17-Sample-Contract-SCCPSS-A101-2017 -Contract-Forms- 5-7-25, 1.pdf

FORMS

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

CONTRACT FORMS

FORMS INDEX:

Performance Bond Payment Bond Statutory Affidavit – O.C.G.A. § 13-10-80 Five Year Bond on Roofs and Walls Specimen Certificate of Manufacturer Certificate of Insurance Bond to Discharge Claim Non-Influence Affidavit – Construction- O.C.G.A. § 36-91-21 Contractor E-Verify Affidavit under O.C.G.A. § 13-10-9l (b)(l) Request for Reimbursement DE Form 0263

Forms

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

Project No. __________

[NEED TO REVIEW BOND FORMS PROPOSED BY SPECIFIC SURETIES.]

PERFORMANCE BOND Bond No.

KNOW ALL MEN BY THESE PRESENTS:

That ___________________________________________________________ as principal (hereinafter referred to (Legal Name and Address of the Contractor) as "Contractor"), and ________________________________________________ as surety (hereinafter referred to

(Legal Title and Address of Surety) as "Surety"), are held and firmly bound unto the Board of Public Education of the City of Savannah and the County of Chatham as Obligee (hereinafter referred to as "Owner") in the amount of DOLLARS ($__________________________), to which payment Contractor and Surety bind Themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with the Owner bearing date of _____________________________for:____________________________________________________________ (Insert Name of Work) in accordance with drawings and specifications prepared by: _____________________________________ which (Full Name and Title) said contract is incorporated herein by reference and made a part hereof, and is hereinafter referred to as the Contract.

NOW THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if the Contractor shall promptly and faithfully perform and comply with the terms and conditions of said contract; and shall indemnify and hold harmless the Owner against and from all cost, expenses, damages, injury or loss to which said Owner may be subjected by reason of any wrongdoing, including patent infringement, misconduct, want of care or skill, default or failure of performance on the part of said Principal, his agents, Subcontractors or employees, in the execution or performance of said contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect.

(1) The said Surety to this bond, for value received, hereby stipulates and agrees that no change or changes, extension of time or extensions of time, alteration or alterations or addition or additions to the terms of the contract, or to the work to be performed thereunder, or the specifications or drawings accompanying same, or the exercise of the Owner’s right to do work with separate contractors or to correct work pursuant to the terms of the Contract, shall in any way affect its obligation on this bond, and it does hereby waive notice of any such change or changes, extension of time or extensions of time, alteration or alterations or addition or additions to the terms of the contract, or to the Work or to the specifications or drawings. In addition, the Surety to this bond, for value received, hereby agrees to the provisions of Paragraph 1.5.1.3 for increases in the penal amount of this bond and waives notice from the Owner of any such changes.

(2) If pursuant to the Contract Documents the Contractor shall be declared in default by the Owner under the aforesaid Contract, the Surety shall promptly perform this bond agreement in accordance with its terms and conditions. It shall be the duty of the Surety to give an unequivocal notice in writing to the Owner, within twenty-five (25) days after receipt of a declaration of default, of the Surety's election to either remedy the default or defaults promptly or to perform the Contract promptly, time being of the essence. In said notice of election, the Surety shall indicate the date on which the remedy or performance will commence, and it shall then be the duty of the Surety to give prompt notice in writing to the Owner immediately upon completion of (a) the remedy and/or correction of each default, (b) the remedy and/or correction or each item of condemned work, (c) the furnishing of each omitted item of work, and (d) the performance of the Contract. The Surety shall not assert the solvency of its Principal as justification for its failure to give notice of election or for its failure to promptly remedy the default or defaults or perform the Contract.

(3) Supplementary to and in addition to the foregoing, whenever the Owner shall notify the Surety that the Owner has notice that the Contractor has failed to pay any Subcontractor, Supplier, or laborer for labor or materials certified by the Contractor as having been paid for by the Contractor in accordance with said Contract, which said labor or materials have been included in a periodical estimate and certified by the Design Professional for payment and paid for by the Owner, the Surety shall, within twenty (20) days of receipt of such notice, cause to be paid any unpaid amounts for such labor and materials.

(4) It is expressly agreed by the Principal and the Surety that the Owner, if he desires to do so, is at liberty to make inquiries at any time of Subcontractors, Suppliers, material men, laborers or other parties concerning the status of payments for labor, materials, or services furnished in the prosecution of the work.

