2025_10_27 RFQAnnualEngineeringServices _ Oct.docx

Request for Qualifications Annual Consulting Services #2025-11-18 City of Social Circle P.O. Box 310 166 N. Cherokee Road Social Circle, Georgia 30025

(770) 464-2380 www.socialcirclega.gov Contents

· Section1:Introduction

· Summary

· Solicitation

· 2 Agreement Renewal

· Open Records

· Section 2: Consulting

· Services Description of Needs Capital Improvements Program

· Categories of Consulting Services

· Category A – Consulting Services

· Category B –Management Services

· Responsibilities of the City of Social Circle

· Section 3: Procurement Process

· Acknowledgement of RFQ•

· Communications

· Schedule

· Section 4: Submittal Requirements Submittal and Due Date

· Format

· Content

· Section 5: Evaluation and Selection 7 Evaluation Criteria

· Selection Process

· Section 6: Additional Required Content

· Forms 9

· Attachment A

· Attachment B

· Attachment C

Section 1: Introduction Summary The City of Social Circle (City) is seeking services from qualified consultants in the areas of engineering, planning, permitting, for natural gas, plan review and management. The goal of this RFQ is to develop an agreement with one (1) or more consulting firm to meet specific needs in project design services, construction services, plan review, and project management, for the natural gas department. We will strive to develop an agreement with a consultant offering expertise in the specified areas and disciplines before February 2, 2026. The agreement will be considered “on-call,” with task orders issued to the Consultant by the City for general and specific tasks, as well as an ongoing agreement for specific services. The agreement will be renewable as discussed later in this document.

Solicitation This Request for Qualifications for Consulting Services (the Project) invites Statements of Qualifications (SOQ), from consultants according to the requirements set forth in this RFQ, including the format and content guidelines specified. SOQs will be reviewed and evaluated by the City selection team and ranked in the order of most qualified using the criteria and process described herein.

Upon completion of the evaluation process, The City will contact all Respondents. Those scored as most qualified may be interviewed, or at the City’s election, the city may directly enter into discussions toward Project award(s). Based on projected needs, we may seek multiple awards.

Agreement Renewal Agreement(s) executed as a result of selection for “on-call” services will be for one (1) year beginning on or about the date of execution of a Notice of Award, and may be renewed up to four (4) successive, one-year periods, for a total of five (5) years, contingent upon the appropriation of funds by the City Council in the annual fiscal-year budget which runs from July 1 through June 30. Agreement(s) executed as a result of selection for “on-going” services will be for one (1) year beginning on or about the date of execution of a Notice of Award, and may be renewed up to four (4) successive, one-year periods, for a total of five (5) years, contingent upon the appropriation of funds by the City Council in the annual fiscal-year budget which runs from July 1 through June 30.Written notice shall be given approximately ninety (90) days before the expiration date of each agreement period.

Section 2: Consulting Services Description of Needs The city occasionally has needs for “on-call” services for planning, permitting, studies, survey, engineering, design, management, and construction phase services in support of Capital Improvement Programs and inhouse repair and maintenance projects, and technical assistance related to natural gas facilities and customers. Additionally, the City has needs for “on-going” services for review of development site plans specific to natural gas projects, proposed customers, and capacities.

Categories of Consulting Services Consultants may choose one or both of the following Categories for consideration. Our Consulting needs can be summarized into the following categories, task areas and sample subtasks:

Category A – On-call Consulting Services Category A broadly includes surveying, planning, engineering and permitting services.

Natural Gas

· Topographic and aerial surveys: Surveys stamped by a Georgia-registered land surveyor in

· Support of engineering and construction

· Ecological and environmental permitting: Biology, NEPA, USACOE, EPD activities Conceptual and preliminary engineering studies

· Writing technical memorandums

· Building and site architecture: Regulator and metering stations, project design and line

· sizing.

