RFP - St Marys Gateway Marina

REQUEST FOR PROPOSALS

ST. MARYS GATEWAY MARINA MANAGEMENT SERVICES

September 13, 2022, 2:00 PM

The City of St. Marys, GA is requesting the submittal of written proposals from qualified contractors who are actively engaged in marina management services. The objective of this RFP is to solicit qualified

Respondents to submit sufficient proposals to enable the City to award a contract for management services. The City of St. Marys, GA, Purchasing Department will receive sealed proposals by mail or hand delivery at 418 Osborne Street, St. Marys, GA, 31558 up to and until September 13, 2022, at 2:00 p.m. No proposal may be withdrawn after the closing time for the receipt of proposals for a period of ninety (90) days.

A proposal package and copy of the specifications may be obtained from the City of St. Marys Purchasing

Department located at 418 Osborne Street, St. Marys, Georgia, 31558 at no charge. A street address, contact person, phone and fax number must be provided to ensure prompt delivery and notification of addenda.

All Submittals shall be labeled and submitted to the Address below.

REQUEST FOR PROPOSALS: ST. MARYS GATEWAY MARINA MANAGEMENT SERVICES

Attn: Finance Department

City of St. Marys

418 Osborne Street

St. Marys, GA 31558

The City is seeking proposals from interested parties to manage marina operations, including dockage and utility services coordination. The scope of services for this proposal includes:

A. Operate, supervise, manage, and maintain the Marina daily.

B. Hire, train and supervise marina staff. These individuals will be employees of the contractor.

C. Implement a dress code and provide on-site personnel with uniforms and name tags to be worn at all times while on duty.

D. Maintain experienced staff and management for marina operations.

E. Collect and manage all payments for services and related deposits.

F. Administer slip assignments.

G. Administer evictions and remove abandoned vessels.

H. Account for and report on Marina financial operations. Ensure that an appropriate dockage reservation system and accounting system is in place and that it has capabilities to export results of operations in a format acceptable to the City.

I. Prepare and implement annual Facility Maintenance Plan.

J. Implement the Marina’s hurricane plan.

K. Administer a customer service program for the Marina.

L. Work with the City to design, maintain and update City Marina web page to incorporate the use of a variety of popular social media links (all information shall be property of the City).

M. Identify and recommend repairs and/or maintenance needed to facilities in a timely manner.

N. Operate the marina facility in a manner to maximize occupancy and revenues for the Marina.

O. Provide assistance with the existing services and work with City staff to improve the level and variety of services available for the benefit and enjoyment of the Marina occupants and the boating community.

P. Protect the City's capital investment in the Marina facilities through the exercise of high standards of management, operation, and reporting of required maintenance/repairs.

Q. Act as the sole and exclusive managing agent of the City to manage and operate the Marina facilities.

R. Use diligent efforts to cause all users of the Marina’s facilities to adhere to posted Marina rules;

strictly enforce such rules; and, comply with such rules.

S. Work in cooperation with City staff to ensure the Marina’s smooth operations.

T. Work specifically with the City Finance Department, as required, to develop and manage financial operations and financial reporting.

All proposals must contain the following information:

1. Company profile.

2. Overall Experience.

3. Related Experience with emphasis on projects in Coastal Georgia.

4. Related Experience in working with the Georgia Department of Natural Resources, US Army

Corps of Engineers, and US Coast Guard.

5. Key Personnel Experience/Staff Qualifications with Resumes

6. Project Responsiveness/Ability to meet schedules and deadlines.

7. Project Understanding and Approach.

8. Cost Proposal.

The above criteria shall be the basis of scoring the proposals received. Each item (1-8 above) will be scored independently by a review committee of City staff on a scale of 1 (low) – 10 (high) and totaled for each firm. An average for each firm will be determined based on the scores of all review committee members. Based on the number of proposals received, a short list of the top scoring firms may be called in for oral presentations to the review committee. The review committee will make a recommendation to the City Council based on the original proposal package and the oral presentations, if any.

All Respondents must submit five (5) proposal packages (1 original and 4 copies plus a thumb drive copy) to the City for Review. Each package shall contain the full name and address of each person/company submitting the package. It shall also contain the words “Request for Proposals – St. Marys Gateway

Marina Management Services” on the outside of the sealed submittal envelope.

The service providers’ response shall include a technical proposal and fee proposal with all other information requested in this Request for Proposal (RFP). The fees shall be the full cost to the City, and the City may request additional information by proposers, including a presentation if deemed necessary to clarify elements of their bid proposals. The City also reserves the right to make independent investigations as to the qualifications of each service provider, including existing customers, or site visits to existing operations.

