RFP Hotel Development in Downtown Douglasvill.pdf

REQUEST FOR PROPOSALS

FOR

Statement of Qualification and Conceptual Information (SQCP) for a Hotel Development within the downtown area of the City of Douglasville, Georgia

RFP 2026-006

ISSUE DATE: July 22, 2026

DUE DATE: September 21, 2026

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Executive Summary

Nestled in the picturesque western region of Georgia, the City of Douglasville, with a history dating back to the 19th century, is a unique blend of historical charm and modern conveniences. Its evolution, catalyzed by the railway connecting Atlanta and Birmingham, has led to a thriving community with diverse commercial and agricultural enterprises. Douglasville's steady growth, driven by its proximity to Atlanta and its appeal as a place to reside, offers a promising opportunity for investment.

Following a thorough market evaluation, we have pinpointed a prime location for a Hotel within the downtown entertainment district. This site is strategically positioned near the Douglasville Conference Center and is just a short walk away from numerous dining options. Moreover, its proximity allows us to leverage the conference center's parking facilities, effectively reducing construction expenses.

With an estimated 2025 population of 41,523, Douglasville has experienced 19.8% population growth since April 2020. According to World Population Review’s 2026 ranking, Douglasville ranks 34th among the fastest-growing cities in Georgia. The city is home to a diverse mix of residents, including young professionals, families, and retirees. With a median household income of $79,107, Douglasville continues to demonstrate strong growth and economic prosperity.

Given the hotel's location in downtown Douglasville, in proximity to full-service restaurants and bars, a full-service restaurant within the hotel is unnecessary. However, amenities are important such as business center, fitness center, a small sundry shop, and ample complimentary parking should be considered, aligning with the expectations of modern hotel guests. Lastly, meeting space should enhance the guest experience our conference center brings along with the downtown businesses that operate here.

In conclusion, the City of Douglasville is actively seeking a partnership with a seasoned developer who shares our enthusiasm for this visionary project and places a paramount emphasis on exceptional design. The City of Douglasville's Hotel RFP presents a remarkable opportunity in a thriving community with a rich history and promising future, underpinned by a prime location and a well-thought-out hotel concept designed to cater to the needs of both residents and visitors.

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Site Information

Parcel Number 0016015D018 Parcel Number 0016015D016 Parcel Number 0016015D017

6730 CHURCH ST BOWDEN ST 8493 BOWDEN ST

Acres: .09 Acres: .5 Acres: .11 Status: Currently developed Status: Currently developed Status Currently developed Utilities available Utilities available Utilities available

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Request for Proposal

You are invited to submit a “Statement of Qualification and Conceptual Information” (SQCP) for a Hotel Development within the downtown area of the City of Douglasville, Georgia, one block from the Douglasville Conference Center and two blocks from the Douglasville Town Green and Greystone Amphitheater.

Boasting innovation and elegance, the newly renovated Douglasville Conference Center (renovation completed February 2026) is a stunning landmark in the heart of downtown Douglasville with an equally impressive interior. The multi-functional facility encompasses over 37,000-square-feet of meeting space including a grand ballroom that can be divided into five sections, a business center, two green rooms, a 150-seat auditorium, two pre-function areas, a 14-person boardroom, three meeting rooms, and a gorgeous rear terrace. More information about the Douglasville Conference Center can be found at https://www.douglasvilleconferencecenter.com/.

With exciting amenities including a splash pad, boulder area and event space, the Douglasville Town Green encourages people to gather with old friends and make new ones. The Greystone Amphitheater is an outdoor venue designed for entertainment and events. Its open-air design provides for a unique and memorable experience whether you're performing or soaking up the atmosphere as a spectator. More information regarding the Douglasville Town Green and Greystone Amphitheater can be found at https://www.greystoneamp.com/Home.

This RFP is the first in a two-step proposal and selection process. This first step is intended to obtain SQCP information related to the qualifications, experience, capabilities, and general overall conceptual vision of prospective Developers. The City of Douglasville, a municipal corporation existing under the laws of the state of Georgia, and the Douglasville Convention and Conference Center Authority, a political subdivision of the state of Georgia semi-public/semi-private in nature, may choose one or more respondent Developers for consideration to advance to Step Two of this proposal and selection process. Step Two will include providing qualified Developers with additional, detailed information related to the site and project for preparation of detailed development and financial proposals.

