2-City of Hazlehurst 797991 Embankment Repairs RFB.pdf

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City of Hazlehurst - Embankment Repairs
Solicitation number
4830-797991
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Kentucky

About this file

This is a Request for Bids (RFB) issued by the City of Hazlehurst, Georgia, for road embankment and dirt road shoulder repairs at multiple locations within city limits. The project encompasses repairs at various sites identified in Appendix A of the RFB, with photographic documentation provided for reference. Sealed bids must be submitted through the DFS Procurement Portal no later than Monday, November 16, 2026, at 2:00 P.M. EST, with late submissions rejected. Bids will be publicly opened and read on the same date at 3:00 P.M. at Hazlehurst City Hall, located at 86 S Cromartie Street, Hazlehurst, Georgia 31539. Contract award is scheduled for the City Council meeting on Thursday, November 19, 2026, at 5:00 P.M. EST. The awarded contractor must complete all work within 60 days of contract award. Bids remain valid for 60 calendar days following the submission deadline. Questions must be submitted through the Portal, with inquiries submitted within 48 hours of the deadline receiving no response.

Bidders are required to submit a bid guarantee equal to 5% of the total bid price in the form of a bid bond, postal money order, certified check, cashier's check, or irrevocable letter of credit. The successful contractor must provide 100% performance and payment bonds before commencing work. Proof of general and professional liability insurance must be included with the bid submission. Hard copies of bids may be delivered to Hazlehurst City Hall, or soft copies uploaded to the DFS Procurement Portal. For Portal registration or technical assistance, bidders should contact procurement@erassist.com.

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CITY OF HAZLEHURST, GEORGIA

DR-4830 – PROJECT 797991 – City of Hazlehurst - Embankment Repairs

REQUEST FOR BIDS

The City of Hazlehurst, Georgia (“City”) is seeking sealed bids for road embankment and dirt road shoulder repairs at multiple locations within city limits. The type of work expected to be performed is the restoration of road embankment and the removal and replacement of dirt road shoulder.

BID SUBMISSION

Bids and all required documents must be submitted online to the DFS Procurement Portal (hereinafter “DFS Portal” or “Portal”) at dfs.bonfirehub.com no later than Monday, November 16, 2026 at 2:00 P.M., local time (EST).

Bids received after the due date and time will be considered non-responsive and will not be considered.

Bids will be publicly opened and read on Monday, November 16, 2026 at 3:00 P.M. at the Hazlehurst City Hall, 86 S Cromartie St, Hazlehurst, GA 31539. The award is scheduled to occur at the regularly scheduled City of Hazlehurst City Council meeting on Thursday, November 19, 2026 at 5:00 P.M., local time (EST), at Hazlehurst City Hall, 86 S Cromartie St, Hazlehurst, GA 31539.

Submission of any bid signifies the Contractor’s agreement that their bid and the content thereof, are valid for sixty (60) calendar days following the submission deadline and will become part of the contract that is negotiated between the City of Hazlehurst and the successful bidder.

All prices submitted with the bid shall remain in effect for the sixty (60) day period.

Bidders must provide insurance policies in the DFS Procurement Portal showing proof of general and professional liability coverage upon submission.

Bidders shall submit a bid guarantee in the amount of 5% percent of the total bid price, which shall be in the form of a firm commitment such as a bid bond, postal money order, certified check, cashier’s check, or irrevocable letter of credit. Bid guaranteed other than bid bonds will be returned (a) to unsuccessful bidders after the opening of bids; and (b) to the successful bidder upon execution of such further contractual documents (i.e., insurance coverage) and bonds as may be required by the bid. Hard copies shall be delivered to the Hazlehurst City Hall, 86 S Cromartie St, Hazlehurst, GA 31539 or a soft copy can be uploaded to the DFS Procurement Portal.

Questions regarding this RFB are to be submitted within the Portal at dfs.bonfirehub.com.

