Request for Proposal

For

Douglasville Commercial Solid Waste Collection Services

RFP 2026-009

Issue Date: October 30, 2026

Due Date: December 01, 2026

City of Douglasville, Georgia Page 2 of 26 RFP , Commercial Solid Waste Collection Services

RFP ESTIMATED TIMELINE

RFP ESTIMATED TIMELINE

Owner issues public advertisement of RFP October 30, 2026

Pre−proposal meeting with site visit following November 12, 2026, at 10 AM

EST

Deadline for written questions/requests for clarification

November 16, 2026, at 4 PM EST

Publish responses to questions November 23, 2026

Deadline for submission of Proposals December 01, 2026, at 4 PM EST

Interviews by Selection Committee (If Required) TBD

Selection recommendation to City Council for approval

TBD

Table of Contents

1. General Project Information and Background

2. Scope of Services

3. Procurement Process and Information

4. Evaluation of Proposals and Presentation

5. General Conditions

6. Exhibits

7. Glossary of Terms

I. General Project Information and Background

The City of Douglasville (the "City" or "Owner") is seeking Proposals from qualified vendors to provide Commercial Solid Waste Collection Services for Douglasville, Georgia, as specified in this RFP. Before award, use “Proposer.” After award, use “Contractor.”

II. Scope of Services

1. General

Supplier shall provide commercial collection services inside the City limits, as shown on Exhibit A, with the following exception: the City has identified a downtown business district which is not included in Supplier's scope of services. The City will provide collection services within the downtown business district, which is shown on Exhibit B.

City of Douglasville, Georgia Page 3 of 26

The City currently services 739 frontload units and 152 rolloff/compactor units and 15 VIP frontload compactor units, excluding the downtown business district.

2. Services to be Provided by Supplier

Supplier shall provide municipal solid waste front end load (FEL) and rolloff (RO) collection and disposal services in accordance with the terms of this Proposal to the City's commercial customers (excluding the downtown business district). No other person or entity except the Supplier may offer or provide these services inside City limits. The City agrees that so long as the Supplier is not in default hereunder, it will not enter into any agreement with any other entity for performance of these services inside City limits. Existing Commercial Collection Agreements. Implementation of any resulting agreement is subject to applicable Georgia law governing existing commercial solid-waste collection agreements. The City does not represent that every commercial customer may immediately transition to the selected Contractor. The Contractor shall cooperate in a lawful transition and shall not provide service to an account in a manner that would cause the City to invalidate an agreement protected by O.C.G.A. § 36-80-22.

Service to affected accounts shall begin only when legally permissible, including after expiration or lawful termination of the applicable agreement.

3. Containers

At the beginning of the contract period, Supplier shall take possession from the City of 739 commercial FEL containers currently in service. Commercial FEL containers shall remain the property of the City but shall remain in the possession and control of Supplier during the term of the contract entered into between Supplier and City. The Supplier will be responsible for maintenance and repair of these containers as needed.

At the beginning of the contract period, Supplier shall take possession from the City of 75 Rolloff containers. If more are needed Supplier shall provide additional containers for commercial RO collection. The Supplier will be responsible for delivery and maintenance of all containers as needed. City to verify and reconcile the container and compactor inventory, ownership, and condition at the mandatory pre-proposal conference and in a transition inventory.

4. Missed Collections

The Supplier will be responsible for receiving all reports of missed collections from the city, rectifying the missed collection, and providing this information to the City. If the missed collection was solely the fault of the Supplier, Supplier shall provide the

City of Douglasville, Georgia Page 4 of 26 applicable collection service within one day of receiving the report. If the missed collection was due to any act or failure to act by the commercial customer, Supplier shall not perform an additional pickup and the commercial customer shall be subject to an approved No-Load charge.

5. Fees and Payments for Services

Exhibit C – Fee Proposal will be issued by addendum. Proposers shall use the City-issued fee sheet and shall identify all rates, charges, pass-throughs, escalation assumptions, and exclusions.

5.1 City Handles Billing

• Supplier will propose a service fee per container to be paid by the City to the Supplier for commercial FEL or RO solid waste collection services.

• The Supplier will invoice the City the municipal solid waste collection service fee for all commercial units on a monthly basis.

• The City will be responsible for invoicing the commercial customers for the required service.

• The City may charge each customer a fee for administration and related expenses.

