ITB _ Janitorial Bid.docx

Invitation to Bid

City of St. Marys

Janitorial Services Contract

Bids will be opened on

April 11, 2024 – 2:00 PM

Invitation to Bid City of St Marys Janitorial Services Contract April 11, 2024 2:00 PM

The City of St Marys is soliciting sealed bids for the Janitorial Services Contract for various facilities in the City. Competitive sealed bids will be received at City of St. Marys, 418 Osborne Street, St. Marys, Georgia 31558, until 2:00 pm, on April 11, 2024, and shall be publicly opened and vendor’s names and amounts of the bid will be read aloud. Bids received after the required time or in any other location will not be accepted. No bid may be withdrawn after the closing time for the receipt of bids for a period of sixty (60) days. Faxed or emailed bids will not be accepted.

Bids shall be submitted in a sealed envelope with the bidder's name and address clearly marked on the front of the package.

Janitorial Services for the following locations:

City Hall – Water Department, City Manager/Mayor/Human Resources, Municipal Court, Finance Department Planning, Building, & Code Enforcement Main Street Office Orange Hall Museum Restrooms Library Senior Citizens Center Public Works Department Police Department U. S. Coast Guard Building

Site inspection is recommended for each location. These inspections can begin any time after March 12, 2024. To schedule a site inspection, all interested bidders must contact Shawn Clearwater at 912-510-0053 or via email at sclearwater@stmarysga.gov before April 5, 2024. Written questions concerning the bid requirement or specifications must be submitted up to and until April 5, 2024, to Sarah Lee at 418 Osborne Street, St. Marys, GA 31558 or via email at slee@stmarysga.gov.

One (1) original and two (2) copies of these bid documents must be submitted in a sealed envelope marked “JANITORIAL SERVICES CONTRACT”. The bid package must be clearly labeled with the following information:

JANITORIAL SERVICES CONTRACT

Attn: Finance Dept.

City of St Marys 418 Osborne Street St. Marys, GA 31558

Bids may be withdrawn by written request only if the request is received prior to the time and date set for the opening bids. Negligence on the part of the bidders in preparing his bid confers no right of withdrawal or modification of his bid after bid has been opened.

Copies of the complete bid package may be obtained from Sarah Lee in the City of St. Marys Finance Department located at 418 Osborne Street, St. Marys, Georgia, 31558. Copies may also be requested via phone at 912-510-4045 or email at slee@stmarysga.gov. A street address, contact person, phone and fax number must be provided to ensure prompt delivery and notification of addenda.

All required Contract Documents and proof of meeting the City’s Insurance Requirements must be fully completed and executed by the Contractor and his/her Surety, and submitted to the Owner on or before the issuance of Notice to Proceed.

The City of St. Marys will select the bid that, in its sole discretion is the most responsive and responsible to the City. The City is not liable for any cost incurred by vendors in the preparation of this bid.

Unauthorized contact regarding this invitation to bid with staff or elected officials may result in disqualification. Any oral communications will be considered unofficial and non-binding on the City of St. Marys. Vendors should rely only on written statements.

The City of St. Marys, in accordance with Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d to 2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively ensure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, sex, age, handicap/disabled in consideration for an award.

The Owner reserves the right to reject any or all bids, to waive informalities and to re-advertise, pursuant to federal and state law.

Scope of Work

To maintain a clean and healthy public environment, the successful vendor will perform cleaning operations in and around the buildings listed in this document as prescribed herein. The successful vendor will be responsible for all labor, cleaning tools, materials, and cleaning supplies. The City desires to award a contract for professional janitorial services for the buildings or departments listed below:

· Offices located at 418 Osborne Street St. Marys, GA 31558:

· St. Marys City Hall

· Water Department, City Clerk

· City Manager/Mayor/Human Resources

· Finance Department/IT Department

· St. Marys Planning, Building & Information Technology Offices

The City may or may not award all locations. The successful contractor must provide quality cleaning services with minimum callbacks.

Bid Submission

One original and two (2) copies of the complete signed bid package document must be submitted and received by 2:00 PM EST on April 11, 2024. Each package shall contain the full name and address of each person/company submitting the bid and “Invitation to Bid – Janitorial Services” on the outside of the sealed submittal envelope.

