RFP PZ740_01 Comprehensive Plan Update.pdf

CITY OF FAYETTEVILLE

REQUEST FOR PROPOSAL

Issue Date:

04/29/2026

RFP Number:

#PZ740-01

RFP Title:

Comprehensive Plan Update

RFP Due Date and Time:

05/27/2026 @ 2 :00 P.M.

Number of Pages: 18

CONTACT INFORMATION

Procurement Agent and Contact for this RFP:

Tina Rich- Purchasing Coordinator

Procurement Official: Tina Rich, Purchasing

Coordinator

City of Fayetteville

Finance & Administrative Services Department

210 Stonewall Avenue W

Fayetteville, GA 30214

Email: trich@fayetteville-ga.gov

Website: www.fayetteville-ga.gov

INSTRUCTIONS TO OFFERORS

Return Hard Copy Sealed Proposal to:

City of Fayetteville

Finance & Purchasing Dept

ATTN: Tina Rich

210 Stonewall Avenue W

Fayetteville, GA 30214

Mark Face of Sealed Envelope/Package:

Offeror’s Name and Address

Comprehensive Plan Update: RFP PZ740-01

DUE BY- 05/27/2026 @ 2:00 P.M.

Special Instructions: Submit 1 original hard copy to address listed and 1 electronic copy emailed to trich@fayetteville-ga.gov with RFP# in subject line.

IMPORTANT: SEE STANDARD TERMS AND CONDITIONS

OFFERORS MUST COMPLETE THE FOLLOWING

Offeror Name & Address:

Authorized Signatory:

(Please Print Name and Sign in Ink)

Offeror Phone Number:

Offeror Fax Number:

Offeror Federal I.D. Number:

Offeror Email Address:

mailto:trich@fayetteville-ga.gov

CITY OF FAYETTEVILLE, GEORGIA COMPREHENSIVE PLAN

APRIL 29, 2026

1. Purpose

The City of Fayetteville, Georgia ("City") seeks consultant(s) for a community planning process that results in the development of a forward-thinking, realistic, and impactful Comprehensive Plan ("Plan").

The selected consultant will lead an inclusive participatory initiative to create a strategy for the physical and economic development of the City for the next 20 years. The Plan will propose long-range implementation strategies and offer practical day-to-day guidance.

The selected consultant will work with the Community Development Director, the City Manager, the

Mayor and City Council, the Planning & Zoning Commission, the Atlanta Regional Commission

("ARC"), stakeholder groups, citizens, and other City staff. The Community Development Director will be the Project Manager, and a Steering Committee will be established to guide the Consultant. It is anticipated that work on the Plan will commence in July of 2026, and the finished product must be adopted by the City no later than June 2027. The Plan must be prepared in accordance with the

Georgia Department of Community Affairs ("DCA") Rules, Chapter 110-12-1, et seq., including a review period for the ARC and the DCA prior to adoption by the City.

2. Background

The City of Fayetteville is located in central Georgia about 20 miles southwest of Atlanta. Fayetteville, the county seat of Fayette County, is a moderately growing community of 21,000 residents encompassing about 13 square miles. Established in 1823, Fayetteville has evolved from a historic courthouse town into a thriving suburban community characterized by high quality of life, strong civic institutions, and continued population growth.

Operating under a council-manager form of government, the City provides a full range of municipal services and has demonstrated a commitment to proactive planning, fiscal responsibility, and community engagement. Fayetteville’s strategic location near major interstate corridors (I-75, I-85, I-285) and Hartsfield-Jackson Atlanta International Airport positions

Fayetteville as both a residential destination and an emerging economic center within the region.

The current Comprehensive Plan was adopted in 2022 and was prepared internally by the

Community Development Department. It guides decisions on growth, land use, infrastructure, and community development through a shared vision and actionable strategies. The Comprehensive

Plan builds on the 2017 plan but responds to recent population growth and economic change in

Fayetteville. The plan emphasizes a cohesive, community-driven vision for Fayetteville’s future, shaped by:

• Public engagement (residents, business owners, civic leaders).

• Use of an advisory committee and steering committee.

• Analysis of current conditions and demographic trends.

Overall, the vision centers on maintaining and enhancing quality of life, managing smart sustainable growth, and preserving community character while accommodating change.