6. General Performance Requirements for Collection Services

Collection of municipal solid waste from each commercial customer will be performed by Supplier in accordance with all performance requirements set forth in the Contract. The successful Proposer shall submit its proposed agreement with its Proposal. The proposed agreement must incorporate this RFP, all addenda, the City-issued fee sheet, the Proposer’s accepted response, and all City-required negotiated terms. No agreement is binding unless approved and executed by the City. The City reserves the right to negotiate all contract terms and to reject unacceptable terms.

6.1 Supplier Responsibilities

• Collection Routes and Days

• Collection Processing and Disposal

• Notification of Improper Set-Outs

• Safety

6.2 City Responsibilities

• Initiation of Accounts and Billing

City of Douglasville, Georgia Page 5 of 26

• Monitoring Supplier Compliance

Required Agreement Provisions. The proposed agreement must include, at a minimum:

contract term (not more than one year with automatic renewals for a specified time period) and renewal structure; City Council approval; annual appropriation/non-appropriation provisions for any multiyear obligation; performance standards and remedies; customer-service and complaint-response standards; reporting; records retention and audit; insurance; indemnification; default and termination;

assignment/change-of-control restrictions; transition-in and transition-out assistance;

disposal facility and contingency requirements; and compliance with all applicable local, state, and federal law.

City of Douglasville, Georgia Page 6 of 26

7. Schedule of Collection

7.1 Hours of Collection

All commercial RO collection must be performed between the hours of 7:00 am and 5:00 pm during the Contract term, Monday through Friday (Monday through Saturday during a Holiday week). Supplier will perform commercial FEL collection seven days per week. Collection hours must adhere to the City noise ordinances. Supplier or City may request a variance to these normal hours of operations when special or unforeseen incidents occur. Holiday week shall be defined in the final agreement. Any schedule change affecting customers requires advance notice approved by the City, except in an emergency.

7.2 Holidays

The Supplier shall not be required to perform collection services on public Holidays as defined by the City, with the exception of hospital and medical facilities, which must be picked up on their normal schedule. The collections that would have been made on a Holiday may be rescheduled by Supplier but must occur within two (2) days of the collection missed due to the Holiday.

8. Supplier Personnel

8.1 Qualified Personnel

Supplier shall furnish qualified drivers, mechanical, supervisory, clerical, and other personnel as may be necessary to provide the collection services in a safe, economical, and efficient manner. All drivers shall be trained and qualified in the operation of collection vehicles and must have a valid commercial driver's license, of the appropriate class, issued by the Georgia Department of Driver Services. All drivers and collection employees shall wear a uniform bearing the Supplier's name and the name of the individual employee.

8.2 Operational and Safety Training

Supplier shall provide annual operational and safety training for all its employees who utilize or operate collection vehicles or equipment for collection of materials under the Contract between City and Supplier. Supplier shall train its employees in solid waste collection to identify and not collect hazardous waste or biomedical waste.

City of Douglasville, Georgia Page 7 of 26

8.3 Employee Training

Supplier will train its employees as to the City's collection rules and regulations, ensuring that employees can answer questions from commercial customers and follow the City's collection rules. This training should be ongoing and reach new hires. All drivers and collection vehicle crews shall be trained in recognizing acceptable commercial municipal solid waste.

9. Collection Equipment

Supplier shall provide a fleet of collection vehicles sufficient in number and capacity to efficiently perform the work required by the Contract in strict accordance with its terms.

Supplier shall have available on days of collection, sufficient back-up collection vehicles to respond to complaints and emergencies. Collection vehicles must be reliable, safe, well maintained, clean, and in good working order. The City reserves the right to inspect all collection vehicles to be used in servicing this Contract. The City shall notify Supplier within ten (10) days of inspection about the failure of any collection vehicle to meet these requirements. The City may inspect vehicles, equipment, container yards, and relevant operating records at reasonable times, without advance notice when necessary to investigate a complaint, safety condition, or service failure.

9.1 Specifications

All collection vehicles used by Supplier in providing collection of materials under this Contract shall comply with all applicable local, County, State, and federal regulations.

Collection vehicles must be enclosed and designed to prevent leakage, spillage, or overflow.

9.2 Identification

Supplier's name, local telephone number, and a unique collection vehicle identification number designated by Supplier for each collection vehicle shall be visibly displayed in at least three places on all collection vehicles, in letters and numbers no less than six inches high. Supplier shall not place the City's name or logo on its collection vehicles.