Answers will be provided within the Portal, and all answered questions will be made public within the Portal. Questions submitted outside of the Portal by email or phone will not be answered. Questions submitted within 48 hours of the submission deadline will not be

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 1 http://dfs.bonfirehub.com http://dfs.bonfirehub.com answered. For questions regarding Portal registration or navigation, please email:

procurement@erassist.com.

GENERAL TERMS & INFORMATION

● All requested information fields in the Portal must be filled out to be considered a valid bid.

● Work is expected to be completed within 60 days of contract award.

● Bidders must provide a Performance Bond and a Payment Bond for 100% of the contract work award amount prior to the start of work and the amounts shall be increased if the contract amount is increased.

● Work will follow all best construction practices. All work shall conform to the GA Department of Transportation’s 2021 Standard Specifications Construction of Transportation Systems, which can be found at:

https://www.dot.ga.gov/PartnerSmart/Business/Source/specs/2021StandardSpecifications.

pdf

● Invoices must include at least 4 Photos of “Before” and 4 Photos “After” work completion.

Photos must be taken with an app (such as Solocator or GPS Camera) that displays the GPS (and preferably road name) and date.

● If rock/aggregate or fill material is supplied as part of this work, the Invoice must list the quarry location of aggregate or the source location of the fill. If rock/aggregate is supplied from a third party, must provide documentation from the third party of the original location of the aggregate or fill. Third party documentation must be signed and submitted on third party letterhead. Fill/borrow material must come from pre-existing stockpiles, material reclaimed from the roadside ditch (without widening or deepening the ditch), or a commercial source that existed before the event. Any other source requires FEMA/Recipient notice and review before extraction. Borrow source documentation is required with the final invoice.

● Work will not be considered complete until all invoice documents are provided and invoice validation is complete. Final invoice with all required documents must be provided in a single transmission (email or link to a dropbox, google drive, or other file sharing service). Multi-part transmission of invoice documentation will cause a delay in validation which will affect payment processing timelines and designation of completion.

● Project locations and site photos are provided in Appendix A of this RFB.

● Contractor shall be responsible for all expenses incurred while performing services under this Agreement. This includes automobile, truck, and other travel expenses; vehicle maintenance and repair costs; vehicle and other license fees and permits; insurance premiums; road, fuel, and other taxes; fines; radio, pager, or cell phone expenses; meals;

and all salary, expenses, and other compensation paid to employees or contract personnel the Contractor hires to complete the work under this Agreement.

● The contractor will restore any landscaping, asphalt, concrete, etc. disturbed during construction to its original state or approved alternative. Any damage to the City’s property caused during construction will be repaired at the contractor’s expense.

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 2 mailto:procurement@erassist.com https://www.dot.ga.gov/PartnerSmart/Business/Source/specs/2021StandardSpecifications.pdf https://www.dot.ga.gov/PartnerSmart/Business/Source/specs/2021StandardSpecifications.pdf

● Contractors will be responsible for determining all requirements and permits needed to complete the reconstruction work and any associated components needed to ensure the proper, efficient, and safe completion of this project. The awarded contractor will also be responsible for obtaining any and all engineering approvals mandated and required by federal, state, or local codes or regulations. All permits, inspections, engineering approvals and associated requirements are the responsibility of the selected Contractor. Copies of required permits and approvals must be provided to the City upon receipt.

● This work is for a specific site/repair with quantities listed on a FEMA grant; as such documentation supporting the quantities must be provided (e.g. quarry tickets, or load counts/truck capacities). Invoices must list the haul off location of any debris, spoils, or waste (example: permitted landfill, recycling location, or road dept for reuse). All repairs are in-kind, restoring pre-disaster design, function, and capacity within the existing footprint.

● Payment will follow only after work is completed, all documentation is received from the Contractor and reconciled by the Grants Management Team, and after approval by the Mayor and City Council. (Documentation to include items such as before/after photos (always required), quarry documentation, quantity documentation, and documentation of disposal).

● Change Orders may be issued if changes to the Scope of Work are necessary in the performance of the awarded contract. No changes shall be made by the contractor without a change order signed by all parties.