Forms

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

(5) No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein or the legal successors of the Owner.

(6) For the purposes of this bond, the name and address of the Authorized State of Georgia Licensed Agent to whom correspondence and telecommunications may be addressed and/or with whom business concerning this bond may be conducted will be as follows:

NAME

ADDRESS

CITY STATE ZIP CODE

TELEPHONE NUMBER

(7) Further, this bond shall be the Performance Bond furnished under O.C.G.A. Title 36 chapter 91 and shall be subject to increase in the penal amount of the bond pursuant to such statutes and Paragraph 1.5.1.3 of the Contract.

SIGNED AND SEALED THIS _______ DAY OF _____________________ , ________________.

IN THE PRESENCE OF:

___________________________________ ______________________________________(SEAL)

WITNESS PRINCIPAL

NAME TITLE

___________________________________ ______________________________________(SEAL)

WITNESS SURETY

Resident Georgia Agent *

(*) Attach Power of Attorney

Section 7 – Forms

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

Project No. __________

[NEED TO REVIEW SPECIFIC PAYMENT BOND PROVISIONS PROPOSED BY SPECIFIC SURETIES.]

PAYMENT BOND Bond No.

That____________________________________________________________ as Principal (hereinafter referred to as the (Legal Title and Address of the Contractor)

"Principal") and ____________________________________________________________ as Surety (hereinafter referred (Legal Name and Address of the Surety) to as "Surety"), are held and firmly bound unto the Board of Public Education of the City of Savannah and the County of Chatham as Obligee (hereinafter referred to as "Owner") for the use and benefit of claimants defined, hereinafter in the amount of:__________________________________________________________ DOLLARS (Insert Contract Price) to which payment Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with Owner dated ___________________ for ___________________________________________________________ in accordance with the drawings and

(Insert Name of Work) specifications prepared by: _________________________________________________ which Contract is incorporated herein (Here insert Full Name and Title) by reference and made a part hereof, and is hereinafter referred to as the Contract.

NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if the Principal shall promptly make payment to all claimants as hereinafter defined, for all labor and materials supplied in the prosecution of the work provided for in said Contract, then this obligation shall be void, otherwise it shall remain in full force and effect subject, however, to the following conditions:

(1) The said Surety to this bond, for value received, hereby stipulates and agrees that no change or changes, extension of time or extensions of time, alteration or alterations or addition or additions to the terms of the Contract or to the work to be performed thereunder, or the specifications or drawings accompanying same, or the exercise of the Owner’s right to do work with separate contractors or to correct work pursuant to the terms of the Contract, shall in any way affect its obligation on this bond, and it does hereby waive notice of any such change or changes, extension of time or extensions of time, alteration or alterations or addition or additions to the terms of the Contract or to the Work or to the specifications or drawings. In addition, the Surety to this bond, for value received, hereby agrees to the provisions of Paragraph 1.5.1.3 for increases in the penal amount of this bond and waives notice from the Owner of any such changes.

(2) A claimant is defined as any Subcontractor or any person supplying labor, materials, machinery, or equipment in the prosecution of the work provided for in said Contract.

(3) Every person entitled to the protection hereunder and who has not been paid in full for labor or materials furnished in the prosecution of the work referred to in said bond before the expiration of a period of ninety (90) days after the day on which the last of the labor was done or performed by him, or materials or equipment or machinery was furnished or supplied by him for which claim is made, shall have the right to sue on such payment bond for the amount, or the balance thereof, unpaid at the time of the commencement of such action and to prosecute such action to final execution and judgment for the sum or sums due him, provided, however, that any person having direct contractual relationship with a Subcontractor, but no contractual relationship express or implied with the Contractor furnishing said payment bond shall have (a) given written notice to said Contractor within ninety (90) days from the day on which such person did or performed the last of the labor, or furnished the last of the materials or machinery or equipment for which such claim is made stating with substantial accuracy the amount claimed and the name of the party to whom the materials were furnished or supplied or for whom the labor was performed or

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

done; and (b) if the Contractor has filed a Notice of Commencement in accordance with the requirements of O.C.G.A.

