210166_PTC SR 141 Gateway Enhancements_Addend.pdf

PDF 6 MB Posted Sep 18, 2023

Attached to: PTC 21-01 SR 141 Gateway Enhancements
Solicitation number: PE-66790-NONST-2024-000000001
Issued by: Crisp County, Georgia

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Written by GovTribe AI · Aug 26, 2024

This document is an Addendum to the contract documents for the SR 141 Gateway Enhancements project in Peachtree Corners, Georgia. The addendum modifies the Index to Drawings and Bid Form for the project, which has a bid due date of October 18, 2023. Key changes include the addition of an Electrical Series to both the Peachtree Industrial Blvd and Medlock Bridge Rd sites, as well as the addition of numerous new bid items related to lighting fixtures, cables, controls, and conduits. The addendum also replaces several drawings for the two sites.

The Bid Form provides unit price bid items for the work, which includes demolition, grading, landscape materials, lighting fixtures, and electrical components for the two project sites. The total bid price will be based on the unit prices provided and the estimated quantities listed. Bidders must provide required bid security, subcontractor/supplier lists, licensing information, and other supporting documentation with their bids.

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ADDENDUM NO. 1 AD1-1

ADDENDUM NO. 1

CONTRACT DOCUMENTS

SR 141 GATEWAY ENHANCEMENTS

PEACHTREE CORNERS, GEORGIA

BIDS DUE OCTOBER 18, 2023

The following modifications are hereby introduced as a part of the Contract Documents:

1. Delete Specification 000115 – Index to Drawings dated 09/18/23, and replace with the revised, attached Index to Drawings dated 10/04/23. The index now reflects the addition of an Electrical Series to both the Peachtree Industrial Blvd. and Medlock Bridge Rd.

sites. See Items #3, #4, #5, and #6 for additional information.

2. Delete Specification 004100 – Bid Form dated 09/18/23, and replace with the revised, attached Bid Form dated 10/04/23. The following changes were made:

A. Peachtree Industrial Blvd. – Item No. 25 – “FIXTURE A – SEE LIGHTING

SCHEDULE” has been added.

B. Peachtree Industrial Blvd. – Item No. 26 – “FIXTURE B – SEE LIGHTING

SCHEDULE” has been added.

C. Peachtree Industrial Blvd. – Item No. 27 – “FIXTURE C – SEE LIGHTING

SCHEDULE” has been added.

D. Peachtree Industrial Blvd. – Item No. 28 – “CABLE, TP XHHW, AWG NO. 12” has been added.

E. Peachtree Industrial Blvd. – Item No. 29 – “CABLE, TP XHHW, AWG NO. 8” has been added.

F. Peachtree Industrial Blvd. – Item No. 30 – “CONTROLS COMPLETE” has been added.

G. Peachtree Industrial Blvd. – Item No. 31 – “ELECTRICAL SERVICE POINT” has been added.

H. Peachtree Industrial Blvd. – Item No. 32 – “CONDUIT, NONMETAL, TP 2, 3/4 IN” has been added.

I. Peachtree Industrial Blvd. – Item No. 33 – “CONDUIT, NONMETAL, TP 2, 1 IN” has been added.

J. Peachtree Industrial Blvd. – Item No. 34 – “ELECTRICAL JUNCTION BOX, REINFORCED PLASTIC MORTAR” has been added.

K. Medlock Bridge Rd. – Item No. 34 – “FIXTURE A – SEE LIGHTING FIXTURE

SCHEDULE” has been added.

L. Medlock Bridge Rd. – Item No. 35 – “FIXTURE B – SEE LIGHTING FIXTURE

SCHEDULE” has been added.

M. Medlock Bridge Rd. – Item No. 36 – “FIXTURE C1 – SEE LIGHTING

FIXTURE SCHEDULE” has been added.

N. Medlock Bridge Rd. – Item No. 37 – “FIXTURE C2 – SEE LIGHTING

FIXTURE SCHEDULE” has been added.

