5-Solicitation Builder Forms.docx

BOND NO._______________________

KNOW ALL MEN BY THESE PRESENTS, that herein after called the PRINCIPAL, and a corporation duly organized under the laws of the State of having its principal place of business at

______________________________in the State of and authorized to do business in the State of Georgia as SURETY, are held and firmly bound unto Clayton County Water Authority, as OWNER, hereinafter called the OBLIGEE, in the amount of five percent (5%) of the Total Bid Amount for the payment for which we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents.

THE CONDITION OF THIS BOND IS SUCH THAT:

WHEREAS, the Principal is herewith submitting his or its Bid for the 2026-GS-05 Lightning Protection System Inspection and Repair Services project, and said Bid, by reference thereto, being hereby made a part hereof.

WHEREAS, the PRINCIPAL contemplates submitting or has submitted a Bid to the OBLIGEE for the furnishing of all labor, materials (except those to be specifically furnished by the Owner), equipment, machinery, tools, apparatus, means of transportation for, and the performance of the work covered in the Bid and the documents, titled: 2026-GS-05 Lightning Protection System Inspection and Repair Services.

WHEREAS, it was a condition precedent to the submission of said Bid that a cashier’s check, certified check, or Bid Bond in the amount of five percent (5%) of the Total Bid Amount be submitted with said Bid as a guarantee that the Bidder would, if awarded the Contract, enter into a written Contract with the Owner for the performance of said Contract, within 10 consecutive calendar days after written notice having been given of the award of the Contract.

NOW THEREFORE, the conditions of this obligation are such that if the PRINCIPAL within 10 consecutive calendar days after written notice of such acceptance, enters into a written Contract with the OBLIGEE and furnishes a Performance Bond and Payment Bond in an amount equal to one hundred percent (100%) of the contract amount, satisfactory to the Owner, then this obligation shall be void; otherwise the sum herein stated shall be due and payable to the OBLIGEE and the SURETY herein agrees to pay said sum immediately upon demand of the OBLIGEE in good and lawful money of the United States of America, as liquidated damages for failure thereof of said PRINCIPAL.

Signed and sealed this_____________day of___________________20_______.

PRINCIPAL

By___________________________________

SURETY

Division 2 Bid Requirements Section 7: Contractor Affidavit and Agreement

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT OF 2006

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

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

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

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

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

Contractor

Authorized Signature:

Name:

Title:

Date:

CLAYTON COUNTY WATER AUTHORITY

1600 Battle Creek Road | Morrow, Georgia 30260

Phone: (770) 960-5880 | Web Site: www.ccwa.us

CONTRACTOR AFFIDAVIT AND AGREEMENT FORM

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

Name of Project

☐ Contractor has less than eleven (11) employees

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

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

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

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

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

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

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

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

*Enter Identification Number as Checked Above

*Date of Authorization/Issuance

*Legal Name of Contractor

*Name of Project

*Street Address, City, State, Zip Code

*Required Entries SECTION C – Contractor With Less Than Eleven (11) Employees (Complete Only If Applicable)

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

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

NOTARY PUBLIC

My Commission Expires

GUIDELINES & GENERAL INFORMATION

CONTRACTOR AFFIDAVIT AND AGREEMENT FORM

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

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

TOPIC 1: APPLICABILITY

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

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

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

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

· Professional and consulting services.

TOPIC 2: CONTRACTOR AFFIDAVIT REQUIREMENT

· Contractors must submit a signed and notarized Contractor Affidavit and Agreement Form (“Affidavit”) confirming registration and participation in the federal work authorization program before contract award or purchase order issuance.

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

TOPIC 3: SUBCONTRACTORS

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

TOPIC 4: STATEWIDE CONTRACT VENDORS

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

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

TOPIC 5: GENERAL COMPLIANCE GUIDANCE

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

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

TOPIC 6: EXEMPTIONS

Contractors With Less Than Eleven (11) Employees

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

· The Clayton County Water Authority must document the contractor’s authorization to be in the United States by verifying acceptable identification, such as:

· A state-issued driver’s license from a state that verifies immigration status through its licensing or renewal process; or

· Other acceptable identification, including a U.S. passport or military ID.

