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WV FORM WORKER VERIFICATION CERTIFICATION - CONTRACTOR Facility Number: Facility Location: The undersigned, ("Contractor"), certifies, pursuant to that certain Construc- tion Agreement dated , 20 ("Contract") between Wal-Mart Stores, Inc. ("Owner") and Contractor, the following: 1. Contractor has fully complied with all Worker Verification Laws, as defined in the Con- tract, its Compliance Exhibit and corresponding or referenced Specifications ("Contract Documents") with regard to each of Contractor's employees who shall perform work on the Project pursuant to the Contract ("Contractor Workers"). 2. As to each Contractor Worker described above, Contractor has on file a Form 1-9 that is free of substantive or uncorrected technical deficiencies (other than timeliness deficien- cies) and that reflects that the Contractor Worker is lawfully eligible to work on the Pro- ject. 3. Contractor will document those specific Contractor Workers in a list exactly in the format below, which shall be affixed to this WV Form, supplemented as necessary, maintained and produced according to the requirements of the Contract Documents prior to the presen- tation of such Contractor Workers for admission to the Project site. Full Legal Name of Individual Name of Employer 4. Legible photocopies of the employment eligibility and identity documentation for Con- tractor Workers (who were hired after the award of the Contract project have been and will continue to be maintained by Contractor for the period required by the Contract Doc- uments. 5. Contractor has reported or will report any and all Worker Verification Incidents (as de- fined in the Contract) to Owner within one (1) hour of such Worker Verification Incident. 6. Contractor has not, and its Subcontractors have not been the subject of enforcement or other action by ICE within the two (2) year period prior to the date of this certification. 7. Contractor intends, and has procedures in place, to ensure that it and all of its Subcon- tractors are in compliance with the Worker Verification Laws and that all Workers on the Project are authorized to work in the United States. 8. None of the Workers is known to Contractor to be employed without lawful authoriza- tion. 9. Contractor shall, and shall cause its Subcontractors to, cooperate with the WV Auditor and provide the WV Auditor with access to such documentation and personnel as may be necessary to complete any certification, review or audit. This Certification may be delivered to and relied upon by Owner. Certified by the undersigned as true, correct and complete this day of 520. 01351-26 1 I� L 1 0706 - Zephyrhills, Florida - 16592140 February 16, 2017 1