3. Scope of Work

The City of Fayetteville is seeking Consultant(s) to review existing planning documents, collect and synthesize demographic and other relevant data, and conduct robust public and stakeholder outreach to develop a comprehensive plan incorporating goals and objectives to address growth management policies, annexation strategies, capital improvements, and service provision over a 20-year time horizon. The Plan must be prepared in accordance with DCA Rules, Chapter 110-12-1, et seq. Specifically, the consultant will:

a. Collect and analyze data, including demographic data on trends and projections with regional comparisons and relevant visual aids

b. Develop and implement an inclusive community participation program

c. Develop and facilitate inclusive participatory exercises to help stakeholders and citizens decide on a vision for the community

d. Identify preliminary and final development challenges and opportunities

e. Identify preliminary and final character areas and/or future land use areas

f. Coordinate with the ARC and Fayette County, particularly on areas outside the city boundary

g. Prepare a Comprehensive Plan including the following elements:

i. Community Vision

ii. Community Goals

iii. Needs and Opportunities

iv. Community Work Program

v. Capital Improvements Element

vi. Land Use Element

vii. Transportation Element

viii. Economic Development Element

ix. Housing Element

x. Natural Environment Element

xi. Broadband Element

xii. Public Engagement summary and findings

h. Prepare digital and printed maps

i. Facilitate, at minimum, bi-weekly meetings with the project manager and relevant staff and provide post-meeting summaries.

j. Facilitate three public hearings at the beginning, middle, and end of the project, compliant with

DCA Rules

k. Assist in the adoption process

l. Coach staff and citizen volunteers through the planning process

m. Review the Unified Development Ordinance and other pertinent ordinances and recommend changes for consistency with the new Plan

4. Deliverables Under the Contract

The consultant will provide, at a minimum, the following deliverables as part of this planning process:

a. Public participation materials, such as survey results, brochures, posters, maps, etc.

b. Data and maps gathered and developed during the planning process.

c. The draft and final plan, in Word, Publisher, or InDesign and PDF formats, plus 20 printed copies.

d. Digital maps shall be provided as digital vector map products using the ESRI File

Geodatabase (preferred) or shapefile format. The City's specific coordinate system is

NAD_1983_StatePlane_Georgia_West_FIPS_1002_Feet.

e. Written report identifying recommended changes to existing City codes for consistency with the new Plan.

f. Materials for the City's website and social media platform.

5. Contents of Proposal

Requirements for the proposal are listed below. To be considered, the submittal shall use the following format. Each section shall be clearly divided and labeled in accordance with the items below, and Consultants shall, at a minimum, address each area in their statement of qualifications:

a. Address the overall timeline and milestones necessary to complete the Comprehensive Plan.

b. Identify specific activities that will be accomplished each month.

c. Identify staff that will specifically work on each task as detailed in the identified Scope of

Work, and the estimated number of hours devoted to each activity.

d. Describe in detail the work products/deliverables resulting from each activity.

e. Describe in detail the expected work to be completed by or coordinated with local staff.

Respondents may propose modifications to each action item based on previous experience if the recommended amendment improves the overall effectiveness of the Plan while maintaining the defined budget and timeline.

Cover Letter

Provide a one-page cover letter which includes the following:

a. A brief statement of the Consultant's understanding of the project.

b. The name, title, phone number, email address, and street address of the Consultant, or the

Consultant's representative(s) who will respond to questions about the proposal.

c. Overview of the respondent's qualifications and ability to perform and complete the

Comprehensive Plan.

Company Overview and Contact Information

This section shall provide the following information about the consulting firm:

a. The name, title, phone number, email address, mailing address, and street address, age of the consulting firm (year established), organization of the firm, and type of ownership, including the names of principals, officers, and directors of the firm.

b. A brief statement demonstrating the background, longevity, and financial stability of the firm.

Statement of Qualifications

Provide a narrative or other statement of the firm's qualifications for the proposed project. Provide any additional information identifying the capacity, ability to perform, equipment, skills, and/or abilities of the firm that may set it apart from other respondents.

Project Team

Identify the designated project manager and the project team, statement of availability, and location of key personnel responsible for each task:

a. Project team organization chart.

b. Project coordinator and primary contact for this project, including name, phone number, and email address.

c. The name, title, phone number, email address, and physical and mailing addresses, background and years of experience, and detailed availability to work on this project for all key personnel and sub-consultants who will specifically produce and complete each task as detailed in the Scope of Work, including: completion of the physical products (deliverables), conducting research, or leading the public engagement process, as part of the team with which the Consultant will rely on to complete the Plan.

d. For each consultant or sub-consultant that will work on this project, provide a resume that includes a summary of professional experience and successfully completed projects relevant to this Comprehensive Plan, professional qualifications, education, and other relevant skills or abilities.

