required forms.pdf

GEORGIA WORLD CONGRESS CENTER AUTHORITY

HAZARDS & INSURANCE

REQUIREMENT

I. Hazards: The contractor shall be responsible from the time of the beginning of the first work, for all injury or damage of any kind resulting from the work to persons or property regardless of who may be the owner of the property. In addition to the liability imposed upon the contractor on account of bodily injury (including death) or property damage suffered through the contractor's negligence, which liability is not impaired or otherwise affected hereby, the contractor assumes the obligation to save the owner harmless and to indemnify and defend the owner from every claim arising out of or through injury (including death) to any person or persons or damage to property (regardless of who may be the owner of the property) arising out of or suffered through any act or omission of the contractor or any sub-contractor, or anyone either (a) directly or indirectly employed by or (b) under the supervision of any of them in prosecution of the work included in this contract.

II. Insurance: Proof of insurance coverage and furnishing of insurance policies shall be as shown herein below:

(A) Compliance with Workmen's Compensation Laws: The contractor agrees to comply with the provisions of the workmen's compensation laws of the State of Georgia and to require all sub-contractors likewise to comply. The contractor agrees that, prior to the beginning of any work by the contractor, the contractor will furnish the following to the owner: Certificate from insurance company showing issuance of workmen's compensation coverage for the State of Georgia or a certificate from Georgia Workmen's Compensation Board showing proof of ability to pay compensation directly. The contractor agrees that the foregoing provision respecting workmen's compensation is also applicable to sub-contractor.

(B). Policies, Certificates, Limits, and Disposition of Documents: The contractor shall obtain at his expense insurance with limits as shown herein below unless the contractor desires to broaden the limits and obtain more protection:

(1) CONTRACTOR'S PROTECTIVE LIABILITY INSURANCE - taken out in the name of the contractor.

Bodily injury, including death - limits of $1,000,000 for each accident.

Property damage - limits of $1,000,000 for each accident and $3,000,000 for the aggregate of operations.

DISPOSITION - Certificate of insurance must be sent to owner prior to commencement of work.

(2) CONTRACTOR'S PUBLIC LIABILITY INSURANCE - taken out in the name of the contractor.

Bodily injury, including death - limits of $1,000,000 for each person and $3,000,000 for each accident.

Property damage - limits of $1,000,000 for each accident and $3,000,000 for the aggregate of operations.

DISPOSITION: Certificate of insurance must be sent to owner prior to commencement of work.

(C) Acceptability of Insurers to Owner: No insurance will be accept unless written by a company licensed by State Insurance Commissioner to do business in Georgia at the time the policy is issued, and the company must in addition be acceptable to the owner. To avoid inconvenience, any general contractor or sub-contractor must get in touch with the owner to determine whether the insurance company or companies he expects to use is, or are, acceptable to the owner. All policies and certificates must be signed or countersigned, as the case may be, by resident Georgia agents.

(D) Termination of Obligation to Insure: Unless otherwise expressly provided to the contrary, the obligation to insure as prescribed herein shall not terminate until the owner shall have executed the final certificate.

(E) Competence of Insurers: The contractor is responsible for any delay resulting from the failure; (1) of his insurance carriers; and, (2) of insurance carriers of his sub-contractors to furnish proof of proper coverage in; (1) the prescribed form; (2) the prescribed manner; and, (3) in good season.

(F) Notice of cancellation or non-renewal. - No notice of cancellation or notice on intent to non-renewal shall be effective if given more than thirty (30) days in advance of cancellation or date of expiration of policy.

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT

CONTRACTOR AFFIDAVIT under O.C.G.A. § 13-10-91(b)(1)

Contract/Project Name: SITE SIGNAGE AND WAYFINDING

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of GEORGIA WORLD CONGRESS CENTER AUTHORITY 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 of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization (E-Verify Number)

Name of Contractor or Entity

Georgia World Congress Center Authority Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on , , 20 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 SEAL]

Notary Public

My Commission Expires:

NON -DISCRIMINATION

AGREEMENT

The undersigned, acting by and through its duly authorized representative (the "Contractor") agrees that during the performance of the Agreement to which this undertaking is appended:

A. The Contractor shall not discriminate against any employee, or applicant for employment, because of race, religion, color, sex or national origin. As used herein, the words "shall not discriminate" shall apply without limitation to the following:

1. Recruitment, whether by advertising or other means; compensation, whether in the form of rates of pay or other forms of compensation; selection for training, including apprenticeship; promotions;

upgradings; demotions; downgrading; transfers; layoffs; and terminations.

