Bidder_s Checklist _ Concrete.pdf

THIS PAGE MUST BE COMPLETED & SUBMITTED AS PART OF YOUR BID

BIDDER’S CHECKLIST

Company Name _________________________________________________________________________________

Please indicate you have completed the following documentation and submit in the following order.

Bidder’s Checklist

Bidder’s Information

References

Addenda Acknowledgement

Certificate of Non-Collusion

Georgia’s Security & Immigration Compliance Act Contractor AƯidavit (E-Verify)

Signature

Date

THIS PAGE MUST BE COMPLETED & SUBMITTED WITH BID

BIDDER’S INFORMATION

Legal Business Name ____________________________________________________ TIN No. ________________

Type of Business: Corporation Partnership Individual Other (specify) _________________

Years in Business under Name stated above ______________________

Physical Address ______________________________________________________________________________ Street City State Zip Code

Billing Address ______________________________________________________________________________ Street City State Zip Code

Primary Contact Name __________________________________ Title ___________________________________

Email _____________________________________________________ Phone No. _________________________

Alt. Contact Name __________________________________ Title ___________________________________

Email _____________________________________________________ Phone No. _________________________

Company Website ___________________________________________________________________________________

Do you have an occupational tax license in the state of Georgia? Yes No

Licensed by City/State? ____________________ Occupational Tax License No. ________________

General nature of work performed by your Company

Jessica Ellis Line

Jessica Ellis Line

Jessica Ellis Line

Jessica Ellis Line

Jessica Ellis Line

Jessica Ellis Line

THIS PAGE MUST BE COMPLETED & SUBMITTED AS PART OF YOUR BID

REFERENCES

Please list three (3) references of current customers who can verify the quality of service your company provides. The County prefers customers of similar size and scope of work to this project/contract.

Reference 1

Government/Company Name _________________________________________________________

Contract Period _______________________

Contract Person ____________________________ Contact Title _________________________

Phone No. ___________________ Email ____________________________________________

Scope of Work ____________________________________________________________________

Reference 2

Government/Company Name _________________________________________________________

Contract Period _______________________

Contract Person ____________________________ Contact Title _________________________

Phone No. ___________________ Email ____________________________________________

Scope of Work ____________________________________________________________________

Reference 3

Government/Company Name _________________________________________________________

Contract Period _______________________

Contract Person ____________________________ Contact Title _________________________

Phone No. ___________________ Email ____________________________________________

Scope of Work ____________________________________________________________________

ADDENDA ACKNOWLEDGEMENT

The Respondent has examined and carefully studied the Invitation to Bid and the following Addenda, receipt of all of which is herby acknowledged:

Addendum Number _____________________________ Date ____________

Addendum Number _____________________________ Date ____________

Addendum Number _____________________________ Date ____________

Addendum Number _____________________________ Date ____________

Authorized Signature Date

Printed Name

Respondent must acknowledge any issued addenda. Bids which fail to acknowledge the Respondent’s receipt of any addenda may result in the rejection of the bid if the addendum contains information that substantively changes the

Owner’s requirements.

THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH BID

CERTIFICATE OF NON-COLLUSION

MISCELLANEOUS CONCRETE REPAIRS

ITB# 26-04-012

STATE OF GEORGIA

OCONEE COUNTY BOARD OF COMMISSIONERS

Being first duly sworn, deposes and says that he is

(sole owner, partner, president, secretary, etc.)

the party making the forgoing Proposal or Bid; that such ITB is genuine and not collusive or sham; that said Respondent has not colluded, conspired, connived, or agreed, directly or indirectly, with any Respondent or person, to put in a sham Response, or that such other person shall refrain from Responding, and has not in any manner, directly or indirectly sought by agreement or collusion, or communication or conference, with any person, to fix the Response price of affiant or any other Respondent, or to fix any overhead, profit or cost element of said Response Price, or of that of any other Respondent, or to secure any advantage against Oconee County, or any other person interested in the proposed Agreement; and all statements in said Proposal or Bid are true; and further, that such Respondent has not, directly or indirectly, submitted this Response, or the contents thereof, or divulged information or data relative thereto any association or to any member or agent thereof.

(Affiant)

Subscribed and Sworn to before me this _______ Day of ___________, 20_____.

(Notary Public in and for)

(County)

My Commission expires ___________, 20_____.

(SEAL)

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

The undersigned contractor (“Contractor”) executes this affidavit to comply with O.C.G.A. § 13-10-91 related to any contract to which Contractor is a party 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 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;

e) The Contractor will contract for the 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(a), (b), and (c);

f) The Contractor acknowledges and agrees that this affidavit shall be incorporated into any contract(s) subject to the provisions of O.C.G.A. § 13-10-91 for the project listed below to which Contractor is party after the date hereof without further action or consent by Contractor; and

g) Contractor acknowledges its responsibility to submit copies of any affidavits, drivers’ licenses, and identification cards required pursuant to O.C.G.A. § 13-10-91 to the public employer within five business days of receipt.

Federal Work Authorization User Identification Number Date of Authorization

Name of Contractor Name of Project

Name of Public Employer

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

Executed on ___________, ____ 202__ in __________________ (city), ______________ (state).

Signature of Authorized Officer or Agent Printed Name & Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS ________ DAY OF _________________, 202__.

Notary Public

My Commission Expires:

Bidders Info

E-Verify Affividavits

SAVE Affidavit

Bidders Info

E-Verify Affividavits

SAVE Affidavit