Addiction Awareness OSCA 11-036 response - REDACTED.pdf

OSCA 11-036 Treatment Court Specialized Service Providers
EXHIBIT C
AFFIDAVIT OF WORK AUTHORIZATION
Comes now Lisa Doyle______________ as Chief Administrative Officer first being duly
(NAME)
(OFFICE HELD)
sworn on my oath, affirm _Addiction Awareness, LLC is enrolled and will continue to
(COMPANY NAME)
participate in a federal work authorization program in respect to employees that will work
in connection with the contracted services related to OSCA-11-036__ for the duration of
(RFP NUMBER)
the contract, if awarded in accordance with RSMo Chapter 285.530 (2). I also affirm that
_Addiction Awareness, LLC does not and will not knowingly employ a person who is an
(COMPANY NAME)
unauthorized alien in connection with the contracted services related to OSCA-
(RFP NUMBER)
for the duration of the contract, if awarded.
In Affirmation thereof, the facts stated above are true and correct (The undersigned understands that false
statements made in this filing are subject to the penalties provided under Section 575.040, RSMo).
Lisa Christine Doyle
Signature (person with authority)
Printed Name
Chief Administrative Officer
Title
Date
Subscribed and sworn to before me this _____________ of ___________________. I am
(DAY)
(MONTH, YEAR)
commissioned as a notary public within the County of ________________, State of
(NAME OF COUNTY)
_______________________, and my commission expires on _________________.
(NAME OF STATE)
(DATE)
Signature of Notary
Date
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