Following submission and review of each proposal, interviews may be scheduled with the project team. Please limit resumes and other information to those people who will be directly involved in this project.

Related Experience and References

The Consultant shall submit a minimum of three detailed descriptions of similar projects that demonstrate the consultant's ability to perform the tasks identified and complete this project as proposed. Each description shall include the following:

a. A description of the project scope and project goals.

b. A timeline of the planning process accompanied by a brief description of each stage of the planning process.

c. A summary of proposed recommendations and implementation steps aligned with the project goals and objectives.

d. A description of the stakeholder and public engagement process.

e. The initial and final line-item budget for the project.

f. A narrative explaining any differences between the initial and final budget.

g. The original and final schedule of work for the project.

h. A narrative explaining any differences between the original and final schedule.

i. References provided by the Consultant and all sub-consultants, which will include the name, title, company name, phone number, email address, and physical address of each reference, and may include work performed on similar projects over the past five years.

In addition to the detailed descriptions of at least three similar projects, the Consultant must submit a copy of the final work product/ plan for one of the projects described as a representation of their work.

Understanding of Project and Approach

This section shall demonstrate the Consultant's understanding of the requirements of this solicitation and the Consultant's approach for addressing the project. This section shall include a work plan with a projected timeline, including each person assigned to each task as proposed by the Consultant, to complete the project based on each task outlined in the Scope of Work. The proposed work plan shall include a Gantt chart, or similar project management tool, with projected start and end dates, a proposed schedule to complete each task, and provide deliverables identified. Also included will be the Consultant's proposed and projected participation, coordination, and involvement with City staff, with projected time and extent to which each staff member will be involved. This section should also include a plan for engagement with stakeholders and the general public that will ensure the

Comprehensive Plan fully addresses the items in the Scope of Work.

Cost Proposal

This section shall include a detailed description of the proposed cost for completion of the Scope of

Work and Deliverables Under Contract as identified in this solicitation.

The Consultant shall provide a clearly labeled “Total Project Cost” at the beginning of this section. The total shall be presented on the first page of the Cost Proposal. The “Total Project Cost” will be the official bid amount and will be used for evaluation and award purposes. In the event of any discrepancy between the Total Project Cost and the detailed cost breakdown, the Total Project Cost submitted shall govern.

The Consultant will provide a detailed cost breakdown for each item, including estimated costs for staff time, wages, and materials necessary to complete the project. The proposed fee should also include additional work not identified in the Scope of Work based upon experience and other associated requirements. This may include, but is not limited to, additional costs related to staff time, research, travel, additional public outreach meetings or methods, and materials. The Consultant will provide an expectation of payment schedule with the project timeline. A budget for this project has not yet been established.

Submission Procedure

All proposals must be organized in a clear and structured manner. Each major section of the submission should be separated by labeled dividers to ensure ease of review and navigation. Section titles should be clearly indicated and consistently formatted throughout the document. Completed forms from Appendix B should be included in proposal.

All interested parties wishing to bid for this opportunity must submit a complete response (BOTH

ELECTRONIC AND HARD COPY) by 2:00 p.m. EDT, Wednesday, May 27, 2026.

Submittal of Electronic and Hard Copy

Electronic Copy should be sent to Tina Rich (trich@fayetteville-ga.gov). Please submit your documents via a shared folder and send an email providing a link to the shared folder. It is the responsibility of the applicant to confirm receipt of the submission via email and that the link remains active through the end of the bid process.

Hard Copy proposals should be sent to The City of Fayetteville, Finance Dept, 210 Stonewall Ave

West, Fayetteville, GA 30214, ATTN: Tina Rich- Purchasing. RFP Name and Number should be clearly displayed on the envelope.

RFP Questions

All questions regarding this RFP must be submitted via email to Tina Rich at trich@fayetteville-ga.gov before 3:00 p.m. EDT on Friday, May 15, 2026. Questions received after this time will not receive a response. Answers to all questions will be posted on the City of Fayetteville website

(https://www.fayetteville-ga.gov/140/Bid-Opportunities) no later than noon EDT, Tuesday, May

19, 2026.