§13-10-62 and Articles 4.3.2 of the Contract, given to said contractor a written Notice to Contractor within 30 days from the filing of the Notice of Commencement or 30 days following the first delivery of labor, materials, machinery or equipment, whichever is later, setting forth:

A) The name, address, and telephone number of the person providing labor, material, machinery, or equipment;

B) The name and address of each person at whose instance the labor, material, machinery or equipment is being furnished;

C) The name and the location of the public work; and

D) A description of the labor, material, machinery, or equipment being provided and, if known, the Contract

Sum or anticipated value of the labor, material, machinery, or equipment to be provided or the amount claimed to be due, if any.

It is provided further that nothing contained herein shall limit the right of action to said 90-day period. Notice may be served by the depositing of a notice, registered mail, postage paid, duly addressed to the Contractor at any place he maintains an office or conducts his business, or his residence, in any post office or branch post office or any letter box under the control of the Post Office Department or notice may be served in any manner in which the sheriffs of Georgia are authorized by law to serve summons or process. Every suit instituted under this section shall be brought in the name of the claimant without Owner being made a party thereof. The official who has custody of said bond is authorized and directed to furnish, to any person making application thereof who submits an affidavit that he has supplied labor or materials for such work and payment therefore has not been made, or that he is being sued on any such bond, a copy of such bond and the contract for which it was given, certified, by the official who has custody of said bond and contract shall be admitted in evidence without further proof.

Applicants shall pay for such certified statements and such fees as the official fixes to cover the cost of preparation thereof, but in no case shall the fixed fee exceed the fees that the clerks of the superior courts are permitted to charge for similar copies.

(4) No action can be instituted on this bond after one year from the date of the Final Certificate of the Design

Professional.

(5) Further, this bond shall be the Payment Bond furnished in compliance with under O.C.G.A. Title 36 chapter 91 shall be subject to increase in the penal amount of the bond pursuant to such statutes and Paragraph 1.5.1.3 of the Contract.

(6) For the purposes of this bond, the name and address of the Authorized State of Georgia Licensed Agent to whom correspondence and telecommunications may be addressed and/or with whom business concerning this bond may be conducted will be as follows:

NAME

ADDRESS

CITY STATE ZIP CODE

TELEPHONE NUMBER

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

SIGNED AND SEALED THIS ___________ DAY OF _______________________________, ______.

IN THE PRESENCE OF:

_____________________________________ _________________________________(SEAL)

WITNESS PRINCIPAL

____________________________________ _________________________________(SEAL)

WITNESS SURETY

Resident Georgia Agent *

Statutory Affidavit

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

STATUTORY AFFIDAVIT

COUNTY OF ______________________________ STATE OF ______________________________

FROM: ___________________________________

Contractor

TO: _____________________________________

Owner Re: Contract entered into the _____ day of ______________, 20____, between the above-mentioned parties for the construction of Project No. ______________________ located at ______________________________

1. The undersigned hereby certifies that all work required under the above Contract has been performed in accordance with the terms thereof, that all Subcontractors, Suppliers, mechanics, and laborers have been paid and satisfied in full, or will be paid and satisfied in full out of the proceeds of this payment as set forth in O.C.G.A. §13- 10-80, and that there are no outstanding claims of any character [including disputed claims or any claims to which the Contractor has or will assert any defense] arising out of the performance of the Contract which have not been paid and satisfied in full except as listed herein below:

2. The undersigned further certifies that to the best of his knowledge and belief there are no unsatisfied claims for damages resulting from injury or death to any employees, Subcontractors, or the public at large arising out of the performance of the Contract, or any suits or claims for any other damage of any kind, nature, or description which might constitute a lien upon the property of the Owner.

3. The undersigned makes this affidavit for the purpose of receiving final payment in full settlement of all claims against the Owner arising under or by virtue of the Contract, and acceptance of such payment is acknowledged as a release of the Owner from any and all claims arising under or by virtue of the Contract.

This ______ day of ____________________________, 20___________.

___________________________________(L.S.)

Signature Title Firm

COUNTY OF _______________________________ STATE OF ________________________________

Personally before me, the undersigned authority, appeared____________________________________________

(NAME OF PERSON SIGNING THE AFFIDAVIT)

who is known to me to be an official of the firm of

(NAME OF CONTRACTOR)

and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct.

Notary Public

My Commission expires _________________This______ day of __________________________, 20____.