2. The Contractor agrees to and shall post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this equal employment opportunity clause.

B. The Contractor shall, in all solicitations or advertisements for employees, placed by or on behalf of the Contractor, state that qualified applicants will receive consideration for employment· without regard to race, religion, color, sex or national origin.

C. The Contractor shall send to each labor union or representative of workers with which the Contractor may have a collective bargaining agreement or other contract or understanding a notice advising the labor union or workers' representative of the Contractor's commitments under the equal employment opportunity requirements set forth herein and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

D. The Contractor shall furnish all information and reports required by the Authority and shall permit access to the books, records and accounts of the Contractor during. normal business hours by the Authority for the purposes of investigation so as to ascertain compliance with the foregoing requirements, including, if requested by the Authority, annual reports reflecting the nature of its work force by position, categories or classifications, and the impact on such work force by employment, promotion, layoff, resignation, transfer and termination of employees during the period covered by the report.

DATED: , 20

CONTRACTOR:

By:

CONTINUED

The undersigned, acting by and through its duly authorized representative, affirmatively undertakes that it will affirmatively encourage and solicit participation by all qualified business enterprises in the subcontracting by the undersigned of any obligation of the undersigned in the performance of the agreement to which this undertaking is appended and in the purchase of goods or services incident to the performance of such agreement, including business enterprises which are owned by or the work force of which is comprised of race, color, creed, sex or national origin minorities and disadvantaged business enterprises. Without limitation of the foregoing, with respect to minority business enterprises and disadvantaged business enterprises, the undersigned agrees that as appropriate and feasible, the undersigned will:

A. Give notice publicly and to appropriate organizations with respect to specific procurement activities of the undersigned that such activity presents contracting opportunities to minority business enterprises or disadvantaged business enterprises for the supply of goods or services to the successful subcontractor or supplier contracting with the Authority.

B. Give notice in connection with specific procurement activities of the potential availability of tax incentives with respect to the purchase of goods, property or service from minority business enterprises or disadvantaged business enterprises.

C. Engage in specific and continuing recruitment and educational efforts directed at organizations representing minority business enterprises or disadvantaged business enterprises.

D. Engage in subcontracting or purchasing procedures which, consistent with the goals of obtaining the highest quality products or services for the lowest cost, enhance opportunities for participation by minority business enterprises or disadvantaged business enterprises.

The undersigned shall maintain records with respect to its activities under this instrument. Such records shall be open to the Authority for the Authority's inspection at reasonable times.

Nothing herein contained shall require the undersigned to award any subcontractor contract for the purchase of goods or services on the basis of the race, creed, color, sex or national origin composition of the ownership or workforce of any firm.

The undersigned further acknowledges that nothing herein is intended to restrict or limit competitive bidding in the award by undersigned of any subcontract or other contract or is intended to increase the cost of any subcontractor or other contract to the undersigned.

As used herein, “disadvantaged business enterprise” means a business which has been and is its participation in the line of business in which it is engaged as a result of any one or more of the following:

A. Disadvantage as a result of prior discrimination against the business on the basis of race, creed, color, sex or national origin of its ownership or work force (i) in the award of contracts or subcontracts; (ii) in the availability of bonds or insurance; or (iii) in the availability of financing; or (iv) in membership in trade associations; or (v) in training opportunities for its work force.

B. Disadvantage because of previously inadequate working capital.

C. Disadvantaged because of pervious inability to meet bonding or insurance requirements.

D. Disadvantage attributable to the developing nature of the business enterprise and consequent limitations on the nature and extent of work which the developing business enterprise has been able to perform.

E. Disadvantage attributable to factors similar to those set forth above.

DATED: , 20

SUBCONTRACTOR:

By:

NON-INFLUENCE AFFIDAVIT

COUNTY OF

STATE OF

I do solemnly swear on my oath that as to the contract dated , 20 , between and the GEORGIA WORLD CONGRESS CENTER

(NAME OF GENERAL CONTRACTOR)

AUTHORITY, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid contract by any employee, officer, or agent of Georgia World Congress Center Authority, or any person connected with the State

Government of Georgia in any way whatsoever.