Interpretations

Each Bidder(s) shall carefully examine the Contract Documents and all addenda or other revisions and thoroughly familiarize himself with the detailed requirements before submitting a Bid. Should a Bidder find discrepancies or ambiguities in, or omissions from Invitation to Bid Documents, or should he be in doubt as to their meaning, he/she shall at once, and, in any event not later than four (4) working days before the bid due date, notify the City of St. Marys who will send written addenda to all proposers. The City of St. Marys will not be responsible for any oral instructions. All addenda sent to bidders will become a part of the Contract Documents. No allowance will be made after Bids are received for oversight by Bidder.

Where a discrepancy occurs between the prices quoted in words and/or numbers, the lowest figure quoted shall take precedence and govern in determining final costs or award of contract.

In case of an error in the extension of prices, the unit's proposed prices shall govern.

Preparations of Bids

Bids shall be submitted on the forms provided herein. These forms must be signed by the bidder or his authorized representative. Any corrections to entries made on bid forms should be initialized by the person signing the bid.

Bidders must quote on all items appearing on the bid forms unless specific directions in the advertisement, on the Bid form, or in the special specifications allow for partial bids. Failure to quote on all items may disqualify the Bid at the election of the City of St. Marys.

Alternative bids will not be considered unless specifically called for.

Bids

Bids containing reservations, conditions, omissions, unexplained erasures or alterations, items not required in the Bid, or irregularities of any kind may be rejected by the City of St. Marys as being incomplete, nonresponsive, and not qualified for consideration.

Each Bid shall indicate the full business name and address of the Bidder and shall be signed by him with the usual signature. It shall also set forth the type of business organization, i.e., corporation, partnership, or individual owner.

A Bid submitted by a partnership shall list the names of all partners and shall be signed in the partnership name by one of the members of the partnership. If no partner is a Georgia resident, the name and address of an entity designated to receive service of process for the partnership in Georgia must be provided.

A Bid submitted by a Corporation shall be signed by the legal name of the Corporation, followed by the state of incorporation and the title designation of the Corporation in legal matters. The name of each person signing the Bid shall be typed or printed below the signature. If not a Georgia Corporation, there must be evidence that the corporation is licensed to do business in Georgia.

Receipt of Bids

Bids must be submitted as directed in the Invitation to Bid.

Bids shall be submitted before the time fixed in the Invitation to Bid. Bids received after the time so indicated shall be returned unopened.

Withdrawal of Bids

Bids may be withdrawn at any time before opening upon written or telegraphic request of the Proposer. Negligence on the part of the Bidder in the preparation of its bid shall not be grounds for modification or withdrawal after the time set for Bid opening.

Presence of Bidders at Bid Opening

At the time and place fixed for opening the bids, the total bid amount of all bids will be made public for the information of all bidders and other interested parties, who may be present in person or by a representative.

One Bid Received

In the event only one Bid is received, the City of St. Marys will reserve the right to accept the Bid or to re-advertise and re-bid the project.

Award of Contract

The City of St. Marys reserves the right to accept or reject any and/or all bids received, to waive irregularities and informalities in this Invitation to Bid, and to make award in any manner deemed in the best interest of the City of St. Marys and to re-advertise pursuant to federal and state law.

The contract shall be awarded to the lowest responsible and responsive bidder. Responsible bidder means a person or entity that has the capability in all respects to perform fully and reliably the contract requirements. Responsive means a person or entity that has submitted a bid that conforms in all material respects to the requirements outlined in the invitation for bid.

The City, in its sole discretion, reserves the right to award to the vendor who offers the services that best serve the interest of the City of St. Marys.

Any Bidder that contacts elected officials or staff directly or indirectly for the purpose of influencing the selection process before a contract award shall be immediately disqualified and removed from consideration.

The Mayor and Council determine the contract award at their regularly scheduled Council Meeting. Staff will make a recommendation for the award and present the bid results. The council makes the final decision. Vendors should not rely on verbal suggestions from staff as to who will be awarded.

Contract Period

Any contract resulting from the Invitation to bid shall be for a period of twelve (12) months commencing on the date of contract execution. The contract shall be renegotiated upon the transitioning of City offices located at 418 Osborne Street to 2603 CC Osborne Road. The contract will contain two (2) one-year extensions for a total possible service agreement of three (3) years. Extensions are not guaranteed and shall be based on the vendor's performance during the previous contract period. Extension may also be based on funds available for the contract.

Emergency Contacts

At least two Emergency contacts must be provided with phone numbers and email addresses. Emergency phone contact must be available during times when service employees will be on site, to include after hour functions.