The City anticipates making a single award; however, it reserves the right to make multiple awards should it deem it in the best interest of the City. Such an award, if any, is projected to be accomplished within ninety (90) days from the proposal opening.

The City of St. Marys reserves the right to accept or reject any or all proposals received, to waive irregularities and informalities in this RFP, and to make award in any manner deemed in the best interest of the City of St. Marys and to re-advertise pursuant to federal and state law. Any Responders that contact elected officials or staff directly or indirectly for the purpose of influencing the selection process prior to a contract award shall be immediately disqualified and removed from consideration.

The City of St. Marys, in accordance with Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d to

2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of

Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively ensure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, sex, age, handicap/disabled in consideration for an award.

Questions regarding this project may be directed in writing to the City of St. Marys, Attn: Bobby Marr, Public Works Director, 418 Osborne Street, St. Marys, Georgia, 31558 or by email to bmarr@stmarysga.gov.

mailto:bmarr@stmarysga.gov

REQUEST FOR PROPOSAL OVERVIEW

A. INTRODUCTION

The City of St. Marys, Georgia is seeking a qualified contractor to provide Marina Management

Services for the St. Marys Gateway Marina.

B. PURPOSE

This request for proposals is for qualified contractors who are actively engaged in marina management services with no guarantee that the City will move forward with the project or, at the City’s discretion, move forward with only a portion of the project.

C. INFORMATION TO OFFERORS

a. SUBMISSION

All Respondents must submit five (5) proposal packages (1 original and 4 copies plus a digital copy on a thumb drive) to the City for review. The complete Package must be received by September 13, by 2:00 p.m., local time.

Each package shall contain the full name and address of each person/company submitting the package. It shall also contain the words “Request for Proposals – St. Marys Gateway

Marina Management Services” on the outside of the sealed submittal envelope. A copy of the Respondents standard Contract/Service Agreement must be included with each proposal submitted. All Respondents should be aware that oral presentations may be required.

Responses are to be addressed to

Attn: Finance Department

City of St. Marys

418 Osborne Road

St. Marys, Georgia 31558

Hand delivered copies may be delivered to the above address ONLY between the hours of

8:00 a.m. and 5:00 p.m. ET, Monday through Friday, excluding holidays observed by the

City of St. Marys

The City of St. Marys shall assume no responsibility for responses that are received after the prescribed time, or that are not properly addressed or identified.

b. CONTACT PERSON

Questions should be submitted in writing to Bobby Marr, Public Works Director, City of

St. Marys, 418 Osborne Street, St. Marys, GA 31558, or by email at bmarr@stmarysga.gov. Any unauthorized contact shall not be used as a basis for responding to this RFP and also may result in the disqualification of the proposer’s submittal.

c. ADDITIONAL INFORMATION/ADDENDA mailto:bmarr@stmarysga.gov

The City of St. Marys will issue responses to inquiries and any other corrections or amendments it deems necessary in written addenda issued prior to the due date.

Proposers should not rely on any representations, statements or explanations other than those made in this RFP or in any addendum to this RFP. Where there appears to be a conflict between the RFP and any addenda issued, the last addendum issued will prevail.

Proposers must acknowledge any issued addenda by including the Addenda

Acknowledgement with the submittal. Submittals which fail to acknowledge the proposer’s receipt of any addendum will result in the rejection of the offer if the addendum contains information which substantively changes the Owner’s requirements.

d. LATE SUBMITTAL AND/OR LATE MODIFICATIONS

Submittals received after the due date and time will not be considered.

Modifications received after the due date will not be considered. The City of St. Marys assumes no responsibility for the premature opening of a submittal not properly addressed and identified, and/or delivered to the proper designation.

e. REJECTION OF SUBMITTALS

The City of St. Marys reserves the right to reject any or all bids, to waive informalities and to re-advertise, pursuant to federal and state law.

Submittals received after said time or at any place other than the time and place as stated in the notice will not be considered.

f. MINIMUM RFP ACCEPTANCE PERIOD

Submittals shall be valid and may not be withdrawn for a period of 90 days from the date specified for receipt of submittals.

g. COST INCURRED BY PROPOSERS

All expenses involved with the preparation and submission of the RFP to the City of St.

Marys, or any work performed in connection therewith is the responsibility of the proposer(s).

h. RFP OPENING

A list of names of the contractor providing Proposals may be obtained from the contact person after the Proposal due date and time stated herein.

i. EQUAL OPPORTUNITY

The consultant and any sub consultants proposed shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract.

j. NONDISCRIMINATION

The Contractor warrants and represents that all of its employees are treated equally during employment without regard to race, color, religion, physical handicap, sex, age, or national origin.

