FY26 _ RFP Engineering Services 02_16_2026.pdf

REQUEST FOR QUALIFICATIONS/ENGINEERING SERVICES

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Request for Qualification (RFQ) To Provide Engineering Services

The City of Douglas, as “Owner”, is seeking Statements of Qualifications from firms interested in providing engineering services to include preliminary reports, final design, construction administration, and inspection/closeout for water and wastewater improvement projects for projects funded through the GEFA SRF Program and/or any other federally funded project in compliance with 24 CFR 570.489(g). The Request for Qualifications (RFQ) is issued to identify the most qualified potential providers of the above-mentioned services. One or more firms that respond to the RFQ and who are determined by the Owner to be especially qualified may be deemed eligible and may be invited to discuss and negotiate for these. All respondents to the RFQ are subject to instructions communicated in this document and additional terms and conditions listed in the Owner’s RFQ. The Owner reserves the right to reject any or all statements of qualifications and to waive technicalities and informalities at the discretion of the Owner.

Restriction of Communication: From the issue date of this RFQ until a successful proposer is selected and announced, proposers are not allowed to communicate for any reason with any members of the Selection Committee or the Owner staff, except for:

a) Submission of questions as instructed in the RFQ,

b) During the proposer's conference (if applicable), or

c) As provided by any existing work agreement(s).

For violation of this provision, the Owner reserves the right to reject the proposal of the offending proposer.

The RFQ package may be obtained at https://ssl.doas.state.ga.us/gpr/ . Statements of Qualifications must be delivered in sealed envelopes and received at the City of Douglas, no later than March 19, 2026, by 2 PM (EST) addressed to: ATTN: City Clerk, Wynetta Bolder, 302 South Madison Avenue, Douglas, GA 31533. The outside of the envelope shall plainly identify the Project: “Engineering Services” along with the name and address of the Proposer and should be delivered in accordance with instructions in the RFQ package. Faxed or electronic (e-mail) responses will not be accepted. Responses received after the designated closing date and time will not be opened or reviewed.

Questions may be directed to Alyssa Fussell, afussell@cityofdouglasga.gov . Questions will be answered via addendum only. The deadline for submitting questions is March 5, 2026, by 5:00 PM (EST). The Owner reserves the right to reject any and all statements of qualifications, as well as to waive technicalities and informalities.

It is the policy of GEFA and other federal funding programs that small businesses, female-owned businesses and minority businesses have a fair and equal opportunity to participate in these opportunities. Contractors and subcontractors who utilize qualified minority subcontractors may qualify for a state income tax credits for qualified payments made to minority subcontractors. See Official Code of Georgia Annotated (O.C.G.A.) Section 48-7-38.

City of Douglas

302 S. Madison Avenue.

Douglas, GA 31533 https://ssl.doas.state.ga.us/gpr/ mailto:afussell@cityofdouglasga.go

Request for Qualifications

To Provide

Engineering Services For Drinking Water Improvements and Wastewater Improvements

Request for Qualifications

Engineering Services Drinking Water Improvements and Wastewater Improvements

The City of Douglas, (“Owner”), is soliciting statements of qualifications from professional firms interested in providing assistance with preliminary reports, final design, construction administration, and inspection/closeout of federally funded projects including water and wastewater improvements for projects funded through the GEFA SRF Program and/or any other federally funded project in compliance with 24 CFR 570.489(g). This Request for Qualifications (“RFQ”) seeks to identify potential providers of the above- mentioned services. One or more firms that respond to this RFQ and who are determined by the Owner to be especially qualified, may be deemed eligible and may be invited to discuss and negotiate for these services. All respondents to this RFQ are subject to instructions communicated in this document and are cautioned to completely review the entire RFQ and follow instructions carefully. The Owner reserves the right to reject any or all statements of qualifications or proposals and to waive technicalities and informalities at the discretion of the Owner. Please note: The issuance of this RFQ invokes a Restriction of Communication on potential respondents, which, if violated, may result in proposal rejection (See Section 8 for details).