Service Employees Requirements

Each service employee must have a background check before entering any City facility. A complete roster of all cleared service employees assigned to the City must be presented before the execution of the contract: and will be maintained with the Finance Department. Failure to submit to a background check for service employees or upon receipt of a negative background may result in termination of the contract or non-award of the contract. Service employees will not be permitted to bring family or friends into the City buildings when performing their job duties. Only authorized service employees will be permitted into City buildings.

Cleaning jobs that require special attention will be reported to Public Works or designated staff to schedule a specific time to complete the task if needed. These items would include large spills, large carpet spots or stains, or situations requiring more than the normal time for routine cleaning.

Changes to Contract

The City may at any time, append the contract by giving fifteen days written notice, delete or add to the work as outlined in the specifications. If such changes cause an increase or decrease in the amount due under the contract, a new fee will be negotiated as necessary. Special cleaning needs outside the contract will be negotiated per needed task.

Cleaning Hours

The City will require some areas to be cleaned during normal business hours. The contractor will have to work with each division to ensure that the cleaning will not disrupt their work.

Contractor Requirements

A. The contractor must provide proof of liability insurance and workers' compensation with the policy effective dates and expiration dates in effect for the length of the contract upon issuance of the Notice of Award.

B. A copy of the Contractor’s current business license must be submitted with the bid.

C. The Contractor will furnish any products or equipment associated with cleaning for all buildings listed. This will include cleaning supplies and tools for cleaning.

D. The contractor will be required to use HEPA vacuum cleaner filters in their vacuum cleaners.

E. Price each building separately on the attached Bid form.

F. State any exceptions or additions to minimum requirements on the Bid Form.

G. Hazardous materials protocols will be followed with any spill or incident involving bodily fluids for the protection of the service employee, staff, and the public.

Invoicing & Payment

The Contractor shall be paid bi-weekly through ACH payment per Contract.

Contract, Bond & Insurance

The bidder to whom the award is made shall enter into a written contract with the City of St. Marys within the time specified in the Bid Documents.

The Contractor shall secure and maintain such insurance policies as required, listing the City of St. Marys as additional insured.

The successful Respondent shall have and maintain insurance in full force and effect for the duration of this agreement protecting against claims for injuries to persons or damages to property that may arise from or in connection with the performance of the work by the contractor, its agents, representatives, employees, or subcontractors. All policies shall be subject to approval by the City’s Attorney regarding form and content.

Minimum Limits of Insurance

Contractor shall maintain insurance policies with coverage and limits no less than:

· Commercial General Liability of $1,000,000 (one million dollars) per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting therefrom.

· Commercial Automobile Liability (owned, non-owned, hired) of $1,000,000 (one million dollars) per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting therefrom.

· Workers’ Compensation limits as required by the State of Georgia and Employers Liability limits of $1,000,000 (one million dollars) per accident or disease.

· Self-Insured Retentions

Any self-insured retentions must be declared to and approved by the City so that the City may ensure the contractor's financial solvency. Insurance is to be placed with insurers with an A. M. Best rating of at least A-VII. The contractor shall furnish the City with certificates of insurance prior to the start of work.

HOLD-HARMLESS AND INDEMNIFICATION CLAUSE

The Contractor covenants and agrees to take and assume all responsibility for the Work rendered in connection with this agreement. The Contractor shall bear all losses and damages, directly and indirectly, resulting to it on account of the performance or character of the work rendered pursuant to this agreement. The Contractor shall defend, indemnify, and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees, servants, volunteers, agents, Owner’s lender, Architect and Architect’s consultants, agents, and employees (hereinafter referred to as the “Owner Parties”) from and against any and all claims, injuries, suits, actions, judgments, damages, losses, costs, expenses and liability of any kind whatsoever, including but not limited to, attorney’s fees and costs of defense (hereinafter “Liabilities”) which may be the result of willful, negligent or tortious conduct arising out of the Work, the performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. This indemnity obligation does not include liabilities caused by or resulting from the sole negligence of the Owner or Owner Parties. Such obligation of indemnity which would otherwise exist as to any party or person described in this provision. In any and all claims against the Owner or Owner Parties by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable the indemnification obligation set forth in this provision shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers’ or workmen’s compensation acts, disability benefit acts or other employee benefit acts. This obligation to indemnify, defend, and hold harmless the Owner and Owner Parties shall survive expiration or termination of this Agreement provided that the claims are based upon or arise out of actions that occurred during the performance of this agreement.