9.3 Vehicle Inventory

Supplier shall furnish the City a written inventory of all collection vehicles used in providing collection services and shall update the inventory annually at the beginning of each Contract year. The inventory shall list all collection vehicles by manufacturer, ID number, date of acquisition, model year, type, and capacity.

City of Douglasville, Georgia Page 8 of 26

III. Procurement Process and Information

A. Request for Proposal Documents

All RFP documents are available in electronic format on Bidnet Direct at https://www.bidnetdirect.com.

B. Availability of Request for Proposal

The RFP is open to all qualified candidates and is available free of charge.

C. Request for Information

All requests for information and clarifications regarding this project shall be submitted on Bidnet Direct (https://www.bidnetdirect.com) no later than November 16, 2026, at 4:00 PM EST. Questions and answers will be issued in the form of an addendum to all interested and will be available submitted on Bidnet Direct (https://www.bidnetdirect.com). It is the proposer's responsibility to check the website for any addenda issued for this RFP.

D. Pre-proposal Meeting, Site Visit and Existing Documents Review

A MANDATORY pre-proposal Conference will be held on November 12, 2026, at 10:00 AM EST at 8145 Cedar Mountain Road, Douglasville, GA. All firms intending to respond to this Request for Proposal must attend. Late attendees will not be admitted.

E. Communication

From the issue date of this (RFP) solicitation until a successful proposer is selected and announced, proposers are forbidden to communicate about this solicitation or this Project for any reason with any members of the City of Douglasville administration and government, except for submission of questions as instructed in the RFP, or during the pre-proposal conference (if applicable), or as provided by any existing work agreement(s). For violation of this provision, the Owner reserves the right to reject the proposal of the offending proposer. If additional assistance is needed, please contact Alyssa Gordon – Procurement Manager at gordona@douglasvillega.gov.

F. Submittal Date and Information https://www.bidnetdirect.com/ https://www.bidnetdirect.com/ mailto:gordona@douglasvillega.gov

City of Douglasville, Georgia Page 9 of 26

All bids must be submitted electronically in PDF format via Bidnet Direct:

(https://www.bidnetdirect.com).), no later than December 01, 2026, by 4:00 PM EST .

The entire submittal should be submitted as one (1) PDF file. Please do not submit individual documents or sections separately. Electronic submittals must include a reference to RFP 2024-009 Douglasville Commercial Solid Waste Collection Services.

No bids will be received after that time.

1. It is the sole responsibility of the Proposer to ensure delivery of the Proposal by the specified deadlines to the correct location; the City cannot accept responsibility for incorrect or late deliveries, regardless of reason.

2. A list of firms submitting responsive Proposals will be available on City of Douglasville RFP/RFQ website after stated deadline.

3. Proposals may not be withdrawn for a period of 60 days after the due date for receipt of proposals. Every Proposal shall include all information and pricing required by this RFP and Exhibit C, as issued by addendum.

4. All Proposers shall provide evidence of insurance with their Proposal or, at the City’s option, a commitment to provide compliant certificates and endorsements before contract execution. The successful Proposer shall maintain, at a minimum, commercial general liability, automobile liability, workers’ compensation/employers’ liability, and umbrella/excess liability insurance in limits specified by the City. The Proposer will be required to indemnify the city for any and all claims that arise from the Proposer’s contract to provide services within the City. Such policies shall include necessary endorsements or language for such indemnification. Policies shall be issued by insurers authorized to do business in Georgia. The final agreement shall require the City to be named as an additional insured where applicable, primary and noncontributory coverage where required, and notice of cancellation or material reduction as required by the agreement.

5. Proposals may be withdrawn by written or email request, provided such withdrawals are received prior to the time and date of the bid closing. Supplier shall present a Liability Insurance Certificate naming the City of Douglasville as an Additional Insured. Supplier shall be responsible for all injuries or damages of any kind to persons or property resulting from its work done pursuant to a contract with the City. Insurance, jurisdiction, and venue requirements shall be governed by the negotiated and executed agreement. Policies are issued by insurers—not surety companies.

6. All expenses for preparing and submitting responses are the sole cost of the party submitting the response. The City is not obligated to reimburse such expenses. All submittals upon receipt become property of the City and are subject to the Georgia Open Records Act, O.C.G.A. § 50-18-70 et seq. A Proposer claiming that specific information is exempt from disclosure shall identify each page or discrete portion, state the legal basis for the claimed

City of Douglasville, Georgia Page 10 of 26 exemption, and provide a redacted copy upon request. The City will make the final disclosure determination and will release records as required by law.