This day of , 20 .

(L.S.)

Signature

Title

Firm

COUNTY OF

STATE OF

Personally before me, the undersigned authority, appeared ( ), (NAME OF PERSON SIGNING AFFIDAVIT) who is known to me to be an official of the firm of ( ) who, (NAME OF GENERAL CONTRACTOR) after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct.

Notary Public

My Commission expires:

This day of , 20

NOTICE TO ALL COMPANIES

Servicing the Georgia World Congress Center and Centennial Olympic Park

Procedures and Guidelines for Working within the Facilities

To assist you in performing your work at the Georgia World Congress Center Authority facilities, these procedures and information have been developed for our mutual benefit. With ever increasing event activity, it is necessary to carefully plan, coordinate and communicate your proposed work with applicable Georgia World Congress Center Authority personnel and departments.

(1) PARKING: Prior to your arrival at the facility in which you will be working, you must contact your “contract administrator” or the party requesting services to make arrangements for a parking pass. At that time you will be given information regarding the appropriate parking location designated for your use and directions to access the designated parking area. We ask that only vehicles that are clearly identified with your company name park in the designated area, and that you limit your stay to the time required performing your work.

You should not try to park in any other area of the campus such as the marshalling yards and docks. They are under the control of the show contractors (by our lease agreement with them) and the upper viaduct will be strictly monitored by GWCCA Police and the shuttle bus companies. Parking in fire exit lanes and service streets is strictly prohibited, and your vehicle will be subject to being towed.

Very short-term parking for the delivery of supplies and/or the unloading of parts is understandable and arrangements to park in other areas if necessary, can be made when you arrive, but, again, coordination with your contract administrator or department designee will help to eliminate any problems.

(2) SIGN-IN: We request that all service firms instruct their personnel to report to and sign-in at the Security Office of the appropriate facility. Both Security Offices are open 24 hours a day. Phones: GWCC/Park – 404.223-4900.

Georgia World Congress Center and Centennial Olympic Park: The main Security Office is located at the corner of Lower International Boulevard and Mangum Street. The Employees’ Entrance to the Georgia World Congress Center should be used as it directly accesses the Security Office.

Your personnel assigned to perform work at either the Georgia World Congress Center or Centennial Olympic Park should report to this office, giving their name, company and where they need to work. A temporary GWCC badge will be issued, and the Security Officer will advise them of designated restricted areas where they may not work on that day.

Additionally, Security will make the necessary arrangements to get your personnel where they must go. If applicable, GWCC Security will contact the private “show security firms” to coordinate your work in either the World Congress Center or Centennial Park.

(3) SIGN-OUT: Upon completion of your work, we request that your personnel return to the appropriate Security Office, turn in the temporary badge, and exit the area.

(4) COORDINATION OF WORK: Generally, there are activities in session at one or more of the facilities every day of the year. It is important that your work is coordinated with us so that there is no conflict, and our clients are not disturbed. If you are planning to work in the facilities, we request that you first call your contact person. Maintenance contractors planning to work in the GWCC or COP should always contact their GWCC Contract Administrator or his designee upon entering or leaving the facilities.

(5) CONCESSION STANDS AND FOOD SERVICE: Unfortunately, there are no facilities available to offer food service to your employees. The staff food facilities are restricted to full time GWCC, Park and the food facilities throughout the campus are provided for our clients as part of the scheduled events. We restrict our own staff, as well as the show service contractors, from these facilities accordingly. During move-in and move-out operations on the exhibit floor we frequently open one of the concession stands for the working personnel setting up the show and your employees may eat there. However, most of the time, these areas are also restricted by the show security. Our advice is to simply arrange for your employees to eat elsewhere.

(6) FIRST AID: In the event of an injury to one or more of your employees which requires assistance, the Security Office for the facility in which you are working should always be notified for assistance. Security may be reached by using any RED HOUSE TELEPHONE and dialing “Ext. 4900” for the GWCC or COP.

Additionally, either Security Office may be contacted through our internal radio system. Most staff members of all three facilities carry internal radios.

