, quality and concentration thereof and any other information
relating thereto. At the time of the delivery of the Goods and Services provided hereunder, Vendor agrees to
furnish to City sufficient written warning and notice (including appropriate labels on containers and packing)
of any hazardous material utilized in or that is a part of the Goods and Services.
LIENS:
Vendor shall not cause or permit the filing of any lien on any of City's property. In the event any such lien is
filed and Vendor fails to remove such lien within ten (10) days after the filing thereof, by payment or bonding,
City shall have the right to pay such lien or obtain such bond, all at Vendor's sole cost and expense.
DEFAULT:
In the event Vendor: (a) repudiates, breaches or defaults under any of the terms or conditions of this
Agreement, including Vendor's warranties; (b) fails to provide the Goods and Services as specified herein;
(c) fails to make progress so as to endanger timely and proper provision of the Goods and Services and does
not correct such failure or breach within five (5) business days (or such shorter period of time as is
commercially reasonable under the circumstances) after receipt of notice from City specifying such failure or
breach; or (d) becomes insolvent, is placed into receivership, makes a general assignment for the benefit of
creditors or dissolves, each such event constituting an event of default hereunder, City shall have the right to
(1) terminate all or any parts of this Agreement, without liability to Vendor; and (2) exercise all other rights
and remedies available to City at law and/or in equity.
INSURANCE AND INDEMNIFICATION:
Vendor shall procure and maintain in full force and effect during the term of this Agreement, with an insurer
licensed to do business in the State of Indiana, such insurance as is necessary for the protection of City and
Vendor .from all claims for damages under any workers' compensation, occupational disease and/or
unemployment compensation act; for bodily injuries including, but not limited to, personal injury, sickness,
disease or death of or to any of Vendor's agents, officers, employees, contractors and subcontractors; and,
for any injury to or destruction of property, including, but not limited to, any loss of use resulting therefrom.
The coverage amounts shall be no less than those amounts set forth in attached Exhibit C. Vendor shall
cause its insurers to name City as an additional insured on all such insurance policies, shall promptly provide
City, upon request, with copies of all such policies, and shall provide that such insurance policies shall not be
canceled without thirty (30) days prior notice to City. Vendor shall indemnify and hold harmless City from and
against any and all liabilities, claims, demands or expenses (including, but not limited to, reasonable attorney
fees) for injury, death and/or damages to any person or property arising from or in connection with Vendor's
provision of Goods and Services pursuant to or under this Agreement or.Vendor's use of City property.
Vendor further agrees to indemnify, defend and hold harmless City and its officers, officials, agents and
employees from all claims and suits of whatever type, including, but not limited to, all court costs, attorney
fees, and other expenses, caused by any act or omission of Vendor and/or of any of Vendor's agents,
officers, employees, contractors or subcontractors in the performance of this Agreement. These
indemnification obligations shall survive the termination of this Agreement.
ISAContrnctsTrof.Sv & Goods Svcs\S1reet120IaCC & TConstructicn Co., Inc. Goods & Services FORM - WITH E -Verify L ngunge.dm:11112016 12:13 PMI
%.
CC & T Construction Company, Inc.
Street Department - 2016
Appropriation #43-509.00; P.O. #33481
Contract Not To Exceed $81,020.00
10. GOVERNMENT COMPLIANCE:
Vendor agrees to comply with all federal, state and local laws, executive orders, rules, regulations and codes
which may be applicable to Vendor's performance of its obligations under this Agreement, and all relevant
provisions thereof are incorporated herein by this reference. Vendor agrees to indemnify and hold harmless
Citytom any loss, damage and/or liability resulting from any such violation of such laws, orders, rules,
regulations and codes. This indemnification obligation shall survive the termination of this Agreement.
11. NONDISCRIMINATION:
Vendor represents and warrants that it and all of its officers, employees, agents, contractors and
subcontractors shall comply with all laws of the United States, the State of Indiana and City prohibiting
discrimination against any employee,'applicant for employment or other person in the provision of any Goods
and Services provided by this Agreement with respect to their hire, tenure, terms, conditions and privileges of
employment and any other matter related to their employment or subcontracting, because of race, religion,
color, sex, handicap, national origin, ancestry, age, disabled veteran status and/or Vietnam era veteran
status.
12. E -VERIFY
Pursuant to I.C. § 22-5-1.7 et seq., as the same may be amended from time to time, and as is incorporated
herein by this reference (the "Indiana E -Verify Law"), Vendor is required to enroll in and verify the work
eligibility status of its newly -hired employees using the E -Verify program, and to execute the Affidavit
attached herein as Exhibit D, affirming that it is enrolled and participating in the E -verify program and does
not knowingly employ unauthorized aliens. In support of the Affidavit, Vendor shall provide the City with
documentation indicating that it has enrolled and is participating in the E -Verify program. Should
Vendor subcontract for the performance of any work under and pursuant to this Agreement, it shall fully
comply with the Indiana E -Verify Law as regards each such subcontractor. Should the Vendor or any
subcontractor violate the Indiana E -Verify law, the City may require a cure of such violation and thereafter, if
no timely cure is performed, terminate this Agreement in accordance with either the provisions hereof or
those set forth in the Indiana E -Verify Law. The requirements of this paragraph shall not apply should the E -
Verify program cease to exist.
13. NO IMPLIED WAIVER:
The failure of either party to require performance by the other of any provision of this Agreement shall not
affect the right of such party to require such performance at any time thereafter, nor shall the waiver by any
party of a breach of any provision of this Agreement constitute a waiver of any succeeding breach of the
same or any other provision hereof.
14. NON -ASSIGNMENT:
Vendor shall not assign or pledge this Agreement, whether as collateral for a loan or otherwise, and shall not
delegate its obligations under this Agreement without City's prior written consent.