● Successful bidders, assigns, and subcontractors must be compliant with all applicable Federal, State and Local laws.

● The City of Hazlehurst reserves the right to accept or reject any or all bids. The right is also reserved to waive any minor irregularities in this bid, and to award the bid to the bidder whose offer is most advantageous to the City and in the best interests of the City.

● The City is an Equal Opportunity Employer. All companies, including women, minority, and veteran owned businesses are encouraged to submit a bid.

● Work can not start until the contract agreement is fully executed and the contractor has made contact with the City of Hazlehurst to schedule work and work supervision/inspection.

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Appendix A - SCOPE OF WORK

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Repair Specifications and Location

Current Site Standard Photos

Walnut St – Site 2A

(31.865262, -82.593944)

1. Restore 6.6 CY of road embankment (10 ft x 6 ft x 6

ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil placement according to GA DOT Standards.

https://www.google.com/maps?q=31.865262,-82.593944

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 5

Current Site Standard Photos

Walnut St – Site 2B

(31.865396, -82.593846)

1. Restore 9.3 CY of road embankment (14 ft x 6 ft x 6

ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil https://www.google.com/maps?q=31.865396,-82.593846

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 6

Current Site Standard Photos

Walnut St – Site 2C

(31.865528, -82.593746)

1. Restore 14 CY of road embankment (21 ft x 6 ft x 6

ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil https://www.google.com/maps?q=31.865528,-82.593746

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 7

Current Site Standard Photos

Walnut St – Site 2D

(31.865574, -82.593674)

1. Restore 6 CY of road embankment (9 ft x 6 ft x 6 ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil https://www.google.com/maps?q=31.865574,-82.593674

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 8

Current Site Standard Photos

Walnut St – Site 2E

(31.865612, -82.593621)

1. Restore 7.3 CY of road embankment (11 ft x 6 ft x 6

ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil https://www.google.com/maps?q=31.865612,-82.593621

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 9

Current Site Standard Photos

Walnut St – Site 2F

(31.865647, -82.593564)

1. Restore 7.3 CY of road embankment (11 ft x 6 ft x 6

ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil https://www.google.com/maps?q=31.865647,-82.593564

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 10

Current Site Standard Photos

Walnut St – Site 2G

(31.865703, -82.593511)

1. Restore 6.7 CY of road embankment (10 ft x 6 ft x 6

ft) through the installation and compaction of base course drainage layers, utility bedding, and topsoil https://www.google.com/maps?q=31.865703,-82.593511

Current Site Standard Photos

Morris Street – Site 9 (31.859967, -82.57938)

1. Remove & replace 28.39 CY of dirt road shoulder (230 ft x 10 ft x 0.33 ft) including compacting and grading the road.

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 11 https://www.google.com/maps?q=31.859967,-82.57938

SAMPLE BID TABLE

All Bid Prices shall be entered into the Bid Table in the Portal. This list is provided for reference only.

Unit pricing shall be all-inclusive and include all labor, equipment, material, and supply costs and shall not be increased or changed for any reason other than changes requested or approved by the City.

Line item

Description of Line Item Unit of Measure Qty

1 Restore road embankment CY 57.2

2 Remove & replace dirt road shoulder CY 28.39

3 Mobilization/Demobilization and Traffic Control Lump Sum 1

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APPENDIX B

DFS Portal Confirmation and Declarations

The following forms are provided in this RFB for reference. Bidders must review each form and enter their response as directed in the Portal’s Required Information section.

The confirmation or declaration statement for each form for which a response is required is provided at the bottom of each form in this document.

All responses must be true and accurate and shall be considered the equivalent of a legally-binding electronic signature.

