Bid Document

103 Roosevelt Drive

Valdosta, Georgia 31602-1886

FOR:

Highway 84 Watermain Extension 2026

Opening Date/Time:

May 5th, 2026 at 11:00 a.m.

GENERAL SPECIFICATIONS

It is the intent of these specifications to furnish the Development Authority with the following requisitioned project, according to the attached. It is clearly understood that the following are minimum specifications and are made in order to show the exact specifications of the work proposed.

The Development Authority reserves the right to accept or reject any or all bids or to choose the bid considered to be in its best interest.

The final decision of purchase will be made upon the award of the Valdosta-Lowndes Development Authority Board.

NO BID WILL BE CONSIDERED IF RECEIVED AFTER THE DATE AND TIME

SPECIFIED.

BIDDING DOCUMENTS AND

CONTRACT DOCUMENTS

For

HIGHWAY 84 WATERMAIN EXTENSION 2026

VALDOSTA-LOWNDES DEVELOPMENT AUTHORITY

TABLE OF CONTENTS

1. Advertisement / Invitation to Bid

2. Instructions to Bidders

3. Proposal/Unit cost schedule

4. Notice of Award

5. Contract Agreement

6. Contract Conditions

7. Notice to Proceed

8. Drug-Free Workplace Certification

9. Waiver of Lien

10. Attachment 1 - Contractor Affidavit and Agreement (E-Verify)

ADVERTISEMENT TO BID

The Valdosta-Lowndes Development Authority is accepting bids for

Highway 84 Watermain Extension 2026

The proposed project includes a ±4267 LF extension of a 16” watermain. The project will be constructed per City of Valdosta Standards and Specifications.

The contract time is 180 calendar days. The bid documents may be viewed at the Development Authority office, 103 Roosevelt Dr, Valdosta, Georgia, and a pdf copy of the bid documents can be requested from LEA at lauren.brown@lea-pc.com.

There will be a mandatory pre-bid meeting on April 21st, 2026 at 11:00 A.M., in the Development Authority conference room at their office located at 103 Roosevelt Dr, Valdosta, Georgia. All attendees please park in the lot behind the development authority.

The Development Authority will receive sealed proposals on this project until May 5th, 2026 at 11:00 A.M., in the Development Authority office, 103 Roosevelt Dr, Valdosta, Georgia, (229-259-9972) where at such time and place the proposals will be publicly opened and read. A 5% bid bond is required.

All bidders shall be licensed underground utility contractors.

Run in Valdosta Daily Times April 2nd and April 16th mailto:lauren.brown@lea-pc.com

INSTRUCTIONS TO BIDDERS

1. Proposals must be made upon the form of proposal attached hereto. They must be enclosed in a sealed plain envelope with the following information on the outside of the envelope:

Bid for: Highway 84 Watermain Extension 2026

Name of Contractor Underground Utility Contractor License #

The bids can be mailed or hand delivered to the Development Authority at 103 Roosevelt Dr, Valdosta, Georgia 31602, Attn: Niki Ogletree.

2. The prices shall be written in the proposal in figures. No Bidder will be allowed to withdraw their proposal for any reason after the bids have been opened.

3. It is expressly understood by the Bidder that written Notice of Award or purchase order by the Development Authority will constitute an agreement by the Development Authority. The Advertisement/Invitation to Bid, Instructions to Bidders, Proposal, Notice of Award, Contract Agreement, Contract Conditions, Notice to Proceed, Drug- Free Workplace Certification, Waiver of Lien, and the referenced Construction Plans and Drawings constitute the entire Agreement and understanding between The Development Authority and the Contractor in respect of this Project, and revokes any prior agreement or understanding relating to the subject matter of this Agreement. No change, amendment, termination or attempted waiver of any of the provisions herein shall be binding upon the other parties unless reduced to writing and signed by all parties hereto.

4. The Bidder agrees that the Development Authority reserves the right to reject any or all proposals, or to accept the part of the bid considered to be in the best interest of the Development Authority.

5. Specifications referred to are a minimum. Therefore, unless otherwise indicated by the

Bidder, the Development Authority will assume proposals meet or exceed all specifications.