ADDENDUM NO. 1 AD1-2

O. Medlock Bridge Rd. – Item No. 38 – “CABLE, TP XHHW, AWG NO. 12” has been added.

P. Medlock Bridge Rd. – Item No. 39 – “CABLE, TP XHHW, AWG NO. 8” has been added.

Q. Medlock Bridge Rd. – Item No. 40 – “CABLE, TP XHHW, AWG NO. 2” has been added.

R. Medlock Bridge Rd. – Item No. 41 – “CONTROLS COMPLETE” has been added.

S. Medlock Bridge Rd. – Item No. 42 – “NON-FUSED DISCONNECT SWITCH” has been added/

T. Medlock Bridge Rd. – Item No. 43 – “ELECTRICAL SERVICE POINT” has been added.

U. Medlock Bridge Rd. – Item No. 44 – “CONDUIT, NONMETAL, TP 2, 3/4 IN” has been added.

V. Medlock Bridge Rd. – Item No. 45 – “CONDUIT, NONMETAL, TP 2, 1 1/2 IN” has been added.

W. Medlock Bridge Rd. – Item No. 46 – “ELECTRICAL JUNCTION BOX, REINFORCED PLASTIC MORTAR” has been added.

3. Peachtree Industrial Blvd – Remove Sheet V-1 dated 09/18/23, and replace with the revised, attached V-1 dated 10/04/23.

4. Peachtree Industrial Blvd – Sheets E-1.0 and E-1.1 have been added to the set.

5. Medlock Bridge Rd – Remove Sheet V-1 dated 09/18/23, and replace with the revised, attached V-1 dated 10/04/23.

6. Medlock Bridge Rd – Sheets E-1.0, E-1.1, E-1.2, and E-1.3 have been added to the set.

Addendum Prepared By

KECK & WOOD, INC.

October 04, 2023

SR 141 GATEWAY ENHANCEMENTS – PEACHTREE CORNERS, GA 10/04/23

INDEX TO DRAWINGS 000115-1

SECTION 000115 - INDEX TO DRAWINGS

SR141 GATEWAY ENHANCEMENTS – PEACHTREE INDUSTRIAL BLVD.

SHEET DRAWING REVISION

NO. TITLE NUMBER DATE

1 COVER SHEET V-1 10/04/23

2 GENERAL NOTES G-1 9/18/23

3 DEMOLITION PLAN C-1.0 9/18/23

4 SITE & GRADING PLAN C-2.0 9/18/23

5 CONSTRUCTION DETAILS C-3.0 9/18/23

6 LANDSCAPE PLAN L-1.0 9/18/23

7 LANDSCAPE DETAILS L-2.0 9/18/23

8 LANDSCAPE DETAILS L-2.1 9/18/23

9 LANDSCAPE DETAILS L-2.2 9/18/23

10 EROSION CONTROL NOTES EC-0.1 9/18/23

11 EROSION CONTROL NOTES EC-0.2 9/18/23

12 EROSION CONTROL NOTES EC-0.3 9/18/23

13 EROSION CONTROL PLAN EC-1.0 9/18/23

14 EROSION CONTROL PLAN EC-2.0 9/18/23

15 EROSION CONTROL PLAN EC-3.0 9/18/23

16 EROSION CONTROL DETAILS EC-4.0 9/18/23

17 ELECTRICAL PLAN E-1.0 10/04/23

18 ELECTRICAL DETAILS E-1.1 10/04/23

SR141 GATEWAY ENHANCEMENTS – MEDLOCK BRIDGE RD.