We appreciate your reviewing these guidelines and procedures with your personnel who will be working in our facilities from time to time. We want to assist you in making your work efficient and safe, while fulfilling our obligations to our clients and customers. Thank you for your assistant. Please contact us if you have concerns or problems that we have not addressed.

HAZARDS & INSURANCE

I. Hazards: The contractor shall be responsible from the time of the beginning of the first work, for all injury or damage of any kind resulting from the work to persons or property regardless of who may be the owner of the property. In addition to the liability imposed upon the contractor on account of bodily injury (including death) or property damage suffered through the contractor's negligence, which liability is not impaired or otherwise affected hereby, the contractor assumes the obligation to save the owner harmless and to indemnify and defend the owner from every claim arising out of or through injury (including death) to any person or persons or damage to property (regardless of who may be the owner of the property) arising out of or suffered through any act or omission of the contractor or any sub-contractor, or anyone either (a) directly or indirectly employed by or (b) under the supervision of any of them in prosecution of the work included in this contract.

II. Insurance: Proof of insurance coverage and furnishing of insurance policies shall be as shown herein below:

(A) Compliance with Workmen's Compensation Laws: The contractor agrees to comply with the provisions of the workmen's compensation laws of the State of Georgia and to require all sub-contractors likewise to comply. The contractor agrees that, prior to the beginning of any work by the contractor, the contractor will furnish the following to the owner: Certificate from insurance company showing issuance of workmen's compensation coverage for the State of Georgia or a certificate from Georgia Workmen's Compensation Board showing proof of ability to pay compensation directly. The contractor agrees that the foregoing provision respecting workmen's compensation is also applicable to sub-contractor.

(B). Policies, Certificates, Limits, and Disposition of Documents: The contractor shall obtain at his expense insurance with limits as shown herein below unless the contractor desires to broaden the limits and obtain more protection:

(1) CONTRACTOR'S PROTECTIVE LIABILITY INSURANCE - taken out in the name of the contractor.

Bodily injury, including death - limits of $1,000,000 for each accident.

Property damage - limits of $1,000,000 for each accident and $3,000,000 for the aggregate of operations.

DISPOSITION - Certificate of insurance must be sent to owner prior to commencement of work.

(2) CONTRACTOR'S PUBLIC LIABILITY INSURANCE - taken out in the name of the contractor.

Bodily injury, including death - limits of $1,000,000 for each person and $3,000,000 for each accident.

Property damage - limits of $1,000,000 for each accident and $3,000,000 for the aggregate of operations.

DISPOSITION: Certificate of insurance must be sent to owner prior to commencement of work.

(C) Acceptability of Insurers to Owner: No insurance will be accept unless written by a company licensed by State Insurance Commissioner to do business in Georgia at the time the policy is issued, and the company must in addition be acceptable to the owner. To avoid inconvenience, any general contractor or sub-contractor must get in touch with the owner to determine whether the insurance company or companies he expects to use is, or are, acceptable to the owner. All policies and certificates must be signed or countersigned, as the case may be, by resident Georgia agents.

(D) Termination of Obligation to Insure: Unless otherwise expressly provided to the contrary, the obligation to insure as prescribed herein shall not terminate until the owner shall have executed the final certificate.

(E) Competence of Insurers: The contractor is responsible for any delay resulting from the failure; (1) of his insurance carriers; and, (2) of insurance carriers of his sub-contractors to furnish proof of proper coverage in; (1) the prescribed form; (2) the prescribed manner; and, (3) in good season.

(F) Notice of cancellation or non-renewal. - No notice of cancellation or notice on intent to non-renewal shall be effective if given more than thirty (30) days in advance of cancellation or date of expiration of policy.

REQUEST FOR PROPOSAL CERTIFICATION FORM

Site Signage and Wayfinding

RFP # GWCCA110623EC

I, , being duly sworn, state that I am (title) of

(firm) and hereby duly certify that I have read and understand the information presented in the attached submittal and any enclosure and exhibits thereto.

I further certify that to the best of my knowledge the information given in response to the Request for Proposal is full, complete and truthful.

I further certify that the submitting firm and any principal employee of the submitting firm has not, in the immediately preceding five (5) years, been convicted of any crime of moral turpitude or any felony offense, nor has had their professional license suspended, revoked or been subjected to disciplinary proceedings.