15. RELATIONSHIP OF PARTIES:
The relationship of the parties hereto shall be as provided for in this Agreement, and neither Vendor nor any
of its officers, employees, contractors, subcontractors and agents are employees of City. The contract price
set forth herein shall be the full and maximum compensation and monies required of City to be paid to
Vendor under or pursuant to this Agreement.
IS9Con rac(s\Prot$v s & Goods Svcs�SIrccI@0161CC & T Construction Co.. Inc. Goods & Services FORM - R7TH E•-Vcrify G ngaigadac:11112016 12:17 PMI
CC & T Construction Company, Inc.
Street Department - 2016
Appropriation #43-509.00; P.O. #33481
Contract Not To Exceed $81,020.00
16. GOVERNING LAW; LAWSUITS:
This Agreement is to be construed in accordance with and governed by the laws of the State of Indiana,
except for its conflict of laws provisions. The parties agree that, in the event a lawsuit is filed hereunder, they
waive their right to a jury trial, agree to file any such lawsuit in an appropriate court in Hamilton County,
Indiana only, and agree that such court is the appropriate venue for and has jurisdiction over same.
17. SEVERABILITY:
If any term of this Agreement is invalid or unenforceable under any statute, regulation, ordinance, executive
order or other rule of law, such term shall be deemed reformed or deleted, but only to the extent necessary to
comply with same, and the remaining provisions of this Agreement shall remain in full force and effect.
18. NOTICE:
Any notice provided for in this Agreement will be sufficient if it is in writing and is delivered by postage
prepaid U.S. certified mail, return receipt requested, to the party to be notified at the address specified
herein:
If to City: City of Carmel AND
Douglas C. Haney,
One Civic Square
Corporation Counsel
Carmel, Indiana 46032
Department of Law
One Civic Square
Carmel, Indiana 46032
If to Vendor: CC & T Construction Company, Inc.
5501 Prospect Street
Indianapolis, Indiana
ATTENTION: Tony Page
Notwithstanding the above, notice of termination under paragraph 19 hereinbelow shall be effective if given
orally, as long as written notice is then provided as set forth hereinabove within five (5) business days from
the date of such oral notice.
19. TERMINATION:
19.1 Notwithstanding anything to the contrary contained in this Agreement, City may, upon notice to
Vendor, immediately terminate this Agreement for cause, in the event of a default hereunder by
Vendor and/or if sufficient funds are not appropriated or encumbered to pay for the Goods and
Services to be provided hereunder. In the event of such termination, Vendor shall be entitled to
receive only payment for the undisputed invoice amount representing conforming Goods and
Services delivered as of thedate of termination, except that such payment amount shall not exceed
the Estimate amount in effect at the time of termination, unless the parties have previously agreed in
writing to a greater amount.
19.2 City may terminate this Agreement at any time upon thirty (30) days prior notice to Vendor. In the
event of such termination, Vendor shall be entitled to receive only payment for the undisputed
invoice amount of conforming Goods and Services delivered as of the date of termination, except
that such payment amount shall not exceed the Estimate amount in effect at the time of termination,
unless the parties have previously agreed in writing to a greater amount.
19.3 The City may terminate this Agreement pursuant to Paragraph 11 hereof, as appropriate.
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4
CC & T Construction Company, Inc.
Street Department - 2016
Appropriation #43-509.00; P.O. #33481
Contract Not To Exceed $81,020.00
20. REPRESENTATIONS AND WARRANTIES
The parties represent and warrant that they are authorized to enter into this Agreement and that the persons
executing this Agreement have the authority to bind the party which they represent.
21. ADDITIONAL GOODS AND SERVICES
Vendor understands and agrees that City may, from time to time, request Vendor to provide additional goods
and.services to City. When City desires additional goods and services from Vendor, the City shall notify
Vendor of such additional goods and services desired, as well as the time frame in which same are to be
provided. Only after City has approved Vendor's time and cost estimate for the provision of such additional
goods and services, has encumbered sufficient monies to pay for same, and has authorized Vendor, in
writing, to provide such additional goods and services, shall such goods and services be provided by Vendor
to City. A copy of the City's authorization documents for the purchase of additional goods and services shall
be numbered and attached hereto in the order in which they are approved by City.
22. TERM
Unless otherwise terminated in accordance with the termination provisions set forth in Paragraph 19
hereinabove, this Agreement shall be in effect from the Effective Date through December 31, 2016 and shall,
on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless
otherwise agreed by the parties hereto.
23. HEADINGS
All heading and sections of this Agreement are inserted for convenience only and do not form a part of this
Agreement nor limit, expand or otherwise alter the meaning,of any provision hereof.
24. BINDING EFFECT
The parties, and their respective officers, officials, agents, partners, successors, assigns and legal
representatives, are bound to the other with respect to all of the covenants, terms, warranties and obligations
set forth in Agreement.
25. NO THIRD PARTY BENEFICIARIES
This Agreement gives no rights or benefits to anyone other than City and Vendor.
26. IRAN CERTIFICATION: Pursuant to I.C. § 5-22-16.5, the Vendor shall certify that, in signing this document,
it does not engage in investment activities within the Country of Iran.
27. ADVICE OF COUNSEL:
The parties warrant that they have read this Agreement and understand it,. have had the opportunity to obtain
legal advice and assistance of counsel throughout the negotiation of this Agreement, and enter into same
freely, voluntarily, and without any duress, undue influence or coercion.
28. ENTIRE AGREEMENT:
This Agreement, together with any exhibits attached hereto or referenced, herein, constitutes the entire
agreement between Vendor and City with respect to the subject matter hereof, and supersedes all prior oral
or written representations and agreements regarding same. Notwithstanding any other term or condition set
forth herein, but subject to paragraph 16 hereof, to the extent any term or condition contained in any exhibit
attached to this Agreement or in any document referenced herein conflicts with any term or condition
contained in this Agreement, the term or condition contained in this Agreement shall govern and prevail.
This Agreement may only be modified by written amendment executed by both parties hereto, or their
successors in interest.
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Y
CC & T Construction Company, Inc.
