BCW On_Demand Engineering Services _2026.pdf

BARTOW COUNTY

REQUEST FOR PROPOSALS

O N-DEMAND ENGINEERING SERVICES

For Bartow County Water Department

Proposal Number: 26-55-03

July 9, 2026

Information on this solicitation may be found at:

www.bartowcountyga.gov

Click on Projects for Bid

Questions should be directed to Kathy Gill, County Clerk via email to:

gillk@bartowcountyga.gov

Bartow County Water Department 50 Nelson Street

Cartersville, GA 30120

(770) 387-5170

Bartow County Commissioner 135 West Cherokee Avenue | Suite 251 | Cartersville, Georgia 30120 http://www.bartowcountyga.gov/ mailto:gillk@bartowcountyga.gov i

Table of Contents

Division 1 General Information Section 1 Request for Proposals

Section 2 Overview

2.1 Project Background

2.2 Standard Agreement

2.3 Proposal Schedule

2.4 Proposal Submission

2.5 Addenda

2.6 Proposal Package

2.7 Evaluation Criteria

2.8 Billing Rate Schedule

Division 2 Proposal Requirements Section 1 Instructions to Proposers

Section 2 Risk Management Requirements

Section 3 Required Proposal Submittals

Section 4 Proposer Qualification Information

Section 5 Contractor Affidavit and Agreement

END OF TABLE OF CONTENTS

On-Demand Engineering Services

July 2026

Division 1 Section 1: Request for Proposals

General Information

Bartow County Water 50 Nelson Street Cartersville, Georgia 30120

Name of Project: On-Demand Engineering Services

Bartow County Water will open sealed proposals from vendors at the Bartow County Commissioner’s Office located at 135 West Cherokee Avenue, Suite 251, Cartersville, GA 30120 on Thursday, August 20, 2026, at 2:00 p.m. (local time) for On-Demand Engineering Services. Any proposals received after the specified time will not be considered.

In an effort to promote responsible environmental practices the proposal package is available in electronic (Adobe PDF) format and can be requested by calling 770-387- 5030, M-F, 8:00 am - 5:00 pm or by e-mail to Kathy Gill, County Clerk, gillk@bartowcountyga.gov. Proposers will need to provide contact information and an email address and any file size transfer limits to insure email transmittals can be made.

A hardcopy proposal package can also be requested at a cost of $25.

Bartow County Water Lamont Kiser, PE Director

END OF SECTION

mailto:gillk@bartowcountyga.gov.

July 2026

Division 1 General Information

Section 2: Overview

2.1 Project Background

Bartow County Water Department (BCWD) is seeking the services of qualified Georgia professional engineering firms for On-Demand Engineering Services to continue supporting the implementation of the ongoing Capital Improvement Program (CIP) and future master plan updates. The CIP includes a listing of the major projects, estimated planning level cost, brief project description, and predecessor and successor projects. The actual work awarded under this contract will be based on follow-up studies and recommendations, available funding and direction by BCWD and may also include projects not specifically listed in the CIP.

Additionally, water and sewer master plans have been completed and as part of this proposal are expected to be updated on a typical 5–10-year planning cycle.

BCWD currently serves as the water and sewer utility for unincorporated Bartow County and provides water connections to the Cities of Emerson, Kingston, and White. The service area represents a population of approximately 65,000 residents and includes over 27,000 active customer accounts. Water is supplied by metered connections from the Cities of Cartersville and Adairsville, as well as Polk, Cobb and Cherokee Counties. BCWD runs a small water reclamation facility currently operating at approximately 50,000 gpd, with a permitted capacity of 0.1 MGD.

Major facilities include one water production spring, 15 ground and elevated storage tanks and booster pump systems, and over 900 miles of water distribution and 250 miles of wastewater collection pipelines.

2.2 Standard Agreement

It is BCWD’s intention to award a Master Services Contract to one or multiple firms to support the needs of BCWD. Work would be assigned through Task Orders based on the Firm’s expertise, cost effectiveness and availability to complete the work responsively. Subsequent work assignments will be based on BCWD project needs, productivity, and quality of prior work completed and may result in a less than an equal distribution of work. All Task Orders will be issued on “As Needed, When Needed” basis. The term of this contract will be five (5) years.