6. The names of a certain brand, make, or definite specifications are to denote a quality standard of the article desired, but do not restrict Bidders to a specific brand, make or manufacturer named; it is to set forth and convey to prospective Bidders the general style, type, character and quality of the article desired.

7. The award of the contract will be made to the lowest responsible Bidder taking into consideration quality performance and the time specified in the proposals for the performance of the contract. The Development Authority reserves the right to reject all bids as they appear in its own best interest and to waive technicalities.

8. During the bidding process, all changes, interpretations, and supplemental instructions to the contract documents shall be issued as addenda to all Bidders. All addenda are to be acknowledged in the proposal.

9. Each bid must be accompanied by a Bid Bond in the amount of 5% of the bid. A certified check for this amount may be submitted in lieu of the Bid Bond. Bid Bonds on the Surety Company’s standard form must be duly executed by the Bidder as principal, and must be by a surety company licensed to do business in the State of Georgia and listed in the latest issue of U. S. Treasury Circular 570. Failure to submit a properly executed Bid Bond or certified check will result in the bid being rejected.

10. Each Bidder must inform themselves fully on all the conditions at the site, transportation conditions, material costs, and all other matters affecting the cost of construction. Each Bidder shall study the plans, specifications, contract and proposal form prior to submitting a proposal. Each Bidder shall also make such examinations on the ground as necessary to be thoroughly familiarized with the nature and extent of the proposed construction.

11. The contract documents are complimentary, and what is called for by one shall be binding as if called for by all.

12. The intent of the contract documents is to provide for all construction and completion of the work shown on the drawings and described in the specifications.

13. The latest edition of the City of Valdosta Utility Standards and Specifications shall govern the water and sewer portion of the work on this project.

14. The contract is a unit price contract with payment to be based on actual quantities of work measured. The list of items shown in the Bid Form is inclusive of all the work shown and described. In case of changes in the drawings and specifications that produce new items of work not described in the unit price schedule, Change Orders will be issued to include such items of work.

15. The Development Authority reserves the right to review and reject any subcontractors.

A list of subcontractors shall be submitted to the Development Authority by the Contractor after the Notice of Award has been issued.

END OF SECTION

PROPOSAL

To the Valdosta-Lowndes Development Authority, Lowndes County, Georgia:

Submitted: , _

The undersigned, as Bidder, hereby declares that they have examined the site of the work and has informed themselves fully in regard to all conditions pertaining to the place where the work is to be done; that they have examined the Specifications and Drawings for the work and contractual documents relative thereto; and that they have satisfied themselves to the work to be performed.

The Bidder proposes and agrees that, if they become the Successful Bidder on the basis of this Proposal, they will contract with the Valdosta-Lowndes Development Authority, Lowndes County, Georgia (herein called the "Owner"), in the form of the contract illustrated to furnish all necessary materials, equipment, machinery, tools, apparatus, means of transportation, and all necessary labor to complete the construction of the work in full, and in complete accord with the shown, noted, described, specified and reasonably intended requirements of the Specifications, Drawings, and Contract Documents to the full and entire satisfaction of the Owner, with a definite understanding that no money will be allowed for extra work except as set forth in the Contract Documents, for the following prices:

Submitted By: ___________________________________ (Company Name)