Street Department - 2016
Appropriation #43-509.00; P.O. #33481
Contract Not To Exceed $81,020.00
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA
by and through its Board of Public
Works and Safety
By:
JaFes Brainard, Presiding 0 ficer
[late: / _ � /-/ I�
Burke,
Date:
Lori S. Watso ember
Date: -;� I ) �
A T:
C stine S./Pauley, Clerk Treasurer
Date: z/ "ri
CC & T Construction Company, Inc.
By:
Authorized Signature
�i N� C
Printed Name
CCS cotis;�r�c� ,oma
Title
FID/TIN: 35-) 77 3 I J /
Last Four of SSN'Jif. Sole Proprietor:
Date: / j —&
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EXHIBiTA
Rang Line Rd Sidewalk and ADA Improvements
North Side of 1st SE to North Side of 2nd SE
�.
mi#DesM two r
1
Curb Ramp, Type G
13 SYS
$
150. D0
$
1 W-00
2
Curb Ramp, Type D
13 SYS
$
160.00
$
50 --OD
3
Curb Ramp, Type H
4 SYS
$
$boo
-00
4
Curb Ramp, Type K
6.5 SYS
$
50.0,0
$
q 75.00
5
Sidewalk, Concrete, 4"
52 SYS
$
56 -DO
$
7.IRW.1049
6
Curb, Mono
123 LFT
$
22,00
$
7.706.00
7
Curb and Gutter
24 LFT
$
55-490
$
20.00
8
ICurb, Removal
127 LFT
$
go -00
$
25y0.OD
9
HMA Surface, 9.5mm (Street)
13 TON
$
52D.u7
$
67(60.00
10
HMA Intermediate, 19.Omm (Street)
16.5 TON
$
360.00
$
0.0o
11
HMA Base, 25.Omm (Street)
25 TON
$
Z75.00
$
b875.00
12
HMA Surface, 9.5mm (Parking Lot)
14 TON
$
520.00
$
7280.04 .
13
HMA Intermediate, 19.Omm (Parking Lot)
18.5 TON
$
Tip 60.00
14
HMA Base, 25.Omm (Parking Lot)
28 TON
$
ZlrJ' •DD
$
7700.09
15
Handrailing
47 LFT
$
211. 190
$
IV. 106-00
16
Common Excavation
81 CYS
$
D5•QO
$
0 -49
17
PCCP For Approaches, 9"
29 SYS
$
D-00
$
2-320.00
18
Sidewalk, Remove
92 SYS
$
22.00
$
U211.,00
19
Casting, Adjust to Grade
2 EA
$
00.0
$
100.04
20
Repour Pad for UPS Drop Box
1 EA
$
50
$
750.00
EXHIBiTA
ESI" HIB IT B
Invoice
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
Date:
Signature
Printed Name
Goods
Services
Person Providing
Goods/Services
Date
Goods/
Service
Provided
Goods/Services Provided
(Describe each good/service
separately and in detail)
Cost Per
Item'
Hourly
Rate/
hours
Worked
Total
GRAND TOTAL
Signature
Printed Name
EXHIBIT C
INSURANCE COVERAGES
Worker's Compensation & Disability
Employer's Liability:
Bodily Injury by Accident/Disease:
Bodily Injury by Accident/Disease:
Bodily Injury by Accident/Disease:
Property damage, contractual liability,
products -completed operations:
General Aggregate. Limit (other than
Products/Completed Operations):
Products/Completed Operations:
Personal & Advertising Injury
Statutory Limits
$100,000 each employee
$250,000 each accident
$500,000 policy limit
$500,000
$500,000
Policy Limit: $500,000
Each Occurrence Limit: $250,000
Fire Damage (any one fire): $250,000
Medical Expense Limit (any one person): $ 50,000
Comprehensive Auto Liability (owned, hired and non -owned)
Bodily Single Limit:
Injury and property damage:
Policy Limit:
Umbrella Excess Liability
Each occurrence and aggregate:
Maximum deductible:
$500,000 each accident
$500,000 each accident
$500,000
$500,000
$ 10,000
EXHIBIT D
AFFTD A VTT
N L , being first duly sworn, deposes and says that
he/she is familiar with and As person knowledge of the facts herein and, if called as a witness in this -
matter, could testify as follows:
I am over eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. I am now and at all times relevant herein have been employed by
C C aL T C U N STCL. u C, ',0/-J (the "Employer")
in the position of P r P 5` k- e "r�-
3. I am familiar with the employment policies, practices, and procedures_ of the Employer and
have the authority to act on behalf of the Employer.
4. The Employer is enrolled and participates in the federal E -Verify program. Documentation
of this enrollment and participation is attached and incorporated herein.
5. The Employer does not knowingly employ any unauthorized aliens.
6. To the best of my information and belief, the Employer does not currently employ any
unauthorized aliens.
7. FURTHER AFFIANT SAYETH NOT.
EXECUTED on the a6 day of _ , 20.
Printed: ell
I certify under the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements and representations are true and correct.
E -Verify Affidavit
Pursuant to Indiana Code 22-5-1.7-11, the Contractor entering into a contract with the City is
required to enroll in and verify the work eligibility status of all its newly hired employees through
the E -Verify program. The Contractor is not required to verify the work eligibility status of all its
newly hired employees through the E -Verify program if the E -Verify program no longer exists.
The undersigned, on behalf of the Contractor, being first duly sworn, deposes and states that the
Contractor does not knowingly employ an unauthorized alien. The undersigned further affirms that,
prior to entering into its contract with the City, the undersigned Contractor will enroll in and agrees
to verify the work eligibility status of all its newly hired employees through the E -Verify program.
(Contractor): M i
By (Written Signature):
(Printed Name): p h
(Title): -?P-es,D em+
Important - Notary Signature and Seal Required i
STATE OF I nvi nyi A
SS:
COUNTY OF l Y ►ft 10 h
Subscribed and sworn to before me this 110 day of
20 11J.