1. General Project

Information Project

Description

Under the guidance of the City of Douglas Administration, it will be the responsibility of the selected firm to provide initial consultation and evaluation, funding assistance with GEFA or other federal funding programs, preliminary Engineering Reports (PER), final design, construction administration, and inspection and close out services for water and wastewater improvement projects. The expectation is that selected companies will provide the technical skills necessary for capital improvement or maintenance projects, or evaluate such projects on very short notice, and on an as-needed basis, as determined by the City. Anticipated projects and programs include improvements to the existing Water distribution system, wastewater collection, treatment, and pumping facilities.

Project Goals

It is envisioned that the successful Project(s) will achieve the following objectives:

• New Headworks

• New Aeration Basins

• New Clarifier

• New Splitter Box/Central RAS Pit

• New UV Structure/Equipment

• New Post Aeration structure

• New Effluent Pumping Station

• New permitted WTP Effluent Outfall

• New Solids Handling Facilities

• New Office/Lab Building

• By-pass Overflow line(s) prior to tertiary treatment

• Other rehabilitation and expansion projects in the water and/or wastewater systems

Project Schedule

The selected firm will immediately begin work to submit environmental permitting for GEFA grant dollars.

Projects will move forward as the city sees fit and as funding is obtained/secured.

2. A/E Consultant Requirements

• History of firm, resources, and mission statement

• Familiarity with the community

• Key personnel/qualifications/license proof

• Current workload and ability to provide proposed services

• Proposed approach, ability, scope and level of service

• Experience with federally funded projects and list of references

• Errors and Omissions Insurance, please provide a copy.

• Statement of Qualifications form

The final scope of services will be developed by the Owner and communicated to eligible firm(s) for negotiation actual agreement. The Owner will provide additional details and a list of general duties required in Engineering Consulting Services for this Project to eligible finalists.

3. RFQ Schedule of Events

The following Schedule of Events represents the Owner’s best estimate of the schedule that will be followed. All times indicated are prevailing times in Georgia. The Owner reserves the right to adjust the schedule as the Owner deems necessary.

4. Selection Process

A Selection Committee, consisting of representatives of the Owner, will identify the finalist firm through a qualifications-based selection process. The Selection Committee will receive and evaluate Statements of Qualifications submitted in response to this RFQ using the following criteria:

a. Owner issues public advertisement of RFQ for a period of 30 days 02/19/2026 N/A

b. Deadline for written questions/requests for clarification (see section 6) 03/05/2026 5 PM

c. Deadline for submission of Statements of Qualifications (see sections 5, 7) 03/19/2026 2 PM

d. Owner completes evaluation, posts results, and issues Notification to Finalist firms 03/20/2026 5 PM

e. Selection Committee Interviews finalist firms 03/26/2026 10 AM

f. Participating Firm(s) notified of eligibility 04/14/2026 5 PM

Criteria for evaluation of Statements of Qualifications

10% Stability of the firm, including the firm’s corporate history, growth, resources, form of ownership, litigation history, financial information, and other evidence of stability.

30% Firm’s relevant project experience and qualifications, including the demonstrated ability of firm in effective Consulting Services for projects comparable in complexity, size, and function. This includes relevant experience and qualifications of the principal Consulting Services lead staff and level of experience in a leadership role over multiple providers and phases of construction for GEFA SRF Projects.

30% Past performance of the firm including references about the quality of leadership of the firm in Consulting Services, the overall services of the firm to previous customers, the firm’s ability to meet established project goals, the firm’s response to the Owner’s needs throughout the project, and the financial and technical success history of the of projects in which the firm provided leadership.

30% Firm’s apparent suitability to provide services for Project, including the firm’s apparent fit to the project type and/or needs of the Owner, any special or unique qualifications for the Project, current and projected workloads experience working for the City of Douglas, and services offered by the firm. The firm’s non-discrimination policies, any policies and past efforts for W/MBE inclusion will be a part of this evaluation, as well as the firm’s record and methodology of addressing public safety and environmental concerns.

Finalist Notification

The names of the firms selected as finalists will be posted on the Georgia Procurement Registry. The firms selected as finalists will receive written notification (Finalist Notification) from the Owner which will address the necessary elements of the remainder of the selection process.

Interview

In the Finalist Notification, each finalist firm shall be informed of the place and time for the interview session. The time allotted to each firm will not exceed 60 minutes to include: 10 minutes for setup, 20 minutes for proposer presentation, 20 minutes for Committee questions, and 10 minutes for knockdown. Electronic presentations, such as PowerPoint presentations, are allowed. Additional interview instructions and guidelines will be provided in the Notice to Finalists, as well as the criteria which will be used to evaluate the interview.

