LMIG SAP 2023.pdf

REQUEST FOR BIDS

PROJECT NO. LMIG SAP 2023 (137)

STRIPING, MARKINGS & SIGNAGE

ON 13 VARIOUS ROADS IN HABERSHAM COUNTY

PROPOSALS DUE:

Wednesday, December 13, 2023

2:00 pm EST

SUBMIT BIDS TO:

Purchasing-Finance Department

Habersham County

130 Jacob’s Way

Suite, 302

Clarkesville, GA 30523 purchasing@habershamga.com

(706) 839-0200

Office of County Commissioners 130 Jacob’s Way, Suite 337, Clarkesville, GA 30523

706-839-0200 Fax: 706-839-0219 www.habershamga.com mailto:purchasing@habershamga.com http://www.co.habersham.ga.us/

Request for Bids

Project Description and General Notes……….………………………………………………………………………………………. 1

RFP Timetable, Submittal Requirements……………………………………………………………………………...…………………………………………………………………………..2

Special Provisions………………………………………………………………………………………………………………………...………………………………3

Insurance Requirements………………………………………………………………………………………………………………………………………………………. 6

Questions and Interpretations………………………………………………………………………………………………………………………………………………………. 7

Safety Action Project Road Information…………………………………………………………….…………………………………………………………………………………………………………………………….. 8

Schedule of Items…………………………………………………………….…………………………………………………………………………………………………………………………….. 9

Maps…………………………………………………………….…………………………………………………………………………………………………………………………….. 10

Signature Sheet…………………………………………………………….…………………………………………………………………………………………………………………………….. 23

Bidders Declaration…………………………………………………………….…………………………………………………………………………………………………………………………….. 24

Certification of Non-Discrimination…………………………………………………………….…………………………………………………………………………………………………………………………….. 25

Contractor's Certification/Drug-Free Workplace…………………………………………………………….…………………………………………………………………………………………………………………………….. 26

Non-Collusion Affidavit…………………………………………………………….…………………………………………………………………………………………………………………………….. 27

E-Verify Affidavit and Agreement…………………………………………………………….…………………………………………………………………………………………………………………………….. 28

W-9…………………………………………………………….…………………………………………………………………………………………………………………………….. 29

Table of Contents

Office of County Commissioners

Project No. LMIG 2023-1 (137) SAP

Proposal Due Wednesday, December 13, 2023

2:00 PM EST

PROJECT DESCRIPTION AND GENERAL NOTES

PROJECT NO.: LMIG SAP 2023 (137) Habersham County

PROJECT SCOPE: Procurement and installation of Striping, Marking and Signage on thirteen

(13) various county roads located throughout Habersham County, approximately 24 centerline miles.

PROPOSAL GUARANTY: Not less than five (5) percent of the total bid.

Performance and Payment Bonds each in a sum equal to the full amount of the bid will be required for this project.

No proposal shall be withdrawn for a period of sixty (60) days from the date of bid opening.

Bidder shall enter all unit prices, make all extensions, and total bid.

PROJECT COMPLETION DATE: April 17, 2024.

NOTE: All work on this project shall be in accordance with the Georgia Department of

Transportation Standards and Construction Detail plans, Special Provisions and the 2021 edition of the Georgia Department of Transportation Standard Specifications and current edition of any applicable Supplemental Specifications as well as the current edition of the Manual on Uniform

Traffic Control Devices (MUTCD).

Addendums Signature

Addendum 1

Addendum 2

Addendum 3

Addendum 4

Addendum 5

RFP Timetable

Description Date

RFP Released Wednesday, November 15, 2023

Mandatory Pre-Bid Meeting Monday, November 27, 2023, at 10:00 am, EST

Deadline for Proposal Questions Monday, December 6, 2023, at 2:00 pm, EST

Submittal deadline Wednesday, December 13, 2023, at 2:00 pm, EST

Monday, December 18, 2023

Project Completion Date April 17, 2024

Bid Submittal Requirements

The MANDATORY pre-bid meeting will be held on Monday, November 27, 2023, at 10:00 am, EST, in the Board of Commissioner’s Meeting Room, Room No. 211 located on the main level at 130 Jacob’s Way, Clarksville, GA 30523.