6. Evaluation and Selection

The applicant and submittal shall be evaluated, scored, and selected based upon the criteria set forth below:

Score Subject

15 Total Project Cost

15 Past experience and quality of deliverables

10 Ability to meet time and budget requirements without amendments to contracts

10 Staff experience and capacity to dedicate time and personnel to the project

15 Detailed proposal for stakeholder and public outreach

10 Comprehensive project approach proposal

Total 75-point scale

Applicants who submit a proposal in response to the RFP may be required to give an oral presentation of their proposal to City representatives. This provides an opportunity for the applicant to clarify or elaborate on the proposal. This is a fact-finding and explanation session only and does not indicate selection. It is an option of the City and at the sole discretion at the City's request.

https://www.fayetteville-ga.gov/140/Bid-Opportunities

7. Indemnity and Disclosure

Responses must include sufficient material for the City to evaluate. The City reserves the right to disqualify any response due to insufficient supporting or explanatory information or to request additional supporting information. References may be checked for all parties identified under the qualifications and experience of the applicant.

The City will not be liable for any costs incurred by any consultant in the preparation and presentation of responses to the RFP or in the participation of negotiations or any other aspect of this

RFP process. Applicants are responsible for errors and omissions in their responses, and any such errors and omissions will not serve to diminish their obligations to the City.

The City assumes no responsibility for delays or mis deliveries resulting from technical difficulties or issues with the delivery of hard copy materials. Submissions must be received in both electronic and hard copy formats to be considered responsive. Late submissions will not be accepted, and extensions will not be granted on an individual basis unless the City extends the submission deadline for all applicants.

The City reserves the right to reject any and all proposals received.

All proposals and associated pricing shall remain valid and binding for a period of ninety (90) days from the proposal due date.

8. Additional Resources

a. City website – https://www.fayetteville-ga.gov

b. 2022 Comprehensive Plan – https://www.fayetteville-ga.gov/719/Plans-and-Studies

c. 2023-2026 Strategic Plan – https://www.fayetteville-ga.gov/719/Plans-and-Studies

d. Future Land Use Map for City of Fayetteville – https://www.fayetteville-ga.gov/277/Maps

e. DCA Rules for Comprehensive Planning - https://dca.georgia.gov/community-assistance/coordinated-planning/governing-statutes-regulations-and-guidance https://www.fayetteville-ga.gov/ https://www.fayetteville-ga.gov/719/Plans-and-Studies https://www.fayetteville-ga.gov/719/Plans-and-Studies https://www.fayetteville-ga.gov/277/Maps https://www.fayetteville-ga.gov/277/Maps https://dca.georgia.gov/community-assistance/coordinated-planning/governing-statutes-regulations-and-guidance https://dca.georgia.gov/community-assistance/coordinated-planning/governing-statutes-regulations-and-guidance https://dca.georgia.gov/community-assistance/coordinated-planning/governing-statutes-regulations-and-guidance

APPENDIX A: STANDARD TERMS AND CONDITIONS

No proposals received after said time or at any place other than the time and place as stated in the notice shall be considered. Unsealed proposals will not be accepted. No responsibility shall attach to The City of Fayetteville for the premature opening of a proposal not properly addressed and identified.

WITHDRAWAL OF PROPOSAL:

An offeror may withdraw his proposal before the expiration of the time during which proposals may be submitted without prejudice to the proposer, by submitting a written request of withdrawal to The City of Fayetteville

Purchasing Office.

REJECTION OF PROPOSAL:

The City of Fayetteville may reject any and all proposals and must reject the proposal of any party who has been delinquent or unfaithful in any formal contract with The City of Fayetteville. Also, the right is reserved to waive any irregularities or informalities in any proposal in the proposing procedure. The City of Fayetteville shall be the sole judge as to which proposal is best, and in ascertaining this, will take into consideration the business integrity, financial resources, facilities for performing the work, and experience in similar operations of the various offerors.

STATEMENT OF EXPERIENCE AND QUALIFICATIONS:

The offeror may be required, upon request, to prove to the satisfaction of The City of Fayetteville that he/she has the skill and experience and the necessary facilities and ample financial resources to perform the contract(s) in a satisfactory manner and within the required time. If the available evidence of competency of any offeror is not satisfactory, the proposal of such offeror may be rejected. The successful offeror is required to comply with and abide by all applicable federal and state laws in effect at the time the contract is awarded.

NON-COLLUSION AFFIDAVIT:

By submitting a proposal, the offeror represents and warrants that such proposal is genuine and not sham or collusive or made in the interest or in behalf of any person not therein named, and that the offeror has not directly or indirectly induced or solicited any other offeror to put in a sham proposal, or any other person, firm or corporation to refrain from bidding and that the offeror has not in any manner sought by collusion to secure to that offeror any advantage over any other offeror.

INTEREST OF:

By submitting a proposal, the offeror represents and warrants that neither a Council Member, employee nor any other person employed by The City of Fayetteville has, in any manner, an interest, directly or indirectly in the proposal or in the contract which may be made under it, or in any expected profits to arise there from.

DOCUMENTS DEEMED PART OF THE CONTRACT:

The notice, invitation to offerors, general conditions, and instructions for offerors, special conditions, specifications, proposal, and addenda, if any, will be deemed part of the contract.

PERFORMANCE PRIOR TO THE EXECUTION OF THE CONTRACT:

The successful offeror shall not begin performance of the project prior to the execution of a formal written contract by the City and the offeror. Any offeror beginning performance prior to the execution of the contract shall be deemed to be proceeding at the offeror's risk and shall not be entitled to any compensation for such performance. In addition, the City reserves the right to withdraw or cancel the award of the bid.

1. The instructions contained herein shall be construed as a part of any bid/proposal invitation and/or specifications issued by The City of Fayetteville and must be followed by each bid/proposal.

2. The written specifications contained in this bid/proposal shall not be changed or superseded except by written addendum from The City of Fayetteville. Failure to comply with the written specifications for this bid/proposal may result in disqualification by The City of Fayetteville.

3. All goods and materials shall be F.O.B. Fayetteville, Georgia and no freight or postage charges will be paid by The City of Fayetteville unless such charges are included in the bid/proposal price.

4. The following number, RFP PZ740-01, should be written clearly on the outside of your envelope in order to avoid opening in error.

5. All bids/proposals must be sealed, received and in-hand at bid/proposal due date and time. Each offeror assumes the responsibility for having his/her bid/proposal received at the designated time and place of bid/proposal due date. Bids/Proposals received after the stated time and date may be subject to rejection without consideration, regardless of postmark. The City of Fayetteville accepts no responsibility for mail delivery.

Unsealed proposals will not be accepted.

6. Unless otherwise stated, all bids/proposals submitted shall be valid and may not be withdrawn for a period of 90 days from the due date.

7. Each bid/proposal form submitted must include the name of the business, mailing address, the name, title and signature of the person submitting the bid/proposal. When submitting a Bid/Proposal package to the City of

Fayetteville, the first page of your bid/proposal package should be the Bid or Proposal Form listing price, delivery, etc. unless the Proposal form is requested to be in a separate sealed envelope.

8. The City of Fayetteville reserves the right to accept a bid/proposal that is not the lowest price if, in the

City's judgment, such bid/proposal is in the best interest of the City and the public. The City reserves the right to reject any and all bid/proposals.

9. Telephone, Telegraphic or Facsimile bids/proposals will not be accepted.

10. No sales tax will be charged on any orders.

11. If applicable, completed questionnaires must be signed manually. The City of Fayetteville reserves the right to accept or reject any bid/proposal on the basis of incomplete or inaccurate answers to the questionnaire.

12. If applicable, warranty information shall be provided.

13. Offerors shall state delivery time after receiving order.

14. Offerors shall identify any subcontractors and include an explanation of the service or product that they may provide.

APPENDIX B: STANDARD FORMS

This section contains the forms necessary to ensure compliance with various laws as described within this RFP.

RFP CERTIFICATION FORM

The undersigned declares that she or he is an authorized agent of the company or firm listed as the primary offeror;

has carefully examined all the documents contained in this Request for Proposals (RFP) solicitation for the project; and certifies to the best of her/his knowledge that this Proposal fully complies with the requirements of the RFP and all addenda and clarifications issued in regard to the RFP.

The undersigned also hereby certifies that no person acting for or employed by the City of Fayetteville is directly or indirectly interested in this Proposal or any subsequent proposal, or in any contract which may be made under it, or in expected profits to arise therefrom; that the undersigned Offeror has not influenced or attempted to influence any other person or corporation to file a Proposal or any subsequent proposal or any other person or corporation; and that this submission is made in good faith without collusion or connection with any other person or corporation applying for the same work under a different Proposal.

The undersigned states that she or he has the necessary licenses, certifications, and professional credentials necessary to practice their respective professions within the State of Georgia.

Acknowledgement of Addenda. By Signing below, the interested Offerors acknowledges receipt of the following addenda to this RFP:

Addenda No. (if any)

SIGNED UNDER THE PENALTY OF PERJURY:

Signature:

(Signature of Authorized Agent)

Print Name:

Title:

Firm Name:

Date:

Project Number:

Project Name:

CITY OF FAYETTEVILLE DISCLOSURE FORM

This form is for disclosure of campaign contributions and family member relations with City of Fayetteville officials/employees.

Please complete this form and return as part of your RFP package when it is submitted.

Name of Offeror __________________________________________________

Name and the official position of the Fayetteville Official to whom the campaign contribution was made. Please use a separate form for each official to whom a contribution has been made in the past two (2) years.

List the dollar amount/value and description of each campaign contribution made over the past two (2) years by the Applicant/Opponent to the named Fayetteville Official.

Amount/Value Description

Please list any family member that is currently (or has been employed within the last 12 months) by the City of

Fayetteville and your relation:

I certify that the provisions of the O.C.G.A. 45-10-20 through 45-10-28 have not been violated and will not be violated in any respect. O.C.G.A. 45-10-20 through 45-10-28 provide that it is unlawful for a state employee to transact business with the agency by which that person is employed for himself, on behalf of a business in which the employee or his spouse or dependents has a substantial interest, or on behalf of anyone as agent, broker, dealer or representative. Transacting business is defined as selling real property, personal property, or services, or purchasing surplus real or personal property.

Authorized Signature______________________________Date_______________________

Print/Type Name_________________________________

Print/Type Company Name Here_______________________________________________

(Sign and return with proposal)

COMPLIANCE WITH GEORGIA SECURITY AND IMMIGRATION ACT

DECLARATION OF EMPLOYEE-NUMBER CATEGORIES

Please indicate the employee/number category applicable to your organization by checking one (1) of the following boxes:

___ 500+ employees

___ 100 to 499 employees

___ 1 to 99 employees

Organization Name: ________________________________________________

I certify that the above information is true and correct.

Signed: ____________________________________

Printed: ____________________________________

Title: ______________________________________

Date: ______________________________________

STATE OF GEORGIA

CITY OF FAYETTEVILLE

GEORGIA SECURITY AND IMMIGRATION

CONTRACTOR AFFIDAVIT AND AGREEMENT

Certification Regarding Georgia Department of Labor Compliance. Contractor certifies that it is in compliance with O.C.G.A. Section 13-10-91 and Chapter 300-10-1 of the Rules of the Georgia Department of Labor, and that it has registered and currently participates in the federal work authorization program* to verify information of all new employees as of July 1, 2007 if Contractor employs 500 or more employees, or July 1, 2008 if Contractor employs 100 or more employees, or July 1, 2009 if Contractor employs fewer than 100 employees or July 1, 2009, with respect to all public employers, contractors or subcontractors. Further, as part of any subcontracting agreement, the Contractor certifies that any subcontractor entering into this contract for the physical performance of services within this state is in compliance with O.C.G.A. Section 13-10-91 and Chapter 300-10-1 of the Rules of the Georgia Department of Labor and has registered and currently participates in the federal work authorization program to verify information of all new employees as of July 1, 2007 if the subcontractor employs 500 or more employees, or July 1, 2008 if the subcontractor employs 100 or more employees, or July 1, 2009 if the subcontractor employs fewer than 100 employees or July 1, 2009, with respect to all public employers, contractors or subcontractors.

The Contractor may be suspended, terminated, or debarred if it is determined that the Contractor has made false certification or that the Contractor has violated such certification by failure to carry out this requirement.

EEV/Basic Pilot Program* User Identification Number

Contractor Name

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

Signature of Authorized Officer or Agent Date

Sworn to and subscribed before me this _____ day of ____________________, 20___.

Notary Public: __________________________________________________

County: ________________________________________________________

Commission Expires: _____________________________________________

NOTE:

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).

TERMINATIONS FORM

Project Name

Contracted With Contract Amount

Start & End Dates Percent Complete

Scope of Work

Reason for Termination or Failure to Complete

Start & End Dates Percent Complete

Scope of Work

Start & End Dates Percent Complete

Scope of Work

Start & End Dates Percent Complete

Scope of Work