1. ATTACHMENT 1: Certification and Cost Proposal Form

2. ATTACHMENT 2: NON-COLLUSION DECLARATION

3. ATTACHMENT 3: CERTIFICATION REGARDING LOBBYING

4. ATTACHMENT 4: FORM 200.321 AFFIRMATIVE STEPS

5. ATTACHMENT 5: CERTIFICATION REGARDING DEBARMENT, SUSPENSION,

INELIGIBILITY and VOLUNTARY EXCLUSION

6. ATTACHMENT 6: CONFLICT/NON-CONFLICT OF INTEREST STATEMENT

7. ATTACHMENT 7: Drug-Free Workplace Affidavit

8. ATTACHMENT 8: INSURANCE COVERAGE DECLARATION

9. ATTACHMENT 9: SAMPLE Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

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ATTACHMENT 1: Certification and Cost Proposal Form

Bidding Certification: I have carefully examined the Request for Bids and any other documents accompanying or made a part of this Request for Bids.

I hereby propose to furnish the goods or services specified in the Request for Bids at the rates quoted in my Bid. I agree that my Bid will remain in effect for a period of up to sixty (60) days.

I agree to abide by all conditions of this Bid and understand that a background investigation may be conducted prior to award.

I certify that all information contained in this Bid is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this Bid on behalf of the Bidder as its act and deed and that the Bidder is ready, willing and able to perform if awarded the Contract.

I certify this Bid is made without prior understanding, agreement, connection, discussion, or collusion with any other person, firm or corporation submitting a Bid for the same product or service. I further certify that no officer, employee or agent of

City or of any other Bidder has a financial interest in this Bid. I further certify that the undersigned executed this Bidder's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so.

DFS Portal Confirmation / Declaration:

By completing and submitting the Bid Table in the Portal, you are certifying all of the above as well as the prices and data entered in the Bid Table in the DFS Portal. The Sample Bid Table previously provided in this RFB is for reference only.

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ATTACHMENT 2: NON-COLLUSION DECLARATION

The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder.

All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price of any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.

I declare under penalty of perjury under the applicable laws that the foregoing is true and correct.

Do you confirm that you have read the Non-Collusion declaration and therefore declare under penalty of perjury under the applicable laws that the Non-Collusion Declaration is true and correct? (Y/N)

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ATTACHMENT 3: CERTIFICATION REGARDING LOBBYING

The undersigned certifies that, to the best of his or her knowledge and belief, that:

1. No Federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instruction.

3. The undersigned shall require that the language of this certification be included in the award document for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31 U.S.

Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Contractor certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees the provisions of 31 U.S.C. Chap 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.

Do you, the Contractor, confirm that you have read the Certification Regarding Lobbying form and certify or affirm the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative

Remedies for False Claims and Statements, apply to this certification and disclosure, if any. (True/False)

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 16

ATTACHMENT 4: FORM 200.321 AFFIRMATIVE STEPS

CONTRACTING WITH SMALL AND MINORITY BUSINESSES, WOMEN’S BUSINESS

ENTERPRISES, AND LABOR SURPLUS AREA FIRMS 2 CFR §200.321

The City of Hazlehurst is required to take all necessary affirmative steps to assure that minority businesses, women's business enterprises, and labor surplus area firms are used when possible. If contractors (including engineers) use subcontractors, they are required to take the following affirmative steps:

● Place qualified enterprises on solicitation lists

● Assure that enterprises are solicited whenever they are potential sources

● Divide total requirements when economically feasible into smaller tasks or quantities to permit maximum participation by enterprises

● Establish delivery schedules, where the requirement permits, which encourage participation by enterprises

● Use the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce

Do you confirm that you have read the 200.321 Affirmative Steps Confirmation and agree to take the listed affirmative steps when using subcontractors. (Y/N)

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 17

ATTACHMENT 5: CERTIFICATION REGARDING DEBARMENT, SUSPENSION,

INELIGIBILITY and VOLUNTARY EXCLUSION

Neither the entity or its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency.

Do you confirm that neither the entity nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency? (Y/N)

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 18

ATTACHMENT 6: CONFLICT/NON-CONFLICT OF INTEREST STATEMENT

To the best of our knowledge the bidder has no potential conflict of interest due to any other clients, contracts, or property interest for this project. [ SELECT YES IF TRUE ]

OR

The bidder, by attachment, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project. [ SELECT NO IF TRUE &

UPLOAD DOCUMENTATION ]

Failure to answer appropriately may result in disqualification of your bid.