The City of Douglasville reserves the right to waive any and all technicalities, formalities, or irregularities in proposals. The City may reject the proposal of any vendor that has previously failed to perform properly or complete on time contracts of a similar nature with the City of Douglasville, or if the proposer has within the last 5 years:

a. Failed to satisfactorily complete a similar contract due to delays caused by the proposer or non−conforming work performed by the proposer; or

b. Incurred criminal sanctions against company or any current proposer officer; or

c. Had its insurance company pay a claim against proposer's insurance, due to proposer's failure to perform.

IV. Evaluation of Proposals and Presentation

The evaluation by the Selection Committee will be based on the Selection Criteria listed below. The City will appoint a committee of key staff members (Selection Committee) to review each response to this RFP and provide a rank list of all the proposers.

1. Operational Capacity and Staffing - 25 Points

• Fleet size and condition

• Staffing levels and qualifications

• Management team experience in waste collection services

• Training programs and safety protocols

2. Experience and Past Performance - 30 Points

• Past performance on similar municipal waste collection contracts

• Experience in providing services of similar scale and complexity

• Client references (whether included in the bid response or not)

• Overall responsiveness to client needs

• Track record of service reliability and customer satisfaction

3. Service Approach and Methodology - 25 Points

• Overall understanding of the scope of the required waste collection services

• Understanding of collection schedules and routes provided by the city

• Strategies for handling peak loads and special events

• Proposed methods for performance tracking and reporting

• Completeness and responsiveness to the RFP requirements

City of Douglasville, Georgia Page 11 of 26

4. Cost Proposal - 20 Points

• Overall cost-effectiveness of the proposed services

• Pricing structure and transparency

• Value for money considering the scope of services offered

Evaluation Process

1. The selection committee members will each review the responses to the RFP and provide a score for each based on the selection criteria above.

2. The selection committee will convene and summarize the points earned by each proposer.

3. A list of proposers found by the selection committee to have submitted bids reasonably susceptible of being selected for award will be estblished.

4. As needed, the selection committee shall select proposers to be invited to provide a presentation of their proposal(s) to the selection committee.

The City may conduct discussions and negotiations with the highest-ranked Proposer or a competitive range of Proposers, request best and final offers, and recommend award only after determining that the selected Proposer is responsible and that the proposed agreement is acceptable to the City. Award is subject to all required City approvals.

V. General Conditions

Upon submission of a bid, the bidder hereby certifies on behalf of his or her company or organization that:

a. This proposal is genuine and not made in the interest of, or on behalf of, an undisclosed person, firm, or corporation.

b. This proposal is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation.

c. The proposer has not directly or indirectly induced or solicited any other proposer to submit a false or sham bid.

d. The proposer has not solicited or induced any person, firm, or corporation to refrain from proposing.

e. The proposer has not sought by collusion to obtain for itself any advantages over any other bidder or over the City of Douglasville.

VI. Exhibits

City of Douglasville, Georgia Page 12 of 26

• Exhibit A - Map of Douglasville City Limits

• Exhibit B - Map of Downtown Business District

• Exhibit C - Fee Proposal

• Exhibit D - Organization's Statement of Experience: Recent Collection Contracts

• Exhibit E - Disclosure Statement

• Exhibit F - Certification Form

• Exhibit G - Contractor's Oath

• Exhibit H - Contractors and Subcontractors affidavits of compliance with the

Georgia Security and Immigration Act

• Exhibit I - Certificate of Corporate Existence

City of Douglasville, Georgia Page 13 of 26

VII. Glossary of Terms

FEL: Front End Load - A type of waste collection container typically used for commercial and industrial applications.

RO:Roll-Off - A type of open-top dumpster characterized by a rectangular footprint and wheels to facilitate rolling the dumpster in place.

Supplier: The company or entity selected to provide the commercial solid waste collection services as outlined in this RFP.

City: The City of Douglasville, Georgia.

Downtown Business District: A specific area within the City of Douglasville, as defined in Exhibit B, where waste collection services are not included in this RFP.

Commercial Customer: A nonresidential customer located within the service area, excluding the Downtown Business District, subject to applicable law and the final agreement.

