Contractor Affidavit (50).pdf
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- Attached to
- Public Health Building Renovation
- Solicitation number
- PE-64800-NONST-2026-000000083
- Issued by
- Douglas County, Georgia
About this file
This is a Contractor Affidavit for compliance with O.C.G.A. 13-10-91 required for the Douglas County Public Health Building Renovation project in Douglas County, Georgia. The affidavit serves as a mandatory compliance document for all contractors bidding on or executing work for this design-build project involving the expansion and remodel of the Douglas County Public Health Center located at 6770 Selman Drive, Douglasville, Georgia. The Project encompasses design, permitting, site preparation, expansion, and renovation services, with all work required to comply with applicable federal, state, and local laws, regulations, ordinances, and codes.
Contractors executing this affidavit must certify registration with and active use of the E-Verify federal work authorization program throughout the contract period, including any renewals or extensions, and must provide written notice to Douglas County should they cease participation in E-Verify, with such cessation constituting material breach of contract. All subcontractors engaged for services must similarly present compliant affidavits to the prime contractor. Contractors bear responsibility for submitting copies of affidavits, drivers' licenses, and identification cards as required by statute to Douglas County within five business days of receipt. The Project will be funded through a combination of Cobb & Douglas Public Health reserve funds and appropriations from the Douglas County Board of Commissioners General Fund, with the Design-Builder responsible for obtaining and maintaining all necessary permits, approvals, and licenses unless expressly identified otherwise in the solicitation.
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Text version
Contractor Affidavit under O.C.G.A. § 13-I0-9l(b)(I)
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 a 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
Name of Contractor:
Date of Authorization
Name of Project
Douglas County, Georgia Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on _______________, 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: _ _ _ _ _ _ _ _ _ _ _ _ lammons Cross-Out
Contractor Affidavit under O.C.G.A. § 13-I0-9l(b)(I)
File details come from the government source that posted it. Updated .