Item Quantity Unit Unit Cost Total Cost

1 Mobilization, Bonds, Temp. Facil ities 1 LS $ -$

2 Traffic Control 1 LS $ -$

3 Temporary Grassing 1.2 AC $ -$

4 Erosion Control check dams (Temporary si lt fence fabric) 10 EA $ -$

5 Maintenance of Check Dams 10 EA $ -$

6 Water Quality Monitoring and Sampling 6 MO $ -$

7 Silt Fence 2012 LF $ -$

8 Demolition (including removal of any debris) 1 LS $ -$

9 Connection to Existing 12" (Complete in Place) 2 EA $ -$

10 16" HDPE DR11 Watermain (Incl. Tee's & Bends) 2436 LF $ -$

11 Directional Dril l 16" DR11 HDPE Watermain 1831 LF $ -$

12 16" Valve Assembly (Complete In Place) 4 EA $ -$

13 12" Valve Assembly (Complete In Place) 1 EA $ -$

14 16"X12" Reducer & Flanged Adapter 1 EA $ -$

15 12" Tapping Sleeve and Valve Assembly (Complete in Place) 1 EA $ -$

16 New Fire Hydrant with valve Assembly (Complete in Place) 4 EA $ -$

17 Permanent Grassing - All disturbed areas 1.2 AC $ -$

18 Watermain Testing and Disinfection 1 LS $ -$

19 Testing 1 LS $ -$

20 As-built survey 1 LS $ -$

Subtotal -$

SWA (10% of Subtotal) -$

TOTAL BID -$

Unit Cost Schedule Highway 84 Watermain Extension

ADDENDA

Receipt of the following addenda is acknowledged:

Addenda Number: Date:

BID BOND

The Bidder proposes and agrees hereby to commence work under this Contract on a date to be specified in a written order of the Owner, and shall fully complete all work thereunder within the time described in the contract agreement.

The undersigned further agrees that, in case of failure on their part to execute the said Contract and the bond within fourteen (14) consecutive calendar days after written notice being given of the award of the Contract, the check or bid bond accompanying this bid and the moneys payable thereon, shall be paid into the funds of the Development Authority, as liquidated damages for such failures; otherwise the check or bid bond accompanying this Proposal will be returned to the undersigned.

Attached hereto is a certified check on the

Bank of

Or a Bid Bond by the

In the amount of Dollars

($__________________________) made payable to the Development Authority in accordance with the conditions herein. The bid security will be in force for sixty (60) calendar days.

Submitted:

By:

Title:

(Note: If the Bidder is a corporation, the Proposal shall be signed by an officer of the corporation; if a partnership, it shall be signed by a partner. If signed by others, authority for signature shall be attached.)

Bidder's Address:

Telephone Number:

NOTICE OF AWARD

To:

PROJECT DESCRIPTION: Highway 84 Watermain Extension 2026

The OWNER has considered the BID submitted by you for the above-described work in response to its advertisement for BIDS.

You are hereby notified that your BID has been accepted for items in the amount of:

You are hereby required to execute the Agreement, and furnish the required Contractor's CERTIFICATION OF INSURANCE with a 30-day notice of cancellation and PERFORMANCE BOND within fourteen (14) calendar days from the date of this NOTICE to you.

If you fail to execute said AGREEMENT and to furnish said BOND and CERTIFICATIONS within fourteen (14) days from the date of this NOTICE, said OWNER will be entitled to consider all your rights arising out of the OWNER'S acceptance of your BID as abandoned and as a forfeiture of your BID BOND. The OWNER will be entitled to such other rights as may be granted by law.

You are required to return an acknowledged copy of the NOTICE OF AWARD to the

OWNER.

Dated this_________day of __________, 2026

Valdosta-Lowndes Development Authority

BY:

TITLE:

CONTRACTOR:

DATE:

CONTRACT AGREEMENT

This agreement made and entered into this day of , 2026 and between Valdosta-Lowndes Development Authority, party of the first part (hereinafter called the Development Authority), and James Warren and Associates, Inc., party of the second part (hereinafter called the Contractor), who have been duly authorized to execute this agreement.

WITNESSETH: Whereas, the Development Authority and the Contractor, desire the improvement and repairs of a certain project and the Contractor desires and agrees to furnish and deliver all the material and to do and perform all the work and labor for said purpose. The project being more particularly described as follows:

Highway 84 Watermain Extension 2026

Failure to perform the above-listed tasks, frequency of tasks, or general instructions will be considered cause for termination of this contract with ten (10) days notice to the Contractor.

NOW, THEREFORE, in consideration hereinafter fully set out, the parties agree as follows:

1. The work and materials shall be in strict and entire conformity with the provisions of this contract and the plans and specification prepared (or approved) by the Development Authority or their authorized representative the originals of which are on file in the office of the Valdosta-Lowndes Development Authority and which said specifications are hereby made a part of this agreement as fully as to the same effect as if the same had been set forth at length in the body of this Agreement.

2. This Agreement is on a unit basis. It is understood that the quantities are approximate only and are subject either to increase or decrease and any increases or decreases are to be paid for at the contract price.