Do you confirm that to the best of your knowledge the undersigned proposer has no potential conflict of interest due to any other clients, contracts, or property interest for this project? (Y/N)

If answered no, documentation must be uploaded containing information regarding what may be a potential conflict of interest due to other clients, contracts, or property interest for this project.

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 19

ATTACHMENT 7: Drug-Free Workplace Affidavit

The undersigned certifies that the responding firm has taken steps to :

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are proposed, a copy of the drug- free workplace statement.

4. In the statement specified in drug-free workplace statement, notify the employees that as a condition of working on the commodities or contractual services that are under bid the employee will abide by the terms of the statement and will notify the employer of any conviction of or plea of guilty or nolo contendere to any violation of any controlled substance law of the United States or any state for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community by any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

Do you confirm that you have read the Drug-Free Workplace Affidavit and certify that the responding company complies fully with the listed requirements? (Y/N)

If answered Yes, please upload Drug-free workplace policy

DR4830 Hazlehurst PROJECT 797991 Embankment Repairs Page 20

ATTACHMENT 8: INSURANCE COVERAGE DECLARATION

Contractor shall attach the following insurance policies (including all endorsements) to this proposal. Failure to do so, may result in a rejected Bid.

1. Commercial General Liability – in the amount of two million dollars ($2,000,000.00) aggregate/one million dollars ($1,000,000.00) per occurrence. The General Aggregate limit shall either apply separately to the resulting Contractor or shall be at least twice the required occurrence limit.

2. Comprehensive Automobile and Water Vehicle Liability – covering any automotive equipment to be used in performance of the service, with a minimum limit in the amount of One Million Dollars ($1,000,000.00) per occurrence combined single limit / any auto.

Physical Damage Insurance covering owned or rented machinery, tools, equipment, office trailers, and vehicles.

3. Worker’s Compensation – Proposer shall provide a policy with employer’s liability coverage with limits of not less than One Million Dollars ($1,000,000.00) per occurrence for each accident or illness. The Worker’s Compensation policy shall state that it cannot be canceled or materially changed without first giving thirty (30) days prior notice thereof in writing to the City. Firms that have owner/operators that have filed a “Notice of Election to be Exempt” shall supply a signed copy of said notice. Any such exemption shall meet the requirements that qualify for an exemption under the applicable Worker’s Compensation law.

Do you confirm that you have read the Insurance Coverage Declaration and have provided copies of the insurance policies. (Y/N)

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ATTACHMENT 9: SAMPLE Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

The undersigned contractor ("Contractor") executes this Affidavit to comply with O.C.G.A § 13-10-91 related to any contract to which Contractor is a party 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 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;

e) The Contractor will contract for the 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(a), (b), and (c);

f) The Contractor acknowledges and agrees that this Affidavit shall be incorporated into any contract(s) subject to the provisions of O.C.G.A. § 13-10-91 for the project listed below to which Contractor is a party after the date hereof without further action or consent by Contractor; and

g) Contractor acknowledges its responsibility to submit copies of any affidavits, drivers' licenses, and identification cards required pursuant to O.C.G.A. § 13-10-91 to the public employer within five business days of receipt.

Federal Work Authorization User Identification Number Date of Authorization

Name of Contractor Name of Project

Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _________, _____, 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: ______________

Bidders must upload a signed, notarized Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1), or the bid may not be considered. The official form is available for download in the Files section of the Portal.

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Appendix A - SCOPE OF WORK
ATTACHMENT 1: Certification and Cost Proposal Form
ATTACHMENT 2: NON-COLLUSION DECLARATION
ATTACHMENT 3: CERTIFICATION REGARDING LOBBYING
ATTACHMENT 7: Drug-Free Workplace Affidavit
ATTACHMENT 8: INSURANCE COVERAGE DECLARATION
ATTACHMENT 9: SAMPLE Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

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