SHEET DRAWING REVISION

NO. TITLE NUMBER DATE

1 COVER SHEET V-1 10/04/23

2 GENERAL NOTES G-1 9/18/23

3 DEMOLITION PLAN C-1.0 9/18/23

4 DEMOLITION PLAN C-1.1 9/18/23

5 DEMOLITION PLAN C-1.2 9/18/23

6 SITE & GRADING PLAN C-2.0 9/18/23

7 SITE & GRADING PLAN C-2.1 9/18/23

8 SITE & GRADING PLAN C-2.2 9/18/23

9 CONSTRUCTION DETAILS C-3.1 9/18/23

10 CONSTRUCTION DETAILS C-3.2 9/18/23

11 LANDSCAPE PLAN L-1.0 9/18/23

12 LANDSCAPE PLAN L-1.1 9/18/23

13 LANDSCAPE PLAN L-1.2 9/18/23

14 LANDSCAPE DETAILS L-2.1 9/18/23

15 LANDSCAPE DETAILS L-2.2 9/18/23

16 LANDSCAPE DETAILS L-2.3 9/18/23

17 EROSION CONTROL PLAN EC-1.0 9/18/23

18 EROSION CONTROL PLAN EC-1.1 9/18/23

19 EROSION CONTROL PLAN EC-1.2 9/18/23

20 EROSION CONTROL DETAILS EC-2.1 9/18/23

21 ELECTRICAL PLAN E-1.0 10/04/23

22 ELECTRICAL PLAN E-1.1 10/04/23

23 ELECTRICAL PLAN E-1.2 10/04/23

24 ELECTRICAL DETAILS E-1.3 10/04/23

END SECTION 000115

EJCDC® C-410, Bid Form for Construction Contracts.

BID FORM

SR141 GATEWAY ENHANCEMENTS

PEACHTREE CORNERS, GEORGIA

PROJECT NO. 210166

TABLE OF CONTENTS

Page

ARTICLE 1 – Bid Recipient

ARTICLE 2 – Bidder’s Acknowledgements

ARTICLE 3 – Bidder’s Representations

ARTICLE 4 – Bidder’s Certification

ARTICLE 5 – Basis of Bid

ARTICLE 6 – Time of Completion

ARTICLE 7 – Attachments to this Bid

ARTICLE 8 – Defined Terms

ARTICLE 9 – Bid Submittal

ARTICLE 1 – BID RECIPIENT

1.01 This Bid is submitted to:

CITY OF PEACHTREE CORNERS, GEORGIA

1.02 The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with Owner in the form included in the Bidding Documents to perform all Work as specified or indicated in the Bidding Documents for the prices and within the times indicated in this Bid and in accordance with the other terms and conditions of the Bidding Documents.

ARTICLE 2 – BIDDER’S ACKNOWLEDGEMENTS

2.01 Bidder accepts all of the terms and conditions of the Instructions to Bidders, including without limitation those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for 60 days after the Bid opening, or for such longer period of time that Bidder may agree to in writing upon request of Owner.

ARTICLE 3 – BIDDER’S REPRESENTATIONS

3.01 In submitting this Bid, Bidder represents that:

A. Bidder has examined and carefully studied the Bidding Documents, and any data and reference items identified in the Bidding Documents, and hereby acknowledges receipt of the following

Addenda:

Addendum No. Addendum Date

B. Bidder has visited the Site, conducted a thorough, alert visual examination of the Site and adjacent areas, and become familiar with and satisfied itself as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work.

C. Bidder is familiar with and has satisfied itself as to all Laws and Regulations that may affect cost, progress, and performance of the Work.

D. Bidder has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or adjacent to the Site and all drawings of physical conditions relating to existing surface or subsurface structures at the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings.

E. Bidder has considered the information known to Bidder itself; information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Bidding Documents; and any Site-related reports and drawings identified in the Bidding Documents, with respect to the effect of such information, observations, and documents on (1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by

Bidder; and (3) Bidder’s safety precautions and programs.

F. Bidder agrees, based on the information and observations referred to in the preceding paragraph, that no further examinations, investigations, explorations, tests, studies, or data are

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 004100-3 necessary for the determination of this Bid for performance of the Work at the price bid and within the times required, and in accordance with the other terms and conditions of the Bidding

Documents.

G. Bidder is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Bidding Documents.

H. Bidder has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Bidder has discovered in the Bidding Documents, and confirms that the written resolution thereof by Engineer is acceptable to Bidder.

I. The Bidding Documents are generally sufficient to indicate and convey understanding of all terms and conditions for the performance and furnishing of the Work.

J. The submission of this Bid constitutes an incontrovertible representation by Bidder that Bidder has complied with every requirement of this Article, and that without exception the Bid and all prices in the Bid are premised upon performing and furnishing the Work required by the

Bidding Documents.