Consultant Selection

Upon completion of the interview process by the Selection Committee, the firms will be evaluated using criteria described herein. A list of Qualified Engineering Firms for city projects to be funded with SRF and/or other federal funding programs will be produced and will be good for up to five (5) years. Negotiations for future work during the five-year period may be initiated with any qualified firm or firms depending on the type of work and based on a proposal or competing proposals for the specific project, including pricing factors. Negotiations will proceed between the city and chosen pre-qualified firm to finalize the fees to be paid and contract language. The actual Form of Contract may be developed by the Owner OR the Consultant’s standard agreement may be utilized.

5. Instructions for Preparing Statement of Qualifications

Each qualification shall be prepared simply and economically, providing straightforward and concise delineation of the Company’s capabilities to satisfy the requirements of this RFQ. Emphasis in each qualification must be on completeness and clarity of content. To expedite the evaluation of qualifications, it is essential that companies follow the format and instructions contained herein. The City factors the qualification itself when considering the Company’s ability to deliver high quality services. All prospective proposers shall thoroughly examine and become familiar with this RFQ and carefully note the items, which must be submitted with the Qualification. Submission of a Qualification shall constitute an acknowledgment that the Proposer has read and understands the required Qualification Documents. The failure or neglect of an offeror to receive an addendum or examine fully the RFQ Document shall in no way relieve it from any qualification submission requirements. The pages of the qualification submittals must be numbered. A table of contents, with corresponding tabs, must be included to identify each section. Responses are limited to 20 pages or less using a minimum of an 11-point font. Any exhibits, affidavits, or other enclosure information called for may be included in an appendix and will not count toward the page limit. Each Statement of Qualifications shall provide a straightforward, concise delineation of respondent’s capabilities. Fancy, colored displays, and promotional materials are not desired. Emphasis must be on completeness, relevance, and clarity of content.

The content of all Statements of Qualifications must be categorized and numbered as outlined below, and responsive to all requested information:

A. Description and Resources of Firm

i. Provide basic company information: Company name, address, name of primary contact, telephone number, fax number, email address, and company website (if available). If the firm has multiple offices, the qualification statement shall include information about the parent company and branch office separately. Identify office from which project will be managed and this office’s proximity to the project site. Provide form of ownership, including state of residency or incorporation, and number of years in business. Is the offeror a sole proprietorship, partnership, corporation, Limited Liability Corporation (LLC), joint venture, or other structure?

ii. Briefly describe the history and growth of your firm(s). Provide general information about the firm’s personnel resources, including disciplines and numbers of employees and locations and staffing of offices

iii. Has the firm been involved in any litigation in the past five years? Describe your experience with litigation with Owners and/or Contractors. List any active or pending litigation and explain.

iv. Provide a statement of disclosure, which will allow the Owner to evaluate possible conflicts of interest. Respondents must provide, in their own format, a statement of all potential legal or otherwise significant conflicts of interests possibly created by the respondent’s being considered in the selection process or by the respondent’s involvement in the project.

Respondents should include information as to the nature of relationship(s) with parties in such potential conflict.

v. Has the firm ever been removed from a Services contract, had a contract terminated for default, or failed to complete a contract as assigned?

B. Experience and Qualifications

i. Provide professional qualifications and description of experience for principal Consulting Services personnel. (At this stage, firms are asked for information on lead staff only, but may list qualifications and experience on more than one lead individual who is qualified and available for proposed project. If the firm is selected as finalist, the Owner will request detailed information on the exact proposed expanded team and their relevant experience.)

Firms that respond as joint teams will be expected to clearly demonstrate their team members’ shared experience, as a joint team, on prior projects of similar magnitude and complexity.

ii. Provide information on the firm’s A/E Consulting Services experience on projects of similar type, size, function, and complexity. Describe no more than 10 and no less than five projects, in order of most relevant to least relevant, which demonstrate the firm's capabilities to perform the project at hand. For each project, the following information should be provided:

a. Project name, location, and dates during which services were performed.

b. Brief description of project and physical description.

c. Services performed by your firm.

d. Owner’s stated satisfaction level in the Consulting Services and/or overall service of your firm.

e. Owner contact information.

iii. Include any certifications, industry ratings, and achievement recognitions, etc., to attest to the level of experience and success. Describe innovations that the firm might have introduced or employed to increase project adherence to technical standards.