Questions or requests may be submitted via Bidnet Direct at https://www.bidnetdirect.com until August 12, 2026, at 4 PM EDT. Questions and answers will be issued in the form of an addendum to all interested and will be available on Bidnet Direct. It is the proposer’s responsibility to check the website for any addenda issued for this RFP.

If further assistance is needed all inquiries regarding proposals must be made to Alyssa Gordon, Procurement Manager, via email at gordona@douglasvillega.gov. Contact with any other person within the Douglasville Convention and Conference Center Authority, the City of Douglasville, or otherwise involved with this project is prohibited and may result in disqualification from further consideration and elimination from the selection process. The requirements contained in this RFP shall not be changed or superseded except by written addendum from the City of Douglasville and/or the Douglasville Convention and Conference Center Authority. Failure to comply with the written requirements for this proposal may result in rejection from further consideration by the City of Douglasville and/or the Douglasville Convention and Conference Center Authority.

http://www.bidnetdirect.com/

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SQCP submittals are due not later than September 21, 2026, at 4:00PM EDT. All bids must be submitted electronically in 1 PDF file via Bidnet Direct: (https://www.bidnetdirect.com), no later than September 21, 2026, at 4:00 PM EDT. Electronic submittals must include a reference to RFP 2026- 006 Statement of Qualification and Conceptual Information” (SQCP) for a Hotel Development within the downtown area of the City of Douglasville, Georgia. No late proposals will be accepted.

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

The City of Douglasville and the Douglasville Convention and Conference Center Authority reserve the right to reject any and all proposals, to waive any technicalities or irregularities, and to award the contract based on the highest and best interest of the City of Douglasville and the Douglasville Convention and Conference Center Authority. Additionally, the City of Douglasville and the Douglasville Convention and Conference Center Authority reserve the right to consider, incorporate and utilize without restriction concepts and ideas proposed by any Offeror whether or not that Offeror is selected for the project.

Proposal Schedule:

The RFP schedule is anticipated as follows:

Step One “SQCP” RFP Issued July 22, 2026 Deadline for submission of questions August 12, 2026, at 4 PM EDT Publish responses to questions August 19, 2026 SQCP Submittal due September 21, 2026, at 4 PM EDT Selection of firms to advance to step two TBD

All expenses involved with the preparation and submission of proposals or any work performed in connection therewith shall be borne by the Developer(s). No payment will be made for any responses or other effort made by the Developer(s) prior to execution of a contract approved by the City of Douglasville and/or the Douglasville Convention and Conference Center Authority.

Developers are encouraged to visit the site and generally inspect and familiarize themselves with the proposed Hotel site. The exterior of the site is open and available to the public and visits do not need to be scheduled or coordinated. In no event shall failure to inspect the site constitute grounds for a claim after contract award.

It is the intent of the City of Douglasville and/or the Douglasville Convention and Conference Center Authority to enter into a Development Contract based on negotiations between the City of Douglasville and/or the Douglasville Convention and Conference Center Authority and the Preferred Developer. The City of Douglasville and/or the Douglasville Convention and Conference Center Authority may reject any or all proposals if such action is in the City of Douglasville’s and/or the Douglasville Convention and Conference Center Authority’s interest.

The City of Douglasville and/or the Douglasville Convention and Conference Center Authority may make such reasonable investigations as deemed proper and necessary to determine the ability of the Developer to perform the work and the Developer shall furnish to the City of Douglasville and/or the Douglasville

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Convention and Conference Center Authority all such information and data for this purpose as may be requested. The City of Douglasville and/or the Douglasville Convention and Conference Center Authority reserve the right to contact Developer respondents for clarifications or additional information and reject any proposal if the evidence submitted by, or investigations of, such Developer fails to satisfy the City of Douglasville and/or the Douglasville Convention and Conference Center Authority that such Developer is properly qualified to carry out the obligations of the contract and to complete the work contemplated therein.