· Natural Gas infrastructure design (basic engineering, design, services during construction)

· DOT permitting

· GIS and asset management: Assist in development of GIS and asset management program

· Policy assistance: Develop and review system ordinances and update of standards

· Bid proposals, project management, design, and other tasks as needed.

· Conceptual and preliminary engineering studies

· Policy assistance: Develop and review system ordinances and update of standards Conceptual and preliminary engineering design

· Writing technical memorandums

· Project management and administration

· Right of way acquisition Owner Representative Services

· Owner’s Representative: Review alternatives and cost proposals from any Construction manager.

· Cost estimating: 3rd party assistance in evaluating proposed construction costs.

· Value engineering: 3rd party assistance in review of concepts and associated costs

· Bidding services

· Construction administration 3rd Party: Administration of project documentation.

· Construction observation 3rd Party: Onsite project representative, inspections.

Category B – Site Plan Review Services (on-going services) Category B broadly includes assistance in development plan review and provides technical assistance in the areas of natural gas.

Review of construction plan submittals

· To assist in reviewing construction plans for proposed in developments within the city. Provide comments on needed revisions to ensure conformance to City Ordinance, natural gas standards and specifications Attend pre-design meetings for proposed developments at the City’s request.

· Review of preliminary and final plat submissions

Responsibilities of City of Social Circle The City of Social Circle, through our assigned project manager(s), will administer the services and work cooperatively with the selected firms to fulfill our Owner responsibilities in a timely manner. We will facilitate the firm’s efficient performance of services. Our commitments include:

· Clearly outlining project requirements.

· Timely reviewing the work products and deliverables.

· Issuing timely responses to the Consultant.

· Furnishing existing studies, drawings, utility locates, plans, specifications, shop drawings, data, information and other documents to assist the consultant in their assigned Tasks.

· Funding the Project(s) and rendering timely compensation.

· Reimbursing fees for permitting, as needed. • Assisting in obtaining permits, as needed.

Section 3: Procurement Process

Acknowledgement of RFQ Each potential Respondent should acknowledge with an email no later than 4:00 p.m., December 19, 2025, that it has received the RFQ. Identify and provide full contact information for the firm’s primary point of contact for any future documents, notices, and addenda associated with this RFQ.

Communications The Owner Contact will act as the sole point of contact for this RFQ and will administer the RFQ process. All communications should be submitted in writing via email and specifically in reference to this RFQ. This RFQ is subject to revision after the date of issuance via written addenda. Any such addenda will be distributed directly to known Respondents via email. All questions and responses will be shared by addenda with all parties having acknowledged the RFQ. Please direct questions to the Owner Contact as follows:

Robbie Groves Public Works Director P.O. Box 310 166 N. Cherokee Road Social Circle, Georgia 30025 Phone: (770)464-6908 Email: rgroves@socialcirclega.gov

Please note that verbal communication with the Owner Contact or other individuals are not binding. With the exception of the Owner Contact or specified delegates, no contact with city staff, City administration, or any public official concerning the RFQ during the procurement process is allowed. Violation of this provision may result in disqualification of Respondent.

The Owner’s Contact may designate alternate contacts to address specific inquiries.

Schedule

The current procurement schedule is as follows:

· Issue RFQ – November 19, 2025

· Last date for RFI – November 19, 2025

· Last date for Addendum – December 8, 2025

· Submit SOQ – December 19, 2025

· Interviews (if required) – TBD

· Award and Agreement – TBD

· Notice to Proceed - TBD

Section 4: Submittal Requirements

Submittal and Due Date We request digital submittals. Based on Categories chosen by Respondent, submit two (2) hard copies and one (1) copy on USB flash drive of the SOQ(s) no later than December 19, 2025, at 10:00 a.m. local time, addressed to Robbie Groves.

Submit the SOQ to City Hall via UPS or Fed Ex to 166 North Cherokee Road, Social Circle, GA 30025. Hand delivery can be made at 166 N. Cherokee Road, Social Circle, GA 30025.