Instructions to Contractor- ENTER THE WORD "NONE" OR LIST THE NAMES OF CLAIMANTS

Five-Year Roof and Wall Bond

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

FIVE YEAR BOND ON ROOFS AND WALLS

STATE OF GEORGIA

COUNTY OF ______________________________

Firmly Bound. Know all men by these presents, that we, ________________ (“Contractor”) as Principal, and (Name of Surety), as Surety, are held and firmly bound unto

(Insert Name of Owner) Owner, in the sum of____________ Dollars ($______________) for the payment of which well and truly to be made and done, we bind ourselves, our executors and administrators, our successors and assigns, jointly and severally, by these presents.

Condition of Obligation. The condition of the above obligation is such that WHEREAS Contractor has entered into a Contract with Owner dated (enter date of contract), for construction of Project No.________________.

Warranty. WHEREAS, the said Contractor warrants with respect to the said work that for a period of five years from the date of the execution of the Final Certificate of the Design Professional, the roofs of the building (or buildings) and roofs of covered passages, including, but not limited to, roof decking; deck sheathing; material used as a roof base or insulation over which roof is applied; roofing materials; promenade decks or any other work on the surface of the roof; flashing; base flashing; counter flashing; metal work, gravel stops; or roof expansion joints shall be absolutely watertight and free from all leaks. At no expense to the Owner, the Contractor will make repairs to any defects which may develop in the work including, but not limited to the following: blisters, exposed felts, ridges, wrinkles, splits, warped insulation, and loose flashing, in a manner compatible to the system and acceptable under industry standards and in accordance with the Contract Documents. The Contractor also warrants that for the same five-year period the walls of the building (or buildings) including, but not limited to the following: vertical and/or horizontal expansion joints, below and/or above grade waterproofing, below and/or above grade damp-proofing, thru-wall flashing, damp course flashing and waterproofing of joints at openings in walls including, but not limited to, door perimeters, window perimeters, vents and pipe openings shall be absolutely watertight and free from all leaks, seepage or dampness, and that he shall, at no expense to the Owner, make repairs to any defects which may develop in the work in a manner compatible to the system and acceptable under industry standards and in accordance with the Contract Documents, provided, however, that the following are excluded from the warranty:

(a) Defects or failures resulting from abuse by the Owner.

(b) Defects in design which the said Contractor shall have brought to the attention of the Owner in writing prior to installation of the work, except, however, that the Contractor shall not be responsible, insofar as liability under this bond is concerned, for bringing to the attention of the Owner defects in design involving failure of

(1) Structural Frame

(2) Load bearing walls

(3) Foundations nor shall the Contractor be responsible for correction of leaks resulting from said failure.

(c) Damage caused by fire, tornado, hail, hurricane, acts of God, wars, riots, civil commotion, terror acts, or terrorist activity.

(d) The Contractor is not an insurer nor is he a guarantor of the suitability of adequacy of design. Any other provisions of this bond to the contrary notwithstanding, the Contractor shall not be required to remedy any unsuitable or inadequate design.

Five-Year Roof and Wall Bond

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

Leaks or Defect. WHEREAS the said Contractor agrees that should any leaks or defects occur in the roofs or walls of the said (Name and Number of Project) the said Contractor will promptly remedy the said leaks or defects and pay for any damage to other work of said Project resulting therefrom, except, however, that when this instrument is executed by a Subcontractor this Contract, shall, insofar as the Subcontractor is concerned, extend only to the work executed by said Subcontractor.

Full Force and Effect. NOW, THEREFORE, the condition of this obligation is such that if the Contractor shall in all things promptly and faithfully perform and comply with the terms and conditions hereinbefore set forth, then this obligation shall be null and void; otherwise, it shall remain in full force and effect.

IN WITNESS WHEREOF, the parties hereto have caused this instrument to be duly executed this ________ day of ____________, 20___.

________________________________ WITNESS

Principal

By:______________________________ _______________________

TITLE____________________________ _______________________

________________________________ WITNESS

Surety

By:______________________________ _______________________

TITLE____________________________ _______________________

Instructions for execution by Contractor

(a) If the firm is a partnership, all members of the partnership must execute.

(b) If the firm is a corporation, the president must sign, the secretary must attest, and the

Seal of Corporation must be affixed.

(c) If the firm operates as a sole proprietorship, the proprietor must execute.