3. The Development Authority hereby agrees to pay to the Contractor for the faithful performance of this Agreement, subject to additions and deductions as provided in the Specifications or Proposal, in lawful money of the United States, the sum of:

Bid Amount ($000,000)

4. The Development Authority and Contractor agree that the financing of this project shall be as follows: Payments will be made on a monthly basis.

5. The Contractor shall commence the work to be performed under this Agreement on a date specified in a written Notice to Proceed and shall substantially complete all work hereunder, except as otherwise provided in these documents for extension of the time limit, within 180 calendar days. Substantial completion is the time at which the project can be fully utilized for its intended purpose. Upon written notification to the Development Authority that the project is substantially complete, a final site visit will be made and a punch list of deficient items will be generated. The Contractor will receive a written copy of the punch list, and must achieve final completion by correcting all punch list items within 30 days of receipt. Time is of the essence on this contract, and the Contractor shall pay to the Development Authority, not as a penalty, but as liquidated damages, the sum of $500.00 each calendar day that they shall be in default of completing the work, both substantial completion and final completion, within the time named herein. Because of the difficulty of fixing damages suffered by the Development Authority on account of such default, damages are herein agreed upon as stated.

6. The work shall be done in accordance with the laws of the State of Georgia under the direct supervision and to the entire satisfaction of the Development Authority. The decision of the Development Authority upon any question connected with the execution or fulfillment of this agreement and interpretation of the specifications or upon any failure or delay in the prosecution of the work by the Contractor shall be final and conclusive.

7. It is mutually agreed upon that the Contractor shall warranty all work done as a part of this contract agreement for a period of one year from the date of final acceptance by the Development Authority.

8. The Development Authority reserves the right to terminate this Agreement for non-compliance by issuing ten (10) days written notice to the Contractor.

9. Employees, aides, staff helpers, or any person who receives any form of consideration for services or who performs any services towards the execution of this Agreement are deemed to be the sole responsibility of the Contractor for the purposes of all Workers’ Compensation and insurance claims. The Development Authority reserves the right to superintend the performance of this Agreement only to the extent that the desired results are obtained. No recommendation or requirement in this Agreement and list of specifications should be deemed to obligate the Development Authority under the Workers’ Compensation Act to Contractor’s employees, aides, staff, helpers or any person who receives any form of consideration for services or who performs any services towards the execution of the Agreement.

10. Nothing contained in the Agreement shall create a contractual relationship with or cause of action of a third party against the Development Authority.

11. Contractor agrees to indemnify, save and hold harmless, and defend the Development

Authority, its officers, boards, and employees, from and against any liability for damages and for any liability or claims resulting from property damage or bodily injuries (including accidental death) which arise out of the Contractor’s operation and provision of services, including but not limited to, reasonable attorneys’ fees and costs if such fees and costs are deemed necessary by the Development Authority.

12. This Agreement may not be assigned by either party hereto without written agreement signed by both parties. This Agreement and the rights of the parties hereunder shall be binding upon and insure to the benefit of the parties hereto and their respective successors and, if applicable, assigns.

13. Any notice or communications required or permitted hereunder shall be sufficiently given if sent Registered or Certified Mail, Return Receipt Requested, postage pre-paid, addressed as follows:

As to Contractor: ATTN:

Contractor address line 1 address line 2

As to the Development Authority:

ATTN: Niki Ogletree Valdosta-Lowndes Development Authority 103 Roosevelt Drive Valdosta, Georgia 31602-1886

Or such address as shall be furnished by such notice to the other parties.

14. No waiver by either party of any default by the other party in the performance of any provision of this Agreement shall operate as to be construed as a waiver of any future default, whether like or different in character.

15. This Agreement shall be governed and construed in accordance with the laws of the

State of Georgia.

16. If any provisions of this Agreement, or application thereof to any person or circumstance, shall to any extent be invalid, then such provision shall be modified if possible, to fulfill the intent of the parties as reflected in the original provision, the remainder of this Agreement or the application of such provision to persons or circumstances other than those as to which it is held invalid, shall not be affected thereby, and each provision of this Agreement shall be valid and enforced to the fullest extent permitted by law.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement under their respective seals on the day and date below written, be it deemed an original contract.

