Contractor Affidavit
28 KB Posted
- Attached to
- CLAY NGC Advanced Metering (Phase I)
- Solicitation number
- 41100-DOD0000041
- Issued by
- Cobb County, Georgia
About this file
This is a Contractor Affidavit document required by the Georgia Department of Defense under O.C.G.A. § 13-10-91(b)(1) for the CLAY NGC Advanced Metering (Phase I) project. The project involves the Georgia Army National Guard (GAARNG) at two sites: Clay National Guard Center in Marietta, Georgia, and Dobbins Air Force Base. The contractor must provide all labor, supervision, equipment (including lifts, scaffolding, elevated platforms, and ladders), and materials necessary to install electrical conduits, wiring, CAT6 cables for network communications, split core style current transformers (CTs), and prepare fifty electrical meters for commissioning—47 meters at Clay and 3 meters at Dobbins. Mandatory attendance at a pre-bid meeting is required, scheduled at Clay National Guard Center, 1000 Halsey Avenue, Building 77 Maintenance Break Room, Marietta, GA 30060. All inquiries should be directed to Contracting Officer Viki S. Moolman at viki.s.moolman@us.army.mil or 678-569-6718.
The affidavit requires the contractor to verify compliance with federal work authorization requirements by registering with and maintaining active use of E-Verify or any subsequent replacement program throughout the contract period. The contractor must provide its federal work authorization user identification number and date of authorization, along with its legal name and address. All subcontractors performing physical services must also present compliant affidavits to the prime contractor. The affidavit must be executed under penalty of perjury before a notary public and submitted as part of the bid response.
Text of this file
Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)
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 the Georgia Department of Defense 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:
______________________________________________(E-Verify Company ID or Individual’s User ID) Federal Work Authorization User Identification Number
_________________________________(Can be obtained from E-Verify Memorandum of Understanding) Date of Authorization Legal Name of Contractor
Legal Address of Contractor
Name of Project Georgia Department of Defense
DOD PO #______________DOD PO Date__________ Name of Public Employer
(for DOD use only)
(for DOD use only) I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on ______, ___, 201__ 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 ______________,201__.
____________________________________________________________ NOTARY PUBLIC.
My Commission Expires:________________________________________
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