Each bidder must submit their proposal, in a sealed envelope or box, and marked with the bidders’ name and address labeled: “LMIG SAP 2023 (137)”, and addressed to:

Habersham County Purchasing, Finance Department

130 Jacob’s Way, Suite 302

Clarkesville, GA 30523

Proposals shall be received no later than Wednesday, December 13, 2023, at 2:00 pm, EST at Habersham County’s Administration Building, Board of Commissioners Meeting Room, Room No. 211 located on the main level at 130 Jacob’s Way, Clarkesville, GA 30523 at which time and place all proposals will be publicly opened and acknowledged.

Hand delivered copies may be delivered to the above address ONLY between the hours of 8:00 am and 5:00 pm, EST, Monday through Friday, excluding holidays observed by the Habersham

County Government. For a complete listing of holidays please visit www.habershamga.com.

http://www.habershamga.com/

SPECIAL PROVISIONS

PROPOSAL GUARANTY: No proposal will be considered unless accompanied by a Proposal

Guaranty consisting of a bid bond, certified check, or negotiable instrument in the amount of Five

(5) Percent of the total bid received with each bid submitted as assurance that the bidder, upon acceptance of his/her bid, can execute such contractual documents as may be required within a specified period of time.

DELIVERY OF PROPOSAL: Each proposal together with the Proposal Guaranty shall be in a sealed envelope so marked as to identify the contents without being opened. Proposals will be received until the time and date set in the Notice to Contractors for opening and must be in the hands of the officials indicated by that time. Proposals received after the time established for opening of bids will be returned unopened to the Bidder.

AWARDS OF CONTRACT: If a contract is awarded, it will be awarded to the lowest responsible bidder whose Proposal shall have met all prescribed requirements. The Contract will be awarded, if at all, within 60 calendar days after opening of Proposals.

CANCELLATION OF AWARD: The County reserves the right to cancel the Award of any

Contract at any time before the execution of said Contract by all parties without any liability against the County.

RETURN OF PROPOSAL GUARANTY: All Proposal Guaranties except that of the lowest responsible Bidder will be returned immediately following the Award of the Contract. The

Guaranty of the successful Bidder to whom the Award is made will be retained until the Contract

Performance and Payment Bonds have been approved.

REQUIREMENTS OF PERFORMANCE AND PAYMENT BONDS: At the time of the execution of the Contract, and as part thereof, the successful Bidder shall furnish Performance and

Payment Bonds each in the sum equal to 100 percent of the Contract. The Bonds shall be executed by the Contractor and a Surety Company acceptable to the County and authorized to do business in the State of Georgia. In the event the bond is furnished by an out-of-state agent, it shall be countersigned by a Georgia resident agent in accordance with laws of Georgia.

PAYMENTS: Payment will be made to the contractor each calendar month based on the estimated amount of work complete in place as prescribed by the current edition of the Georgia Department of Transportation (GDOT) Standard Specifications.

NOTICE TO PROCEED: The work shall begin within 10 days after notification to begin work by the County and shall be carried through to completion without unreasonable delays and without suspension of the work unless authorized in writing by the County. If there are unreasonable delays or unauthorized suspensions of the work, The County reserves the right to charge the Contractor, not as a penalty, but as liquidated damages as prescribed by the current edition of the Georgia

Department of Transportation (GDOT) Standard Specifications.

RETAINAGE: Retainage will be withheld at the rate of five (5) percent of the monetary value of the work completed until the project has reached Fifty (50) percent complete. At that time the retainage may be reduced to two and one half (2 ½) percent if the status of the work is satisfactory and approved by the Director. Retainage will not accrue interest. Final Payment of the amounts withheld will not be made until the project has been satisfactorily completed and accepted by the

Georgia Department of Transportation (GDOT) and/or Habersham County.

GDOT STANDARD SPECIFICATIONS

SECTION 107 LEGAL REGULATIONS AND RESPONSIBILITY TO THE PUBLIC:

Delete Sub-Section 107.15 and substitute the following:

107.15 RESPONSIBILITY FOR CLAIMS: The contractor shall indemnify and save harmless the

County, its officers and employees, from all suits, actions, or claims of any character brought because of any injuries or damage received or sustained by any person, persons, or property on account of the operations of the said Contractor; or on account of or in consequence of any neglect in safe-guarding

THE WORK; or through use of unacceptable materials in constructing THE WORK; or because of any act or omission, neglect or misconduct of said Contractor; or because of any claims or amount recovered from any infringements or patent, trademark, or copyright; or from any claims or amounts arising or recovered under the “Workmen’s Compensation Act,” or any other law, ordinance, order, or decree; and so much of the money due the said Contractor under and by virtue of his Contract as may be considered necessary by the County for such purpose may be withheld for use of the County; or, in case no money is due, his surety may be held until such suit or suits, action or actions, claim or claims for injuries or damages as aforesaid shall have been settled and suitable evidence to that effect furnished to the County;

except that money due the Contractor will not be withheld when the Contractor produces satisfactory evidence that he is adequately protected by public liability and property damage insurance.