Executed on behalf of Executed on behalf of

VALDOSTA-LOWNDES CONTRACTOR

DEVELOPMENT AUTHORITY

The day of , 2026 The day of , 2026

By: By:

Chairman of Valdosta-Lowndes Contractor Development Authority

Recommended: __________________________ Exec Director, Development Authority

Date: _____________________________

Witness for Development Authority: Witness for Contractor:

CONTRACT CONDITIONS

1. All contract items and work shall be in accordance with the current edition of the City of

Valdosta Standards and Specifications for the water and sewer portion of the work, and/or special provisions and supplemental specifications attached and made a part of the contract.

2. Insurance - The contractor shall procure and maintain insurance of the types and to the limits specified in paragraphs (a) through (f) inclusive below. The contractor shall require each of his subcontractors to procure and maintain, until completion of the subcontractor's work, insurance of the types and to the limits specified in paragraphs (a) through (f) inclusive below. It shall be the responsibility of the contractor to ensure that all their subcontractors meet these requirements. Except as otherwise stated, the amounts and types of insurance shall conform to the following minimum requirements:

(a) Worker's Compensation - Coverage to apply for all employees for

STATUTORY limits in compliance with applicable state and federal laws; if any operations are to be undertaken on or about navigable waters, coverage must be included for the USA Longshoremen & Harbor Workers Act and Jones Act; in addition, the policy must include EMPLOYERS LIABILITY for limits of $500,000/each accident; $500,000/disease - policy limit; $500,000/disease -each employee.

(b) Commercial General Liability - Coverage must be afforded, under an occurrence form policy, including Premise Operations, Independent Contractors, Products and Completed Operations, Broad Form Property Damage Endorsement, with Additional Insured Endorsement in favor of the Development Authority in limits not less than $3,000,000/general aggregate;

$3,000,000/products-completed operations (aggregate); $3,000,000/personal injury-advertising liability; $3,000,000/each occurrence; $100,000/fire damage legal; $10,000 medical payments. This coverage may be layered with excess umbrella liability coverage.

(c) Business Auto Policy - Coverage must be afforded including coverage for all Owned vehicles, Hired/Non-Owned vehicles, with an Additional Insured Endorsement in favor of the Development Authority, for a combined single limit (bodily injury and property damage) of not less than $3,000,000/combined single limit (Bodily Injury/Property Damage); personal injury protection-statutory limits; $1,000,000 uninsured/underinsured motorist;

$1,000,000/hired/non-owned auto liability. This coverage may be layered with excess umbrella liability coverage.

(d) Certificate of Insurance - Certificates of all insurance required from the contractor shall be filed with the Development Authority and shall be subject to its approval for adequacy and protection. Certificates from the insurance carrier, stating the types of coverage provided, limits of liability and expiration dates, shall be filed with the Development Authority before operations are commenced. Valdosta-Lowndes Development Authority shall be identified as an Additional Insured for each type of coverage required by paragraphs (a) to

(c) above. The required certificates of insurance shall not only name types of policies provided, but shall also refer specifically to this contract/bid.

(e) The contractor shall provide a Certificate of Insurance to the Development Authority with a thirty (30) day notice of cancellation. In addition, the Development Authority will be shown as Additional Insured, with a Hold Harmless Agreement in favor of the Development Authority. The certificate should also indicate if the cover is provided under a "claims made" or "per occurrence" form. If any cover is provided under a claims made form, the certificate will show a retroactive date (in instances of contract renewals or extensions), which should be the same date of the original/first contract or prior.

(f) If the initial insurance expires prior to the completion of the work, renewal certificates shall be furnished thirty (30) days prior to the date of their expiration.

3. All construction supervision and measurements of quantities will be made by the

Development Authority or their representative. Final acceptance of the project will be made by the Development Authority’s Engineer and presented to the Development Authority for final payment.

4. The Contractor is required to furnish the Development Authority with test reports and technical data showing that the materials and installation (compaction tests, pressure tests, Bac-T tests, etc) meet the appropriate requirements of the contract documents.