My commission expires:
5.7-10.18
Residing in AA !A iq-n
JACQUELYN DOWNEY
Notary Public- Seal
State of Indiana
My Commission Expires May 26, 2018
Vj1C4trm bei
County,• 11% it/
EXHIBIT D
AFFIDAVIT
. 0kiy ��� being first drily sworn, deposes and says that
lie/she is familiar with and has personal knowledge of the facts herein and, if called as a witness.in this
matter, could testify as follows:
1. I. am over eighteen (1.8) years of age and am competent to testify to the facts contained
herein.
2. 1 am now and at all times relevant herein have been employed by
6e- Me _ (the "Employer")
in theposition of Po del,.�
3. 1 am familiar with the employment policies, practices, and procedures of the Employer and
have the authority to act on behalf of the Employer.
4. The Employer is enrolled and participates in the federal E -.Verify prograin. Documentation
of this enrollment and participation is attached and incorporated herein.
5. The Employer does not knowingly employ any unauthorized aliens.
6. To the best of my information and belief, the Employer does not currently employ any
unauthorized aliens.
7. FURTHER .AFFIANT SAYETH NOT.
EXECUTED on the day of moi., 20 .
I certify under the penalties for perjury under the laws of the United States of America and the State of {
Indiana that the foregoing factual statements and.representations #red ue and correct.
Printed. � L� U� Wh 1 &V ✓t
.T
Company ID Number: 718949
THE E -VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION
MEMORANDUM OF UNDERSTANDING
ARTICLE I
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets forth the points of agreement between the
Department of Homeland Security (DHS) and CC&T Construction Co.. Inc. (Employer)
regarding the Employer's participation in the Employment Eligibility Verification Program (E -
Verify). This MOU explains certain features of. the E -Verify program and enumerates specific
responsibilities of DHS, the Social Security Administration (SSA), and the Employer. E -Verify is
a program that electronically confirms an employee's eligibility to work in_ the United States after
completion of the Employment Eligibility Verification Form (Form 1-9). For covered government
contractors, E -Verify is used to verify the employment eligibility of all newly hired employees and
all existing employees assigned. to Federal contracts or to verify the entire workforce if the
contractor so chooses.
Authority for the E -Verify program is found - in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996 (1IRIRA), Pub. L. 104-208, 110 Stat. 3009, as
amended (8 U.S.C. § 1324a note). Authority for use of the E -Verify program by Federal
contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility
Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this-MOU as
a "Federal contractor with the FAR E -Verify clause") to verify the employment eligibility of
certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive
Order 12989, as amended.
ARTICLE 11
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer with available information that allows the Employer to
confirm the accuracy of Social Security Numbers provided by all employees verified under this
MOU and -the employment authorization of U.S.-citizens.
2. SSA agrees to provide to the Employer appropriate assistance with operational problems that
may arise during the Employer's participation in the E -Verify .program. SSA agrees to provide
the Employer with names, titles, addresses, and telephone numbers of SSA representatives to
be contacted during the -E-Verify process.
3. SSA agrees to safeguard the information provided by the Employer through the . E -Verify
program procedures, and to limit, access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E -Verify program or such other persons or entities who may be authorized by SSA as governed
Page 1 of 13 1 E -Verify MOU for Employer 1. Revision Date 09/01/09 www.dhs.gov/E-Verify
-V rIfVe�Q I e
1nc�z
Company ID Number: 718949
by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA
regulations (20 CFR Part 401).
4. SSA agrees to provide a means of automated verification that is designed (in conjunction with
DHS's automated system if necessary) to provide confirmation or tentative nonconfirmation of
U.S. citizens' employment eligibility within 3 Federal Government work days of the initial inquiry.
5. SSA agrees to provide a means of secondary verification -(including updating SSA records as
may be necessary) for employees who contest SSA tentative nonconfirmations that is designed
to provide final confirmation or nonconfirmation of U.S. citizens' employment eligibility and
accuracy of SSA records for.both citizens and non -citizens within 10 Federal Government work
days -of the date of referral to SSA, unless SSA determines that more than 10 days may be
necessary. In such cases, SSA will provide additional verification instructions.
B. RESPONSIBILITIES OF DHS
1. After SSA verifies the accuracy of SSA records for employees through E -Verify; DH,S agrees
to provide the Employer access to selected data from DHS's database to enable the :Employer
to conduct, to the extent authorized by this MOU:
• Automated verification checks on employees by electronic means, and
• Photo verification checks (when available) on employees.
2. DHS agrees to provide to the Employer appropriate assistance with operational problems that
may arise during the Employer's participation in the E -Verify program. DHS agrees to provide
the Employer names, titles, addresses, and telephone numbers of DHS representatives to be
contacted during the E -Verify process.
3. DHS agrees to make available to the Employer at the E -Verify Web site and on the E -Verify
Web browser, instructional materials on E -Verify policies, procedures and requirements for both
SSA and DHS, including restrictions on the use of E -Verify. DHS agrees to provide training
materials on' E -Verify.
4. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation
in the E -Verify program. DHS also agrees to provide to the Employer anti-discriminationnotices
issued by the Office of Special Counsel for Immigration -Related Unfair Employment Practices
(OSC), Civil Rights Division, U.S. Department of Justice.
5. DHS agrees to issue the Employer a user identification number and password that permits
the Employer to verify. information provided by employees with DHS's database.
6. DHS agrees to safeguard the information provided to DHS by the Employer, and to limit
access to such information to individuals responsible for the verification of employees'
employment eligibility and for evaluation of the E -Verify program, or to such other persons or
entities as may be authorized by applicable Jaw. Information will be .used only to verify the
accuracy of Social Security Numbers and employment eligibility, to enforce the Immigration and
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Company ID Number: 718949
Nationality Act (INA) and Federal criminal laws, and to administer Federal contracting
requirements.