Submittal envelopes must be sealed labeled on the outside front with the Responding firm’s name, contact and address and reference this RFQ with the following: Annual Consulting Services RFQ – 2025. Each Respondent assumes full responsibility for timely submittal of its SOQ at the required location. The Respondent shall furnish and sign all information required by the RFQ. An authorized agent of the company must sign on behalf of the firm.

Format We value brevity. For either Category, A or B, please provide ten (10) pages or less (excluding resumes, project sheets and appendices), conveying the Respondent’s transmittal letter, qualifications, experience, and project management approach. An 11 X 17-inch sheet size may be used for a team chart or other exhibit and will count as 1 page.

If Respondent requests consideration in both Categories, then provide two (2) submittals.

All other items required or called for should be located in the appendices. Limit total page count to 60 or less,

8.5 X 11 inch equivalent, minimum 11 point font.

Content Letter of Interest Provide a 1-page Letter of Interest describing how the city will benefit with your firm as a trusted advisor. In the letter, please acknowledge receipt of any and all addenda.

Team and Qualifications

The ten (10) pages should demonstrate how your firm’s team, qualifications, and experience meet our needs as we embark on Natural Gas System projects.

Category Qualifications

Category A – On-Call Consulting Services: Respondents should possess and demonstrate a minimum of 10 years of firm / key team member experience in the natural gas arena for municipal, public or private agencies. Engineering Respondent’s key team members, including the Project Manager and Project Engineer(s), should be licensed Professional Engineers in the State of Georgia.

Respondents on non-engineering disciplines and professions should demonstrate similar career milestone credentials in their respective fields, such as SWS, AICP, etc.

Construction Phase Respondent’s offering key team members who possess Professional Engineer’s License in the State of Georgia and / or certifications including PMP from Project Management Institute and / or Construction Management Professional from the Construction Management Association or other milestone qualifications will be viewed favorably.

Consultants from non-construction disciplines should demonstrate similar professional credentials.

Category B – Site Plan Review Services (on-going services): Respondents should demonstrate a minimum of 10 years of firm / key team member experience, and the ability to provide technical assistance on the types of tasks listed in the RFQ related to natural gas arena for municipal, public or private agencies. Identify other municipal organizations for which these same services are provided, and a detailed project approach, outlining the method of operation used to complete services of this nature.

Experience The SOQ must describe the experience of the firm and Project team members on projects relevant to the Tasks described in the RFQ. The Respondent should include reference projects to demonstrate relevant experience.

Category A: Respondents should have a minimum of 10 years of progressive project experience in natural gas infrastructure projects. Within the past ten (10) years, category A Respondents should have successfully completed at least fifty (50) projects for municipal clients in the Southeastern United States. The Respondent should have completed at least twenty (20) similar or representative projects for municipal gas agencies in Georgia in the last 5 years.

Category B: Respondents should have a minimum of 10 years of progressive development plan review assistance for gas projects. Respondents should demonstrate a clear understanding of federal, state and local regulatory laws and ordinances, and any standards and specifications for construction for the City of Social Circle and State of Georgia.

Respondents considering one or both categories will highlight ten (10) relevant projects for the respective category.

Relevant Project sheets may be included in the Appendix. If both categories are contemplated, then a separate submittal should be made for each category.

Each project description shall contain the following information:

· Owner

· Owner contact information (including email address)

· Role of firm

· Contract value (if applicable)

· Year completed (if applicable)

· Description of the project demonstrating relevance to the City’s needs

· Key team members involved in the relevant projects, along with a concise description of the role and responsibilities of each.

Resumes Include resumes for key team members in the Appendix. Resumes should be 1-page maximum length.

Project Management Approach Consider this section as an opportunity to write persuasively about a documented success story. Include within the ten (10) pages, your firm’s approach for achieving outstanding results for a hypothetical (or real) assigned Task under this Project. Provide a real-life example(s) of where this approach has been successful.