Foreign Companies

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

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

Division 2 Bid Requirements Section 9: References

REFERENCES

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

COMPANY/GOV’T ENTITY NAME: ______________________________________________

COMPANY/GOV’T ENTITY NAME: ______________________________________________

COMPANY/GOV’T ENTITY NAME: ______________________________________________

COMPANY/GOV’T ENTITY NAME: ______________________________________________

COMPANY/GOV’T ENTITY NAME: ______________________________________________

Division 3 Contract Forms Section 2: Non-Collusion Certificate

STATE OF

, COUNTY OF

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

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

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

ATTEST:

By:

Bidder

By:

By:

Name

Name

Title:

Title:

Sworn to and subscribed before me this day of

, 20

Notary Public:

My Commission expires:

Division 3 Contract Forms Section 3: Certification of Absence of Conflict of Interest Required for each contract or arrangement to prepare or develop specifications or requirements (O.C.G.A. § 36-80-28) The undersigned Contractor (Consultant), who is entering into a contract or arrangement with the Clayton County Water Authority (CCWA) to prepare or develop specifications or requests for bids, requests for proposals, purchase order, or any other type of solicitation for CCWA, by signing below acknowledges and certifies to follow the requirements below:

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

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

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

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

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

CLAYTON COUNTY WATER AUTHORITY

PROCUREMENT AND COMPLIANCE

1600 BATTLE CREEK ROAD | MORROW, GEORGIA 30260

Phone: (770) 960-5223 | Web Site: www.ccwa.us

VENDOR INFORMATION FORM

VENDOR INFORMATION FORM

Purpose of this Form: The Vendor Information Form is used by the Clayton County Water Authority (CCWA) to add Vendors/Suppliers to its financial database system and add business designations when applicable.

Important Note: What name will appear on the Invoice? Invoice name shall be reflected on the Vendor Information Form and match the W-9 Form.

PURCHASING DATA

NIGP CODE(s):

CCWA REQUESTING DEPARTMENT CONTACT:

VENDOR INFORMATION

VENDOR NAME:

PAYMENT REMITTANCE INFORMATION

PAYMENT TERMS:

NET 30

PAYMENT TYPE:

PAPER CHECK

ACH PAYMENT (If selected, ACH Authorization Form will be emailed to the awarded vendor).

BUSINESS CLASSIFICATION

CCWA SLBE WBE MBE DBE Other SBE Veteran-Owned Business

Division 3 Contract Forms Section 7: Performance Bond

KNOW ALL MEN BY THESE PRESENTS THAT ___________________________

_____________________________ (as CONTRACTOR, hereinafter referred to as the “Principal”), and _____________________________________(as SURETY COMPANY), hereinafter referred to as the “CONTRACTOR’S SURETY”), are held and firmly bound unto the Clayton County Water Authority (as OWNER, hereinafter referred to as “CCWA”), for the use and benefit of any “Claimant” as hereinafter defined in the sum of _________________________________________ Dollars ($____________________) lawful money of the United States of America, for the payment of which the Principal and the Contractor’s Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with CCWA, dated _______________________, which is incorporated herein by reference in its entirety (hereinafter referred to as the “CONTRACT”), for the construction of a project known as Restroom Renovations (hereinafter referred to as “the PROJECT”).

NOW THEREFORE, the conditions of this obligation are as follows:

That if the Principal shall fully and completely perform each and all of the terms, provisions and requirements of the Contract, including and during the period of any warranties or guarantees required thereunder, and all modifications, amendments, changes, deletions, additions, and alterations thereto that may hereafter be made; and if the Principal and the Contractor’s Surety shall indemnify and hold harmless CCWA from any and all losses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for delay, which CCWA may incur, sustain or suffer by reason of the failure or default on the part of the Principal in the performance of any and all of the terms, provisions and requirements of the Contract, including all modifications, amendments, changes, deletions, additions, and alterations thereto and any warranties or guarantees required thereunder, then this obligation shall be void; otherwise to remain in full force and effect;

In the event of a failure of performance of the Contract by the Principal, which shall include, but not be limited to, any breach of default of the Contract;

a. The Contractor’s Surety shall commence performance of its obligations and undertakings under this Bond no later than thirty (30) days after written notice from CCWA to the Contractor’s Surety;

b. The means, method or procedure by which the Contractor’s Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of CCWA.