ARTICLE 4 – BIDDER’S CERTIFICATION

4.01 Bidder certifies that:

A. This Bid is genuine and not made in the interest of or on behalf of any undisclosed individual or entity and is not submitted in conformity with any collusive agreement or rules of any group, association, organization, or corporation;

B. Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid;

C. Bidder has not solicited or induced any individual or entity to refrain from bidding; and

D. Bidder has not engaged in corrupt, fraudulent, collusive, or coercive practices in competing for the Contract. For the purposes of this Paragraph 4.01.D:

1. “corrupt practice” means the offering, giving, receiving, or soliciting of anything of value likely to influence the action of a public official in the bidding process;

2. “fraudulent practice” means an intentional misrepresentation of facts made (a) to influence the bidding process to the detriment of Owner, (b) to establish bid prices at artificial non-competitive levels, or (c) to deprive Owner of the benefits of free and open competition;

3. “collusive practice” means a scheme or arrangement between two or more Bidders, with or without the knowledge of Owner, a purpose of which is to establish bid prices at artificial, non-competitive levels; and

4. “coercive practice” means harming or threatening to harm, directly or indirectly, persons or their property to influence their participation in the bidding process or affect the e execution of the Contract.

ARTICLE 5 – BASIS OF BID

5.01 Bidder will complete the Work in accordance with the Contract Documents for the following price(s):

FORMAT FOR UNIT PRICE BID

SITE 1: PEACHTREE INDUSTRIAL BLVD.

Item

No.

Description Unit

Estimated

Quantity

Bid Unit

Price Bid Price

DEMOLITION, MOBILIZATION

& GRADING COMPLETE

LS 1

DESIGN-BUILD: MONUMENT

WALL & SIGNAGE

LS 1

3 RIVER STONE CHANNEL SF 1,350

DECORATIVE LANDSCAPE

BOULDER

EA 6

A. BUERGERANIUM / TRIDENT

MAPLE

EA 5

C. CANDENSIS / EASTERN

REDBUD

EA 21

C. JAPONICA / JAPANESE

CRYPTOMERIA

EA 5

MAGNOLIA GRANDIFLORA

‘LITTLE GEM’ / LITTLE GEM

MAGNOLIA

EA 7

T. DISTICHUM / BALD

CYPRESS

EA 10

10 Q. IYRATA / OVERCUP OAK EA 6

Q. SHUMARDII / SHUMARD

OAK

EA 4

12 Q. TEXANA/NUTTALL OAK EA 2

IIEX CORNUTA ‘BURFORDII

NANA’ / DWARF BURFORD

HOLLY

EA 136

L. CHINENSE VAR. RUBRUM

‘DARUMA’ / DARUMA

LOROPETALUM

EA 136

S. JAPONICA ‘CANDY CORN’ /

DOUBLE PLAY CANDY CORN

SPIREA

EA 64

C. HORIZONTALIS / ROCK

SPRAY COTONEASTER

EA 94

H. X ‘STELLA DE ORO’ /

STELLA DE ORO DAYLILY

EA 311

J. CONFERTA ‘BLUE PACIFIC’ /

BLUE PACIFIC JUNIPER

EA 299

L. ‘CHAPEL HILL YELLOW’ /

CHAPEL HILL YELLOW

LANTANA

EA 220

M. CAPILLARIS / PINK MUHLY

GRASS

EA 152

Item

No.

Description Unit

Estimated

Quantity

Bid Unit

Price Bid Price

P. VIRGATUM ‘SHENANDOAH’

/ SHENANDOAH

SWITCHGRASS

EA 136

22 ANNUAL BED SF 460

LONG-LEAF PINESTRAW

MULCH

SF 12,000

24 TIFTUF BERMUDA SOD SF 50,000

FIXTURE A – SEE LIGHTING

FIXTURE SCHEDULE

EA 1

FIXTURE B – SEE LIGHTING

FIXTURE SCHEDULE

EA 1

FIXTURE C – SEE LIGHTING

FIXTURE SCHEDULE

EA 6

28 CABLE, TP XHHW, AWG NO. 12 LF 1,100

29 CABLE, TP XHHW, AWG NO. 8 LF 120

30 CONTROLS COMPLETE EA 1

31 ELECTRICAL SERVICE POINT EA 1

CONDUIT, NONMETAL, TP 2,

3/4 IN

LF 300

CONDUIT, NONMETAL, TP 2,

1 IN

LF 20

ELECTRICAL JUNCTION BOX,

REINFORCED PLASTIC

MORTAR

EA 2

SITE 2: MEDLOCK BRIDGE RD.