Billing Rates Also in the Appendix, provide the firm’s hourly billing rate schedule, including the key personnel and others involved in the work. Billing rates should be expressed as labor grades comprising all disciplines to be offered. The schedule should include any billing multipliers to be assessed on expenses or sub-consultant charges. Key personnel are to be mapped to the billing rate schedule.

Provide a description of how the firm expects to be compensated (hourly with estimated maximum, lump sum, etc.) for various types of assignments. City of Social Circle may request services to be compensated on a lump sum basis (small designs, studies, etc.) in addition to tasks compensated on time and materials basis.

Open Records All materials submitted in connection with this RFQ will be public documents and subject to the Open Records Act and policies of the City. All such materials shall remain the property of City of Social Circle. If the Consultant has notified the Owner Contact that the Consultant’s submittal contains trade secrets, proprietary commercial or financial information, which is privileged and confidential, we will make every effort to protect those portions of the submittal. The title page and each page containing proprietary information must be marked.

Section 5: Evaluation and Selection Evaluation Criteria A selection team comprised of City staff with relevant knowledge and experience will evaluate and rank the responsive SOQs that best satisfy the City’s requirements. The selection team will apply the evaluation criteria below.

· Qualifications Experience – 20 points

· Project Management Approach Cost- 20 points

· Efficiency of Billing Rates local Vendor – 20 points

· Preference – 20 points

Selection Process

Submittals will be scored on a zero-to-point scale, and bonus points will be awarded to those firms who demonstrate a close working relationship from previous experience with the city. After evaluation and recommendations for selection, the city will notify Respondents. The top ranked Respondent(s) will be either selected for contract award or offered the opportunity to negotiate the final terms of the City’s Agreement for Professional Services. If the City determines that the top-ranked Respondent(s)’s proposed final terms are not advantageous to the City, the City may choose to either select or negotiate with the next highest ranked Respondent. Placement on the list of qualified on-call consultants does not constitute a commitment by the City to enter a contract with the consultant(s) and does not guarantee work. Contract award also does not guarantee work to the consultant(s). As appropriate, the City may conduct additional competitive processes within the pool of on-call consultants(s) as our purchasing policy dictates (e.g., soliciting bids or issue Requests for Proposals) prior to issuing task orders. The City reserves the right to solicit competitive bids and issue Requests for Proposals from outside parties through the competitive bid process as may be required by the City’s purchasing policy. The City reserves the right to reject all proposals received.

Request for Qualifications

Section 6:

Forms Additional Required Content

Include the items described in Attachment A and return them in the SOQ’s Appendix including:

· Firm’s comments, if any, on the proposed agreement for consulting services.

· Provide Sample Certificate of Insurance meeting requirements found in agreement.

Respondents are required to complete the forms in Attachment B and return them in SOQ including:

· Consultant’s Affidavit (E-Verify)

· SAVE Affidavit

· W-9

Attachment A

· Proposed Agreement for Engineering Services between Owner and Consultant

· Insurance Requirements (As described in the Agreement for Engineering Services)

STATE OF GEORGIA

COUNTY OF WALTON

AGREEMENT FOR ENGINEERING SERVICES

THIS AGREEMENT made and entered into by and between THE CITY OF SOCIAL CIRCLE organized and existing under the laws of the State of Georgia and authorized to do business in the State of Georgia (hereinafter referred to as OWNER), and __________________, a corporation organized and existing under the laws of the State of Georgia (hereinafter referred to as ENGINEER).