Power of Attorney

A Power of Attorney or other satisfactory evidence of the authority of the officer signing on behalf of the Corporation shall be furnished for the City of St. Marys’ records.

Local Vendor Preference

Local Vendor means a bidder or offeror who operates and maintains a brick-and-mortar business, i.e., a physical business address, within the city limits of the City of St. Marys, has a current business license, has paid in full all real and personal taxes owed the City, is considered a vendor in good standing with the City, and can obtain an active vendor status.

A local vendor may receive an opportunity to match purchases, bids, proposal or contracts over $1,000 and less than $50,000. The local vendor may be given an opportunity to match the lowest price proposal if the quotation or bid of the local vendor is within 5% of the lowest price proposal by a non-local vendor. In the event a local vendor matches the lowest price proposal, including all other terms, quality, services, and conditions, then the local vendor shall be awarded the contract.

In the event the price proposal of more than one local vendor is within 5% of the lowest overall price proposal of a non-local vendor, the local vendor with the lowest proposal will be given the first opportunity to match the lowest overall price proposal. If this local vendor declines to match the price proposal, then the local vendor with the next lowest bid within 5% will be given the opportunity to match the lowest proposal. This process will continue with all local vendors having proposal within 5% of the lowest overall bid by a non-local vendor.

Policy to be stated. This policy shall be so stated in all applicable solicitations.

Exemptions. This provision does not apply to public works construction projects or road projects pursuant to the laws of the State of Georgia (O.C.G.A §36-91 or §32-4).

Minority and Small Business Enterprise

It is the policy of the city of St. Marys that minority-owned business enterprises (MBE), woman-owned business enterprises (WBE) and small business enterprises (SBE), have a fair and equal opportunity to participate in the purchasing process. Therefore, the Owner encourages all MBE, WBE and SBE to compete for contracts to provide goods, services, and construction, and encourages contractors to solicit MBE, WBE and SBE in procuring subcontractors and suppliers. This desire on the part of the Owner is not intended to restrict or limit competitive bidding or to increase the cost of the work. The Owner supports a healthy free market system that seeks to include responsible businesses and provides ample opportunity for business growth and development.

Contractors and subcontractors who utilize qualified minority subcontractors may qualify for Georgia state income tax credits for qualified payments made to minority subcontractors. In accordance with the Official Code of Georgia Annotated (O.C.G.A.) Section 48-7-38, when computing taxable net income of a Georgia-based corporation, partnership, or individual, there shall be subtracted from federal taxable income or federal adjusted gross income 10 percent of the amount of qualified payments to certified minority subcontractors for state-agency-related construction projects. For more information on filing only, contact the Georgia Department of Revenue at 404-417-2399.

A company cannot receive an MBE Certification with the City of St. Marys local government without first receiving the DBE certification. To obtain information on the DBE/MBE Certification contact:

Georgia Department of Transportation One Georgia Center 600 West Peachtree NW Atlanta, GA 30308 404-631-1990

DOAS Supplier Relations 200 Piedmont Avenue, S.E.

Suite 1308, West Tower Atlanta, Georgia 30334-9010 404-657-6000

DETAILED SCOPE OF WORK/CLEANING REQUIREMENTS

City Hall to include Water Department, City Manager, Mayor & HR, Finance Department, Finance & IT Annex, Community Development, Public Works, Library, and Senior Center

Areas must be cleaned five (5) days per week after hours.

Daily Requirements

· Vacuum all carpeted areas.

· Clean and disinfect all toilets, urinals, and basins interior/exterior, and wipe counters.

· Sweep and mop all restroom floors with Lysol or other disinfectant cleaner.

· Clean mirrors.

· Sweep and mop all uncarpeted areas and clean any spots or stains.

· Clean interior & exterior glass entrance doors and windows in front and back (Tuesday’s and Thursday’s)

· Break room – Clean and disinfect tables, counter tops, and sink.

· Clean and wipe down water coolers.

· Check all doors to make sure they are secure.

· Set alarm before leaving.

Weekly Requirements

· Disinfect bathroom walls.

· Sweep outside of all entrances and exits.

· Eliminate all cobwebs.

· Clean windows in Water Department and remove fingerprints and smudges.