Certificate of Manufacturer

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

SPECIMEN CERTIFICATE OF MANUFACTURER

INSTRUCTIONS FOR PREPARATION OF CERTIFICATE: To be acceptable, the certificate must be prepared in the form indicated by this specimen on the official letterhead of the manufacturer. No portions of the certificate may be omitted. Attached is a copy of the Contract provision under which the certificate is required. The Owner needs only one copy of the certificate. If equipment of a manufacturer is not installed in strict compliance with the recommendations of the manufacturer or if in the design of the work the equipment is not applied in strict compliance with the recommendations of the manufacturer, a letter from the manufacturer should be forwarded to the Contractor [with copies to the Design Professional and the Owner] setting forth a list of the deviations from the recommendations of the manufacturer and stating what remains to be done in order to bring the work into strict compliance with the recommendations of the manufacturer. Prior to calling upon the representative of the manufacturer for performance of the services necessary to enable him to execute a certificate in accordance with this specimen, it is the obligation of the Contractor to have installed the work in strict compliance with the recommendations of the manufacturer [See Article 2.2.4 of the Contract], and it is likewise the obligation of the Contractor to have put the equipment in good operating condition in absolute and final readiness for the "start-up,” "testing,” and "placing into operation" as defined herein below by the representative of the manufacturer.

Definitions:

1. “Start-up” is defined as putting the equipment into action.

2. “Testing” is defined as performing testing as stipulated in the Contract Documents.

3. “Placing into operation” is defined as operating the equipment for a sufficient period of time under normal operating conditions for determination to be made it is performing properly.

[Company Letterhead ]

Date:_______________________________

To: Savannah Chatham County Public School System 208 Bull Street, Room 305 Savannah, Georgia 31401

To Re: Certificate of [JOHN DOE CORPORATION] that equipment or components furnished by it has [or have, as the case may be] been installed in strict compliance with its recommendations and is [or are, as the case may be] operating properly at PROJECT NO._________________

Savannah Chatham County Public School System:

1. We certify through our duly authorized and acting agent that the following item [or items, as the case may be] furnished by us to the Project named in the caption was [or were, as the case may be] started up, tested, and placed in operation by our authorized field representative on [enter the date on which the field representative performed the start-up, test, and placing into operation] and is [or are, as the case may be] operating properly:

[List the item or items furnished to the job. Show catalogue number or numbers.]

2. We certify further that the aforesaid equipment was installed in strict compliance with our recommendations as published by us in the following document [or documents, as the case may be]:

[Insert the date, name, or other positive means of identifying the exact document or documents in which the recommendations for installation and use of the item or items are published.] [Date Must be Shown]

3. A copy of the aforesaid document(s) is (are) attached hereto.

Certificate of Manufacturer

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

This __________________ day of________________, 20____

JOHN DOE CORPORATION

By:_________________________________ Authorized Representative [See Article 6.4.1.2.5]

Final Certification of Costs

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

INSTRUCTIONS TO PRODUCING AGENT: COMPLETE THE SHADED PORTIONS OF THIS CERTIFICATE AND RETURN TO THE

INSURED. NO CONDITION, TERM, QUALIFICATION, LIMITATION, EXCEPTION, EXEMPTION, MODIFICATION, OR PROVISO SHALL

APPEAR ON THE CERTIFICATE.

Certificate of Insurance

Name, Address and Telephone Number of Producing Agent

PROJECT NO.:

PROJECT NAME:

Name and Address of Insured Contractor (Contractor)

Certificate Holder(Owner):

Address

Type of Insurance

Policy No.

Company Affording

Coverage

Policy

Expiration Date

Limits

Commercial General Liability(1993 ISO Occurrence Form or its equivalent);

Includes XCU Coverage

General Aggregate

$2,000,000.00 (per project) Products-Co./Op Agg

$1,000,000.00 Personal & Adv injury

$1,000,000.00 Contractual

$1,000,000.00 Each Occurrence

$1,000,000.00

Commercial Business Automobile Liability Including, but not limited to, owned, hired and non-owned autos

Combined Single Limit

$1,000,000.00

OR

Bodily Injury $1,000,000.00

(per person)

Property Damage

Workers Compensation The Proprietor/Partners/ Executive Officers are included as required

W C Statutory Limits

Employers’ Liability

Each Accident

Disease – Policy Limit $1,000,000.00 Disease-Each Employee

Commercial Umbrella Liability

Each Occurrence

$2,000.000.00 Aggregate

$4,000,000.00

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

Builders Risk written on 2001 Cause of Loss-Special Form or its equivalent(See endorsement below)

