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WV FORM WORKER VERIFICATION AUDITOR CERTIFICATION Facility Number:_ Facility Location: General Contractor Subject to Audit ("Contractor"): Subcontractors Subject to Audit ("Subcontractors"): (List) 1 11 The undersigned, , has been engaged as a Worker Verification Auditor to: 1. Review the Forms I-9 and copies of employment eligibility and identity documentation required to ' be maintained for Worker Verification Compliance pursuant to the Contract between ("Contractor") and Wal-Mart Stores, Inc. ("Owner"), for each Worker (as defined in that Contract) of any tier and duration, on the above referenced Project, and 2. Certify whether the documentation supplied and reviewed confirm that the Contractor and Subcon- tractor have verified the eligibility of such Workers and are in compliance with Form I-9 requirements and all applicable immigration laws, statutes, rules, codes, orders and regulations, including, without limitation, the Immigration Reform and Control Act of 1986, as amended, the Immigration and Na- tionality Act, as amended, and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, as amended, and any successor statutes, laws, rules and regulations thereto (collectively, the "Worker Verification Laws") as well as the Contract, and 3. Certify whether any errors or items of concern exist in the documentation reviewed which could call into question the eligibility of a Worker. I hereby certify the following: 1. I reviewed the Forms I-9 for the individuals listed in the Worker Verification Audit Summary Sheet (which is attached hereto and incorporated herein by reference as "WV Form Audit Summary"). 2. Regarding the review of Forms I-9 (and employment eligibility and identity documents where appli- cable) in this audit: a. The total number of I-9 Forms reviewed in conjunction with this audit is b. The total number of individuals whose employment eligibility and identity were verified through the review of their 1-9 is c. The total number of Forms I-9 which contained errors or items of concern which could call into question the eligibility of the Worker(s) is d. The total number of Worker(s) for whom employment eligibility and identity documentation which appear to be tampered with or fraudulent on their face is 3. A list of the Worker(s) referred to in paragraph 2.c. and 2.d. hereinabove has been provided to Owner and to Contractor, a. Who has confirmed the removal of such Worker(s) from the Project, and b. The total number of such Worker(s) who have provided additional proof of eligibility which I have reviewed and whose eligibility I have confirmed through that review is 4. Contractor has provided documentation evidencing payment by Contractor to all Subcontractors as of the date of this audit. 5. Contractor has provided proof of solvency for any and all bond companies for the Project. Certified by the undersigned as true, correct and complete this day of , 20_ n �7 17 L 0706 - Zephyrhills, Florida - 16592140 01351-32 February 16, 2017 1