Non-Discrimination: The City/Authority shall require, prior to, or incidental to, the award of a contract, confirmation by the respondent stating that the respondent has not discriminated and will not discriminate on the basis of race, creed, color, sex, religion or national origin in any of its employment practices with respect to the work force of the business, or procurement services in connection with this project. The successful respondent will be required to execute certificates, affirming these requirements of non-discrimination.

Incentives

Flexible Compensation Terms: The terms of a purchase contract for City-owned property are open to negotiation. The City would consider an up-front purchase of the entire assembly, a phased take-down, a ground lease of the property, or combination thereof. The City will select a developer who offers the best combination of quality products and compensation terms which, in the City’s sole judgment, best accomplish long-term redevelopment objectives for Downtown Douglasville. These terms may or may not reflect full market value.

Low-Cost Loan Funds: The Georgia Downtown Development Revolving Loan Fund, along with the Georgia Cities Foundation Revolving Loan Fund, are invaluable resources aimed at fostering economic growth and community revitalization throughout the state. These initiatives provide low-cost loans to local businesses and organizations, supporting their efforts to invest in downtown development projects. By offering affordable financing options, they enable communities in Georgia to breathe new life into their city centers, creating vibrant, thriving downtown areas that benefit both residents and visitors alike.

Tax Allocation District (TAD) Financing: The City may allocate TAD funding to assist with infrastructure cost and/or permitting fees. The City and its TAD Advisory Committee will be open to receiving an application for TAD funds from the selected developer, in accordance with established policies and procedures, IF the uses and financial justification for said funds are shown to be necessary, produce added public benefits or generate increased property tax increments to offset the requested TAD payment.

Zoning & Permitting: The City of Douglasville and the Douglasville Convention and Conference Authority, in collaboration with our chosen developer, are committed to ensuring that zoning regulations are thoughtfully aligned with the project pro-forma while maintaining the most reasonable density required for the success of this venture. We are equally dedicated to expeditiously handling all necessary permits, fostering a streamlined and efficient process to facilitate the project's progress. Our goal is to foster a thriving and harmonious development that benefits our community and promotes economic growth.

City Objectives

The City of Douglasville and the Douglasville Convention and Conference Authority extend a warm invitation to prospective developers, urging a comprehensive review of the provided site information to ensure that

Page | 7 the project aligns seamlessly with the city's vision and aspirations. While we embrace a diverse range of innovative approaches, it is imperative that proposals meet the following essential criteria:

1. Room Capacity: The development should encompass a minimum of 65 rooms to cater to our growing community and visitors.

2. Meeting Space: A generous allocation of at least 3,000 square feet for meeting areas is required to foster community engagement and collaboration.

3. Art Integration: Both internal and external spaces should showcase local art, enhancing the aesthetic and cultural appeal of the development.

Our paramount redevelopment objective for the site revolves around the creation of a harmonious blend of hotel leisure and our business community. Our overarching goal is to establish an amenity that serves as a beacon and catalyst for further investments in Downtown Douglasville. The City of Douglasville and the Douglasville Convention and Conference Authority eagerly anticipate collaborating with developers who share our vision, embarking on a transformative journey that will shape a dynamic future for Downtown Douglasville.

Proposal Content

ALL PROPOSALS RECEIVED WILL BECOME A PART OF THE OFFICIAL CONTRACT FILE AND MAY BE SUBJECT TO PUBLIC RECORDS REQUESTS. Note: Labeling sections of the SQCP information as proprietary or confidential does not waive this provision.

ALL MATERIALS SUBMITTED AS PART OF THIS RFP BECOME THE PROPERTY OF THE CITY OF

DOUGLASVILLE AND/OR THE DOUGLASVILLE CONVENTION AND CONFERENCE AUTHORITY.

A complete signed proposal must include the following elements:

Transmittal Letter

In this initial section, present your proposal and establish a direct line of communication. The Cover Letter shall include:

• The name, address, and telephone number of your firm.

• The contact information for the individual serving as the primary point of contact during the evaluation phase.

• Provide cover letter and statement of interest.

Business Information

Provide relevant information regarding organizational stability and strength. Documentation should include:

1. A narrative description of the founding of the company, its purpose and business focus, years in business and overall growth and capabilities.