OR

Installation Floater (for other than new construction)

The Undersigned has reviewed the insurance coverages required by the Contract Documents for the project referenced above and makes the following certifications which shall serve to bind the various insurance carriers to the coverages as required by the Contract Documents:

Such insurance as is herein certified (i) applies to all in connection with the work required by the provisions of the documents forming the , (ii) applies whether or not the Contract Documents between the insured contractor and the Owner have been executed, (iii) is written in accordance with the company’s regular policies and endorsements, subject to the company’s applicable manuals or rules and rates in effect, as modified by this certificate and the insurance article of the contract, (iv) have been issued to the insured named above, and (v) are in force at this time.

With the exception of the Workers Compensation policy, the Officers, Members, Agents, & Employees of the Owner and the State of Georgia are included as additional insureds as their interests may appear. Each Insurer is hereby notified that the statutory requirement that the Attorney General of Georgia shall represent and defend the Indemnities remains in full force and effect and is not waived by issuance of any policy of insurance.

The Builders Risk policy has been endorsed as follows: “The following may occur without diminishing, changing, altering or otherwise affecting the coverage and protection afforded the insured under this policy: (i) Furniture and equipment may be delivered to the insured premises and installed in place ready for use; and (ii) Partial or complete occupancy by Owner; and (iii) Performance of work in connection with construction operations insured by the Owner, by agents or lessees or other contractors of Owner, or by contractors or the lessee of the Owner.”

Each policy has been endorsed to provide that the policy shall not be canceled, changed, allowed to lapse, or allowed to expire for any reason, except for non-payment of premiums, until thirty (30) days after Owner has received written notice thereof as evidenced by return receipt of registered letter.

Authorized Representative: _____________________________________________________________________________ Date: ___________________

Typed Name: _____________________________________________________________________________

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

BOND TO DISCHARGE CLAIM

WHEREAS, _______________________________________________________ (hereinafter referred to as “Claimant” has filed a claim against _______________________________________________________________ (the Contractor, hereinafter referred to as “Principal”) on the following contract:

WHEREAS, the undersigned Principal and Surety dispute the Claimant’s entitlement to all or part of the claim and expressly reserve all rights and defenses available at law in connection therewith;

WHEREAS, ___________________________________________________________ as Principal and __________________________________________________ as Surety, desire to continue to receiving payments from the Owner for work done on the above referenced project, NOW THEREFORE, in consideration of these premises, the undersigned Principal and Surety do hold themselves firmly bond unto _______________________________________ as Claimant, in the total amount of _______________________________________ dollars ($_____________), representing double the amount of the claim.

The condition of this bond is such that should the undersigned Principal or Surety pay to the Claimant the sum that may be found to be due to the Claimant upon the trial of any action that may be filed by said Claimant, or if Principal or Surety pay to the Claimant a sum agreeable to Claimant and Claimant accepts such payment, then this Bond shall be void; otherwise to remain in full force and effect.

IN WITNESS WHEREOF, the said Principal and Surety have set their hands and seals this _____ day of ____________, 20___.

Principal by:_______________________________

Surety* by:_______________________________ Attorney-in-Fact Type Name Above

Non-Influence Affidavit- O.C.G.A. § 36-91-21

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

NON-INFLUENCE AFFIDAVIT – CONSTRUCTION

O.C.G.A. § 36-91-21

Excerpt from Georgia Laws OCGA Section 36-91-21

(d) Whenever a public works construction contract for any governmental entity subject to the requirements of this chapter is to be let out by competitive sealed bid or proposal, no person, by himself or herself or otherwise, shall prevent or attempt to prevent competition in such bidding or proposals by any means whatever. No person who desires to procure such work for himself or herself or for another shall prevent or endeavor to prevent anyone from making a bid or proposal therefore by any means whatever, nor shall such person so desiring the work cause or induce another to withdraw a bid or proposal for the work.