MOBILIZATION, DEMOLITION,

& GRADING COMPLETE

LS 1

DESIGN-BUILD: MONUMENT

TOWER

EA 2

DESIGN-BUILD: MONUMENT

WALL - SOUTH

LS 1

DESIGN BUILD: MONUMENT

WALL W/ SIGNAGE - NORTH

LS 1

DESIGN – BUILD: LANDSCAPE

IRRIGATION

LS 1

DECORATIVE LANDSCAPE

BOULDER

EA 22

A. BUERGERANIUM / TRIDENT

MAPLE

EA 10

A. RUBRUM / RED MAPLE

EA 10

Item

No.

Description Unit

Estimated

Quantity

Bid Unit

Price Bid Price

A. GRANDIFLORA 'AUTUMN

BRILLIANCE' / AUTUMN

BRILLIANCE SERVICEBERRY

EA 7

CERCIS CANDENSIS /

EASTERN REDBUD

EA 7

CORNUS KOUSA VAR.

CHINENSIS / CHINESE

DOGWOOD

EA 5

MAGNOLIA GRANDIFLORA

‘LITTLE GEM’ / LITTLE GEM

MAGNOLIA

EA 8

T. DISTICHUM / BALD

CYPRESS

EA 3

14 Q. LYRATA / OVERCUP OAK EA 9

Q. SHUMARDII / SHUMARD

OAK

EA 9

16 Q. TEXANA / NUTTALL OAK EA 9

C. AMERICANA / AMERICAN

BEAUTYBERRY

EA 29

IIEX CORNUTA ‘BURFORDII

NANA’ / DWARF BURFORD

HOLLY

EA 19

ITEA VIRGINICA ‘HENRY’S

GARNET’

EA 25

L. CHINENSE VAR. RUBRUM

‘DARUMA’ / DARUMA

LOROPETALUM

EA 18

L. CHINENSE VAR. RUBRUM

‘PEACK’ / PURPLE PIXIE

LOROPETALUM

EA 17

H. X ‘STELLA DE ORO’ /

STELLA DE ORO DAYLILY

EA 254

IRIS VIRGINICA / SOUTHERN

BLUE FLAG IRIS

EA 52

CONFERTA ‘BLUE PACIFIC’ /

BLUE PACIFIC JUNIPER

JUNIPERUS

EA 58

LANTANA ‘CHAPEL HILL

YELLOW’ / CHAPEL HILL

YELLOW LANTANA

EA 323

Item

No.

Description Unit

Estimated

Quantity

Bid Unit

Price Bid Price

R. HIRTA / BLACK-EYED

SUSAN

EA 40

R. COLORATA / WHITE TOP

SEDGE

EA 168

M. CAPILLARIS / PINK MUHLY

GRASS

EA 34

ANNUAL BED

SF 360

LONG-LEAF PINESTRAW

MULCH

SF 26,300

SHREDDED CYPRESS MULCH

SF 1,000

TENNESSEE RIVER STONE

MULCH

SF 2,850

TIFTUF BERMUDA SOD

SF 50,750

FIXTURE A – SEE LIGHTING

FIXTURE SCHEDULE

EA 8

FIXTURE B – SEE LIGHTING

FIXTURE SCHEDULE

EA 2

FIXTURE C1 – SEE LIGHTING

FIXTURE SCHEDULE

EA 27

FIXTURE C2 – SEE LIGHTING

FIXTURE SCHEDULE

EA 6

38 CABLE, TP XHHW, AWG NO. 12 LF 3,300

39 CABLE, TP XHHW, AWG NO. 8 LF 2,220

40 CABLE, TP XHHW, AWG NO. 2 LF 2,200

41 CONTROLS COMPLETE EA 1

NON-FUSED DISCONNECT

SWITCH

EA 2

43 ELECTRICAL SERVICE POINT EA 1

CONDUIT, NONMETAL, TP 2,

3/4 IN

LF 1,240

CONDUIT, NONMETAL, TP 2,

1 1/2 IN

LF 700

ELECTRICAL JUNCTION BOX,

REINFORCED PLASTIC

MORTAR

EA 6

Item

No.

Description Unit

Estimated

Quantity

Bid Unit

Price Bid Price

Total of All Unit Price Bid Items

Bidder acknowledges that (1) each Bid Unit Price includes an amount considered by Bidder to be adequate to cover Contractor’s overhead and profit for each separately identified item, and (2) estimated quantities are not guaranteed, and are solely for the purpose of comparison of Bids, and final payment for all unit price Bid items will be based on actual quantities, determined as provided in the Contract Documents.