2. If the name of the Developer/Offeror is a corporation/trust. The proposal shall be signed by an authorized person of the corporation, with the designation of the signer’s official capacity. The proposal shall show the state in which the corporation is chartered, and that the corporation is responsible and authorized to do

Page | 8 business in and in good standing the State of Georgia. A statement of organizational structure (e.g., ownership structure, partners, board of directors, joint venture partners, etc.), a listing of financial references.

3. If the Developer/Offeror is a partnership, the proposal shall be signed in the name of the partnership by a general partner or other person duly authorized to bind the partnership. The capacity and title of the person signing shall be shown set forth on the document.

4. If the Developer/Offeror is an individual or sole proprietorship, the Proposal shall be signed by the individual in person, stating the name or style, if any, under which the Offeror is doing business.

5. In any case, the proposal shall show the present business address of the Developer/Offeror at which communications from the City/Authority and notices served are to be received.

6. The hotel brands and Operator(s) that the Developer would recommend as appropriate.

Elevations and Renderings of Proposed Concept

In this section, unveil the visual and conceptual aspects of your proposal. It includes:

• Conceptual Site Plan: A comprehensive depiction of the proposed site plan, illustrating the spatial arrangement, land use, and overall vision.

• Estimated Building Square Footages and/or Unit Counts: Outline the approximate sizes and quantities of buildings and units, shedding light on the scope of the project.

• Amenities: A detailed presentation of the amenities planned to incorporate to enhance the project's appeal and functionality.

Financials

In this section, provide the financial information for your proposal, encompassing:

• Preliminary Estimate of Total Construction Cost: An initial estimate of the overall construction cost, providing insight into the budgetary aspect of the project.

• Estimated Price Ranges: Room rates for each level of room.

• Sources and Uses: A transparent breakdown of the financial sources and intended uses, offering a comprehensive understanding of the project's funding structure.

• Projected Pro Forma: A financial forecast that outlines the anticipated income, expenses, and profitability of the project.

• Exit Strategy: A proposed exit strategy, highlighting the planned methods for realizing returns and concluding the project successfully.

• Proposed partnership: A proposed structure of the financial arrangement between your firm and the City of Douglasville and the Douglasville Convention and Conference Center Authority.

Firm/Team Experience/Qualifications

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Include an organization chart depicting the team structure and include resumes and a description of the area of responsibility for each team member to be directly assigned or involved in deliver and execution of this project.

a. Representative projects of similar size, scale, use and complexity developed within the last 10 years. Please include project information including photos, location, overall project cost, architect and contractor, and date completed. Experience with major hotel brand such as IHG, Hilton, Marriott, etc. preferred.

b. Failure to Complete Prior Projects – disclose whether the Developer (or any general partner or joint venture of the Developer) has ever failed to complete a project of similar size and scale. If so, list the date of the commencement of the project and the entity for which the project was to be performed, and explain why the project was not completed.

c. Disclose information and provide explanation regarding any contracts involving the Developer or joint venture firm within the last three years which exceeded initial program or project budget, exceeded initial schedule, and any contract penalties or damages assessed.

Understanding of the Project Requirements and Contributions to Douglasville

Provide a written description of the Development team’s understanding of the project’s goals, objectives and requirements and overall conceptual vision for the project. Include any preliminary conceptual design concepts, strategies or preliminary proforma indicating the anticipated plan for Development including design and construction. Provide in the proposal a narrative of the generally anticipated impact and contributions the Hotel will provide to downtown Douglasville.

Program

Provide a narrative of the firm’s envisioned Program of Space Requirements for the development of this site and the hotel. List all proposed development uses, including square footages, lobby size, room size, and proposed parking. Outline any amenities that may be offered both to hotel guests and outside users (spa or other). Please share thoughts and recommendations about potential hotel Brands or proposed operators. (Note: A hotel market study will be required the cost of which is to be covered by the successful developer. The study is to be conducted by a qualified firm to be approved by the City of Douglasville and/or the Douglasville Convention and Conference Center Authority.)

Design

Provide a narrative of Offeror’s approach to design of the project.

Construction

Provide a description of the Offeror’s plan and approach to construction of the project including thoughts about site management and construction phasing. Clearly describe any special accommodations the Developer will provide to assist in minimizing disruptions and impacts to the on-going operations of downtown Douglasville.