July 2026

Division 1

Prior to issuing a Task Order, The Firm will meet with BCWD staff to discuss and review the project requirements. The Firm shall evaluate the project requirements to include site visits and other activities necessary to properly assess the work and will then prepare a detailed written scope of work including all costs, broken down by tasks and levels of effort. Upon review and concurrence with the scope of work and costs, as well as the necessary authorization, BCWD will issue a notice to proceed for the Task Order to The Firm for the work.

For certain projects it is anticipated that BCWD may request a scope of work and cost estimate from all firms to determine the best solution for BCWD. Where BCWD determines that current firm(s) have not provided expertise or costs that are acceptable to BCWD, BCWD reserves the right to procure services from others.

BCWD expects the Firm to have sufficient depth and breadth in all discipline areas to support BCWD’s needs. Where a specific project arises that requires a subcontractor with specific expertise, those subcontractors can be added to the Firm’s project team. Above and beyond our On-Demand Engineering Firms, teaming and subcontractor relationships are permitted, however teams without a record of successful project delivery working together will not be considered as highly. Where “Prime/Subcontractor” relationships are proposed, the prime contractor will be required to provide majority of the work. All teaming relationships must be clearly identified and defined.

2.3 Proposal Schedule

The planned schedule for proceeding with the selection process for this work is as follows:

Deadline for Questions Thursday, August 6, 2026, 2:00 PM

Issue Last Addendum Tuesday, August 11, 2026, 2:00 PM

Proposal Opening Thursday, August 20, 2026, 2:00 PM

Short-list Notification On or before Friday, September 11, 2026, 2:00 PM

Presentations Wednesday, September 30, 2026 – time TBD

Commissioner Approval TBD

Sign Contract Within 30 days of Commissioner Approval

Planned Start Date January 1, 2027

July 2026

Division 1

During the Request For Proposal (RFP) process no Firm or individual is to have verbal or written communication on any aspect of this RFP with any BCWD employee. All questions and requests shall be made in writing to Kathy Gill, County Clerk, gillk@bartowcountyga.gov. This is to ensure that all prospective respondents have the same level of knowledge of the work as well as ensuring that all data is uniformly and consistently made available to all respondents. Failure to comply with this requirement may result in disqualification from the process.

2.4 Proposal Submission

One (1) original, four (4) bound copies and one (1) Flash Drive (in compatible electronic format) of the proposal shall be submitted in a sealed, opaque container and delivered by hand, courier service, or mailed via the United States Postal Service. No facsimiles will be accepted. At the time specified for the proposal opening deadline, the sealed containers shall be publicly opened and the names of firms shall be read aloud. The cost portion (Billing Rate Schedule) of the proposal must be sealed in a separate envelope and placed within the completed sealed RFP submittal package. No other references or mentioning of costs should be included in any other section of your proposal submittal. The Billing Rate Schedule is to be opened after the first initial evaluation of the proposal.

2.5 Addenda

To be considered, all questions must be received via email by 2:00 p.m. EST, Thursday, August 6, 2026 at gillk@bartowcountyga.gov. Any and all responses to questions will be issued in the form of an addendum by email. All addenda issued shall become part of the submittal package.

2.6 Proposal Package

Proposal response for below Sections 1 through 4 shall be limited to a maximum length of 35 pages. Each Proposal Package should be prepared and presented to include the information outlined below and be tabbed to denote the sections noted below. In order for the Proposal Package to be considered responsive, Sections 1 through 4 need to be complete as described below.

S ection 1 - Cover Letter and Firm Identification.

A letter (4 pages maximum) of introduction and interest on letterhead. Provide the full legal name, firm’s principal business office with address and satellite offices, if any, and indicate the location from which these professional services for BCWD mailto:gillk@bartowcountyga.gov mailto:gillk@bartowcountyga.gov.

July 2026

Division 1 would be conducted. Specifically offer the location of the client and project manager. Include information on the Firm’s history, business activities, size, employees (per office), and ownership. Include telephone number, point of contact and official signature of an authorized company representative. Indicate whether you operate as a single proprietorship, partnership, or corporation. Include the state(s) in which you are incorporated and/or licensed to operate.