Monthly Requirements

· Dust all blinds, floor corners, floor edges, doorframes, picture frames, windowsills, and ledges.

· Clean all reachable areas of walls for smudges and smears.

· Clean walls and doors around switch plates and handles.

· Clean ceiling vents with a duster or vacuum cleaner

· Clean kitchen appliances.

Bi-Annual Requirements

· Clean all light fixtures and windows.

· Wash and dry all blinds, and wipe down upholstered furniture.

· Shampoo all carpets and strip and wax all uncarpeted areas.

PLEASE NOTE: The City Council meetings are held on the 1st and 3rd Mondays of every month in the Council Chambers at City Hall. Throughout the year, various other meetings are held after hours at the same location. Please make arrangements for cleaning after these meetings or before 8:00 am the following morning. Please note that meetings being held in the Council Chambers at City Hall are listed on the calendar on the City’s website. (www.stmarysga.gov)

Orange Hall Museum Restrooms

· Bathrooms must be cleaned in the mornings 5 days per week.

(Saturday, Monday, Wednesday, Thursday, Friday)

· Clean and sanitize toilets, sinks, mirrors, and mop floors. Refill paper towels, toilet paper dispensers, and anti-bacterial hand soap.

· Clean walls and sanitize as needed.

St. Marys Police Department

The building must be cleaned three (3) days a week, Monday, Wednesday, and Friday during the hours of 8:00 am and 5:00 pm only, unless prior arrangements have been made. Must provide monthly cleaning schedule. Must notify in advance if cleaning schedule needs to be changed. Must clean during business hours unless prior arrangements have been made. You will not have 24-hour access to the PD building. There will not be unlimited access to the PD building.

Daily Cleaning Requirements

· Sweep/ mop all tiled floor areas, including breakroom.

· Bathrooms -- Clean and sanitize toilets and sinks, clean mirrors, wipe counters, and mop. Restock paper towels and toilet paper. Refill handsoap.

· Clean glass entrance doors.

· Clean customer service glass and wipe down countertop areas.

· Water Fountains -- Wipe down and sanitize.

Weekly Requirements

· Bathrooms -- Clean walls with disinfectant.

· Dust furniture tops, file cabinet tops, framed pictures, door frames, and counters.

· Eliminate cobwebs.

· Sweep outside the entranceway in front of the building.

· Clean glass windows

· Gym -- clean, disinfect benches, sweep floor, clean mirrors.

· Shower room in the locker room -- clean, wipe down, disinfect.

Bi-Monthly Requirements

· Clean vinyl and leather furniture.

· Buff floors

Bi-Annual Requirements

· Clean baseboards

· Clean light fixtures.

· Vacuum drapes, blinds, and upholstered furniture.

· Dust paneled walls and picture frames.

· Strip and wax floors.

U.S. Coast Guard Building

The area must be cleaned four (4) days per week (Monday through Thursday) during office hours (between 0900 and 1500). This includes the main building and boat house.

Daily Cleaning Requirements Mon – Thurs

· Vacuum all carpeted areas.

· Sweep/ mop all floors.

· Empty trash cans and replace liners.

Dispose of all empty boxes in hallways.

· Bathrooms -- Clean and sanitize toilets and sinks, clean mirrors, wipe counters, mop. Restock paper towels,

· toilet paper, and refill hand soap.

· Water Fountains -- Wipe down and sanitize.

Conference Room -- Clean conference table glass and sweep floors.

· Break Room -- Clean tables, counters and sweep floors.

Weekly Requirements (Thursdays)

· Bathrooms -- Clean walls with disinfectant.

Dust furniture tops, file cabinet tops, framed pictures, and counters.

· Eliminate cobwebs.

· Sweep outside entrance way in front of building.

· Gym -- clean, disinfect benches, sweep floor, clean mirrors.

· Shower room in locker room -- clean, wipe down, disinfect.

Monthly Requirements (Last Thursday of month)

· Clean vinyl and leather furniture.

· Clean all glass doors and windows.

Wipe windowsills and ledges.

Quarterly Requirements

· Clean baseboards.

Bi-Annual Requirements

· Clean light fixtures.

· Vacuum drapes, blinds, and upholstered furniture.

· Dust paneled walls and picture frames.

· Strip and wax floors. Shampoo carpets.

Experience, References, Licenses

Name of Bidder, address, phone, cell phone, email

Number of years in the janitorial services business _____________ (5 year Minimum)

Provide business license number, county/city license there in.

List Business Owner and/or Officers Name, Title and Contact Information

List Professional References of Similar Contracts Include Company Name, Contact Person, Address, Phone, Email, Etc.

BID FORM FOR JANITORIAL SERVICES

City Hall (City Manager, Mayor, HR, Finance, & Additional Finance Offices)

Water Department

Executive Offices

Community Development - Building - Code Enforcement

St. Marys Library

Orange Hall Restrooms

Public Works

Police Department

U. S. Coast Guard

St. Marys Senior Center

TOTAL ANNUAL BID AMOUNT

Bidder Information Sheet

Company Name: _____________________________________________________

Address: _____________________________________________________

Phone: _______________________ Fax: ________________________

Tax ID # or SSN: _______________________________________________

Owner’s Name: ______________________________________________

The vendor has examined and carefully studied the Invitation to Bid Package, visited the service locations, reviewed the scope of work and contract requirements, and received addenda no ______________, receipt of all of which is hereby acknowledged.

The following statement must be signed and submitted with the bid. Failure to sign this statement will render bid invalid.

“I certify that this bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a bid for the same materials, supplies, or equipment and is in all respects fair and without collusion or fraud. I understand that collusive bidding is a violation of State and Federal law and can result in fines, prison sentences, and civil damage awards. I agree to abide by all conditions of this bid and certify that I am authorized to sign this bid for the bidder. (O.C.G.A. 50-5-67). I further certify that the provisions of the official code of Georgia annotated 45-10-20 et seq. have not and will not be violated in any respect.”

Authorized Signature Date

Name (Typed or Printed) Title

IMMIGRATION AND SECURITY FORM

(GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT)

Contractor’s Name:

State Entity’s Name:

State Solicitation/ Contract No.:

CONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned Contractor verifies its compliance with O.C.G.A. §13-10-91, stating affirmatively that the Contractor identified above has registered with and is participating in a federal work authorization program*, 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 State Entity, Contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the attached Subcontractor Affidavit. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the State Entity at the time the subcontractor(s) is retained to perform such service.

EEV / E-VerifyTM Company Identification Number

(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 SEAL]

Notary Public My Commission Expires:

*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. 99-603

Contractor’s Name:

State Entity’s Name:

State Solicitation/ Contract No.:

ADDITIONAL INSTRUCTIONS TO CONTRACTOR: Identify all subcontractors used to perform under the state contract. In addition, you must attach a signed and notarized affidavit (third page of this form) from each of the subcontractors listed below. The contractor is responsible for providing a signed and notarized affidavit to the State Entity within five (5) days of the addition of any new subcontractor used to perform under the identified state contract.

Contractor’s Name:

Subcontractors:

Contractor’s Name:

Subcontractor’s (Your) Name:

State Entity’s Name:

SUBCONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned Subcontractor verifies its compliance with O.C.G.A. §13-10-91, stating affirmatively that the Subcontractor which is engaged in the physical performance of services under a contract with the Contractor identified above on behalf of the State Entity identified above has registered with and is participating in a federal work authorization program*, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

EEV / E-VerifyTM Company Identification Number

(Subcontractor 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 ______________________, 2012

________________________________________ [NOTARY SEAL]

Notary Public My Commission Expires:

*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. 99-603

City of St. Marys

Affidavit Verifying Status For City Public Benefit Application

By executing this affidavit under oath, as an application for a City of St. Marys, Georgia Business License or Occupation Tax Certificate, Alcohol License, Taxi Permit or other public benefit as referenced in O.C.G.A. Section 50-36-1, I am stating the following with respect to my application for:

Please check one

Name:

Name of natural person applying on behalf of an individual, business, corporation, partnership, or other private entity

OR

qualified alien or non-immigrant under the Federal Immigration and Nationality

Act 18 years of age or older and lawfully present in the United States. *

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of the Code Section 16-10-20 of the Official Code of Georgia.

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

Printed Name

DAY OF

,20

Alien Registration number for non-citizens

Notary Public

My Commission Expires:

*Note: O.C.G.A. § 50-36-1 (e)(2) requires that aliens under the Federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provided their alien registration number. Because legal permanent residents are included in the federal definition of “alien,” legal permanent residents must also provide their alien registration number. Qualified aliens who do not have an alien registration number may supply another identifying number below:

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