The Contractor’s Surety hereby waives notice of any and all modifications, omissions, additions, changes and advance payments or deferred payments in or about the Contract, and agrees that the obligations undertaken by this Bond shall not be impaired in any manner by reason of any such modifications, omissions, additions, changes, and advance payments or deferred payments. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal.

IN WITNESS WHEREOF, the principal and Contractor’s Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers or attorneys-in-fact, this ________ day of_________________20___.

(Name of Principal)

(Name of Contractor’s Surety)

By:

By:

Name Printed:

Name Printed:

Title:

Title:

Attest:

Attest:

Name:

Name:

Date:

Date:

(ATTACH SURETY’S POWER OF ATTORNEY)

Division 3 Contract Forms Section 8: Payment Bond

KNOW ALL MEN BY THESE PRESENTS THAT _________________________ (as CONTRACTOR, hereinafter referred to as the “Principal”), and _____________________________(as SURETY COMPANY, hereinafter referred to as the “CONTRACTOR’S SURETY”), are held and firmly bound unto the Clayton County Water Authority (as OWNER, hereinafter referred to as “CCWA”), for the use and benefit of any “Claimant” as hereinafter defined in the sum of _____________________ Dollars ($ ), lawful money of the United States of America, for the payment of which the Principal and the Contractor’s Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with CCWA, dated , which is incorporated herein by reference in its entirety (hereinafter referred to as the “CONTRACT”), for the construction of a project known as Restroom Renovations (hereinafter referred to as “the PROJECT”).

NOW THEREFORE, the condition of this obligation is such, that if the Principal shall promptly make payment to any Claimant, as hereinafter defined, for all labor, services and materials used or reasonably required for use in the performance of the Contract, then this obligation shall be void; otherwise to remain in full force and effect.

“Claimant” shall be defined herein as any subcontractor, person, party, partnership, corporation or other entity furnishing labor, services or materials used or reasonably required for use in the performance of the Contract, without regard to whether such labor, services or materials were sold, leased or rented, and without regard to whether such Claimant is or is not in privity of the Contract with the Principal or any subcontractor performing work on the Project.

In the event of any claim made by the Claimant against CCWA, or the filing of a Lien against the property of CCWA affected by the Contract, the Contractor’s Surety shall either settle or resolve the Claim and shall remove any such Lien by bond or otherwise as provided in the Contract.

The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal.

IN WITNESS WHEREOF, the Principal and Contractor’s Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this ________ day of_________________20_____.

(Name of Principal)

(Name of Contractor’s Surety)

By:

By:

Name Printed:

Name Printed:

Title:

Title:

Attest:

Attest:

Name:

Name:

Date:

Date:

(ATTACH SURETY’S POWER OF ATTORNEY)

STATE OF GEORGIA

COUNTY OF CLAYTON

WAIVER AND RELEASE OF LIEN AND PAYMENT BOND RIGHTS

UPON INTERIM PAYMENT

The undersigned mechanic and/or materialman has been employed by the Clayton County Water Authority to furnish: __________________________________________________ [describe materials and/or labor] for the construction of improvements known as:

_____________________________________________ [title of the project or building];

which is located in the City of _____________________, County of _______________, and is owned by the Clayton County Water Authority and more particularly described as follows:

[describe the property upon which the improvements were made using either a street address of the project, metes and bounds description, or the land lot district, block and lot number]: See Attachment: yes no Upon the receipt of the sum of $ , the mechanic and/or materialman waives and releases any and all liens or claims of liens it has upon the foregoing described property or any rights against any labor and/or material bond through the date of _______________ [date of signature ] and excepting those rights and liens that the mechanic and/or materialman might have in any retained amounts, on account of labor or materials, or both, furnished by the undersigned to or on account of said contractor for said building or premises.

NOTICE: WHEN YOU EXECUTE AND SUBMIT THIS DOCUMENT, YOU SHALL BE CONCLUSIVELY DEEMED TO HAVE WAIVED AND RELEASED ANY AND ALL LIENS AND CLAIMS OF LIENS UPON THE FOREGOING DESCRIBED PROPERTY AND ANY RIGHTS REGARDING ANY LABOR OR MATERIAL BOND REGARDING THE SAID PROPERTY TO THE EXTENT (AND ONLY TO THE EXTENT) SET FORTH ABOVE, EVEN IF YOU HAVE NOT ACTUALLY RECEIVED SUCH PAYMENT, 90 DAYS AFTER THE DATE STATED ABOVE UNLESS YOU FILE AN AFFIDAVIT OF NONPAYMENT PRIOR TO THE EXPIRATION OF SUCH 90 DAY PERIOD. THE FAILURE TO INCLUDE THIS NOTICE LANGUAGE ON THE FORM SHALL RENDER THE FORM UNENFORCEABLE AND INVALID AS A WAIVER AND RELEASE UNDER O.C.G.A. § 44-14-366.

COUNTERPARTS AND ELECTRONIC SIGNATURES: This Waiver may be executed in one or more counterparts, each of which will be deemed to be an original, but all of which together will constitute one and the same instrument. An executed signature page delivered via facsimile transmission or electronic signature shall be deemed as effective as an original executed signature page.

GIVEN UNDER HAND AND SEAL THIS ____ DAY OF _____________, 20___.

____________________________________ (SEAL)

(Signature of Deponent)

(Printed/Typed Name and Title) Deponent, individually, and as duly authorized agent and duly elected and acting officer of Company.

(Company Name)

PERSONALLY, APPEARED BEFORE ME, a Notary Public in and for said State and County, the Deponent, who, being personally known to the undersigned and being duly sworn and on oath deposed and said that the within and foregoing statements are true and correct this _______day of _________________, 20_____.

Notary Public ____________________________________

Commission Expiration Date: _______________________

(NOTARY SEAL)

STATE OF GEORGIA

COUNTY OF CLAYTON

WAIVER AND RELEASE OF LIEN AND PAYMENT BOND RIGHTS

UPON FINAL PAYMENT

The undersigned mechanic and/or materialman has been employed by the Clayton County Water Authority to furnish: __________________________________________________ [describe materials and/or labor] for the construction of improvements known as:

_____________________________________________ [title of the project or building];

which is located in the City of _____________________, County of _______________, and is owned by the Clayton County Water Authority and more particularly described as follows:

[describe the property upon which the improvements were made using either a street address of the project, metes and bounds description, or the land lot district, block and lot number]: See Attachment: yes no Upon the receipt of the sum of: $ , the mechanic and/or materialman waives and releases any and all liens or claims of liens it has upon the foregoing property or any rights against any labor and/or material bond on account of labor or materials, or both, furnished by the undersigned to or on account of Clayton County Water Authority for said property.

NOTICE: WHEN YOU EXECUTE AND SUBMIT THIS DOCUMENT, YOU SHALL BE CONCLUSIVELY DEEMED TO HAVE WAIVED AND RELEASED ANY AND ALL LIENS AND CLAIMS OF LIENS UPON THE FOREGOING DESCRIBED PROPERTY AND ANY RIGHTS REGARDING ANY LABOR OR MATERIAL BOND REGARDING THE SAID PROPERTY TO THE EXTENT (AND ONLY TO THE EXTENT) SET FORTH ABOVE, EVEN IF YOU HAVE NOT ACTUALLY RECEIVED SUCH PAYMENT, 90 DAYS AFTER THE DATE STATED BELOW UNLESS YOU FILE AN AFFIDAVIT OF NONPAYMENT PRIOR TO THE EXPIRATION OF SUCH 90 DAY PERIOD. THE FAILURE TO INCLUDE THIS NOTICE LANGUAGE ON THE FORM SHALL RENDER THE FORM UNENFORCEABLE AND INVALID AS A WAIVER AND RELEASE UNDER O.C.G.A. § 44-14-366.

COUNTERPARTS AND ELECTRONIC SIGNATURES: This Waiver may be executed in one or more counterparts, each of which will be deemed to be an original, but all of which together will constitute one and the same instrument. An executed signature page delivered via facsimile transmission or electronic signature shall be deemed as effective as an original executed signature page.