S ection 2 - Company Experience.

Clearly identify the project categories BCWD is to consider in the evaluation of the proposal. Provide a listing of company experience profiling relevant expertise summarized by the following project categories:

A. Water. Plant and unit process evaluation and design, pumping system design, back-up power generation systems, disinfection by product (DBP) -micro constituent management, taste and odor treatment technology implementation, instrumentation and control systems, facility optimization, value engineering, constructability reviews, construction management, source water monitoring and controls, reservoir management, regulatory and permitting assistance, groundwater treatment.

B. Water Reclamation. Advanced treatment unit process evaluation, design and bid services, value engineering, constructability reviews, and construction management. Experience with constructed wetlands, indirect reuse, wastewater sludge pelletizing/solids management and reuse, facility optimization, instrumentation and control systems, Georgia Environmental Protection Division (EPD) / National Pollutant Discharge Elimination System (NPDES) permitting.

C. Distribution and Conveyance Systems. Distribution and collection system hydraulic modeling, condition assessment / asset management programs, water systems leak detection and water loss management, wastewater flow monitoring, sewer system evaluation surveys (SSES) - Infiltration/Inflow (I/I) studies, pipeline design and rehabilitation, trenchless technologies, lift station design, program/project management, and construction management.

D. Utility Wide. Strategic short- and long-range master planning, Collaborative Project Delivery Methods, Utility wide regulatory and permitting/Metro North Georgia Water Planning District (Statewide Water, Wastewater, and Watershed Management Plan and Audits), Georgia

July 2026

Division 1

E. Department of Transportation (GDOT) road design project implementation (utility relocation), SCADA systems and evaluation, geographical information

– computerized maintenance management systems (GIS – CMMS, note specific software experience), business process evaluation and improvements, public education and involvement, water meter technologies (AMI), integrated utility management (asset management program to support strategic objectives, performance enhancement, etc.), emergency response planning, general environmental/engineering studies (Environmental Impact, Design Development, biological/habitat assessment reports), Design and Construction Administration services for Federally Funded Projects related to economic development, Preliminary Engineering Report preparation, Program management/Project Management Office (PMO), Architectural/Building Services, Information technology, public education/relations, state and federal grant funding opportunities, and other related duties.

F. Provide a table/matrix to identify company experience (projects) against the project categories listed above. IF additional services are proposed which are not included in paragraphs A-D above, please indicate those separately.

S ection 3 - Project Team.

Provide an organizational chart showing business and technical staff and summary resumes for key personnel and any subcontractors (including their title) proposed for the work. Specify the office/location/discipline-role for each person, subcontractor identified. Identify current project assignments, completion dates and percentage availability. Full resumes may be included in an Appendix and will not be included in the page limit.

Provide a summary of company-wide resources. Note the total employees and resources of the company, number of offices/locations/local staff and office breakdowns by operating business units.

Provide a summary of professional liability (E&O) claims and lawsuits for the last 5 years. This summary should include any judgments, claims, arbitration proceedings or suits pending or outstanding against The Firm, proposed partners and any proposed subcontractors. Additionally provide a summary of your safety

July 2026

Division 1 program and your quality control and quality assurance program.

Provide a table/matrix to identify all members of the proposed project team with respect to the projects included in Section 2, reference projects included in Section 4, as well as the project categories listed above.

Section 4 - Project References.

Provide up to 5 one-page project descriptions that are representative of the project categories above of recent work of a similar nature to proposed projects that demonstrate experience that highlight the project team’s ability to successfully complete the work. Provide name of client, a brief description of the work, dates/completion status, reference contact information (phone, email, Section 2:

Overview and mailing address), schedule and cost outcomes. These projects should be included in the appropriate matrices located in Section 2 and 3.

2.7 Evaluation Criteria

Proposals will be evaluated by BCWD staff and ranked based on the following criteria to develop a short list of the top scoring firms. After a short-list of top scoring firms is completed, presentations and interviews will be conducted along with a review of the cost submission portion of the proposal to complete the selection process. Ranking of proposals and proposed contract award will be made at the sole discretion of Bartow County.

