NORCROSS SAVE Affidavit.pdf
PDF 577 KB Posted
- Attached to
- Safety Action Plan (RFP PW 26-02)
- Solicitation number
- PE-66780-NONST-2026-000000039
- Issued by
- Gwinnett County, Georgia
About this file
This file is an affidavit related to a Safety Action Plan proposal (RFP PW 26-02) issued by the City of Norcross, Georgia. The City of Norcross is soliciting proposals from qualified firms with expertise in transportation planning and design to develop a comprehensive safety action plan addressing the city's safety needs, particularly in high-risk areas such as the historic downtown and major roadways. The plan must ensure safe travel for all residents, including underserved communities, and must incorporate all components specified by the U.S. Department of Transportation in the SS4A grant notice of funding availability. Proposals must be submitted by 11:00 a.m. on Wednesday, February 18, 2026, in the form of two printed copies and one electronic copy on USB to the City of Norcross Public Works Department at 345 Lively Avenue, Norcross, GA 30071, attention Charlene Marsh, Capital Projects Manager, with the package clearly marked "RFP PW 26-02 SAFETY ACTION PLAN" on its face.
The file indicates this project is funded through a SS4A (Systemic Safety 4 All) grant from the U.S. Department of Transportation. No specific pricing terms, contract duration, renewal options, incumbent information, or award date details are outlined in this affidavit document. The affidavit serves as a formal attestation related to the proposal submission process and requirements for the Safety Action Plan development project.
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Text version
Instructions: As required by Georgia Security and Immigration Compliance Act of 2006, as amended, every agency administering or providing Public Benefits is responsible for requiring that applicants for public benefits execute a sworn affidavit verifying the applicant’s lawful presence in the United States (Ga. Code 50-36- 1(f)(2). The applicant shall execute this affidavit in front of a Notary and return it to the city along with the associated application, renewal form, contract, bid packet, or other applicable document.
By executing this affidavit under oath, as an applicant for (Occupational Tax license or Alcoholic Beverage license or any other Public benefit) as referenced in O.C.G.A. § 50-36-1, from the City of Norcross, the undersigned applicant verifies one of the following with respect to my application for public benefit.
(Please check one)
1) I am a United States citizen. (REQUIRES VERIFICATION AT SUBMISSION)
2) I am a legal permanent resident of the United States.
3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency.
My alien number issued by the Department of Homeland Security or other federal immigration agency is: _.
The undersigned applicant has also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by Georgia Law O.C.G.A § 50-36-1(f) (1) A complete list of secure and verifiable documents on back of this form.
REQUIRES VERIFICATION AT SUBMISSION – Which type of secure and verifiable document was provided with this affidavit? .
In making the above representation under oath, I understand that any person who knowingly and willfully who makes a false, fictitious, or fraudulent statement or representation in this affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute.
MUST BE COMPLETED BY NOTARY
I, (representative for) (Printed NAME of individual and natural person) (Name of BUSINESS, corporation, partnership, etc.)
Signature of Applicant Date
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20
Executed in (City), (State)
NOTARY PUBLIC Signature My Commission Expires
65 Lawrenceville St. Norcross, GA 30071 [P] 770.448.2122 [F] 770.448.5945 www. norcrossga.net
SAVE Public Benefit Affidavit
O.C.G.A. § 50-36-1
File details come from the government source that posted it. Updated .