1-Solicitation Builder Forms.pdf

REFERENCES

The bid must include at least three (3) references from separate, independent entities with similar experience within the past five (5) years. Each reference must provide a contact person, address, and phone number. The Clayton County Water Authority may not be listed as a reference.

COMPANY/GOV’T ENTITY NAME: ______________________________________________

CONTACT NAME: ___________________________________________________________

EMAIL ADDRESS: ___________________________________________________________

PHONE NUMBER: ___________________________________________________________

COMPANY/GOV’T ENTITY NAME: ______________________________________________

CONTACT NAME: ___________________________________________________________

Division 2 Bid Requirements Section 7: Contractor Affidavit and Agreement

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT OF 2006

A. Pursuant to the Georgia Security and Immigration Compliance Act of 2006, the Contractor understands and agrees that compliance with the requirements of O.C.G.A. § 13-10-91 and Georgia Department of Labor Rule 300-10-.02 are conditions of this Agreement. The Contractor further agrees that such compliance shall be attested by the Contractor through execution of the contractor affidavit required by Georgia Department of Labor Rule 300-10-1-.07, or a substantially similar contractor affidavit. The Contractor’s fully executed affidavit is attached hereto and is incorporated into this Agreement by reference herein.

B. By initialing in the appropriate line below, the Contractor certifies that the following employee-number category as identified in O.C.G.A. § 13-10-91 is applicable to the Contractor:

1. 500 or more employees.

2. 100 or more employees.

3. Fewer than 100 employees.

C. The Contractor understands and agrees that, in the event the Contractor employs or contracts with any subcontractor or subcontractors in connection with this Agreement, the Contractor shall:

1. Secure from each such subcontractor an indication of the employee-number category as identified in O.C.G.A. § 13-10-91 that is applicable to the subcontractor.

2. Secure from each such subcontractor an attestation of the subcontractor’s compliance with O.C.G.A. § 13-10-91 and Georgia Department of Labor Rule 300-10-1-.02 by causing each such subcontractor to execute the subcontractor affidavit required by Georgia Department of Labor Rule 300-10-1-.08, or a substantially similar subcontractor affidavit. The Contractor further understands and agrees that the Contractor shall require the executed subcontractor affidavit to become a part of the agreement between the Contractor and each such subcontractor. The Contractor agrees to maintain records of each subcontractor attestation required hereunder for inspection by the Clayton County Water Authority at any time.”

Contractor

Authorized Signature:

Name:

Title:

Date:

CLAYTON COUNTY WATER AUTHORITY

1600 Battle Creek Road | Morrow, Georgia 30260 Phone: (770) 960-5223 | Web Site: www.ccwa.us

CONTRACTOR AFFIDAVIT AND AGREEMENT FORM

SECTION A – Project Information / Contractor’s Employee Status / General Attestations

Check one: ☐ Contractor currently employs eleven (11) or more employees Name of Project ☐ Contractor has less than eleven (11) employees

The undersigned contractor (“Contractor”) executes this Affidavit and Agreement Form (“Affidavit”) to comply with O.C.G.A § 13- 10-91 related to any contract to which Contractor is a party with Clayton County Water Authority that is subject to O.C.G.A. § 13-10- 91 and hereby verifies its compliance with O.C.G.A. § 13-10-91, attesting as follows:

a) The Contractor acknowledges and agrees that Contractor will contract for the performance of services in satisfaction of the Project only with subcontractors who present an affidavit to the Contractor with the information required by O.C.G.A. § 13- 10-91. Contractor agrees to maintain such affidavits for inspection upon request of Clayton County Water Authority.

b) The Contractor acknowledges and agrees that this Affidavit is incorporated into any contract or purchase order for the Project and shall survive any renewal or extension thereof.

SECTION B – Contractor With Eleven (11) or More Employees (E-Verify Registration Required) (Complete Only If Applicable) By completing the information in this Section, the Contractor further attests as follows:

a) The Contractor has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program;

b) The Contractor will continue to use the federal work authorization program throughout the contract period, including any renewal or extension thereof;

c) The Contractor will notify the public employer in the event the Contractor ceases to utilize the federal work authorization program during the contract period, including renewals or extensions thereof;

d) The Contractor understands that ceasing to utilize the federal work authorization program constitutes a material breach of Contract;

*Enter Identification Number as Checked Above *Date of Authorization/Issuance

*Legal Name of Contractor *Name of Project

*Street Address, City, State, Zip Code *Required Entries

SECTION C – Contractor With Less Than Eleven (11) Employees (Complete Only If Applicable) ☐ By checking this box, Contractor certifies that Contractor has less than eleven (11) employees and does not hire or intend to hire employees for purposes of satisfying or completing the terms and conditions of any part of the above-referenced Project.

☐ By checking this box, Contractor acknowledges that Contractor must attach a copy of the front and back of their state issued driver’s license or state issued identification card to this submission of this affidavit.

SECTION D – Execution (Completion Required by All) I hereby declare under penalty of perjury that the foregoing is true, correct, and complete. I understand and acknowledge that knowingly and willfully making a false, fictitious, or fraudulent statement or representation in this Affidavit constitutes a violation of O.C.G.A. § 16-10-20 and may subject the Contractor to criminal prosecution, termination of any Contract or Purchase Order, or both.

Executed this of , (month) 20 , in (City), (State).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF __________, 20 ____.