Item Criteria Points

1 Company Experience 40

2 Project Team 40

3 Project References 20

4 Total Possible Points (without presentations) 100

5 Presentation by short-listed firms 50

6 Total Possible Points (with presentations) 150

2.8 Billing Rate Schedule

Once a firm has been notified, they have been selected to the short-list of firms, a Billing Rate Schedule must be provided. The Billing Rate Schedule should be

July 2026

Division 1 provided on the Proposer’s own form. Provide a classification schedule of employees by billing category showing hourly rates that will be used to support this work, along with a complete, detailed listing noting hourly rates, expense categories, subcontractor rates/categories and markups. BCWD reserves the right to negotiate cost with any and all firms that may be awarded work under this Request for Proposal. Additionally, BCWD reserves the right to negotiate parity in any and all costs with any and all Firms.

July 2026

Proposal Requirements Division 2 Section 1: Instructions to Proposers

These instructions are to be followed by every entity proposing to provide Bartow County with goods and/or services. These instructions constitute an integral part of the proposal, and any Proposer agrees that tender of a proposal constitutes acknowledgment and acceptance of its obligation to adhere to these instructions, which are to be incorporated into and considered part of any contract the Proposer ultimately executes with Bartow County.

1. Information submitted by the Proposer in the proposal process shall be subject to disclosure after proposal award in accordance with the Georgia Open Records Act.

Proprietary information must be identified and be accompanied by a signed affidavit outlining the redacted information. Entire proposals may not be deemed proprietary.

2. Proposals must include the enclosed proposal forms as listed on page 13. Unless otherwise requested, one (1) original and at least two (2) copies of the proposal forms need to be submitted, and these copies must be typewritten or printed in ink. All copies of any proposal forms must be signed in ink by the person or persons authorized to sign the proposal forms. The person signing the proposal forms must initial any changes or corrections.

3. The name of the person, firm, or corporation making the proposal must be printed in ink, along with the Proposer’s signature, on all separate sheets of the proposal forms.

If a proposal is made by an individual, his name and post office address must be shown. If made by a firm, or partnership, the name and the post office address of each member of the firm or partnership must be shown. If made by a Corporation, the person or persons signing the proposal must show the name of the State under the laws of which the Corporation is chartered and his, or their, authority for signing same.

The names, titles and addresses of the President, Secretary and the Treasurer and the corporate authority for doing business in this state shall be listed and returned with the proposal forms.

4. All proposals must be hand delivered, delivered by courier service, or mailed via the

United States Postal Service. No facsimiles will be accepted. The person, firm, or corporation making the proposal shall submit it in a sealed envelope on or before the date and time specified in the proposal package. The envelope shall be marked “Sealed Proposal” and carry the proposal title, and date and time of opening as set forth in the proposal package. The envelope shall also bear the name of the party making the proposal and the party’s address. Address proposals to Bartow County Water Department – On-Call Engineering Services, 135 West Cherokee Avenue, Suite 251, Cartersville, GA 30120. Even if a proposal is not submitted, the proposal forms should be returned signed and with an explanation, otherwise the result will be deletion from the mailing list.

July 2026

5. Alterations to the documents are strictly prohibited and shall result in automatic disqualification of the proposal. If there are "exceptions" to the specifications or comments to any of the solicitation requirements or other language, then the proposer may ask questions regarding those requirements or submit additional documentation as to the variation from the specifications but may not alter any of the language contained in the solicitation.

6. In the case of goods, the person, firm or corporation making the proposal may propose all items. All items may be considered separately, at the discretion of Bartow County.

7. When public work is let out for proposal, no person shall prevent or attempt to prevent competition in such proposal. Such Proposers must make an oath filed with the officer who makes payments under the contract that they have not prevented or attempted to prevent competition in the proposal process. Such oath must be signed by: if a partnership, all partners and any officer or agent or other person who acted on the partnership’s behalf during the proposal process; if a corporation, all officers, agents, or other persons who acted for the corporation in the proposal process.

8. Proposals shall not be withdrawn or cancelled by the proposer past the proposal opening date and time. The proposer may make modifications/corrections to the proposal by submitting a corrected seal proposal but only if the change is prior to the proposal opening. The corrected document should be clearly marked that it supersedes the proposal originally submitted. No modification or corrections will be allowed subsequent to the proposal opening.