Disadvantaged Business Enterprise (DBE) utilization is strongly encouraged. Proposed

DBE firms are to be certified by the Georgia Uniform Certification Program.

During the performance of this contract, the contractor, for itself, its assignees, and successors in interest (hereinafter referred to as the "Contractor"), agree as follows:

1. Compliance with Regulations

The Contractor shall comply with the Regulations relative to nondiscrimination in federally-assisted programs of the City of St. Marys (hereinafter referred to as

City), Title 49, Code of Federal Regulations, part 21, as they may be amended from time to time, (hereinafter referred to as the Regulations), which are herein incorporated by reference and made a part of this contract.

2. Nondiscrimination

The Contractor, with regard to the work performed by it during the contract, shall not discriminate on the grounds of race, color, sex, or national origin in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The Contractor shall not participate either directly or indirectly in discrimination prohibited by Section 21.5 of the Regulations, including employment practices when the contract covers a program set forth in

Appendix B of the Regulations.

3. Solicitations for Subcontracts, Including Procurement of Materials and Equipment

In all solicitations either, by competitive bidding or negotiations made by the

Contractor for work to be performed under a subcontract, including procurement of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Contractor of the Contractor's obligations under this contract and the Regulations relative to nondiscrimination on the ground of race, color, sex, or national origin.

4. Information and Reports

The Contractor shall provide all information and reports required by the regulations or directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information and its facilities as may be determined by the City to be pertinent to ascertain compliance with such

Regulations, orders, and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish this information, the Contractor shall so certify to the City, as appropriate, and shall set forth what efforts it has made to obtain the information.

5. Sanctions for Noncompliance

In the event of the Contractor's noncompliance with the nondiscrimination provisions of this contract, the City shall impose such contract sanctions as it may determine to be appropriate, including, but not limited to:

a. Withholding of payments to the Contractor under the contract until the

Contractor complies; and/or

b. Cancellation, termination, or suspension of the contract, in whole or in part.

6. Incorporation of Provisions

The Contractor shall include the provisions of paragraphs (1) through (5) in every subcontract, including procurement of materials and leases of equipment, unless exempt by the Regulations, or directives issued pursuant thereto. The Contractor shall take such action with respect to any subcontractor or procurement as the City may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that in the event a Contractor becomes involved in, or is threatened with, litigation with a subcontractor or supplier as a result of such direction, the Contractor may request the City enter into such litigation to protect the interests of the state and, in addition, the Contractor may request the United States to enter into such litigation to protect the interests of the

United States.

k. INSURANCE

The successful Respondent shall have and maintain in full force and effect for the duration of this agreement, insurance protecting against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work by the contractor, its agents, representatives, employees or subcontractors. All policies shall be subject to approval by the City’s Attorney to form and content.

Consultant shall maintain insurance policies with coverage and limits no less than:

Commercial General Liability of $1,000,000 (one million dollars) per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting therefrom.

Commercial Automobile Liability (owned, non-owned, hired) of $1,000,000 (one million dollars) per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting therefrom.

Workers’ Compensation limits as required by the State of Georgia and Employers Liability limits of $1,000,000 (one million dollars) per accident or disease.

Self-Insured Retentions: Any self-insured retentions must be declared to and approved by the City so that the City may ensure the financial solvency of the Contractor.

Insurance is to be placed with insurers with an A. M. Best rating of no less than A-VII.

Contractor shall furnish the City with certificates of insurance prior to the start of work.

l. HOLD-HARMLESS AND INDEMNIFICATION CLAUSE

The Contractor covenants and agrees to take and assume all responsibility for the Work rendered in connection with this agreement. The Contractor shall bear all losses and damages directly and indirectly resulting to it on account of the performance or character of the work rendered pursuant to this agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees, servants, volunteers, agents, Owner’s lender, Architect and Architect’s consultants, agents, and employees (hereinafter referred to as the “Owner Parties”) from and against any and all claims, injuries, suits, actions, judgments, damages, losses, costs, expenses and liability of any kind whatsoever, including but not limited to, attorney’s fees and costs of defense (hereinafter “Liabilities”) which may be the result of willful, negligent or tortious conduct arising out of the Work, performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. This indemnity obligation does not include liabilities caused by or resulting from the sole negligence of the Owner or Owner Parties. Such obligation of indemnity which would otherwise exist as to any party or person described in this provision. In any and all claims against the Owner or Owner Parties by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the

Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable the indemnification obligation set forth in this provision shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers’ or workmen’s compensation acts, disability benefit acts or other employee benefit acts. This obligation to indemnify, defend, and hold harmless the Owner and Owner Parties shall survive expiration or termination of this Agreement provided that the claims are based upon or arise out of actions that occurred during the performance of this agreement.

m. TERMINATION

Both Parties to this agreement may terminate the agreement without cause and without prejudice by providing the other Party a written notice of termination 60 days in advance of the termination date. All satisfactory work completed by the vendor prior to the termination will be an obligation that must be honored by the City of St. Marys.

n. ILLEGAL IMMIGRATION REFORM AND ENFORCEMENT ACT OF 2011

Vendors submitting a response to this RFP must complete the Contractor

Affidavit under O.C.G.A. §13-10-91(b)(1) which is provided with the RFP package to verify compliance with the Illegal Immigration Reform and Enforcement Act of 2011.

i. The form must be signed by an authorized officer of the contractor or their authorized agent.

ii. The form must be notarized.

iii. The Contractor will be required to have all subcontractors and sub-subcontractors who are engaged to complete physical performance of services under the final contract executed between the City of St. Marys and the Contractor complete the appropriate subcontractor and sub-subcontractor affidavits and return them to the

City of St. Marys a minimum of five (5) days prior to any work being accomplished by said subcontractor or sub-subcontractor. Format for this affidavit can be provided to the Contractor if necessary.

D. SCOPE OF WORK

a. The scope of work to be included in the contract may include, but is not limited to, the following:

U. Operate, supervise, manage, and maintain the Marina daily.

V. Hire, train and supervise marina staff. These individuals will be employees of the contractor.

W. Implement a dress code and provide on-site personnel with uniforms and name tags to be worn at all times while on duty.

X. Maintain experienced staff and management for marina operations.

Y. Collect and manage all payments for services and related deposits.

Z. Administer slip assignments.

AA. Administer evictions and remove abandoned vessels.

BB. Account for and report on Marina financial operations. Ensure that an appropriate dockage reservation system and accounting system is in place and that it has capabilities to export results of operations in a format acceptable to the City.

CC. Prepare and implement annual Facility Maintenance Plan.

DD. Implement the Marina’s hurricane plan.

EE. Administer a customer service program for the Marina.

FF. Work with the City to design, maintain and update City Marina web page to incorporate the use of a variety of popular social media links (all information shall be property of the City).

GG. Identify and recommend repairs and/or maintenance needed to facilities in a timely manner.

HH. Operate the marina facility in a manner to maximize occupancy and revenues for the Marina.

II. Provide assistance with the existing services and work with City staff to improve the level and variety of services available for the benefit and enjoyment of the

Marina occupants and the boating community.

JJ. Protect the City's capital investment in the Marina facilities through the exercise of high standards of management, operation, and reporting of required maintenance/repairs.

KK. Act as the sole and exclusive managing agent of the City to manage and operate the Marina facilities.

LL. Use diligent efforts to cause all users of the Marina’s facilities to adhere to posted

Marina rules; strictly enforce such rules; and, comply with such rules.

MM. Work in cooperation with City staff to ensure the Marina’s smooth operations.

NN. Work specifically with the City Finance Department, as required, to develop and manage financial operations and financial reporting.

E. SUBMISSION REQUIREMENTS

The criteria to be used in the screening, ranking of the proposals, and selection of the successful firm are as follows:

To facilitate review of your proposal document by the City of St. Marys, it is required that your proposal conform to the following format.

i. Cover Letter and Company Profile: List project title, the name of your firm, and the name, address, and telephone number of a contact person for questions concerning the proposal submitted.

ii. Overall Experience: Provide a narrative of your firm’s prior experience.

iii. Related Experience with emphasis on projects in Coastal Georgia: Provide a narrative of your firm’s prior experience and qualifications for similar projects in

Coastal Georgia. Provide a list of projects. Also, provide the name, address and telephone number of at least four (4) references familiar with the quality of work done by your firm on similar projects. Please ensure points of contact at each reference are current so that verification can be accomplished with little difficulty.

iv. Related Experience in working with the Georgia Department of Natural

Resources, US Army Corps of Engineers, and the US Coast Guard: Provide a narrative of your firm’s prior experience and qualifications for similar projects working with the above agencies. Provide a list of projects.

v. Key Personnel Experience/Staff Qualifications with Resumes: Provide a list of key individuals who will be assigned to work with the City of St. Marys. Provide a brief resume for each person listing specific similar project experience.

vi. Project Responsiveness/Ability to meet schedules and deadlines: Provide a brief summary of the primary firm's current workload and ability to meet schedules and deadlines.

vii. Project Understanding and Approach: Provide a brief narrative of your project understanding and your firm’s plan to approach the project.

viii. Cost Proposal.

F. SELECTION PROCESS:

The above criteria shall be the basis of scoring the proposals received. Each item (i-viii above) will be scored independently by a review committee of City staff on a scale of 1 (low) – 10

(high) and totaled for each firm. An average for each firm will be determined based on the scores of the review committee members. Based on the number of proposals received, a short list of the top scoring firms may be called in for oral presentations to the review committee. The review committee will make a recommendation to the City Council based on the original proposal package and the oral presentations, if any.

The service providers’ response shall include a technical proposal and fee proposal with all other information requested in this Request for Proposal (RFP). The fees shall be the full cost to the City, and the City may request additional information by proposers, including a presentation if deemed necessary to clarify elements of their bid proposals. The City also reserves the right to make independent investigations as to the qualifications of each service provider, including existing customers, or site visits to existing operations.

The City anticipates making a single award; however, it reserves the right to make multiple awards should it deem it in the best interest of the City. Such an award, if any, is projected to be accomplished within ninety (90) days from the proposal opening.

The City of St. Marys reserves the right to accept or reject any or all proposals received, to waive irregularities and informalities in this RFP, and to make award in any manner deemed in the best interest of the City of St. Marys and to re-advertise pursuant to federal and state law.

Any Responders that contact elected officials or staff directly or indirectly for the purpose of influencing the selection process prior to a contract award shall be immediately disqualified and removed from consideration.

The City of St. Marys, in accordance with Title VI of the Civil Rights Act of 1964, 42 U.S.C.

2000d to 2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively ensure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, sex, age, handicap/disabled in consideration for an award.

IMMIGRATION AND SECURITY FORM

(GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT)

Contractor’s Name:

State Entity’s Name:

State Solicitation/

Contract No.:

St. Marys Gateway Marina Management Services

CONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned Contractor verifies its compliance with O.C.G.A. §13-10-91, stating affirmatively that the Contractor identified above has registered with and is participating in a federal work authorization program*, 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 State Entity, Contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the attached Subcontractor Affidavit. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the State Entity at the time the subcontractor(s) is retained to perform such service.

EEV / E-VerifyTM Company Identification Number

BY: Authorized Officer or Agent Date

(Contractor Name)

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

_____ DAY OF ______________________, 20__

________________________________________ [NOTARY SEAL]

Notary Public

My Commission Expires:

*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

Entity’s Name:

Solicitation Name or

ADDITIONAL INSTRUCTIONS TO CONTRACTOR: Identify all subcontractors used to perform under the state contract. In addition, you must attach a signed and notarized affidavit (third page of this form) from each of the subcontractors listed below. The contractor is responsible for providing a signed and notarized affidavit to the State Entity within five (5) days of the addition of any new subcontractor used to perform under the identified state contract.

Subcontractors:

Subcontractor’s

(Your) Name:

Entity’s Name:

Solicitation Name or

SUBCONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned Subcontractor verifies its compliance with O.C.G.A. §13-10-91, stating affirmatively that the Subcontractor which is engaged in the physical performance of services under a contract with the Contractor identified above on behalf of the State Entity identified above has registered with and is participating in a federal work authorization program*, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

EEV / E-VerifyTM Company Identification Number

BY: Authorized Officer or Agent Date

(Subcontractor Name)

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

_____ DAY OF ______________________, 20__

________________________________________ [NOTARY SEAL]

*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

Affidavit Verifying Status

For City Public Benefit Application

By executing this affidavit under oath, as an application for a City of St. Marys, Georgia Business License or

Occupation Tax Certificate, Alcohol License, Taxi Permit or other public benefit as referenced in O.C.G.A. Section

50-36-1, I am stating the following with respect to my application for:

Business License

Georgia Occupational Tax Certificate

Alcohol License

Taxi Permit or

Other public benefit

Please check one

Name:

Name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity

1. I am a United States citizen

OR

2. I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality

Act 18 years of age or older and lawfully present in the United States. *

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of the Code

Section 16-10-20 of the Official Code of Georgia.

Signature of Applicant Date

SUBCRIBED AND SWORN

BEFORE ME ON THIS THE Printed Name

DAY OF ,20

Alien Registration number for non-citizens

*Note: O.C.G.A. § 50-36-1 (e)(2) requires that aliens under the Federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provided their alien registration number. Because legal permanent residents are included in the federal definition of “alien,” legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below: