Bid Document

REQUEST FOR QUALFICATIONS AND PROPOSAL FOR

CONSTRUCTION MANAGEMENT AT RISK SERVICES

2012 and 2018 SPLOST CONSTRUCTION PROJECTS

Contact Information:

Gordon County

Attn: Purchasing Director

201 North Wall Street

Calhoun, Georgia 30701 rbramblett@gordoncounty.org

2012 and 2018 SPLOST CONSTRUCTION PROJECTS

The Gordon County Board of Commissioners desires to retain the services of a professional Construction Manager

(CM) firm for the management, under construction management/contractor format, for the remaining 2012 and 2018

SPLOST construction projects (and possibly other projects). The projects include, but are not necessarily limited to:

2012 Projects:

-Construction of Amenities at Brookshire Park

-Renovations to the Senior Center

2018 Projects:

-New Evidence Building and Morgue

-Renovations to County Administration Building

-Construction of a Multiuse/Agricultural Facility

-Renovations to Salacoa Creek Park Facilities

-Renovation of the E-911 Facility, Sugar Valley Fire Station, and Sugar Valley Community Center

To qualify for consideration, a firm must be prepared to provide the expertise, resources and personnel experienced in project planning, cost management, project control, pre-construction and construction techniques, value-engineering analysis, scheduling and quality assurance throughout the planning and construction phases of the project.

The services to be performed by the CM will have as their objective the efficient, economical, and timely delivery of the project by managing the construction of the project within the time and cost limitations and within established quality requirements. The services will be performed during the pre-construction phase and construction phase including working with owner and architect in project planning, arrangement of bid packages, bidding and award of the trade contracts and management of construction until occupancy is achieved.

CM contract with owner will be a modified AIA A133-2009, which references and incorporates the AIA General

Conditions.

Responses must be received by the Gordon County Board of Commissioners at 201 N. Wall Street Calhoun, GA

30701 on or before 2:00 PM Eastern Daylight Time on August 18, 2021, after which time and date they will no longer be accepted. Late responses will be returned unopened and will not be considered. No proposal may be withdrawn for a period of ninety (90) days after time has been called on date of opening of Qualifications and

Proposals.

To be accepted, all responses must be submitted in a sealed package marked “Proposal for CM at Risk Services”.

Eight (8) copies of each proposal must be forwarded or delivered to:

Regan Bramblett, Gordon County Purchasing Director, at the above address.

Oral, email, or telegraphic (including FAX) responses are not acceptable.

Any questions regarding this Request shall be submitted by email to Carter Watkins Architects at info@carterwatkins.com no later than 5:00 PM on Friday, August 13, 2021.

Site visits to inspect the site and/or facilities can be arranged by appointment with Ms. Bramblett. It is the responsibility of the respondent to arrange and conduct any site visits necessary to familiarize themselves with existing conditions.

The owner reserves the right to select or reject any and all responses as a result of this Request for Proposal. The owner is not liable for any costs incurred by any person or firm responding to this Request for Proposal.

If a contract is awarded, the successful respondent will be required to indemnify, defend and hold Gordon County, Georgia, harmless from and against all claims, loss, liability, cost and expenses, including attorney’s fees, howsoever arising or incurred, alleging damage to property or injury to, or death of, any person, arising out of, or attributable, to the Construction Manager’s performance of the contract awarded.

Respondents agree to waive any claims they have or may have against the Owner, it’s employees, agents, members, representatives and legal counsel, arising out of or in connection with the administration, evaluation, recommendation or selection of any proposal or qualifications; waiver of any representations under the proposal or documents; accept or reject any proposal or qualifications and award of a contract.

E-verify Affidavit: Before any proposal can be considered, the proposer must comply with O.C.G.A. § 13-10-

90, et. seq., including but not limited to providing a copy of an affidavit as required by O.C.G.A. § 13-10-

91(b)(1).

GENERAL INFORMATION

1. Proposal Format:

Proposals must be submitted in the format outlined in this document. Prior to actual evaluation, each Proposal will be reviewed to determine whether or not it is complete. Proposals that do not contain the information requested may not be considered.

Respondents shall use the prescribed format to clearly indicate their experience and qualifications.

2. CM Responsibility

The selected CM will be required to assume total responsibility for all services offered in his/her proposal. The selected CM will be considered the primary contractor and the sole point of contact with regard to all contractual matters. The CM shall also be required to obtain at least three bids for each bid package (work category), exclusive of the CM’s guaranteed maximum price for the individual bid packages (work categories). If any bid packages receive less than three qualified bids, the Owner reserves the right to require rebidding these packages.

3. Required Bonds and Insurance

The CM shall provide the owner with a 100 percent performance and payment bond for its faithful performance, pursuant to O.C.G.A. § 36-91-40, et seq.

To adequately protect the interests of the owner, the successful respondent shall procure, and maintain in effect during the life of the agreement, the following insurance coverage:

Workers Compensation:

State: Statutory

Employers Liability:

$1,000,000.00 Each Accident

$1,000,000.00 Disease Policy Limit

$1,000,000.00 Disease Each Employee

Comprehensive General Liability (including Premises-Operations; Independent Contractors Protective;

Products and Completed Operations; Broad Form Property Damage; X-C/U Explosion, Collapse and

Underground Coverage):

o General Aggregate: $2,000,000.00 o Products/Completed & Operations Aggregate: $2,000,000.00 o Each Occurrence: $1,000,000.00 o Personal & Advertising Injury: $1,000,000.00 o Fire Damage - Any One Fire: $100,000.00

Comprehensive Automobile Liability:

o Combined Single Limits: $1,000,000.00

Umbrella Excess Liability:

o General Aggregate: $1,000,000.00 o Products/Completed & Operations Aggregate: $1,000,000.00 o Each Occurrence: $1,000,000.00 o Personal & Advertising Injury: $1,000,000.00 o Completed Value/Builders Risk including interests of the Owner, Contractor, Subcontractors and Sub-subcontractors and covering the entire project including materials stored off site and materials in transit.

Insurance policies to be carried under the agreement shall not be changed, canceled, or allowed to expire without thirty (30) days prior written notification by the insurer to the to the Owner via registered mail, return receipt requested.

4. Taxes, Fees, Code Compliance and Licensing:

The CM shall be responsible for the payment of any required taxes or fees associated with the execution of a contract.

The CM shall also be responsible for compliance with all applicable codes, statutes, regulations and rules. All installation and construction work shall be done by sub-contractors, as required, to be licensed in the State of Georgia.

5. Payment:

CM shall submit monthly payment applications using AIA G702, AIA G703, and DOE 0263 (Revised April 2010)

Continuation Sheets. The CM agrees to not submit any monthly payment applications to the owner prior to the execution of AIA Document A133-2009 Exhibit A – Guaranteed Maximum Price Amendment. A copy of the contract is available upon request.

6. References and Proprietary Information:

Submission of a response authorizes the owner to make inquiries concerning the respondent and its officers to any persons or forms deemed appropriate by the owner.

7. Inquiries:

Questions that arise prior to the proposal submittal date shall be submitted in writing to the architect.

SCOPE AND STYLE OF SERVICES TO BE PERFORMED

In issuing the RFP, it is the intent of the owner that the successful CM will provide the required services for a fixed fee to be mutually agreed upon by the parties. It is further the intent of the owner that the successful CM will provide a Guaranteed Maximum Price (GMP) for the cost of the construction of the project(s) to include a Guaranteed

Delivery Date (GDD). Owner also intends that the successful CM accept the following stipulations:

1. Provide Performance and Material and Labor Payment Bonds in the amount of 100% of the GMP, pursuant to

O.C.G.A. § 36-91-40, et seq.

2. Individual Trade Contracts will be between the CM and the Trade Contractors, subject to owner approval.

3. The CM will not perform any portion of the project with its own forces except as may be mutually agreed to by the owner and the CM.

4. The CM will be “at risk” in the proposed undertaking and will be responsible for completing the project within the GMP.

5. ALL unused allowances and contingencies shall revert to the owner.

6. An agreed percentage of pay applications will be held in retention.

7. The owner shall have the authority to suspend or terminate performance of the project.

8. CM will share the calculations and assumptions on which the CM’s proposed GMP is based.

LIST OF REPRESENTATIVE SERVICES TO BE PROVIDED BY THE CM

Project Planning:

The CM is required to work with the owner to plan the project to include:

1. Reviewing ideas and suggestions offered by the owner with regard to feasibility or constructability of design.

2. Evaluate existing designs with respect to constructability issues.

3. Provision of Cost Estimates for projects.

4. Evaluate value-engineering opportunities.

Bidding and Awarding Phase

Any costs associated with Bidding and Award Phase Services should be included in the Respondent’s proposals for

Pre-Construction Services or General Condition. Bidding and Award Phase Services shall include, but are not limited to the following:

1. Arrange bid packages.

2. Develop requirements to assure time, cost and quality control during construction.

3. Provide a provisional construction schedule for issuance with the bid package.

4. Identify bidders and generate bidder interest.

5. Schedule and conduct pre bid conferences in conjunction with the architect and representatives from Gordon

County Board of Commissioners.

6. Advertise and distribute bidding documents.

7. Monitor bidder activity to ensure adequate contractor and vendor participation.

8. Review and analyze bids and recommend awards.

9. Update project schedule.

10. All bids are to be opened publicly in the board room of Gordon County Board of Commissioners.

Construction Phase

1. Maintain on-site staff for construction management.

2. Establish and maintain coordinating procedures.

3. Develop and maintain a detailed schedule including delivery, approvals, inspection, testing, construction and occupancy necessary for completion of the project by the targeted date.

4. Coordinate, conduct, and document regular construction meetings.

5. Prepare and submit change order documentation for approval of the architect and Gordon County Board of

Commissioners.

6. Maintain a system for tracking the timely submittal, review, and approval of shop drawings.

7. Maintain records and submit routine reports to architect and owner.

8. Maintain quality control and ensure conformity to contract documents.

9. Provide cost control through progress payment review and verification according to the approved schedule and contract amounts.

10. Coordination of post completion activities, including the assembly of guarantees, manuals and the owner’s final acceptance.

11. Provide owner with final set of “as-built” construction documents.

Warranty Phase Services

1. Resolve remaining “punch-list” items.

2. Coordinate post-completion activities, including the assembly of guarantees, manuals, closeout documents, training, and Owner’s final acceptance

3. Monitor, coordinate, and resolve all warranty complaints to the satisfaction of the Owner during the one-year general warranty period.

SELECTION PROCESS

The selection process for these services may proceed in three phases. The following is a summary of the selection process.

Phase I - Proposal Evaluation

Interested CM’s responding to this Proposal Request must provide the information required to meet the criteria contained in “Response Format and Contents”. The committee will evaluate submittals and choose the most highly qualified CM, and may invite them to participate in Phase II of the selection process. The following criteria will be considered in choosing the most highly qualified CM:

Firm History, Capability, and Current Projects

Letters of Recommendation

Project Personnel Qualifications

Project and Claims History

Proposers Ability to Provide Services

Fees

Phase II - Interviews

The CM(s) chosen as a result of the Phase I evaluation process may, at the discretion of the committee, be asked to participate in oral interviews. Following these interviews, the committee will tentatively select a CM.

Phase III – Negotiation of Fee

A sole CM will be selected after Phase I and II. The owner and CM will negotiate the total fee that will be paid to the

CM for the project(s). Total fee includes general conditions, overhead and profit. Each portion of the fee will be clearly delineated out by the CM for the owner. It is the owner’s expectation that a competitive fee, in light of current economic conditions, will be presented and ultimately agreed upon by both the owner and CM.

Negotiation and Signing of Contract

AIA Document A133-2009 contract, as modified by Owner, without Mandatory Amendment #1 will be executed between the selected CM and the owner. A copy of the contract is available upon request. A guaranteed maximum price will be prepared by the CM and shall incorporate all costs incurred by the CM for each phase or phases associated with the project. The AIA Document A133-2009 Exhibit A – Guaranteed Maximum Price Amendment shall be submitted to the owner and shall include a preliminary schedule of values. Upon agreement by all parties on the AIA Document A133-2009 Exhibit A – Guaranteed Maximum Price Amendment, and acceptance of the AIA

Document A133-2009 Exhibit A – Guaranteed Maximum Price Amendment by the owner, the Mandatory

Amendment #1 will be completed, signed and attached to the contract and shall constitute the full contract for the project. In the event an AIA

Document A133-2009 Exhibit A – Guaranteed Maximum Price Amendment cannot be agreed upon by all parties, the

CM will receive no compensation for pre-construction services.

SELECTION EVALUATION

The services being sought under the RFP are considered professional in nature. Consequently, the evaluation of the proposals will be based upon consideration of the demonstrated qualifications and capabilities of the proposers which will result in an award that is in the best interest of Gordon County Board of Commissioners.

Factors and weights to be considered in the evaluation include:

1. Staffing – Evaluation of the list of personnel specifically assigned to the proposed project, including their qualifications, overall experience and recent experience on projects of similar nature and complexity to the proposed project. Points: 10

2. Experience/Performance – Review of past performance on projects of similar nature and complexity as the proposed projects; evaluation of client references whether included in the proposal response or not; overall responsiveness to Owner’s needs and history of litigation and proposers safety history will be considered. Points: 15

3. Local Sub Contractor and Minority Participation – Review local sub contractor and minority participation in previous projects of similar nature. Points 15

4. Approach – Evaluation of the overall understanding of the scope of the proposed projects;

completeness, adequacy and responsiveness to the required information of the request for proposals.

This should include a preliminary Project schedule by task and milestones that will be used to procure the Project. Provide in detail the services your firm will be providing. Points: 10

5. Experience with Northwest GA Issues – Review projects performed in the Northwest GA area.

The County is interested in previous projects in the Northwest GA area as evidenced by staff utilized in the Northwest GA area. Points 10

6. Availability – Evaluation of the work load of the Proposer and the staffing to be assigned to the proposed project; time schedule of the Proposer in relation to that of the proposed project location of the offices or facilities from which the services are to be provided to the Owner. Points: 10

7. Financial Stability – Evaluation of the overall financial position of the Proposer as determined from financial information required by the Request for Proposal or from other independent sources.

Points: 10

8. Cost – Evaluation of overall weekly costs and willingness to provide initial services of pricing and project management prior to contract and GMP being signed. Points: 20

Evaluations will be performed by a committee appointed by the County Administrator. Following completion of the initial evaluations (Phase I), if deemed necessary by the committee, firms best qualified may be granted an opportunity to appear before the Evaluation Committee to make an oral presentation and submit to an interview

(Phase II).

RESPONSE FORMAT AND CONTENTS

Responses must be submitted in the format outlined in this section. Each response will be reviewed to determine if it is complete prior to actual evaluation. Failure to provide accurate, up-to-date responses to any and all portions of the

RFP may result in disqualification without prejudice. The owner reserves the right to eliminate from further consideration any responses that are deemed to be substantially or materially unresponsive to the requests for information contained in this section. The intent of the owner is that all responses follow the same format in order to evaluate each response fairly. The owner may, during the course of the evaluation process, request additional information to supplement and/or clarify the information provided.

Proposals will be evaluated in light of the material and substantiating evidence presented in the proposal, and not on the basis of what is inferred.

Each respondent shall provide the owner with eight (8) copies of his/her response. Begin each section and subsection as described herein on a separate page. Number the pages in each section consecutively. Each page shall have the name of the respondent indicated clearly across the bottom of each page.

Cover Letter

Each proposal shall include a one-page cover letter at the beginning of the proposal. The cover letter shall include a project title, CM information (including name, address, email address, telephone and fax number), names, email addresses, telephone and fax numbers of persons authorized to provide any clarifications required.

Overview

Complete the attached form 1-A.

Financial Information

A. Provide a compliance letter from your bonding company showing consent to provide 100% Performance and

Payment Bonds for your services as a Construction Manager.

B. Each respondent shall provide a certificate of insurance detailing their firm’s present coverage and limits.

Insurance agent shall certify that they are licensed to perform business in the State of Georgia.

Project Approach (Provide the following items in the order listed)

A. Relevant Experience:

Provide a summary of your relevant experience and qualifications Georgia City and County government facilities that distinguishes your firm from other Construction Management firms.

B. Relevant Projects:

Complete the attached form 2-A.

C. Pre-construction Services:

Provide a description of your approach to providing pre-construction services. Pre-construction Services shall also include the complete review and coordination of the final construction documents, for construction means and methods proficiency along with preliminary cost estimates and value engineering comments no later than two weeks prior to bid date for each subcontractor work categories.

D. Schedule Control:

Provide a description of your approach to schedule control and specific methods/techniques that you intend to utilize in this project. Include a sample CPM time line showing the necessary activities and schedule for implementation of this type project.

E. Quality Assurance/Control:

Provide a description of any formal program that your firm utilizes to ensure quality. Include CM‘s philosophy and implementation procedures for cooperation with Architect to assure quality documents that will allow for accurate GMP costs.

F. Safety:

Complete the attached form 3-A.

G. Project Management:

Each respondent shall use the attached form 4-A to list the members of their team. A one-page resume including education, experience and any other pertinent information shall be included for each team member assigned to this project.

Should respondent’s proposal be accepted, the respondent agrees that the Job Superintendent and Project

Manager shall not be reassigned without approval by the owner.

H. Project Staffing:

Each respondent shall attach a project staffing plan. The plan shall include: 1.) initial staffing showing the percentage of time each staff member is to be assigned to the project team 2.) project organization chart showing a graphic representation of the participants listed as members of the project team and their responsibilities in the program.

I. Change Orders:

Provide a list of similar projects listing the value of the project and a total of all change orders (described) in the last five years. See Attachment 5-A.

J. Non-Collusion Affidavit:

Complete the attached form 6-A.

K. Proposed Fees:

Complete the attached form 7-A.

Claims History

List all litigations, arbitrations and mediations in which the firm has been involved in the past five (5) years. This involves claims for more than $50,000 made by an owner against the firm or by the firm against the owner and indicate the disposition of each such claim, the name of the owner and the nature of the claim.

Current Projects

List all major projects with which the firm is currently involved and identify the firm’s role on the project (e.g.

contractor, construction manager).

Affidavit

Interested CM’s shall submit an affidavit in the form of the Affidavit of Non-Collusion (see attachment 6-A below) to be included in the Proposal Documents. If the CM is a partnership, all of the partners and any officer, agent, or other person who may have represented or acted for them in bidding for or procuring the Contract for the Project shall also sign the affidavit. If the CM is a corporation or other entity, all officers, agents, or other persons who may have acted for or represented the corporation or other entity in bidding for or procuring the Contract for the Project shall also sign the affidavit.

Conflicts of Interest

Responder must provide a list of all entities with which it has relationships that create, or appear to create, a conflict of interest with the work that is contemplated in this request for proposals. The list should indicate the name of the entity, the relationship, and a discussion of the conflict. The responder warrants that, to the best of its knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances which could give rise to organizational conflicts of interest. An organizational conflict of interest exists when, because of existing or planned activities or because of relationships with other persons, a vendor is unable or potentially unable to render impartial assistance or advice to the owner, or the vendor’s objectivity in performing the contract work is or might be otherwise impaired, or the vendor has an unfair competitive advantage. The responder agrees that, if after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to the

Gordon County Board of Commissioners, which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organization conflict of interest is determined to exist, the owner may, at its discretion, cancel the contract. In the event the responder was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict, the owner may terminate the contract for default.

ATTACHMENT 1-A: OVERVIEW

BIDDER INFORMATION

Company Name:

Company Address:

Authorized By (typed or printed name):

Title:

Authorized Signature: Date:

Telephone Number:

Fax Number :

Email Address:

Company’s Web Page:

REMITTANCE INFORMATION (where payments should be sent)

Remit to Name:

Remit to Address:

City: State: Zip: County:

Phone: Fax: Toll Free:

Contact: Email:

Tax ID: SSN Federal Tax ID

Business Type: Individual Business Misc.

MBE/DBE/WBE STATUS (check appropriate box(es))

□ African American □ Hispanic □ Native American □ Asian American

□ Disabled □ Veteran □ Woman-Owned □ Not-Applicable

Number of years doing business under this name? __________________

Number of permanent employees? __________________

Have you ever defaulted on a contract? If so, explain

How many contracts has your firm completed under a GMP arrangement as a CM at Risk only within the last five years? __________________

What is your firm’s current bonding capacity and bonding rate? __________________

References

Following is a reference list of contracts that are similar to this project:

NAME OF PROJECT/DATE LOCATION CONTACT PHONE #

ATTACHMENT 2-A: RELEVANT PROJECTS

List all similar projects completed under the firm’s name in the last five (5) years.

List the project name, building type, building size, and project cost.

ATTACHMENT 3-A: SAFETY

What is your company policy on drugs?

Who is responsible for your company’s safety program?

Describe below your safety program and your safety and experience rating for the past five (5) years.

ATTACHMENT 4-A: PROJECT TEAM

Name Position Years with Firm Years of Experience in Construction

ATTACHMENT 5-A: CHANGE ORDERS

Provide a list of similar projects and include a listing of the value of the project and a total of all change orders

(described) in the last five years. Be sure to include in your description the reason for the change order(s) and all fees and costs that was added to the project due to the change order.

Additionally, provide a narrative describing your firm’s approach to change orders and what processes you have in place to either eliminate or decrease the number of change orders needed for a project.

ATTACHEMENT 6-A: AFFIDAVIT OF NON-COLLUSION

I certify under penalty of perjury:

1. That I am the Responder (if the Responder is an individual), a partner in the company (if the Responder is a partnership), or an officer or employee of the responding corporation having authority to sign on its behalf (if the Responder is a corporation);

2. That the proposal submitted in response to the Gordon County Board of Commissioners has been arrived at by the Responder independently and has been submitted without collusion with and without any agreement, understanding or planned common course of action with, any other Responder of materials, supplies, equipment or services described in the Statement of Work, designed to limit fair and open competition;

3. That the contents of the proposal have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any such persons prior to the official opening of the proposals;

4. That neither I, nor any member or agent of this company or corporation, have or will contact other companies regarding participation in any future reverse auction conducted under this program; and

5. That I am fully informed regarding the accuracy of the statements made in this affidavit.

Responder's Name: __________________________________________

Firm Name: ________________________________________________

Authorized Signature: ________________________________________

Date: ________________

Subscribed and sworn to me this ____day of ____________, 2021

Notary Public: ______________________________

My commission expires: ________________________________

ATTACHMENT 7-A: PROPOSED FEES

Please provide figures that are all-inclusive and comprehensive which include all charges.

1. Project Planning/Pre-construction Services-

For professional consulting services prior to construction commencement, providing cost estimating services, scheduling services, value engineering constructability and related services described in this

Request. The fixed fee for Pre-Construction services is inclusive of all incidental and direct expenses including, but not limited to, travel sustenance, reproduction, salaries, wages, office expenses and fees to trade contractors and vendors assisting the construction manager as defined in this Request. Should the Owner not authorize the Construction Manager to proceed with construction, the fee for Pre-

Construction Services is the maximum amount the owner is liable to the Construction Manager.

Provide the total fee for the following:

a. Project Cost ranging between $10,000.00 and $500,000.000 $

b. Project Cost ranging between $500,001.00 and $1,000,000.00 $

c. Project Cost ranging between $1,000,001.00 and $3,000,000.00 $

d. Project Cost ranging between $3,000,001.00 and $5,000,000.00 $

2. Bidding and Award/Construction Services-

If authorized by the Owner to proceed with construction, the Construction Manager will execute the work and be reimbursed for the actual costs as defined in the proposed Construction Management

Agreement, and a Construction Manager’s fee. The fee shall be submitted as a percentage of the actual construction costs including General Conditions. If the Owner and Construction Manager agree upon a

Guaranteed Maximum Price, the Construction Manager’s fee shall be converted to a fixed dollar amount and will include any unpaid Pre-Construction service fees.

Provide the total fee per month for the following:

e. Project Cost ranging between $10,000.00 and $500,000.000 %

f. Project Cost ranging between $500,001.00 and $1,000,000.00 %

g. Project Cost ranging between $1,000,001.00 and $3,000,000.00 %

h. Project Cost ranging between $3,000,001.00 and $5,000,000.00 %

Provide any notes and/or clarifications in the space below:

INSURABILITY STATEMENT

Please check appropriate item(s):

By submission of this form, this firm confirms the ability to acquire and maintain the required levels of insurance as outlined in the bid document. It is the understanding of this firm that proof of

Insurance must be provided prior to contract execution and maintained throughout the entire term of the contract.

Company Name:

Authorized By (typed name):

Authorized Signature:

Title: Date:

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE ___ DAY OF ______________, 2021

My Commission Expires: ________________

________________________ [Notary Seal]

Notary Public

Construction Management Services 21

CONTRACTOR’S

AFFIDAVIT AND AGREEMENT

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 Gordon County Board of Commissioners 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

GORDON COUNTY BOARD OF COMMISSIONERS

Name of Public Employer

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

Executed on ____________, ______ 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 ___________, ______ .

NOTARY PUBLIC

My Commission Expires: