8-Contractor Affidavit and Agreement Form FINAL - v09182026.pdf

v09182026

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

*Legal Name of Contractor *Street Address, City, State, Zip Code

Check one: ☐ Contractor currently employs one or more employees Name of Project ☐ Contractor has no 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 Employees (E-Verify 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 *Required Entries

SECTION C – Contractor With No Employees (Complete Only If Applicable) ☐ By checking this box, Contractor certifies that Contractor has no employees and does not hire or intend to hire employees for purposes of satisfying or completing the terms and conditions of any part of the above-referenced Project.

☐ By checking this box, Contractor acknowledges that Contractor must attach a copy of the front and back of their state issued driver’s license or state issued identification card to this submission of this affidavit.

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.

Executed this of , (month) 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 v09182026

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 No Employees

Contractors with no employees are not eligible to obtain an E-Verify number.

In lieu of an affidavit, the Clayton County Water Authority must document the contractor’s authorization to be in the United States by verifying acceptable identification, such as:

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