7. DHS agrees to provide a means of automated verification that is designed (in conjunction
with SSA -verification procedures) to provide confirmation or tentative nonconfirmation of
employees' employment eligibility within 3 Federal Government work days of the initial inquiry.
8. DHS agrees to provide a means of secondary verification (including updating DHS records as
may be necessary) for employees who contest DHS tentative nonconfirmations and photo non -
match tentative nonconfirmations that _is- - designed to provide .final confirmation or
nonconfirmation of the employees' employment eligibility within 10 Federal Govemment work
days of the date of referral to DHS, unless DHS determines that more than 10 days may be
necessary. In such cases, DHS will provide additional verification instructions.
C. RESPONSIBILITIES OF THE EMPLOYER
1. The Employer agrees to display the notices supplied by- DHS in a prominent place that is
clearly visible to prospective employees and all employees who are to be verified through the
system.
2. The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and
telephone numbers of the Employer representatives to be contacted regarding E -Verify.
3. The Employer agrees to become familiar with and comply with the most recent version of the
E -Verify User Manual.
4. The Employer agrees that any . Employer Representative who will perform employment
verification queries will complete the E -Verify Tutorial before that individual initiates any queries.
A. The Employer agrees that all Employer representatives will take the refresher tutorials
initiated by the E -Verify program. as a condition of continued use of E -Verify.
B. Failure to complete a refresher tutorial will prevent the Employer from continued use
of the program.
5. The Employer agrees to comply with current Form 1-9 procedures, with two exceptions:
- If an employee presents a "List B" identity document, the Employer agrees to only
accept "List B".documents that
contain a photo. (List B.documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can be
presented during the Form 1-9
process to establish identity.) If an employee objects to the photo requirement for
religious reasons, the Employer
should contact E -Verify at 888-464-4218.
• If an employee. presents a DHS Form 1-551 (Permanent Resident Card) or Form 1-766
-(Employment Authorization Document) to complete the Form -1-9, the Employer agrees to
make a photocopy of the document and to retain the photocopy with the employee's
Form 1-9. The photocopy must be of sufficient quality to allow for verification of the photo
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and written information. The employer will use the photocopy to verify the photo and to
assist DHS with its review of photo non -matches that are contested by employees. Note
that employees retain the right to present any List A, or.List B and List C, documentation
to complete the Form 1-9. DHS may in the future designate other documents that
activate the photo screening tool.
6. The Employer understands that participation in E -Verify does not exempt the Employer from
the responsibility to complete, retain, and make available for inspection Forms 1-9 that relate to
its employees, or from other requirements of applicable regulations or laws, including the
obligation to comply with the antidiscrimination requirements of section 274B of the INA with
respect to Form 1-9 procedures, except for the following modified requirements applicable by
reason of .the Employer's participation in E -Verify: (1) identity documents must have photos, as
described in paragraph 5 above; (2) a rebuttable presumption is established that the Employer
has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect
to the hiring of any individual if it obtains confirmation of the identity and employment eligibility of
the individual in good faith compliance with the terms and conditions of E -Verify; (3) the
Employer must notify DHS if it continues to employ any employee after receiving a final
nonconfirmation, and is subject to a civil money penalty between $550 and $1,100 for each
failure to notify DHS of continued employment following a final nonconfirmation; (4) the
Employer is subject to a rebuttable presumption that it has knowingly employed an unauthorized
alien in violation of section 274A(a)(1)(A) if the Employer continues to employ an employee after
receiving a final nonconfirmation; and (5) no person or entity participating in E -Verify is civilly or
criminally liable under any law for any action taken in good faith based on information provided
through the confirmation system -. DHS reserves the right to conduct Form 1-9 and E -Verify
system compliance inspections during the course of E -Verify, as well as to conduct any other
enforcement activity authorized by law.
7. The Employer agrees to initiate &Verify verification procedures for new employees within 3
Employer business days after each employee has been hired (but after the Form 1-9 has been
completed), and to complete as many (but only as many) steps of the E -Verify process as are
necessary according to the E -Verify User Manual, or in the case of Federal contractors with the
FAR E -Verify clause, the E -Verify User Manual for Federal Contractors. The Employer is
prohibited from initiating verification procedures before the employee has been hired and the
Form 1-9 completed. If the automated system to be queried is temporarily unavailable, the 3 -day
time period is extended until it is again operational in -order to accommodate the Employer's
attempting, in good faith, to make inquiries during the period of unavailability. Employers may
initiate verification by notating the Form 1-9 in circumstances where the employee has applied
for a Social Security Number (SSN) from the SSA and is waiting to receive the SSN, provided
that the Employer performs an E -Verify employment verification query using the employee's
SSN as soon as the SSN becomes available.
8. The Employer agrees not to use E -Verify procedures for pre-employment screening of job
applicants, in support of any unlawful employment practice, or for any other use not authorized
by this MOU. Employers must use E -Verify for all new employees, unless an Employer is a
Federal contractor that qualifies for, the exceptions described in Article II.D.1.c..Except as
provided in Article ILD, the Employer will not verify selectively and will not verify employees
hired before the effective date of this MOU. The Employer understands that if the Employer
uses the E -Verify system for any purpose other than as authorized by this MOU, the Employer
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may be subject to appropriate legal action and termination of its access to SSA and DHS
information pursuant to this MOU.
9: The Employer agrees to follow appropriate procedures (see Article III. below) regarding
tentative nonconfirmations, including notifying employees in, private of the finding and providing
them written notice of the findings, providing written -referral instructions to employees, allowing.
employees to contest the finding, and not taking adverse action against employees if they
choose to contest the finding. Further, when employees contest a tentative nonconfirmation
based upon a photo non -match, the Employer is -required to take affirmative steps (see Article
III.B. below) to contact.DHS with information necessary to resolve the challenge.