Exhibit A – Downtown Douglasville

City of Douglasville, Georgia Page 15 of 26

Exhibit B – Map of City limits

Exhibit C – Fee proposal roll off

Bid Pricing Sheet

TYPE OF SERVICE REQUESTED: ROLL-OFF

DELIVERY CHARGE: _______________________________

HAUL CHARGE: ___________________________________

NO LOAD HAUL CHARGE: _____________________________

PER TON CHARGE: ____________________________

RENTAL PER MONTH: ____________________ per day ___________________

TYPE OF SERVICE REQUESTED: COMPACTOR

HAUL CHARGE: ___________________________________

NO LOAD HAUL CHARGE: _____________________________

PER TON CHARGE: ____________________________

COMPACTOR REPLACEMENT KEYS: ____________________________

City of Douglasville, Georgia Page 17 of 26

Exhibit C – Fee proposal for FEL

PROPOSAL COST FORM

Front End Load (FEL) Pricing Provide monthly pricing per container for each container size and frequency (per week) listed. Include all fees, charges, and surcharges.

SIZE 1X 2X 3X 4X 5X 6X

2 YD $ $ $ $ $ $

4 YD $ $ $ $ $ $

6 YD $ $ $ $ $ $

8 YD $ $ $ $ $ $

Extra pickup / disposal fee:

Front End Load (FEL) VIP COMPACTOR Pricing Provide monthly pricing per container for each container size and frequency (per week) listed. Include all fees, charges, and surcharges.

SIZE 1X 2X 3X 4X 5X 6X

2 YD $ $ $ $ $ $

4 YD $ $ $ $ $ $

6 YD $ $ $ $ $ $

8 YD $ $ $ $ $ $

SIZE PRICE

2 YD $

4 YD $

6 YD $

8 YD $

City of Douglasville, Georgia Page 18 of 26

Exhibit E

BIDDERS’ DISCLOSURE STATEMENT

All bidders should be aware that the Project is a public project, and the City is a public agency. Pursuant to the laws, rules and Executive Orders of the State of Georgia, the City of Douglasville shall make every effort to avoid even the appearance of a conflict of interest or any impropriety in both the selection process for this project and the negotiation and performance of any resulting contract. As part of any submittal you intend to make for this project, you must include a Disclosure Statement with your submittal which answers the following specific questions:

1. Describe any business transactions occurring within the prior two years between your firm and the City of Douglasville. <Insert Response Here>

2. Describe any gift, hospitality, or benefit of any sort that your firm has provided to the

City of Douglasville, within the prior one-year period.

<Insert Response Here>

3. A conflict of interest or potential conflict of interest is defined as any action, decision, or recommendation by a person acting in a capacity as a public official, the effect of which is or could be to the private monetary or financial benefit or detriment of the person, the person’s relative, or any business with which the person or a relative of the person is associated. The potential conflict of interest is viewed from the perspective of a reasonable person who has knowledge of the relevant facts.

Based upon this definition, describe any conflict of interest or potential conflict of interest that your firm has with the City of Douglasville. <Insert Response Here>

This Disclosure Statement should be dated and signed by an authorized signer for the bidder and submitted with the Bidder’s submittal.

Name of Firm

Authorized Signature Date

Printed Name and Title of Authorized Agent

City of Douglasville, Georgia Page 19 of 26

Exhibit F – Certification form

CERTIFICATION FORM

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 bid 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 bids is full, complete and truthful.

I further certify that the bidder and any principal employee of the bidder have not, in the immediately preceding five 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 bidder has not, in the immediately preceding five years, been suspended or debarred from contracting with any federal, state or local government agency, and further, that the bidder is not now under consideration for suspension or debarment from any such agency.

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

I acknowledge, agree and authorize, and certify that the bidder acknowledges, agrees and authorizes, that the City of Douglasville may, by means that the City of Douglasville deems appropriate, determine the accuracy and truth of the information provided by the bidder and that the City of Douglasville or their agents may contact any individual or entity named in the RFB for the purpose of verifying the information supplied therein.

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

A materially false statement or omission made in conjunction with this bid is sufficient cause for suspension or debarment from further contracts, or denial of rescission of any contract entered into based upon this bid 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 bid 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.

Signature

SWORN AND SUBSCRIBED BEFORE ME

This (day) of (month), 20 (year)

NOTARY PUBLIC SIGNATURE

My Commission Expires:

NOTARY SEAL

City of Douglasville, Georgia Page 20 of 26

Exhibit H – Contractor and Subcontractor affidavits

CONTRACTOR AFFIDAVIT AND AGREEMENT REGARDING GEORGIA SECURITY AND

IMMIGRATION COMPLIANCE.