5. All base pits and borrow pits required for completion of the work shall be provided by the Contractor.

6. Retainage shall be as follows: An amount of five (5) percent of the gross total invoiced amount will be retained for the project.

7. Retainage amounts shall be held until:

(a) All items on the punch list are resolved.

(b) A lien release is provided by the Contractor to the Development Authority for

All Subcontractors and material suppliers.

(c) A final pay request is submitted to the Development Authority.

(d) The project is accepted by the Development Authority.

8. The Contractor represents that it has a current Occupational Tax Receipt from a local government in Georgia.

9. The Contractor shall obtain all necessary local, state, federal permits as required by law for the construction of the project.

10. The Contractor shall notify the City of Valdosta Engineering Department at least 24 hours prior to beginning any phase of construction so that the appropriate Inspector can be present.

11. Traffic Control shall be provided in accordance with the Georgia Department of

Transportation Special Provision, Section 150. Unless otherwise indicated in the Proposal, this item will not be paid for as a separate pay item but shall be incorporated as a part of the contract.

12. All construction plans and drawings can be obtained from the Development Authority.

13. This Agreement will terminate immediately and absolutely as such time as appropriated and otherwise un-obligated funds are no longer available to satisfy the obligation of the Development Authority under this Agreement.

14. Should completion of any portion of the services be delayed for causes beyond the control or without the fault or negligence of the Development Authority including force majeure, the time for performance shall be extended for a period equal to the delay and the parties shall mutually agree on the terms and conditions upon which the services may be continued. Force majeure includes, but is not restricted to, acts of God or the public enemy, acts of the Government of the United States or of the several states, or any foreign country, or any of the preceding acts of contractors or agents, fires, floods, epidemics, riots, quarantine restrictions, strikes, civil insurrections, freight embargoes, and unusually severe weather.

15. The contractor performing the sewer and water installation must be a licensed underground utility contractor in the state of Georgia.

16. If the gravity sewer is not operational by the substantial completion date, the contractor shall be responsible for providing a bypass pumping system to convey the sewer effluent from Project Forage to an acceptable discharge location.

NOTICE TO PROCEED

DESCRIPTION: Highway 84 Watermain Extension 2026

You are hereby notified to commence WORK, in accordance with the Agreement dated _____________ on or before __________ and you are to complete the work within _____ consecutive calendar days thereafter. The date of substantial completion of the work is therefore________________.

Valdosta-Lowndes Development Authority

ACCEPTANCE OF NOTICE

Receipt of the above NOTICE TO PROCEED is hereby acknowledged

Contractor:

This the day of , 2026

Employer Identification Number:

DRUG-FREE WORKPLACE CERTIFICATION

The undersigned certifies that the provisions of code sections 1 through 50-24-6 of the Official Code of Georgia Annotated, related to the "DRUG-FREE WORKPLACE ACT", have been complied with in full. The undersigned further certifies that:

1. A Drug-Free workplace will be provided for the Contractor's employees during the performance of the contractor; and

2. Each Contractor who hires a sub-contractor to work in a Drug Free workplace shall secure from that sub-contractor the following written certification:

(Contractor name) certifies to the Valdosta-Lowndes Development Authority that a Drug-Free workplace will be provided for the Contractor's and/or sub-contractor's employees during the performance of this contract known as Highway 84 Watermain Extension 2026, Pursuant to paragraph (7) of subsection (B) of Code Section 50-24-3 O.C.G.A. Also, the undersigned further certifies that he/she will not engage in the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana during the performance of the contract.

Contractor or Sub-Contractor Date

Title

WAIVER OF LIEN

Know by all persons by these presents, on the Highway 84 Watermain Extension 2026 project, that all bills for labor, materials, supplies, etc., and applicable state taxes in connection with the construction of this project are paid in full, and that there are no outstanding accounts whatsoever as a result of WORK performed on this project.

Therefore, does hereby waive, release, and relinquish any and all right to claim any lien or liens for work done or material furnished, or any kind or class of lien whatsoever.

Contractor

DATE:

Notary Public

Date

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

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 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 _________, _____, _______ 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: _____________________________