Transportation

Provide a narrative and conceptual drawings or sketches describing how the proposed hotel addresses public transportation and both vehicular and pedestrian traffic around the development.

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Sustainability

Provide a narrative describing envisioned strategies and approaches related to sustainability. Include information concerning the long-term commitment Developer seeks to make regarding renewable energy, the sustainable elements of the physical construction of the building, and all related infrastructures.

Financial Capability

The financial capability section provides a comprehensive view of your financial standing and demonstrates your ability to engage in due diligence with government assistance, including:

• Previous and/or Current Banking Relationships: An overview of your banking relationships, indicating your history of sound financial management.

• Commitment of Equity Partners (Up to Limits): A demonstration of the commitment of your equity partners, underlining their support for this project.

• Balance Sheet: Your balance sheet, showcasing your financial strength and stability.

• As otherwise described in the Evaluation criteria.

Mandatory Documents

Developer must complete, execute, and include with the proposal the Mandatory documents attached to this proposal.

Selection Process and Evaluation Criteria

After review and evaluation of proposals, the City of Douglasville and/or the Douglasville Convention and Conference Center Authority intends to select one or more Developer(s) for interviews and discussions.

These interviews will be with the Developer(s) whose SQCP proposals have been determined to be in the highest and best interest of the City of Douglasville and/or the Douglasville Convention and Conference Center Authority. The goal of the selection process is to identify one or more Developer(s) to undertake, construct, open and successfully operate a Hotel in Downtown Douglasville. These proposals will be evaluated by an Evaluation Committee (thus referred to as “The Committee”) that will rank the proposals and make a recommendation to the City of Douglasville and/or the Douglasville Convention and Conference Center Authority.

Evaluation Criteria (Maximum 100 Points)

1. FIRM / TEAM EXPERIENCE / QUALIFICATIONS 20 points

• Stability, Qualifications, and Experience of Developer and any envisioned team members (Architect, Engineer, Builder)

• Experience with projects of similar size and complexity

• Experience of envisioned Hotel operator with convention hotels in similar settings

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2. OVERALL CONCEPTUAL VISION 60 points (divided as described below)

a. Impact on Downtown – 20 points

• Commitment to alignment and support of Douglasville Conference Center and City of Douglasville goals of:

• Workforce development and paying a living wage

• Development enhances a vibrant sustainable downtown

b. Program Vision- 10 points

• Understanding of the Program Requirements and Alignment of Vision to the Program Goals

• Inclusion of Program Requirements, Enhancements to Program Elements

• Ability to block rooms for conventions

• Ability to handle large numbers at one time (elevators, and food service)

c. Vision for Design- 10 points

• Design sensitive to scale of Downtown area

• Consideration of Design Requirements and Design Guidelines

d. Sustainability- 10 points

• LEED Certification

• Renewable energy plans/initiatives

• Material sustainability

• Operational efficiencies

• Economically sustainable

e. Wage/Employment 10 points

• Support objectives to support a reasonable wage for hotel employees

3. FINANCIAL 20 points

• Financial viability/Developer’s capital resources capabilities

• Identification of viable funding sources

• Proposed arrangements dedicated to this project for capital cost

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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:

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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, t 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

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Georgia Security and Immigration Compliance.

Compliance with the requirements of O.C.G.A. 13-10-91 and Georgia Department of Labor Rule 300-10- 1-.02 are conditions of this contract. Contractor certifies that it has the following number of employees (check one appropriate box):

_____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.

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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 and Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA).

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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).

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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 RFB 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 SUSCRIBED BEFORE ME

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

NOTARY PUBLIC SIGNATURE

My Commission Expires:

NOTARY SEAL

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List of Similar Projects:

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

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2. Project Name: _________________________________________________

Project Owner: ___________________________________________________ Owner Contact (Name and Phone): ___________________________________ Project Contract Amount: ___________________________________________ Description of Project: ______________________________________________

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3. Project Name: _________________________________________________

Project Owner: ___________________________________________________ Owner Contact (Name and Phone): ___________________________________ Project Contract Amount: ___________________________________________ Description of Project: ______________________________________________

<Insert Response Here>