NOTARY PUBLIC My Commission Expires http://www.ccwa.us/

GUIDELINES & GENERAL INFORMATION

CONTRACTOR AFFIDAVIT AND AGREEMENT FORM

The following guidance is provided for informational purposes only and does not supersede, modify, or constitute a legal interpretation of Official Code of Georgia Annotated (O.C.G.A.) § 13-10-91. Contractors remain solely responsible for ensuring compliance with applicable law when completing the Affidavit and Agreement Form. In the event of any conflict between this guidance and the statute, the statute shall control.

Pursuant to O.C.G.A. § 13-10-91(b), a public employer (Clayton County Water Authority) shall not enter into a contract for the physical “performance of services” unless the contractor is registered with and participates in the federal work authorization program (E-Verify). Before any Solicitation, Purchase Order or Contract for such services is considered, the contractor must submit a signed and notarized affidavit. NOTE: A Purchase Order (PO) is considered a contract pursuant to O.C.G.A. § 13-10-91.

TOPIC 1: APPLICABILITY

These requirements apply to any contract or purchase order involving the physical performance of services exceeding $2,499.99.

“Physical performance of services” means any performance of labor or services for a public employer using a bidding process or by contract or purchase order and includes, but is not limited to:

• Routine operation, repair, and maintenance of facilities or office space;

• Services necessary for normal business operations (e.g., IT support, janitorial services, equipment repair); and

• Professional and consulting services.

TOPIC 2: CONTRACTOR AFFIDAVIT REQUIREMENT

• Contractors must submit a signed and notarized Contractor Affidavit and Agreement Form

(“Affidavit”) confirming registration and participation in the federal work authorization program before contract award or purchase order issuance.

• If a contractor enters into multiple contracts with the public employer within a calendar year, a separate affidavit is required for each Contract and/or Purchase Order.

TOPIC 3: SUBCONTRACTORS

If the contractor intends to use subcontractors, the contractor is responsible for obtaining a signed and notarized affidavit from each subcontractor and ensuring compliance with O.C.G.A. § 13-10-91.

TOPIC 4: STATEWIDE CONTRACT VENDORS

• If the vendor is on a statewide contract, E-Verify information may be obtained from the supplier records maintained by the Georgia Department of Administrative Services (DOAS).

• In such cases, a separate affidavit is not required.

TOPIC 5: GENERAL COMPLIANCE GUIDANCE

• Public employers and contractors are encouraged to err on the side of caution.

• If there is uncertainty as to whether an affidavit is required, requesting one is acceptable and recommended to ensure compliance.

TOPIC 6: EXEMPTIONS

Contractors With Less Than Eleven (11) Employees

• Contractors with less than eleven (11) employees are not eligible to obtain an E-Verify number.

• The Clayton County Water Authority must document the contractor’s authorization to be in the

United States by verifying acceptable identification, such as:

o A state-issued driver’s license from a state that verifies immigration status through its licensing or renewal process; or o Other acceptable identification, including a U.S. passport or military ID.

Foreign Companies

• Foreign companies that do not have an E-Verify number are not required to submit information related to Title 13 of the O.C.G.A.

• If the foreign company or its personnel will enter the United States, the public employer must verify that the required authorization to enter the U.S. has been obtained.

Division 3 Contract Forms

Section 4: Non-Collusion Certificate

STATE OF , COUNTY OF

Personally appeared before the undersigned officer duly authorized by law to administer oaths who, after being first duly sworn, depose and say that they are all the officers, agents, persons or employees who have acted for or represented

, and that said in proposing or procuring the Contract with the Clayton County Water Authority on the following project:

has not by (himself, themselves) or through any persons, officers, agents or employees prevented or attempted to prevent by any means whatsoever competition in such bidding; or by any means whatsoever prevented or endeavored to prevent anyone from making a proposal therefore or induced or attempted to induce another to withdraw a bid for said work.

ATTEST:

By:

Bidder

Name

Name

Title: Title:

Sworn to and subscribed before me this day of , 20

Notary Public: My Commission expires:

Division 3 Contract Forms Section 5: Certification of Absence of Conflict of Interest Required for each contract or arrangement to prepare or develop specifications or requirements

(O.C.G.A. § 36-80-28)

The undersigned Contractor (Consultant), who is entering into a contract or arrangement with the Clayton County Water Authority (CCWA) to prepare or develop specifications or requests for bids, requests for proposals, purchase order, or any other type of solicitation for CCWA, by signing below acknowledges and certifies to follow the requirements below:

(1) Contractor shall avoid any appearance of impropriety and shall follow all of CCWA’s policies and procedures related to the project.

(2) Contractor shall immediately disclose to CCWA any material transaction or relationship, including, but not limited to the Consultant, Consultant’s employees, agents or subsidiaries, that reasonably could be expected to give rise to a conflict of interest, including, but not limited to, past, present, during the pendency of the contract or arrangement, or known prospective engagements, involvement in litigation or other dispute, client relationships, or other business or financial interest.

(3) Contractor acknowledges that any violation or threatened violation of the agreement may cause irreparable injury to CCWA entitling CCWA to seek injunctive relief in addition to all other legal remedies.

Any person may bring an action to declare null and void any purchase in violation of this Code section or to seek injunctive relief and damages against a person who makes any type of solicitation in violation of this Code section.

DISCLOSURES (Write “N/A” if Non-Applicable):

Name of Contractor Name of Contractor’s Authorized Official

Signature of Contractor’s Authorized Official

Date