10. The Employer agrees -not to take any adverse action against an employee based upon the
employee's' perceived employment eligibility status while SSA or DHS is processing .the
verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(1))
that -the employee is not work authorized. The Employer understands that an initial inability of
the SSA or DHS automated verification system to verify work authorization, a tentative
nonconfirmation, a case_ in continuance (indicating the need for additional 'time for the
government to resolve a case), or the finding of a photo non -match, does not establish, and
should not be interpreted as evidence, that the employee isnot-work authorized. In any of the
cases listed above, the employee must be provided a full and fair opportunity to contest the
finding, and if he or she does so, the employee may not be terminated. or suffer any adverse
employment consequences based upon the employee's perceived employment eligibility status
(including denying, reducing, or extending work hours, delaying or preventing. training, requiring
an employee to work in poorer conditions, refusing to assign the employee to a Federal contract
or other assignment, or otherwise subjecting an employee to any assumption. that he.oe she is
unauthorized to .work) until and unless .secondary verification by SSA or DHS has been
completed and a final.. nonconfirmation has been issued. If -the employee does_ not choose to. -
contest a tentative nonconfirmation or a photo non -match or if a secondary verification is
completed and a final nonconfirmation is issued, then the Employer can find the employee is not
work authorized and terminate the employee's employment. Employers or employees with
questions about a final nonconfirmation may call E -Verify at 1-888-464-4218 or OSC at 1-800-
255-8155 or -1-800-237-2515 (TDD).
11. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section
274B of the INA, as applicable_, by not discriminating unlawfully against any individual in hiring,.
firing, or recruitment or referral practices because of his or her national origin or, in the case of a.
protected individual as defined in section. 27413(a)(3) of the INA, because of his or her
citizenship status. The Employer understands that such illegal practices can include selective
verification or use of E -Verify except as provided in part D below, or discharging or refusing to
hire employees because they appear or - sound "foreign" or have received tentative
nonconfirmations. The -Employer further understands that any violation of the unfair immigration -
related employment practices provisions in section 274B of the INA could subject .the Employer
to civil penalties, back pay awards, and other sanctions, and violations -of Title VII could subject.
the. Employer to back pay awards, compensatory and punitive damages. Violations of either
section 27413 of the INA or Title VII may also lead to the termination of its participation in E -
Verify. If the. Employer has any questions relating to the anti -discrimination provision, it should
contact OSC-at 1-800-255-8155 or 1-800-237-2515 (TDD).
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Company ID Number: 718949
12. The Employer agrees to record the case verification number on the employee's Form 1-9 or
to print the screen containing the case verification number and -attach it to the employee's Form
1=9..
13. The Employer agrees that it will use the information it receives from SSA or DHS pursuant
to E -Verify and this MOU only to confirm the employment eligibility of employees as authorized
by this MOU. The Employer agrees -that it will safeguard this information, and means of access
to it (such as PINS and passwords) to ensure that it is not used for�any other purpose and as
necessary to protect its confidentiality, including .ensuring that it is not disseminated to any
person other than employees -of the Employer who are authorized to perform the Employer's
responsibilities under this MOU, except for such dissemination as may be authorized in advance.
by SSA or DHS for legitimate purposes.
14. The Employer acknowledges that the information. which it receives from SSA is governed by
the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)),
and that any person who obtains. this information under false pretenses or uses it for any
purpose other than as provided for in this MOU may be subject to criminal penalties.
15. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and
evaluation of E -Verify, including by permitting DHS .and SSA, upon reasonable notice, to. review
Forms 1-9 and. other employment records and to interview it and its employees regarding the
Employer's use of E -Verify, and to respond in a timely and accurate manner to. DHS requests
for information relating to -their participation in E -Verify.
D. RESPONSIBILITIES OF FEDERAL CONTRACTORS WITH THE FARE VERIFY CLAUSE
1.. The. Employer understands- that if it is a subject to the employment verification terms
in Subpart 22.18 of the FAR, it must verify the employment eligibility of any existing employee
assigned to the contract and all new hires, as discussed in the Supplemental Guide for Federal
Contractors. Once . an employee has been verified through E -Verify by the Employer, the
Employer may not reverify the employee through E -Verify.
a. Federal contractors with the FAR E -Verify clause agree to become familiar with and
comply with the most .recent versions of the E -Verify User Manual for Federal Contractors and
the E -Verify Supplemental Guide for Federal Contractors.
b. Federal contractors with .the FAR E -Verify clause agree to complete a tutorial for
Federal contractors with the FAR E -Verify clause.
c. Federal contractors with the FAR E -Verify clause not enrolled 'at the time of contract
award: An Employer that is not enrolled in E -Verify at the time of a: contract award must enroll
as a Federal contractor with the FAR E -Verify clause in E=Verify within 30 calendar days of
contract award and, within 90 days of enrollment, begin to use E -Verify to initiate verification of.
employment eligibility of new hires of the Employer who are working in the United States,.
whether or not assigned to the contract. Once the Employer begins verifying new hires, such
verification of new hires must be initiated within 3 business days after the date of hire. Once
enrolled in E -Verify as a Federal contractor with the FAR E -Verify clause, the Employer must
initiate verification of employees assigned to the contract within 90 calendar days from the time
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Company ID Number: 718949
of enrollment in the system and after the date and selecting which employees will be verified in
E -Verify or within 30 days of an employee's assignment to the contract, whichever date is later.
d. Employers that are already enrolled in E -Verify at the time of a contract award but are
not enrolled in the system as a Federal contractor with the FAR E -Verify clause: Employers
enrolled in E -Verify for 90 days or more at the time of a contract award must use E -Verify to
initiate verification of employment eligibility for new hires of the Employer who are working in the
United States, whether or not assigned to the contract, within 3 business days after the date of
hire. Employers enrolled in E -Verify as other than a Federal contractor with the FAR E -Verify
clause, must update E -Verify to indicate that they are a Federal contractor with the FAR E -
Verify clause within 30 days after assignment to the contract. If the Employer is enrolled in E -
Verify for 90 calendar days or less at the time of contract award, the Employer must_, within 90
days of enrollment, begin to use E -Verify to initiate verification of new hires of the contractor
who are working in the United States, whether or not assigned to the contract: Such verification
of new hires must be initiated within 3 business days after the date of hire. An Employer
enrolled as a Federal contractor with the FAR E -Verify clause in E -Verify must initiate
verification of each employee assigned to the contract within 90 calendar days after date of
contract award or within 30 days after assignment to the contract, whichever is later.