W I T N E S S E T H:

WHEREAS, the OWNER contracts with ENGINEER to provide engineering services for _______________________________ (the “Project”);

WHEREAS, ENGINEER desires to enter into this agreement and meet with the OWNER, as required, in order to implement the terms of this Agreement;

WHEREAS, the ENGINEER is staffed with professional engineers and other professionals, registered under the laws of the State of Georgia and is competent and certified in the development, drafting, planning, engineering, and creating of waterline extension projects;

NOW, THEREFORE, the OWNER and ENGINEER, in consideration of their mutual covenants herein, agree with respect to the performance of professional engineering and other services by the ENGINEER and payment for those services by the OWNER, as set forth below:

SECTION 1 – ENGINEER’S SERVICES

The ENGINEER shall provide planning, design, drafting and engineering services with regard to the Project of the OWNER as specifically set forth on the letter proposal attached hereto as Exhibit “A”; however, to the extent that there are terms in the attached Exhibit “A” that conflict with the terms herein, the terms herein shall control.

SECTION 2 – OWNER’S RESPONSIBILITIES

The OWNER’S responsibilities to the ENGINEER shall specifically include, but not be limited to, the following:

2.1 Provide full information as to its requirements for the Project;

2.2 Make available from its files any data and information pertinent to the Project;

2.3 Guarantee access to and make all provisions for the ENGINEER to enter upon public and private property as required for the ENGINEER to perform its services;

2.4 Furnish the ENGINEER, as required by the ENGINEER for performance of its services, data if available to the City such as land plans, property survey, topographic surveys, core borings, probings, subsurface investigations or explorations; inspection of materials and equipment; appropriate professional interpretations of all the foregoing; zoning and deed restrictions; fees, bonds, etc., required by government agencies for review of plans, applications, and documents; and other special data and consultants all of which the ENGINEER may rely upon in performing its services under the Agreement;

2.5 Examine all studies, reports, sketches, estimates, specifications, drawings, proposals, and other documents presented by the ENGINEER and render, in writing, decisions pertaining thereto within a reasonable time so as not to delay the services of the ENGINEER;

2.6 Designate, in writing, a person to act as OWNER’s Representative with respect to the work to be performed under this Agreement, and such person shall have complete authority to transmit instructions, receive information, interpret and define OWNER’s policies and decisions with respect to materials, equipment, elements, and systems pertinent to the services covered by this Agreement;

2.7 Give prompt written notice to the ENGINEER whenever OWNER observes or otherwise becomes aware of any defect in the Project or changed circumstances affecting the Project; and

2.8 Bear all costs incident to compliance with the requirements of this Section.

SECTION 3- PERIOD OF SERVICE

The services, as described herein, shall be commenced promptly upon authorization by the OWNER, and shall be completed in accordance with a schedule mutually agreed upon by OWNER’S representative and ENGINEER.

SECTION 4- PAYMENTS TO THE ENGINEER

4.1 FEES FOR PROFESSIONAL SERVICES

4.1.1 BASIC SERVICES

The OWNER shall pay the ENGINEER for the work required by this Agreement an amount not to exceed ________________________________ ($__________). ENGINEER shall be paid monthly for work completed and approved by the OWNER’S REPRESENTATIVE. Invoices shall be submitted to OWNER’S REPRESENTATIVE on or before the first of each month.

No action shall be taken and no additional services shall be authorized until written approval has been sent by the OWNER confirming the approval of official action recorded in the minutes of a meeting of the Mayor and Council demonstrating authorization of the approval of the additional services.

4.1.2 Notwithstanding any provision herein to the contrary, under no circumstances or conditions shall the OWNER be required to pay the ENGINEER sums in excess of _________________________________ ($__________) for the work described in this Agreement and any necessary appurtenant work performed thereto. Additional services must be approved by an official action of the Mayor and Council in writing.

4.1.3 ENGINEER shall provide the time for the Project on a lump sum basis. There shall be no additional services for engineering time without prior approval from the Mayor and Council.

4.1.4 The fee for professional services to ENGINEER shall include travel expenses to and from meetings with the OWNER and the proposed site and any other expenses incurred in performing the work required by this Agreement.