SECTION 108.08 FAILURE OR DELAY IN COMPLETING THE WORK ON TIME:

Any Liquidated Damages Assessed by the County for failure or delay in completing the Work on time shall be in accordance with Section 108.08 of the latest edition of the Georgia Department of

Transportation Standard Specifications.

According to Section 108.08 Failure or Delay in Completing Work on Time, the Contractor shall be backcharged $450/workday until completed and inspected. Temporary and permanent centerline striping shall be placed in the center of the roadway and not the paving joint. Failure to perform correctly will result in milling and restriping. Delays in project will apply to milling and restriping.

SECTION 150 – TRAFFIC CONTROL DURING CONSTRUCTION:

Traffic Control during Construction shall be the sole responsibility of the Contractor. Reference

GDOT Standard Traffic Control Detail for Lane Closure on Two-Lane Highway, Number 9102, for minimum acceptable Traffic Control. All traffic control devices used during construction shall be in full compliance with the current edition of the Manual on Uniform Traffic Control Devices

(MUTCD). Pilot vehicles or reliable means of communication shall be used to control traffic through the construction area at all times unless other methods are approved by the Director. If directed, restrictive hours may be applied to the project to accommodate school bus travel through the project.

SECTION 429 – RUMBLE STRIPS:

Rumble Strips are to be installed at street locations noted in the Summary of Quantities and in accordance with GDOT Construction Details for Rumble Strips: Roundabouts and Stop Controlled

Intersections, Number T-19. Rumble Strips shall be thermoplastic reflectorized pavement marking compound. Existing Rumble Strips located on Old Historic Hwy 441 and Tom Born Rd will be replaced. New Rumble Strips to be added at the following locations shall be installed as per GDOT

Construction Details T-19:

• J Warren Rd – each side of intersection with Level Grove Rd

• The Orchard Rd - intersection with Old Historic Hwy 441

• Tommy Irvin Rd - intersection with Dicks Hill Pkwy

SECTION 653 – THERMOPLASTIC TRAFFIC STRIPE:

All thermoplastic Words and Arrows will replace existing, if applicable. New thermoplastic

Words and Arrows, as designated in the Summary of Quantities, will be placed at intersections as directed.

INSURANCE REQUIREMENTS:

The Limits of Liability for the insurance by the General Conditions shall not be less than the following amounts:

A. WORKERS COMPENSATION:

(1) State Statutory

(2) Applicable Federal (e.g. Longshoreman’s) Statutory

(3) Employer’s Liability $1 Million

B. Comprehensive General Liability (including Contractual Liability, Premises-Operations;

Independent Contractor’s Protective; Products Liability - Completed Operations; Broad Form

Property Damages):

(1)

(2) Products – Completed Operations Aggregate $1 Million

(3) Personal and Advertising Injury (per Person/Organization) $1 Million

(4) Each Occurrence (Bodily Injury) $25,000

(5) Each Occurrence (Property Damage) $50,000

(6) Excess or Umbrella Liability $3 Million

a. General Aggregate $3 Million

b. Each Occurrence $3 Million

NOTICE TO ALL BIDDERS: Certificates of Insurance must be available at the time the contract is signed by the Board of Commissioners.

INSURANCE

ALL BIDDERS MUST FURNISH PROOF OF LIABILITY INSURANCE, WORKER’S

COMPENSATION LIABILITY INSURANCE, AND ANY OTHER INSURANCE REQUIRED

BY APPLICABLE STATE, FEDERAL, AND ADMINISTRATIVE LAW.

Such proof shall be submitted with the bid/proposal and show evidence of insurability satisfactory to Habersham County as to form and content. If the bid is selected by the County, the

Bidder must maintain, at a minimum, the insurance policies and minimums indicated in the selected bid. If the Bidder maintains broader coverage and/or higher limits than shown in the bid, Habersham County shall be entitled to coverage for the higher limits maintained by the Bidder.