e. Institutions of higher education, State, local and tribal governments and sureties:
Federal contractors with the FAR E -Verify clause that are institutions of higher education (as
defined at 20 U.S.C. 1001(a)), State or local governments, governments of Federally recognized
Indian tribes, or sureties performing under a takeover agreement entered into with a Federal
agency pursuant to a performance bond may choose to only verify new and existing employees
assigned to the Federal contract. Such Federal contractors with. the FAR E -Verify clause may,
however, elect to verify all new hires, and/or all existing employees hired after November 6,
1986. The provisions of Article ILD, paragraphs 1.a.and 1.b of this MOU providing timeframes
for initiating employment verification of employees assigned to a contract apply to such
institutions of higher education, State, local and tribal governments, and sureties.
f. Verification of all employees: Upon enrollment, Employers who are Federal contractors
with the FAR E -Verify clause may elect to verify employment eligibility of all existing employees
working in the United States who were hired after November 6, 1986, instead of verifying only
new employees and those existing .employees assigned to a covered Federal contract. After
enrollment, Employers must elect to do so only in the manner designated by DHS and initiate E -
Verify verification of all existing employees within 180 days.after the election.
g-. Form 1-9 procedures for.existing- employees of -Federal contractors with the. FAR E -
Verify clause:, Federal contractors with the FAR E -Verify clause may choose to complete new
Forms 1-9 for all existing employees other than those that are completely exempt from this
process. Federal contractors with the FAR E -Verify clause may also update previously
completed Forms 1-9 to initiate E -Verify verification of existing employees who are not
completely exempt as long as that Form 1-9 is complete (including the SSN), complies with
Article II.C.5, the employee's work authorization has not expired,. and the Employer has
reviewed the information reflected in the Form 1-9 either in person or in communications with the
employee to ensure that the employee's stated basis in section 1 of the Form 1-9 for work
authorization has not changed (including, but not limited to, a lawful permanent resident alien
having become a naturalized. U.S. citizen). If the Employer is unable to determine that the Form
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Company ID Number: 718949
I-9 complies with Article II.C.5, if the employee's basis for work authorization as attested in
section 1 has expired or changed, or if the Form 1-9 contains no SSN or is otherwise incomplete,
the Employer shall complete a new 1-9 consistent with Article-II.C.5, or update the previous 1-9
to provide the necessary information. If section 1 of the Form 1-9 is otherwise valid .and up-to-
date and the form otherwise. complies with Article II.C.5, but reflects documentation (such as a
U.S. passport or Form 1-551) that expired subsequent to completion of the Form 1-9, the
Employer shall not, require the production of additional documentation, or use the photo.
screening tool described in Article II.C.5, subject to any additional or superseding instructions
that may be provided on this subject in the Supplemental Guide for Federal Contractors.
Nothing in this section shall be construed to require a second verification using E -Verify of any
assigned employee who has previously been verified as a newly hired employee under this
MOU, or to authorize verification of any existing employee by any Employer that is not -a Federal
contractor with the FAR E -Verify clause.
2. The Employer understands that if it is a Federal contractor with the FAR E -Verify clause, its
compliance with this. MOU is a performance requirement under the terms of 'the Federal
contract or subcontract,. and the, Employer consents to the release of information relating to
compliance with its verification responsibilities under this MOU to contracting officers or other
officials authorized tor review the Employer's compliance with Federal contracting requirements.
ARTICLE III
REFERRAL OF INDIVIDUALS TO SSA AND DHS
A. REFERRAL TO SSA
1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print
the .notice as directed. by the -E-Verify system. and provide- it. to the employee so that the
employee may. determine whether he or she will contest the tentative nonconfirmation. The
Employer must review the tentative nonconfirmation with the employee in private.
2. The Employer will refer employees to SSA field offices only as directed by the automated
system based on a tentative nonconfirmation, and only after the Employer records the case
verification number, reviews the. input to detect any transaction errors, and determines that the
employee contests the tentative nonconfirmation. The Employer will transmit the Social Security .
Number to SSA for verification again.if this review indicates a need to do so. The Employer will
determine whether the employee contests the tentative nonconfirmation as soon as; possible .
after the Employer receives it.
3. If the employee contests an SSA -tentative nonconfirmation, the Employer will provide the
employee with a system -generated referral letter and instruct the employee to visit an SSA
office within 8 Federal Government work days. SSA will electronically transmit the result of the
referral to the Employer within 10 Federal Government work days of the referral unless it
determines that more than 10 days is necessary. The Employer agrees to check the E -Verify
system regularly for case updates.
4. The .Employer agrees not to ask the employee to obtain a printout from the- Social Security
Number database (the Numident) or other written verification of the ,Social Security Number .
from the SSA.
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Company ID Number: 718949
B. REFERRAL TO DHS
1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must print
the tentative nonconfirmation notice as directed by the E -Verify system and provide it to the
employee so that the employee may determine whether he or she will contest the tentative
nonconfirmation. The Employer must review the tentative nonconfirmation with the employee in
private.
2. If the Employer finds a photo non -match for an employee who provides a document -for which
the automated system has transmitted a photo, the employer must print the photo non -match
tentative nonconfirmation notice as directed by the automated system and provide it to the
.employee so that the employee may determine whether he or she will -contest the finding. The
Employer must review the tentative nonconfirmation with the employee in private.