4.2 PAYMENT SCHEDULE

The ENGINEER will submit monthly invoices to the OWNER for services performed by the ENGINEER in connection with services authorized by the OWNER. The amounts of said invoices will be based upon the amount and value of the services performed by the ENGINEER under this Agreement.

The OWNER will pay the ENGINEER the full amount of the invoice within thirty (30) days of the date of invoice(s) submitted by the ENGINEER. If the OWNER fails to make payment to the ENGINEER within thirty (30) days after the date of invoice submitted by the ENGINEER, the ENGINEER reserves the right to suspend services under this Agreement until all such invoices are paid in full for the amounts then due. Interest will be charged at the rate of 3.5% per year on the unpaid principal amount due and payable for thirty (30) days or more.

SECTION 5- GENERAL CONDITIONS

5.1 INSURANCE

The ENGINEER will secure and maintain such insurance as will protect it from claims under workers’ compensation acts (including claims for damages because of bodily injury, sickness, disease or death of any of its employees) and from claims for damages because of injury or death of any other person; and from claims for damages because of injury to or destruction of tangible personal property, including loss of use resulting therefrom.

5.2 SUCCESSORS AND ASSIGNS

The ENGINEER and OWNER each binds itself and its successors, executors, administrators and assigns to the other party of this Agreement and to the successors, executors, administrators and assigns of such other party in respect to all covenants of this Agreement; except as above, neither the ENGINEER nor the OWNER will assign, sublet or transfer any interest in the Agreement without the consent of the other. Nothing herein shall be construed as giving any rights or benefits hereunder to anyone other than the ENGINEER and the OWNER.

5.3 TERMINATION

This Agreement may be terminated by the OWNER by ten (10) days’ written notice. Outstanding fees for any services performed by the ENGINEER up to and including date of termination shall be due and payable upon effective date of termination.

5.4 OWNERSHIP AND USE OF DOCUMENTS

All documents, including original drawings, estimates, specifications, field notes, and data are and remain the property of the OWNER as instruments of services. Upon termination of this Agreement, ENGINEER shall deliver all originals including computer data created and used in performing this project.

5.5 MODIFICATION

This Agreement constitutes the entire understanding between the OWNER and ENGINEER and may be modified only by a written instrument duly executed by the parties hereto.

5.6 STANDARDS OF PROCEDURE

All work shall be done in a workman-like manner. ENGINEER shall certify and seal all plans, profiles and approve all contract documents. This certification shall mean that the work has been performed in a workman-like manner and shall meet regulatory specifications and safety requirements by any supervising public entity and all engineering standards applicable to such a project. As used herein, the word “certify” shall mean an expression of the ENGINEER’s professional opinion to the best of its information, knowledge and belief, and does not constitute a warranty or guarantee by the ENGINEER.

5.6.1 The standard of care for all professional engineering and related services performed or furnished by ENGINEER under this Agreement will be the care and skill ordinarily used by members of ENGINEER's profession practicing under similar circumstances at the same time and in the same locality.

5.6.2 ENGINEER shall be responsible for the technical accuracy of its services and documents resulting therefrom, and OWNER shall not be responsible for discovery of deficiencies therein. ENGINEER shall correct such deficiencies without additional compensation, except to the extent such action is directly attributable to deficiencies in OWNER-furnished information.

5.6.3 ENGINEER shall perform or furnish services in all phases of the Project to which this Agreement applies. ENGINEER shall serve as OWNER's prime professional for this Project. ENGINEER may employ such ENGINEER's Consultants as ENGINEER deems necessary to assist in the performance or furnishing of the services. ENGINEER shall not be required to employ any ENGINEER's Consultant unacceptable to ENGINEER.

5.6.4 ENGINEER and OWNER shall comply with applicable laws, codes, regulations, and OWNER-mandated standards in effect as of the date of the execution of this Agreement.

5.6.5 OWNER shall make decisions and carry out its other responsibilities in a timely manner so as not to delay the services of ENGINEER.