C. Statement of Suitability

i. Provide any information that may serve to differentiate the firm from other firms in suitability for the project. Suitability may include, but is not limited to, the firm’s fit to the project and/or needs of the Owner, any special or unique qualifications for the project, current and projected workloads, experience working for the City of Douglas, and any services offered by the firm that may be particularly suitable for this project.

ii. Provide any non-discrimination and affirmative action policies of the firm and the firm’s history of W/MBE inclusion in sourcing for projects.

6. Submittal of Questions and Requests for Clarification

Questions about any aspect of the RFQ, or the project, must be submitted in writing (email is preferable) to: Alyssa Fussell, afussell@cityofdouglasga.gov . The deadlines for submission of questions relating to the RFQ are the times and dates shown in the RFQ Schedule of Events in Section 3. Proposers are cautioned to review and adhere to the Restriction of Communication (See Section 8) for this Project.

7. Submittal of Statements of Qualifications

The outside of the qualification envelope must be clearly labeled with the Company’s name, address, contact information and labeled RFQ121520 DESIGN & ENGINEERING SERVICES FOR WATER AND WASTEWATER IMPROVEMENTS. The qualification envelope must only contain five (5) copies and one digital copy on a CD or flash drive of the Company’s response. Each submittal must include a transmittal letter. Statements of Qualifications must be received by the Owner prior to the deadline indicated in the Schedule of Events (See Section 3) at the exact address below:

ATTN: City Clerk Wynetta Bolder 302 S. Madison Avenue Douglas, GA 31533 mailto:afussell@cityofdouglasga.gov

8. Additional Terms and Conditions

Restriction of Communication

From the issue date of this (RFQ) solicitation until a successful proposer is selected and the selection is announced, proposers are not allowed to communicate about this solicitation or this Project for any reason with any members of the Selection Committee, the Owner, except for submission of questions as instructed in the RFQ, or during the proposer's conference (if applicable), or as provided by any existing work agreement(s). For violation of this provision, the Owner reserves the right to reject the proposal of the offending proposer.

Submittal Costs and Confidentiality

All expenses for preparing and submitting responses are the sole cost of the party submitting the response.

The Owner is not obligated to any party to reimburse such expenses. All submittals upon receipt become the property of the Owner. Labeling information provided in submittals “proprietary” or “confidential”, or any other designation of restricted use will not protect the information from public view. Subject to the provisions of the Georgia Open Records Act, the details of the proposal documents will remain confidential until final award.

Award Conditions

This request is not an offer to contract or a solicitation of bids. This request and any statement of qualifications or proposal submitted in response, regardless of whether the proposal is determined to be the best proposal, is not binding upon the Owner and does not obligate the Owner to procure or contract for any services. Neither the Owner nor any party submitting a response will be bound unless and until a written contract mutually accepted by both parties is negotiated as to its terms and conditions and is signed by the Owner. The Owner reserves the right to waive non-compliance with any requirements of this Request for Proposal and to reject any or all proposals submitted in responses. Upon receipt and review of responses, the Owner will determine the party(s) and proposal that in the sole judgment of the Owner is in the best interest of the Owner (if any is so determined), with respect to the evaluation criteria stated herein. The Owner then intends to conduct negotiations with such party(s) to determine if a mutually acceptable contract may be reached.

Statement of Agreement

With submission of a statement of qualifications or proposal, the Proposer agrees that he/she has carefully examined the solicitation, and the Proposer agrees that it is the Proposer’s responsibility to request clarification on any issues in any section of the solicitation with which the Proposer disagrees or needs clarified. The Proposer also understands that failure to mention these items in the proposal will be interpreted to mean that the Proposer is in full agreement with the terms, conditions, specifications and requirements in the therein. With submission of a proposal, the Proposer hereby certifies: (a) that this proposal is genuine and is not made in the interest or on behalf of any undisclosed person, firm, or corporation; (b) that Proposer has not directly or indirectly included or solicited any other Proposer to put in a false or insincere proposal; (c) that Proposer has not solicited or induced any person, firm, or corporation to refrain from sending a proposal.