3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest
a tentative nonconfirmation received from DHS automated verification process or when the
Employer issues a tentative nonconfirmation based upon a photo non -match. The Employer will
determine whether the employee contests the tentative nonconfirmation as soon as possible
after the Employer receives it.
4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will
provide the employee with a referral letter and instruct the employee to contact DHS through its
toll-free hotline (as found on the referral letter) within 8 Federal Government work days.
5. If the employee contests a tentative nonconfirmation based upon a .photo non -match; the
Employer will provide the employee with a referral letter to DHS. DHS will electronically transmit
the result of the referral to the Employer within -10 Federal Government work days of the referral
unless it determines that more than 10 days is necessary. The Employer agrees to check the E-
Verify system regularly for case updates.
6. The Employer agrees that if an -employee contests a tentative nonconfirmation based upon a
photo non -match, the Employer will send a copy of the employee's Form 1-551 or Form I-766 to
DHS for review.by:
- Scanning and uploading the document, or
• Sending a photocopy of the document by an express mail account (paid for at
employer expense).
7. If the Employer determines that there is a photo non -match -when comparing the photocopied
List B document described in Article II.C.5 with the image generated in E -Verify, the Employer
must forward the employee's documentation to DHS using one of the means described in the
preceding paragraph, and allow DHS to resolve the case.
ARTICLE IV
SERVICE PROVISIONS
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SSA and DHS will not charge the Employer for verification services performed under this MOU.
The Employer is responsible for providing equipment needed to make inquiries. To access E -
Verify, an Employer will need a personal computer with Internet access.
ARTICLE V
PARTIES
A. This MOU is effective upon the signature of all parties, and shall continue in effect for as long
as the SSA and DHS conduct the E -Verify program unless modified in writing by the mutual
consent of all parties, or terminated by any party upon 30 days prior written notice to the others.
Any and all system enhancements to the E -Verify program by DHS or SSA, including but not
limited to the E -Verify checking against additional data sources and instituting new verification
procedures, will be covered under this MOU and will not cause the need for a supplemental
MOU that outlines these changes. DHS agrees to train employers on all changes made to E -
Verify through the use of mandatory refresher tutorials and updates to the E -Verify User
Manual, the E -Verify User Manual for Federal Contractors or the E -Verify Supplemental Guide
for Federal Contractors. Even without changes to E -Verify, DHS reserves the right to require
employers to take mandatory refresher tutorials. An Employer that is a Federal contractor with
the FAR E -Verify clause may terminate this MOU when the Federal contract that requires its
participation in E -Verify is terminated or completed. In such a circumstance, the Federal
contractor with the FAR E -Verify clause must provide written notice to DHS. If an Employer that
is a Federal contractor with the FAR E -Verify clause fails to provide such notice, that Employer
will remain a participant in the E -Verify program, will remain bound by the terms of this MOU
that apply to participants that are not Federal contractors with the FAR E -Verify clause, and will
be required to use the E -Verify procedures to verify the employment eligibility of all newly hired
employees.
B. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU if deemed
necessary because of the requirements of law or policy, or upon a determination by SSA or
DHS that there has been a breach of system integrity or security by the Employer, or a failure
on the part of the Employer to comply with established procedures or legal requirements. The
Employer understands that if it is a Federal contractor with the FAR E -Verify clause, termination
of this MOU by any party for any reason. may negatively affect its performance of its contractual
responsibilities.
C. Some or all SSA and DHS responsibilities under this MOU may be performed by
contractor(s), and SSA and DHS may adjust verification responsibilities between each other as
they may determine necessary. By separate agreement with DHS, SSA has agreed to perform
its responsibilities as described in this MOU.
D. Nothing in this MOU is intended, or should be construed, to create any right or benefit,
substantive or procedural, enforceable at law by any third party against the United States, its
agencies, officers, or employees, or against the Employer, its agents, officers, or employees.
E. Each party shall be solely responsible for defending any claim or action against it arising out
of or related to E -Verify or this MOU, whether civil or criminal, and for any liability wherefrom,
including (but not limited to) any dispute between the Employer and any other person or entity
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Company ID Number: 718949
regarding the applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by
the Employer.
F. The Employer understands that the fact of its participation in E -Verify is not confidential.
information and may be disclosed as authorized or required, by law and DHS or SSA policy,
including but not limited to, Congressional oversight, E -Verify publicity and media inquiries,
determinations of compliance with Federal contractual requirements, and responses to inquiries
under the Freedom of Information Act (FOIA).
G. The foregoing constitutes the full agreement on this subject between DHS and the Employer.
H. The individuals whose signatures appear below represent that they are authorized to enter
into this MOU on behalf of the Employer and DHS respectively.
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Company ID Number: 718949
To be accepted as a participant in E -Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E -Verify at 888-464-4218.
Employer CC&T Construction Co., Inc.
Anthony Page
Name (Please Type or Print)
Electronically Signed
Title
10/22/2013
Signature
Date
Department of Homeland Security — Verification Division
SCIS Verification Division
Name (Please Type or Print)
Electronically Signed
Title
10/22/2013
Signature
Date
Information Required for the E -Verify Program
Information relating to our Company:
Company Name:
C&T Construction Co., Inc.
Company Facility Address:
5051 Prospect Street
Indianapolis, IN 46203
Company Alternate
Address:
County or Parish:
MARION
Employer Identification
Number:
51773157
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Company ID Number: 718949
North American Industry
Classification Systems
Code:
238
Administrator:
Number of Employees:
20 to 99
Number of Sites Verified
for:
re you verifying for more than .1 site? If yes, please provide the number of sites verified for. .
in each State:
• INDIANA 1 site(s)
Information relating to the Program Administrator(s) for your Company on. policy
questions or operational problems:
Name: Jacquelyn J Downey
Telephone Number: (317) 356 - 6385 Fax Number: (317) 356 - 2175
E-mail Address: jdowney11108@aol.com
Page 13 of 13 1 E -Verify MOU for Employer. i Revision Date 09/01/09 www.dhs.gov/E-Verify