5.6.6 ENGINEER shall not be required to sign any documents, no matter to whom requested, that would result in the ENGINEER having to certify, guarantee, or warrant the existence of conditions whose existence ENGINEER cannot ascertain. OWNER agrees not to make resolution of any dispute with ENGINEER contingent upon ENGINEER’s signing any such certification.

5.7 MISCELLANEOUS

5.7.1 This Agreement is governed by the laws of the State of Georgia.

5.7.2 Time is of the essence in this Agreement.

5.7.3 The OWNER employs the ENGINEER as an independent contractor and not as an employee or agent of the OWNER.

5.7.4 All disputes arising from this Agreement or the services to be provided hereunder shall be heard in the Superior Court of Walton County, Georgia. The parties hereto hereby waive any objections to jurisdiction or venue in the Superior Court of Walton County, Georgia.

IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as of the _____ day of ________________________, _________.

OWNER: CITY OF SOCIAL CIRCLE

, GEORGIA

By:

, Mayor

ENGINEER:

By:

, President

(Delete this page if Scope of Services is provided in the Task Order)

Project Summary: ___________________________________________________________________

Project Schedule: _____________________________________________________________________

See Attached Project Schedule

Commencement Date ______________________ or within 10 calendar days from Notice to Proceed.

Estimated Completion Date ____________________ or _________ months from Notice to Proceed.

EXHIBIT C -COMPENSATION

(Delete this page if Compensation is included in the Task Order)

Project Summary

Attachment B Mandatory Forms-The following forms must be completed and returned with the Respondent’s proposal in the SOQ’s Appendix:

· Consultant’s Affidavit (E-Verify)

· SAVE Affidavit

· W-9

Page - 21

CONSULTANTS AFFIDAVIT OF EMPLOYMENT ELIGIBILITY

Walton County

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 City of Social Circle has registered with, is authorized to use and 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 in O.C.G.A. §13-10-91. Furthermore, the undersigned Contractor will continue to use the Federal work authorization program throughout the contract period.

The undersigned further agrees that, should it employ or contract with any Subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Social Circle. Contractor will secure from such Subcontractor(s) similar verification of compliance with O.C.G.A. 13-10-91. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Social Circle at the time the Subcontractor(s) is retained to perform such service. Contractor hereby attests that its Federal work authorization user identification number and date of authorization are as follows:

E-Verify Company ID Number _______________________________

Date of Authorization _______________________________________

Name of Contractor ________________________________________

Name of Project ___________________________________________

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

Executed on the _________ day of _______________, 20_____ the city of ______________________

County of __________________, State of ______________________

Signature of authorized agent ___________________________________________________________

Printed name and title of authorized agent _________________________________________________

SUBSCRIBED AND SWORN BEFORE ME on this the _______ day of ______________, 20_______

Notary Public ____________________________________________

My Commission expires _____________________________________

SAVE AFFIDAVIT

Walton County

By executing this affidavit under oath, as an applicant for a public benefit, as referenced in O.C.G.A. §50-36-1, administered by the Georgia Department of Community Affairs, the undersigned applicant verifies one of the following with respect to my ability to enter a contract with the City of Social Circle:

1) I am a United States citizen.

OR

2) I am a legal permanent resident of the United States.

OR

3) I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act and lawfully present in the United States with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: ______________________________________________

The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. §50-36-1(f)(1), with this affidavit.

The secure and verifiable document provided with this affidavit can best be classified as: _____________________

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A §16- 10-20, and face criminal penalties as allowed by such criminal statute.

Executed this the ______ day of ______________, 20____ in the city of __________________, In the County of _________________, in the State of _________________

Signature of Applicant _____________________________ Printed name of Applicant __________________________

SUBSCRIBED AND SWORN BEFORE ME on this the _______ day of _______________, 20_______ Notary Public__________________________________

My Commission expires ______________________ image1.png image2.png image3.png image4.png image5.png