Private Employer Affidavit Pursuant To O.C.G.A. § 36-60-6(d)

By executing this affidavit under oath, the undersigned private employer verifies one of the following with respect to its application for a business license, occupational tax certificate, or other document required to operate a business as referenced in O.C.G.A. § 36-60-6(d):

Section 1. Please check only one:

(A) ________ On January 1 st of the below-signed year, the individual, firm, or corporation employed more than ten (10) employees

*** If you select Section 1(A), please fill out Section 2 and then execute below.

(B) ________ On January 1 st of the below-signed year, the individual, firm, or corporation employed ten (10) or fewer employees.

*** If you select Section 1(B), please skip Section 2 and execute below.

Section 2.

The employer has registered with and utilizes the federal work authorization program in accordance with the applicable provisions and deadlines established in O.C.G.A. § 36-60-6. The undersigned private employer also attests that its federal work authorization user identification number and date of authorization are as follows:

Name of Private Employer

Federal Work Authorization User Identification Number

Date of Authorization

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: __________________________

To determine the number of employees for purposes of this affidavit, a business must count its total number of employees company-wide, regardless of the city, state, or country in which they are based, working at least 35 hours a week.

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT OCGA 13-10-90

TO ALL PROSPECTIVE VENDORS:

If you are providing service, or performing work for The City of Douglas, Georgia, the applicable Georgia Security and Immigration Compliance documents found here must be completed, signed, notarized and submitted with your bid/proposal.

1) The City of Douglas Georgia shall comply with the Georgia Security and Immigration

Compliance Act OCGA 13-10-90 et. seq.,

2) In order to insure compliance CONTRACTOR agrees to comply with all of the contractor requirements of the “Georgia Security and Immigration Compliance Act” of 2006 as codified in O.C.G.A. Sections 13-10-90 and 13-10-91 and regulated in Chapter 300-10-1 of the Rules and Regulations of the State of Georgia, "Public Employers, Their Contractors and Subcontractors Required to Verify New Employee Work Eligibility Through a Federal Work Authorization Program," accessed at http://www.dol.state.ga.us, as further set forth below.

A. Contractor Agreement to Verify the Work Eligibility of its New Hires through the

U.S Department of Homeland Security’s “Employment Eligibility Verification (EEV) / Basic Pilot Program.” CONTRACTOR agrees to verify the work eligibility of all of CONTRACTOR’S newly hired employees through the U.S.

Department of Homeland Security’s Employment Eligibility Verification (EEV) / Basic Pilot Program, accessed through the Internet at https://www.vis-dhs.com/EmployerRegistration, in accordance with the provisions and timeline found in O.C.G.A. 13-10-91 and Rule 300-10-1-.02 of the Rules and Regulations of the State of Georgia. As of July 1, 2007, the verification requirement applies to contractors and subcontractors with five-hundred (500) or more employees.

B. Contracts Affected by the “Georgia Security and Immigration Compliance Act.”

CONTRACTOR agrees that the contractor and subcontractor requirements of the “Georgia Security and Immigration Compliance Act” of 2006 apply to contracts for, or in connection with, the physical performance of services within the State of Georgia.

C. Timeline for Application of the Worker Eligibility Verification Requirements to

Contractors and Subcontractors. CONTRACTOR agrees that the following Georgia Security and Immigration Compliance Act contract compliance dates apply to this contract, pursuant to O.C.G.A. 13-10-91:

On or after July 1, 2007, to public employers, contractors, or subcontractors of 500 or more employees;

On or after July 1, 2008, to public employers, contractors, or subcontractors of 100 or more employees; and http://www.dol.state.ga.us/ https://www.vis-dhs.com/EmployerRegistration https://www.vis-dhs.com/EmployerRegistration

On or after July 1, 2009, to all other public employers, their contractors, and subcontractors.