ARTICLE 6 – TIME OF COMPLETION

6.01 Bidder agrees that the Work will be substantially complete and will be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions on or before the dates or within the number of calendar days indicated in the Agreement.

6.02 Bidder accepts the provisions of the Agreement as to liquidated damages.

ARTICLE 7 – ATTACHMENTS TO THIS BID

7.01 The following documents are submitted with and made a condition of this Bid:

A. Required Bid security;

B. List of Proposed Subcontractors;

C. List of Proposed Suppliers;

D. List of Project References;

E. Evidence of authority to do business in the state of the Project; or a written covenant to obtain such license within the time for acceptance of Bids;

F. Contractor’s License No. or GDOT Prequalification No.: __________ [or] Evidence of

Bidder’s ability to obtain a State Contractor’s License and a covenant by Bidder to obtain said license within the time for acceptance of Bids;

G. Required Bidder Qualification Statement with supporting data; and

H. Affidavits of Non-Collusion and O.C.G.A. 13-10-91(b)(1) federal work authorization program.

ARTICLE 8 – DEFINED TERMS

8.01 The terms used in this Bid with initial capital letters have the meanings stated in the Instructions to

Bidders, the General Conditions, and the Supplementary Conditions.

ARTICLE 9 – BID SUBMITTAL

BIDDER: [Indicate correct name of bidding entity]

By:

[Signature]

[Printed name]

(If Bidder is a corporation, a limited liability company, a partnership, or a joint venture, attach evidence of authority to sign.)

Attest:

[Signature]

[Printed name]

Title:

Submittal Date:

Address for giving notices:

Telephone Number:

Fax Number:

Contact Name and e-mail address:

Bidder’s License No. or

Prequalification No.:

(where applicable)

COMPETITIVE BID AFFIDAVIT

STATE OF GEORGIA

__________________________________, being first duly sworn, deposes and says that:

1. He/She is the __________________________________________ of

(Owner, Partner, Officer, Representative or Agent)

_______________________________________________ the Bidder that has submitted the attached Bid;

2. He/She is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such bid;

3. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, have in any way, directly or indirectly, prevented or attempted to prevent competition in such bidding or proposals by any means whatever; nor prevented or endeavored to prevent anyone from making a bid or proposal therefor by any means whatever; nor cause or induce another to withdraw a bid or proposal for the work.

By: _______________________________

Its: ________________________________

(Title)

Subscribed and sworn to before me this _____ day of ________________, 20___.

Notary Public

My Commission expires: _________________

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

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 __________________ (name of public employer) 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 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:

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 and that this affidavit was executed in Duluth, Georgia this ____ day of _______________, 20__.

Signature of Authorized Officer or Agent

Printed Name / Title of Authorized Officer or Agent

SWORN TO AND SUBSCRIBED before me this ____ day of ______________, 20__.

My Commission Expires:

Systematic Alien Verification for Entitlements (SAVE) Program

O.C.G.A. § 50-36-1(e)(2) Affidavit

By executing this affidavit under oath, as an applicant for a supplier of goods/services, as referenced in

O.C.G.A. § 50-36-1, from (name of government entity), the undersigned applicant verifies one of the following with respect to my application for a public benefit:

1. I am a United States citizen.

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

3. I am a 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 of 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(e)(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 in (city), (state).

Signature of Applicant

Printed Name/Title of Applicant

SWORN TO AND SUBSCRIBED before me this ____ day of ______________, 20__.

My Commission Expires:

LOCLOC

LOC

LOC LOC LOC LOC LOC LOC LOC LOC LOC LOC

LOC

CITY OF PEACHTREE CORNERS

3090 PREMIERE PARKWAY, SUITE 200

DULUTH, GA 30097

(678) 417-4000 keckwood.com

09/18/2023

> SWALE >

X X X X X X

CITY OF PEACHTREE CORNERS

3090 PREMIERE PARKWAY, SUITE 200

DULUTH, GA 30097

(678) 417-4000 keckwood.com

09/18/2023

File details come from the government source that posted it. Updated Aug 26, 2024.