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 contracting with the City of Douglasville has registered with and is participating in a federal work authorization program* [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], 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 City of Douglasville, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 or a substantially similar form. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Douglasville at the time the subcontractor(s) is retained to perform such service.

Company ID Number: EEV/Basic Pilot Program* Authorization Date

Name of Contractor Name of Project

Name of Public Employer

Signature by Authorized Officer or Agent Date

Printed Name of Authorized Officer/Agent of Contractor

Title of Authorized Officer/Agent of Contractor

SUBSCRIBED AND SWORN BEFORE ME ON THIS

THE ___ DAY OF ______________________, 20____

Notary Public My Commission Expires: ________________

* As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is the “EEV / Basic Pilot Program” operated by the U. S. Citizenship and Immigration

City of Douglasville, Georgia Page 21 of 26

SUBCONTRACTOR AFFIDAVIT FOR GEORGIA SECURITY AND IMMIGRATION COMPLIANCE.

By executing this affidavit, the undersigned subcontractor 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 under a contract with (name of contractor)| on behalf of the City of Douglasville has registered with and is participating in a federal work authorization program* [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], in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

Company ID Number: EEV/Basic Pilot Program* Authorization Date

Name of Subcontractor Name of Project

Name of Public Employer

Signature by Authorized Officer or Agent Date

Printed Name of Authorized Officer/Agent of Subcontractor

Title of Authorized Officer/Agent of Subcontractor

SUBSCRIBED AND SWORN BEFORE ME ON THIS

THE ___ DAY OF ______________________, 20____

Notary Public My Commission Expires: ________________

* As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is the “EEV / 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).

City of Douglasville, Georgia Page 22 of 26

Georgia Security and Immigration Compliance.

_____500 or more employees, or

_____100 or more employees, or

_____fewer than 100 employees, as identified in O.C.G.A. 13-10-91. In the event the Contractor employs or contracts with any subcontractor(s) in connection with this contract, the Contractor will secure from the subcontractor(s) such subcontractor(s’) indication of the employee-number category applicable to the subcontractor. The contractor’s compliance with the requirements of O.C.G.A. 13-10-91 and Rule 300-10-1-.02 is attested by the execution of the contractor affidavit as shown in Rule 300-10-1-.07, or a substantially similar contractor affidavit, which document is attached to this Contract, and is a part of this Contract.

In the event the Contractor employs or contracts with any subcontractor(s) in connection with this contract, the Contractor will secure from such subcontractor(s) attestation of the subcontractor’s compliance with O.C.G.A. 13-10-91 and Rule 300-10-1-.02 by the subcontractor’s execution of the subcontractor affidavit shown in Rule 300-10-1-.08 or a substantially similar subcontractor affidavit, and maintain records of such attestation for inspection by the City at any time. Such subcontractor affidavit shall become a part of any contractor/subcontractor agreement.

City of Douglasville, Georgia Page 23 of 26

BIDDER hereby submits this Bid as set forth above:

Bidder:

(typed or printed name of organization)

By:

(individual’s signature) Name:

(typed or printed) Title:

(typed or printed)

Date:

(typed or printed)

If Bidder is a corporation, a partnership, or a joint venture, attach evidence of authority to sign.

Attest:

(individual’s signature)

Name:

(typed or printed)

Title:

(typed or printed)

Date:

(typed or printed)

Address for giving notices:

Bidder’s Contact:

Name:

(typed or printed)

Title:

(typed or printed)

Phone:

Email:

Address:

Bidder’s Contractor License Number:

City of Douglasville, Georgia Page 24 of 26

List of Similar Projects:

1. Project Name: _________________________________________________ Project Location: __________________________________________________ Project Owner: ___________________________________________________ Owner Contact (Name and Phone): ___________________________________ Project Contract Amount: ___________________________________________ Description of Project: ______________________________________________

City of Douglasville, Georgia Page 25 of 26

2. Project Name: _________________________________________________ Project Location: __________________________________________________ Project Owner: ___________________________________________________ Owner Contact (Name and Phone): ___________________________________ Project Contract Amount: ___________________________________________ Description of Project: ______________________________________________

City of Douglasville, Georgia Page 26 of 26

3. Project Name: _________________________________________________ Project Location: __________________________________________________ Project Owner: ___________________________________________________ Owner Contact (Name and Phone): ___________________________________ Project Contract Amount: ___________________________________________ Description of Project: ______________________________________________

<Insert Response Here>