PERSONALLY, APPEARED BEFORE ME, the undersigned officer, duly authorized by law to administer oaths, comes ____________________ (the "Deponent"), who after first being duly sworn according to law, deposes and says under oath as follows:

1. That Deponent is the duly authorized agent and duly elected and acting officer of __________________________________________ (the "Contractor"), and is duly authorized to execute this Final Contractor's Affidavit, Lien Waiver and Indemnification (this "Affidavit") in a representative capacity on behalf of Contractor, as well as in Deponent's individual capacity, and Deponent has made diligent inquiry into and is personally familiar with and has full knowledge of all facts set forth herein.

2. That Contractor acted as the sole general contractor in charge of and directly responsible for the building and construction of all improvements (the "Work") located as reflected above (the "Property"), all of which Work was performed pursuant to the terms of that certain agreement dated __________________ (the "Agreement") by and between Contractor and the Clayton County Water Authority as the owner or agent of the owner of the Property (the "Owner"). The Work includes, without limitation, all Work under or related to the Agreement and all change orders to the Agreement, and all supplemental contracts and subcontracts, whether oral or written, for any extra, additional or replacement labor or materials. Contractor is, and performed the Work as, an independent general contractor and Contractor is not an agent of Owner, and all of the Work was furnished and performed at the instance of Contractor as general contractor.

3. That the Work has been fully and finally completed in strict accordance with the terms of the Agreement, and Contractor has at all times since the commencement of the Work been in direct charge of all aspects of the Work, and Contractor has obtained a current valid permanent certificate of occupancy for the Property and the Work, and the Work has been completed within the boundary lines of the Property.

4. Upon receipt of the sum reflected above, Contractor acknowledges that Owner has paid in full to Contractor the full contract price under the Agreement (the "Contract Price"), which Contract Price includes, without limitation, all amounts and bills for all labor, materials, fixtures and supplies of any type whatsoever used in the Work. Upon receipt of these monies, all contractors, subcontractors, subcontractors of subcontractors, materialmen, suppliers and laborers will be paid in full the agreed price or reasonable value for all materials and supplies ordered, used or furnished and services and labor rendered in connection with or as a part of the Work, and none of such parties have or will have any claim, demand or lien against the Property, and all of the amounts paid by Owner to Contractor under the Agreement have been and will be used to pay for labor or materials used in the Work when no liens or claims of lien were filed or outstanding. There are no disputes regarding the Agreement or any other contracts or subcontracts with respect to the Work or the Property, and, except for bills associated with these final monies, there are no amounts due or unpaid bills of any nature, either for labor or services related to the Work or the Property or any materials which have been or may have been placed upon, or applied or delivered to the Property, and Contractor does hereby unconditionally agree to hold harmless and indemnify Owner from and against all claims for mechanic's or materialman's liens or claims of lien, including, without limitation, any attempted foreclosure thereof, which in any way arise out of or are related to the Work or the Property, including, without limitation, any attorney's fees incurred in connection therewith.

5. That Contractor does hereby for itself, and its employees, suppliers, subcontractors, mechanics and materialmen and all other persons acting for, through, or under Contractor, waive, remise, relinquish and release all right to file or to have filed or to maintain any materialman's or mechanic's lien or liens or claim or claims against the Property or arising out of or related to the Work. This Affidavit is executed and given in favor of and for the benefit of, and may be relied upon by, Owner and each and every party legally or equitably, now or hereafter, owning or holding any interest in the Property.

6. That this Affidavit is a sworn statement made under the provisions of Official Code of Georgia Annotated Section 44-14-361.2, and is made for the purpose of inducing Owner to pay to Contractor the balance of the Contract Price pursuant to the terms of the Agreement.

GIVEN UNDER HAND AND SEAL THIS ____ DAY OF _____________, 20___.

____________________________________ (SEAL)

(Signature of Deponent) (Printed/Typed Name and Title)

NOTARY ACKNOWLEDGMENT

Sworn to and subscribed before me, a Notary Public in and for said State and County, the Deponent, who, being personally known to the undersigned and being duly sworn and on oath deposed and said that the within and foregoing statements are true and correct this _______day of _________________, 20_____.

Notary Public ____________________________________ Commission Expiration Date: _______________________ (NOTARY SEAL) image5.jpg image6.jpg image7.jpg image8.png image1.png image2.jpg image3.jpg image4.jpg