9. By tendering a proposal, a Proposer agrees to leave the proposal open for acceptance by Bartow County for one hundred twenty (120) days after the date set for the opening thereof.

10. By tendering a proposal, the Proposer certifies that the Proposer has carefully examined these instructions and the terms and specifications applicable to and made a part of the proposal. Proposers are required to inform themselves fully as to the availability of materials and the conditions relating to construction and labor under which any work will be or is now being performed. No error or misjudgment nor any lack of information on local conditions, general laws or regulations on the part of the Proposer shall merit withdrawal of the proposal.

11. The successful Proposer must comply with the applicable Risk Management Requirements prior to beginning performance, and during the contract period.

12. The Contract between Bartow County and the Proposer shall be executed on a form

July 2026 provided by Bartow County and will be subject to all requirements of the contract documents (which include but may not be limited to the Contract, these instructions, any Purchase Orders, the Risk Management Requirements, and the Hold Harmless Agreement), and shall form a binding contract between the contracting parties. A copy of the standard form agreement will be provided to each successful proposer.

13. Award of this proposal shall be by action of the Bartow County Commissioner at a regular monthly meeting.

14. It is the policy of Bartow County to promote award of sub-agreements for goods and/or services to qualified minority and women-owned businesses. Proposers are encouraged to solicit small local, minority and women- owned businesses whenever they are potential sources.

15. Proposers are encouraged to utilize the services and assistance of the U.S. Small

Business Administration (SBA), and the office of the Department of Commerce Minority Business Development Agency (MBDA). These agencies can provide assistance in securing the names of qualified minority and women-owned businesses.

The Georgia Department of Transportation (DOT) has established a list of qualified Disadvantaged Business Enterprises. Information is available online under the tab for “Directories”, link for “UCP Directory - Excel” at:

h ttp://www.dot.ga.gov/PS/Business/DBE.

The successful Proposer will be asked to provide, along with his Request for Payment each month a list of qualified SLBE and MBE/WBE businesses utilized on this Project.

http://www.dot.ga.gov/PS/Business/DBE

July 2026

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT OF 2006

16. Pursuant to the Georgia Security and Immigration Compliance Act of 2006, the successful Proposer 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 proposal and contract document. The Proposer further agrees that such compliance shall be attested by the Proposer and any of his Subcontractors by execution of the appropriate Affidavit and Agreement included after the Agreement Form of these documents.

Division 2 Proposal Requirements

Section 2: Risk Management Requirements

During performance of services, the firm will provide insurance coverage and limits as per the following.

All insurance coverage must be placed with an insurance company approved by Bartow County, admitted to do business in the State of Georgia, and rated Secure (“B+” or better) by A.M. Best Company in the latest edition of Property and Casualty Ratings, or rated by Standard & Poor’s Insurance Ratings, latest edition as Secure (“BBB” or better). Worker’s Compensation self-insurance for individual Contractors must be approved by the Worker’s Compensation Board, State of Georgia and/or Self-Insurance pools approved by the Insurance Commissioner, State of Georgia.

Automobile Liability - Automobile liability coverage for owned, hired and non-owned vehicles in the amount of $1,000,000 combined single limit.

Commercial General Liability – Coverage to be provided on “occurrence” not “claims made” basis. The coverage is to include Contractual liability, Per Project Limit of Liability, losses caused by Explosion, Collapse and Underground (“xcu”) perils, “Bartow County” is to be added as an Additional Insured and Products and Completed Operations coverage is to be maintained for three (3) years following completion of work

Professional Liability – Professional liability is required at a coverage limit of at least $1,000,000. Additional insurance may be required for larger project design scopes.

$1,000,000 Per Occurrence

$1,000,000 Personal and Advertising

$50,000 Fire Damage*

$5,000 Medical Payments*

$1,000,000 General Aggregate

$1,000,000 Products/Completed Operations per Occurrence and Aggregate

Section 3: Proposal Submittals

3.1 Required Proposal Submittals:

The following items are required to be included as part of the proposal response.