Any and all Insurance Coverage(s) and Bonds required under the terms and conditions of the contract shall be maintained during the entire length of the contract, including any extensions or renewals thereto, and until all work has been completed to the satisfaction of Habersham

County. Evidence of said insurance coverages shall be provided on or before the inception date of the Contract.

Bidder shall provide written notice to Habersham County immediately if it becomes aware of or receives notice from any insurance company that coverage afforded under such policy or policies shall expire, be cancelled or altered.

Certificates of Insurance are to list Habersham County Government, its’ Officers, Officials and Employees as an Additional Insured (except for Workers’ Compensation and Professional

Liability). This insurance shall apply as Primary Insurance before any other insurance or self-insurance, including any deductible, non-contributory, and Waiver of Subrogation provided in favor of Habersham County. If Habersham County shall so request, the Bidder will furnish the

County for its inspection and approval such policies of insurance with all endorsements, or confirmed specimens thereof certified by the insurance company to be true and correct copies.

The obligations for the Bidder to procure and maintain insurance shall not be constructed to waive or restrict other obligations. It is understood that neither failure to comply nor full compliance with the foregoing insurance requirements shall limit or relieve the Bidder from any liability incurred as a result of their activities/operations in conjunction with the Contract and/or

Scope of Work.

Questions, Interpretations and Addenda

No inquiries or interpretation of meaning concerning this Request for Bids will be made to any interested party orally. Every inquiry or request for interpretation should be made in writing via e-mail. All inquiries and requests for interpretation should be sent via e-mail to Purchasing at purchasing@habershamga.com all questions and all answers will be posted on the website www.habershamga.com. It will be the responsibility of interested parties to periodically check the website for any new information and/or addenda.

mailto:purchasing@habershamga.com http://www.habershamga.com/

P ri o ri ty

County Road Name

C o u n ty R o a d

N u m b e r

From: To:

C e n te rl in e

E d g e li n e s

S to p B a rs

W o rd s

S y m b o ls

R u m b le S tr ip s

S ig n s

S p e e d L im it

(m p h

T o ta l

R ig h t-o f-

W a y

T o ta l

P v m t.

W id th

T o ta l

L e n g th

(m il e s

1 Antioch Church Rd CR 117 US 23/US 441/SR 365 SR 17 Alt/Talmadge Dr X X X 55 80 21 2.20

2 Camp Creek Rd CR 391 Old SR 197 S/CR 546 Tommy Irvin Rd/CR 547 X X X X X 50 80-100 20 4.50

3 Cody Rd CR 107 SR 197 Camp Creek Rd/CR 391 X X X X X 35-40 80 21 2.68

4 Habersham Mill Rd CR 383 US 441 Bus/SR 385 SR 115 X X X X X 45 30 21 3.54

5 Hill Crossing Rd CR 548 SR 17/SR 115/Toccoa Hwy SR 385/Historic US 441 X X X 50 80 21 0.79

6 Hulsey Rd CR 784 US 23/US 441/SR 365 Dicks Hill Pkwy/CR 545 X X X --- NFI 18 0.98

CR 428 Duncan Bridge Rd/CR 389 US 441/SR 15 X X X 35 80 21 1.48

8 J Warren Rd CR 542 Level Grove Rd/CR 386 ----- X X X X X X 40 80 21 0.20

9 Old Historic Hwy 441 CR 648 SR 385/Talmadge Dr The Orchard Rd/CR 392 X X X X X X 35-55 50-80 21-33 3.50

10 Old Historic Hwy 441 CR 648 The Orchard Rd/CR 392 US 23/US 441/SR 365 X X X X X X 45 50-80 21 2.20

11 The Orchard Rd CR 392 Old Historic Hwy 441/CR 648 ----- X X X X X X 50 80 21 0.20

12 Tom Born Rd CR 125 John Wood Rd/CR 123 Old Historic Hwy 441/CR 648 X X X X X X --- 80 21 1.34

13 Tommy Irvin Rd CR 547 Dicks Hill Pkwy/CR 545 ----- X X X X 45-50 80 21 0.20

23.81

LMIG SAFETY ACTION PROJECT - LIST BY ROADS

HABERSHAM COUNTY

Project : LMIG SAP 2023 (137)

Project No. LMIG SAP 2023 (137) Habersham County

Item Description Unit Approx.

Qty.

Unit Price Extended Item Cost

150-1000 Traffic Control LS 1 . .

429-1000 Rumble Strips EA 16

636-1033 Highway Signs, TP 1 Matl., Refl. Sheeting, TP 9 SF 992.5

636-1036 Highway Signs, TP 1 Matl., Refl. Sheeting, TP 11 SF 359 . .

636-2070 Galv. Steel Posts, TP 7 LF 3,168 . .

652-2501 Solid Traffic Stripe, 5 IN, White LM 49.27 . .

652-2502 Solid Traffic Stripe, 5 IN, Yellow LM 49.87 . .

652-3501 Skip Traffic Stripe, 5 IN, White GLM 0.50 . .

652-3502 Skip Traffic Stripe, 5 IN, Yellow GLM 2.10 . .

652-9001 Traffic Stripe, White SY 650.00

652-9002 Traffic Stripe, Yellow SY 570.00

653-0120 Thermo Pvmt. Marking, TP 2 Arrow EA 12 . .

653-0220 Thermo Pvmt. Marking, TP 2 Word EA 27

653-0230 Thermo Pvmt. Marking, TP 3A Word EA 2

653-0240 Thermo Pvmt. Marking, TP 4 Word EA 14

653-1704 Thermoplastic Solid Traffic Stripe, 24 IN, White LF 365 .

Signature of Duly Authorized Representative

Schedule of Items

TOTAL BASE BID__________________________________________________

Submitted By:______________________________________________________

Name of Corporation, Partnership, Individual

Address:______________________________________ cmcgrew Callout Begin Project cmcgrew Callout End Project

Callout Begin Project cmcgrew

Callout Begin Project cmcgrew

Callout Begin Project cmcgrew

Callout Begin Project cmcgrew

Callout Begin Project cmcgrew

Callout Begin Project approx. 1000 ft from Level Grove Rd Intersection cmcgrew

End Project approx. 1000 ft from Level Grove Intersection

Callout Begin Project cmcgrew

Callout Begin Project at intersection with Old Historic Hwy 441 cmcgrew

End Project approx. 1500 ft from intersection with Old Historic Hwy 441

Callout Begin Project cmcgrew

Callout Begin Project cmcgrew

Callout Begin Project cmcgrew

End Project approx. 1000 ft from intersection with Dicks Hill Pkwy

Callout Begin Project cmcgrew

SIGNATURE SHEET

PROJECT NO.: LMIG SAP 2023 (137)

HABERSHAM COUNTY

BID SUBMITTED BY:___________________________________________________________

(Print Name of Firm)

CONTRACT EXECUTED ON BEHALF OF THE CONTRACTOR:

This the_______________Day of___________________________,2023

BY:________________________________________________TITLE____________________

Printed Name of Official Signing Contract

WITNESS FOR THE

CONTRACTOR__________________________________________________________

CONTRACT EXECUTED ON BEHALF OF HABERSHAM COUNTY:

This the _______________Day of____________________________, 2023

BY:_________________________________________________________________________

Habersham County Commission Chairman

WITNESS FOR THE

COUNTY_______________________________________________________________

CONTRACT ACCEPTED BY THE COUNTY ON__________________________,2023

ATTEST:_________________________________COUNTY COMMISSION CLERK

BIDDERS DECLARATION

The bidder understands, agrees and warrants:

That the bidder has carefully read and fully understands the full scope of the requirements.

That the bidder has the capability to successfully undertake and complete the responsibilities and obligations in said specifications.

That the bidder has liability insurance and a declaration of insurance form will be provided before the commencement of any work.

That this bid may be withdrawn by requesting such withdrawal in writing at any time prior to

Wednesday, December 13, 2023, at 2:00 p.m. but may not be withdrawn after such date and time.

That Habersham County reserves the right to reject any or all bids and to accept that bid which will, in its opinion, best serve the public interest. Habersham County reserves the right to waive any technicalities and formalities in the bidding.

That by submission of this bid the bidder acknowledges that Habersham County has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information supplied by the bidder.

If a partnership, a general partner must sign.

If a corporation, the authorized corporate officer(s) must sign and the corporate seal must be affixed to this bid.

BIDDER:

__________________________ __________________________________ Name Title

Name Title

AFFIX CORPORATE SEAL (If Applicable)

CERTIFICATE OF NON-DISCRIMINATION

STATE OF GEORGIA

HABERSHAM COUNTY

PROJECT NO. LMIG SAP 2023 (137)

In connection with the performance of work under this contract, the bidder agrees as follows:

The bidder agrees not to discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, ancestry or disability. The vendor shall take affirmative action to insure that employees are treated without regard to their race, creed, color, sex, national origin, ancestry or disability. Such action shall include, but not be limited to the following:

employment, upgrading, demotion, transfer, recruiting or recruitment, advertising, lay-off or termination, rates of pay or other compensation and selection for training, including apprenticeship.

In the event of the bidder’s non-compliance with this non-discrimination clause, the contract may be canceled or terminated by Habersham County. The bidders may be declared, by

Habersham County, ineligible for further contracts with Habersham County until satisfactory proof of intent to comply shall be made by the vendor. The bidder agrees to include this non-discrimination clause in any sub-contracts connected with the performance of this agreement.

BIDDER

SIGNATURE

TITLE

CONTRACTOR’S CERTIFICATON

DRUG- FREE WORKPLACE

STATE OF GEORGIA

HABERSHAM COUNTY

PROJECT NO. LMIG SAP 2023 (137)

I hereby certify that I am a principle and duly authorized representative of

Whose address is _______________________________________________________________

And that:

1. The provisions of Section 50-24-1 of the Official Code of Georgia Annotated, relating to the “Drug Free Workplace Act” have been complied with in full; and,

2. A drug-free workplace will be provided for the contractor’s employee’s during the performance of the contract; and,

3. Each subcontractor hired by the Prime Contractor shall be required to ensure that the subcontractor’s employees are provided a drug-free workplace. The Prime Contractor shall secure from the subcontractor the following written certification: “As a part of the subcontracting agreement with__________________________________________ certifies to the Prime Contractor that a drug-free workplace will be provided for the subcontractor’s employees during the performance of this contract pursuant to paragraph

(7) of subsection (b) of the Official Code of Georgia annotated Section 50-24-3”: and

4. It is certified that the undersigned will not engage in unlawful manufacture, sale distribution, possession, or use of an uncontrolled substance or marijuana during the performance of the contract.

Date:______________________ ________________________________

Signature

NON-COLLUSION AFFIDAVIT

HABERSHAM COUNTY

PROJECT NO. LMIG SAP 2023 (137)

The bidder, by its officers and agents or representatives present at the time of filing this bid, being duly sworn, on their oaths say that neither they nor any member of their firm, have in any way, directly or indirectly, entered into any arrangement or agreements with any other bidder, or with any public officer of the County whereby such affiant or affiants or either of them, has paid or is to pay to such bidder or public officer any sum of money, or has given, or is to give to such other bidder or public officer anything of value whatever; or such affiant of affiants or either of them has not, directly or indirectly; entered into any arrangement or agreement with any other bidder(s), which tends to, or does lessen or destroy free competition in the letter of the contract sought for by the attached bids; that no inducement of any form or character other than that which appears upon the face of the bid will be suggested, offered, paid or delivered to any person whomsoever to influence the acceptance of the bid or awarding of the contract, nor has this bidder any understanding or agreement of any kind whatsoever, with any person whomsoever to pay, deliver to, or share with any other person in any way or manner, any of the proceeds of the contract sought by this bid.

Contractor:___________________________________

By:__________________________________________

Authorized Contractor Representative

This the __________Day of _________________, 2023

Notary Public: _________________________________

My Commission Expires:______________________, 20____

PROGRAM VENDOR/CONTRACTOR AFFIDAVIT AND AGREEMENT

COMES NOW before me, the undersigned officer duly authorized to administer oaths, the undersigned contractor, who, after being duly sworn, states as follows:

By executing this affidavit, the undersigned contractor verifies it’s compliance with O.C.G.A 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Habersham County has registered with, is authorized to use, and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. 13-10-91.

Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. 13-10-91 (b).

Contractor hereby attests that its federal work authorization user identification number and date are as follows:

EEV / Basic Pilot Program User ID Number (E-Verify)

FURTHER AFFIANT SAYETH NOT.

BY: Authorized Officer or Agent Signature Contractor Address

Title of Authorized Officer or Agent of Contractor Above

Company / Contractor Name Contractor City, State, Zip Code

Date of Contract between Contractor and Habersham County

Sworn to and subscribed before me

This day of , 20

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 (!RCA), P.L. 99-603. As of the effective date of O.C.G.A. § 13-10-91, the applicable federal work authorization program is the "EEV I 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).

Office of County Commissioners 130 Jacob’s Way, Suite 301, Clarkesville, GA 30523

706-839-0200 Fax: 706-839-0219 www.habershamga.com http://www.co.habersham.ga.us/