The prospective CONTRACTOR must initial one of the sections below:

Contractor has 500 or more employees [CONTRACTOR must register with the Employment Eligibility Verification/Basic Pilot Program and begin work eligibility verification on July 1, 2007, and execute and send to DEPARTMENT a “Contractor Affidavit and Agreement” attesting to registration with the EEV / Basic Pilot Program];

Contractor has 100-499 employees [CONTRACTOR must register with the Employment Eligibility Verification/Basic Pilot Program and begin work eligibility verification by July 1, 2008];

or

Contractor has 99 or fewer employees [CONTRACTOR must begin work eligibility verification by July 1, 2009].

3) In the event that the contractor employs or contracts with any subcontractor in connection with a covered contract the contractor will secure from the subcontractor attestation of the subcontractor’s compliance with O.C.G.A. § 13-10-90 et seq. and Georgia Department of Labor Rule 300-10-1-.02 by the subcontractor’s execution of the subcontractor affidavit shown in Georgia Department of Labor Rule 300-10-1-.02 or a substantially similar affidavit.

4) Contractor agrees that, in the event the (insert your company’s name) ________________

____________________________________________ employs or contracts with any sub-contractor in connection with the covered contract to Require “Georgia Security and Immigration Compliance Act” Compliance of its Subcontractors Connected with this Contract. CONTRACTOR agrees to require O.C.G.A. Sections 13-10-90 and 13-10-91 compliance in all written agreements with any subcontractor employed by CONTRACTOR to provide services connected with this contract, as required pursuant to O.C.G.A. 13-10-91., that the (insert company’s name) ____________________________ ________________________________will secure from each sub-contractor the employee-number applicable to the sub-contractor.

CONTRACTOR agrees to obtain from any subcontractor that is employed by CONTRACTOR to provide services connected with this contract, the subcontractor’s indication of the employee-number category applicable to the subcontractor.

5) Contractor agrees to provide the City of Douglas with and secure all affidavits from any subcontractor engaged to perform services under this Contract an executed the “Subcontractor Affidavit,” as required pursuant to O.C.G.A. 13-10-91 and Rule 300-10-

1-.08 of the Rules and Regulations of the State of Georgia, which rule can be accessed at http://www.dol.state.ga.us.

CONTRACTOR agrees to maintain all records of the subcontractor’s compliance with O.C.G.A. Sections 13-10-90 and 13-10-91 and Chapter 300-10-1 of the Rules and Regulations of the State of Georgia.

http://www.dol.state.ga.us/

CONTRACTOR AFFIDAVIT AND AGREEMENT

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. 13 1 0-91, stating affirmatively that the individual, firm, or corporation which is contracting with The City of Douglas, has registered with and is participating in a federal work authorization program* [any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-6031], in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Douglas, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. 13- 10-91 on the Subcontractor Affidavit provided in Rule 300- 10-01 -.08 or a substantially similar form. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the (name of the public employer) at the time the subcontractor(s) is retained to perform such service.

EEV / Basic Pilot Program* User Identification Number

BY: Authorized Officer or Agent Date (Contractor Name)

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____

Notary Public My Commission Expires: _____________

*As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is the "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).

Authority O.C.G.A. 13-10-91

SUBCONTRACTOR AFFIDAVIT

Contractors shall use the following affidavit form, or an affidavit form that is substantially similar to that provided below, to document a subcontractor's compliance with the requirements of O.C.G.A. 13-10-91:

By executing this affidavit, the undersigned subcontractor 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 under a contract with (name of contractor) ________________ ___________________________________________ on behalf of the City of Douglas has registered with and is participating in a federal work authorization program* [any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-6031], in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

EEV / Basic Pilot Program* User Identification Number

BY: Authorized Officer or Agent Date (Contractor Name)

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____

Notary Public My Commission Expires: _____________

*As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is the "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).

Authority O.C.G.A. 13-10-91

INSURANCE SPECIFICATIONS PAGE:

Insurance is required on projects being done on City property as specified on the Request for Quote unless waived by City of Douglas. A Certificate of Insurance made out to City of Douglas must be furnished before any work can begin.

Please provide the following information.

Liability Insurance Coverage*:

⇒ Bodily injury: $_____________________________________________________ (Minimum $500,000. required)

⇒ Property damage: $__________________________________________________ (Minimum $500,000. required)

⇒ Workman’s Compensation: $___________________________________________ (Statutory coverage as required by the State of Georgia.)

*Liability coverage must be provided to include premises, operations, products and completed operations.