I further certify that the submitting firm has not, in the immediately preceding five (5) years, been suspended or debarred from contracting with any federal, state or local government agency, and further, that the submitting firm is not now under consideration for suspension or debarment from any such agency.

I further certify that the submitting firm has not in the immediately preceding five (5) years been defaulted in any federal, state or local government agency contract and further, that the submitting firm is not now under any notice of intent to default on any such contract.

I acknowledge, agree and authorize, and certify that the proposer acknowledges, agrees and authorizes, that the Authority may, by means that either deems appropriate, determine the accuracy and truth of the information provided by the proposer and that the Authority may contact any individual or entity named in the Proposal for the purpose of verifying the information supplied therein.

I acknowledge and agree that all of the information contained in the Proposal is submitted for the express purpose of inducing the Authority to award a contract.

I certify we have not employed or retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this contract and that we have not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for us, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or the making of this contract.

I certify that any proposal we submit for this project shall be made without prior understanding, agreement, or connection with any corporation, firm, or person submitting or who will be submitting a separate proposal on the same project or for the same services, materials, labor, supplies, or equipment and is in all respects fair and without collusion or fraud. We understand collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards. We agree to abide by all conditions of this solicitation. We certify that no person associated with our firm is a member of the Board of Governor’s or officer or employee of the Authority or holds any statewide elective or appointed office. We further certify that no person who holds any state-wide elective or appointed office or who is a member of the Board of Governors or officer or employee of the Authority has been paid or promised by the firm any compensation in connection with this procurement by the Authority.

A material false statement or omission made in conjunction with this proposal is sufficient cause for suspension or debarment from further contracts, or denial of rescission of any contract entered into based upon this proposal thereby precluding the firm from doing business with, or performing work for, the State of Georgia. In addition, such false statement or omission may subject the person and entity making the proposal to criminal prosecution under the laws of the State of Georgia of the United States, including but not limited to O.C.G.A. §16- 10-20, 18 U.S.C. §§1001 or 1341.

Sworn and subscribed before me

This day of , 20 . Signature

NOTARY PUBLIC

My Commission Expires: NOTARY SEAL

SUPPLIER DATA SHEET

1. Firm:

Address:

2. Orders to be mailed to:

Firm:

3. Payments to be made to:

Firm:

4. Contract Administrator:

Name:

Title:

Telephone: ( ) Toll Free Phone (if available)

Fax Number: ( ) E-mail address:

5. Cash Discount % Days

6. Payment Terms: Net 30 Days

Revised: 12/22/2010 SPD-SP045

TAX COMPLIANCE

INSTRUCTIONS TO SUPPLIERS

Please complete the following information:

Supplier’s Name:

Physical Location Address:

Federal Identification Number (FEI):

Have you ever been registered in the State of Georgia?

If so, please provide the following information, if applicable:

o State Taxpayer Identification Number (STI):

o Sales and Use Tax Number:

o Withholding Tax Number:

What type of service will you perform?

Will you sell any tangible personal property or goods?

Supplier’s Affiliate’s Name:

o FEI:

o STI:

o Sales and Use Tax Number:

o Withholding Tax Number:

If there is more than one affiliate, please attach a separate sheet listing the information above.

Person responsible for handling supplier’s tax issues (such as the CFO, the company tax officer, etc.):

o Name:

o Telephone Number:

o E-mail Address:

NOTICE TO SUPPLIER:

In the event the supplier is considered for contract award, the information provided in the form will be submitted by the State Entity to the Georgia Department of Revenue (“DOR”) for a determination as to whether the supplier is a “prohibited source” (as defined by O.C.G.A. §50-5-82) or whether there are any other outstanding tax issues. MISSING, INCOMPLETE, OR ERRONEOUS DATA MAY

DELAY OR PROHIBIT VERIFICATION OF YOUR ELIGIBILITY FOR CONTRACT AWARD.

NO PROHIBITED SOURCE MAY RECEIVE CONTRACT AWARD; THEREFORE, YOU ARE

STRONGLY ENCOURAGED TO CHECK YOUR TAX STATUS NOW AND RESOLVE ANY

OUTSTANDING TAX LIABILITIES AND/OR MISSING TAX RETURNS.

STATE ENTITY: Please submit this form via email to DOR at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.

mailto:tsd-state-contractors@dor.ga.gov