(e) Before commencing the work, any person who procures such public work by bidding or proposal shall make an oath in writing that he or she has not directly or indirectly violated subsection (d) of this Code section. The oath shall be filed by the officer whose duty it is to make the payment. If the contractor is a partnership, all of the partners and any officer, agent, or other person who may have represented or acted for them in bidding for or procuring the contract shall also make the oath. If the contractor is a corporation, all officers, agents, or other persons who may have acted for or represented the corporation in bidding for or procuring the contract shall make the oath. If such oath is false, the contract shall be void, and all sums paid by the governmental entity on the contract may be recovered by appropriate action.

STATE OF GEORGIA

COUNTY OF _______________________

I do solemnly swear on my oath that, as to the Contract dated _______________________, 20________, between

___________________________________________________ and The Board of Public Education for the City of Savannah and the County of Chatham, Georgia, I have not directly or indirectly influenced or the attempted exertion of any influence on behalf of the firm on behalf of which this affidavit is made, in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by or on any employee, officer, or agent of the Board, or any person connected with SCCPSS in any way whatsoever and I have not directly or indirectly violated subsection (d) of OCGA 36-91-21.

This ___________ day of _________________________, 20_____.

_______________________________________________________(L.S.)

Signature

Title

Firm

Sworn to and subscribed before me this _________day of _______, 2008

Notary Public

My Commission expires ____________________________________

This __________ day of ___________________________, 20 _____.

O.C.G.A. § 13-10-91 Contractor Affidavit

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

Contractor Affidavit Under O.C.G.A. § 13-10-9l(b)(l)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of the Savannah Chatham County Public School District (the “District”) has registered with and is authorized to use and actually uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established by O.C.G.A. § 13-10-

01. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Name of Public Employer

Name of Project

Name of Contractor

Federal Work Authorization User Identification

Number

Date of Authorization

I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on _________________, 201___ 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 ______________________, 201____.

NOTARY PUBLIC

My Commission Expires: ______________________________________

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

Georgia Department of Education Facilities Services Unit

Certificate of the Contractor or His Duly Authorized Representative

Reimbursement Request Number _______ Project Number(s)

Project Name

To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work and material shown on this Reimbursement Request Number __________________________ are correct and that all work has been performed and materials supplied in full accordance with the terms and conditions of the contract documents between the __________________________(Owner) and ___________________(Contractor); dated: _______________ and all authorized changes thereto; and that the following is a true and correct statement of the contract account up to and including the last day of the period covered by this estimate and that no part of the "amount due this estimate" has been received.

1. Original Contract Sum

$0.00

2. Net change by Change Orders

$0.00

3. Contract Sum to Date( I + 2)

$0.00

a. Total amount earned for work in place (original contract)

$0.00

b. Total amount earned for work in place (change orders)

$0.00

c. Value of materials stored at site

$0.00

d. Total amount earned (a plus b plus

$0.00

e. Amount retained (10%)

$0.00

f. Total earned less retained percentage (d minus e)

$0.00

g. Total previously approved

$0.00

h. Total due this request for contractor (f minus g)

$0.00

i. Amount due this request for architect

$0.00

j. Total amount requested (h plus i)

$0.00

I further certify that all claims outstanding against the undersigned contractor for labor, materials and expendable equipment employed in the performance of said contract have been paid in full in accordance with the requirements of said contract, except such outstanding claims as are listed below or on the attached sheet, which statement contains all claims against the contractor which are not yet paid, including all disputed claims and any claims to which the contractor has or will assert any defense.

I further certify that all the materials indicated on this Reimbursement Request as being stored on the site, but not yet incorporated into the building have been purchased, delivered and are now stored on the site for future incorporation into the building, and until so incorporated the title to same is, upon payment of this statement, vested in the owner. Furthermore, the undersigned contractor assumes full responsibility

SCCPSS PROJECT NO. ______

[INSERT PROJECT NAME HERE] Rev. 5/7/25

FORMS

for the existence, protection, and, if necessary replacement of the above mentioned materials until the completion of this contract.

Contractor/Construction Mgr. _____________________________________________ Date

By _____________________________________________(Signature) Title

Certificate of the Supervising Architect:

I certify that I have verified this Reimbursement Request and that to the best of my knowledge and belief it is a true and correct statement of work performed and materials supplied by the contractor and that the contractor's certified statement of this account and the amount due him is correct and just and that all work and materials in this Reimbursement Request have been performed in full accordance with the terms and conditions of the contract documents and authorized changes thereto.

Architect _____________________________________________________________ Date

By _____________________________________________(Signature) Title

DE Form 0263, Revised June 2010