Failure to include any of these items may result in the Firm being deemed non-responsive:

A. Proposal Response, as described in Division 1, Section 2.

B. Proposer Qualification Information Form.

C. Georgia Security and Immigration Compliance Act of 2006 Form.

D. Contractor Affidavit and Agreement Form.

E. Subcontractor Affidavit Form.

If a Contractor/Subcontractor will not be performing any services under this contract, the Contractor/company submitting the bid MUST also complete, sign, date, and have both Affidavit forms notarized and make proper notation of "N/A" - Not Applicable.

Bartow County Water Department (BCWD) cannot consider any proposal which does not include completed affidavits. It is not the intent of this notice to provide detailed information or legal advice concerning the Georgia Security & Immigration Compliance Act of 2006 (as amended). All Firms intending to do business with Bartow County are responsible for independently apprising themselves and complying with the requirements of that law, and its effect on Bartow County procurements and their participation in those procurements.

F. Addenda (if any).

Section 4: Proposer Qualification Information

COMPANY NAME OF PROPOSER:

NUMBER OF YEARS IN BUSINESS

BUSINESS ADDRESS OF COMPANY:

TELEPHONE NUMBER:

FAX NUMBER:

POINT OF CONTACT NAME:

POINT OF CONTACT EMAIL ADDRESS:

COMPANY TAX ID NUMBER:

COMPANY WEBSITE: _

ENTITY TYPE: Individual/Sole Proprietor Employee-Owned Company

Privately Held Corporation/LLC Partnership

Publicly Owned Company Attorney Other (specify):

NAME OF PRINCIPAL OFFICERS: _

Section 5: 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 as Exhibit _ 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:

1. 500 or more employees;

2. 100 or more employees;

3. Fewer than 100 employees.

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 Bartow County at any time.”

Contractor

Authorized Signature:

Name:

Title:

Date:

Notary Public My Commission Expires

CONTRACTOR AFFIDAVIT AND AGREEMENT

By executing this affidavit, the undersigned contractor verifies its compliance with OO.C.G.A.

91, stating affirmatively that the individual, firm, or corporation which is contracting with Bartow County has registered with, is participating in, uses, and will continue to use for the duration of the contract, the federal work authorization program - EEV/Basic Pilot Program operated by the U. S. Citizenship and Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA), commonly known as E-Verify, in accordance with the applicability provisions established in OO.C.G.A. 13-10-91.

The undersigned further agrees that, in connection with the physical performance of services pursuant to this contract with the Bartow County , the contractor will only employ or contract with subcontractor(s), who can present a similar affidavit verifying the subcontractor’s compliance with OO.C.G.A. 13-10-91. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to Bartow County within five days of the subcontractor(s) presenting such affidavit(s) to the contractor.

EEV / Basic Pilot Program* User Identification Number Enter four to six digit numbers

BY: Authorized Officer or Agent (Contractor Name) Date

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS

THE DAY OF 20 .

SUBCONTRACTOR AFFIDAVIT AND AGREEMENT

By executing this affidavit, the undersigned subcontractor verifies its compliance with OO.C.G.A. 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with on behalf of Bartow County has registered with, is participating in, uses, and will continue to use for the duration of the contract the federal work authorization program - EEV/Basic Pilot Program operated by the U. S. Citizenship and Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA), commonly known as E-Verify, in accordance with the applicability provisions and deadlines established in OO.C.G.A. 13-10-91.

The undersigned further agrees that, in connection with the physical performance of services pursuant to this contract with _ on behalf of the Bartow County, the subcontractor will only employ or contract with sub-subcontractor(s), who can present a similar affidavit verifying the sub-subcontractor’s compliance with O .C.G.A. 1 3-10-91.

The undersigned further agrees that the Subcontractor will maintain records of such compliance and provide a copy of each such verification to the Contractor within five days of the sub-subcontractor(s) presenting such affidavit(s) to the Sub-contractor.

EEV / Basic Pilot Program* User Identification Number Enter four to six digit numbers

BY: Authorized Officer or Agent (Subcontractor Name) Date

Title of Authorized Officer or Agent of Subcontractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON

THIS THE DAY OF 20

Notary Public My Commission Expires