City of Madison RFQ #2026-3500-01

Request for Qualifications (RFQ)

City of Madison, Georgia

Table of Contents Page

Contact Info 2

A. Section I - Introduction and Project Overview 3

B. Section II – Scope of Work 3 – 6

C. Section III – Pre-Submittal Inquiries and Responses 6 – 7

D. Section IV – Qualification and Submittal Requirements 7 – 9

E. Section V – Submission Instructions 9 – 10

F. Section VI - Selection Process and Evaluation Criteria 11 - 12

G. Section VII - Proposed Schedule 12

H. Section VIII - Terms and Conditions 12 – 13

I. Checklist and Exhibits 14+

RFQ No. 2026-3500-01

Project Location: City of Madison

Description of Project: Architectural Services for New Fire Station

Primary Contact: Laurinda Mason, Procurement Agent

Email: lmason@madisonga.com

Project Documents: All addenda, schedule changes, and other important updates related to this solicitation will be published in the local newspaper and posted on the State of Georgia Procurement Registry and the City of Madison’s procurement website: https://www.madisonga.com/Bids.aspx

City of Madison

Attn: Laurinda Mason

132 N. Main St. Madison, GA. 30650 lmason@madisonga.com

706-752-5596

The City reserves the right to reject any or all submittals and to waive informalities or technicalities or to re-advertise at their discretion. Any objection to the specification/ documents as set forth should be filed in writing not less than five days prior to the bid opening.

The City of Madison gives public notice that it is the policy of the City to ensure full compliance with Title VI of the Civil Rights Act of 1964, the Civil Rights Restoration Act of 1987, and related statues and regulations in all programs and activities. It is our policy that no person in the United

States of America shall, on the grounds of race, color, national origin, sex, age or disability be excluded from the participation in, be denied the benefits of, or be otherwise subjected to discrimination under any of our programs or activities.

Section I - Introduction and Project Overview

The City of Madison, Georgia is soliciting Request for Qualifications (RFQ) from qualified architectural firms to provide professional design and construction administration services for a new fire station. The facility will support both full-time and volunteer firefighters, reflecting a modern, combination-style operational model.

The purpose of this RFQ is to identify an experienced and capable design team with proven expertise in fire station design and construction documentation. The selected firm will provide complete architectural services from preliminary planning through construction completion.

This project represents a major public safety investment for the City of Madison and aims to enhance emergency response capabilities, provide efficient and safe firefighter accommodations, and address community growth.

Section II - Scope of Work

The selected Architect/Engineer (A/E) firm will serve as the Architect of Record and be responsible for all design phases, including schematic design, design development, construction documentation, and construction administration. They will be responsible for coordinating with

Fire Marshal, City staff, and permitting authorities throughout the project.

The facility is anticipated to include multiple apparatus bays, administrative offices, sleeping quarters, kitchen, training area, and storage. The total estimated facility size is approximately

12,000 – 16,000 square feet, which is subject to change.

The A/E firm will perform the following services:

1. Pre-Design

Conduct site analysis and review of available and environmental data.

Meet with Fire Department leadership and City staff to confirm apparatus needs and operational flow.

2. Design Services Prepare conceptual, schematic, design development, and final construction documents for:

A new single-story fire station designed and constructed with provisions to support a future second floor capable of full live-load capacity

Four (4) drive-through apparatus bays

Administrative offices, kitchen, living quarters, exercise gym room, sleeping dorms, along with shower/toilet/sink, storage rooms, SCBA filling station and

Decon room, Turnout Gear Room, training and support spaces

Exterior natural gas generator to provide backup power to the entire facility

Provide an initial construction cost estimate appropriate for this region

3. Other Services o Coordinate with permitting authorities and utility providers as necessary o Incorporate accessibility, resiliency, and sustainable design best practices o Environmental assessments o Interior design and documentation o Schematic design development including structural elevations o Mechanical, electrical, plumbing and fire alarm systems and protection systems design and documentation o Interior graphic design to include selection and specification of furniture, fixture and equipment o Detailed low voltage and data and telecommunications design services o Lighting design and documentation o Audiovisual design and documentation o Testing and investigation (as applicable to architectural disciplines) o Interior and exterior video and security system design and documentation o Shop drawing review and approval o Attend all requested meetings with Fire Department and stakeholders o Attend all requested meetings with the City Council o Attend relevant meetings with the community (up to (4) meetings) o Consultant site visits as required and requested by The City

Expanded Scope of Work

The successful Respondent shall provide 100% complete Construction Documents suitable for permitting and public bidding. All documents must be prepared and submitted for building permits and land disturbance permits within six (6) months or less from the Notice to Proceed (as issued upon execution of the contract). The six-month period does not include City review time.

The selected firm shall produce all design deliverables required for public advertisement, including bidding specifications, technical specifications, construction drawings, and testing requirements necessary for full construction procurement.

Design submittals shall be provided in sequential stages as follows:

35% – Schematic Design

(SD)

Conceptual floor plans, site plan, basic elevations, list of spaces, outline specifications, and early cost estimate

Architect submits deliverables → City reviews for completeness

65% – Design

Development (DD)* (see footnote)

Updated plans, sections, preliminary structural, mechanical, electrical, plumbing layouts, refined materials, updated cost estimate

Review confirms that most design decisions are made and systems are coordinated

95% – Construction

Documents (CD)

Nearly final drawings and specifications, ready for permit review

Checked for completeness and coordination

100% – Final CDs Signed, sealed, and fully coordinated documents ready for bidding and construction

Approved by City for release

*An opinion of probable construction cost (OPCC) shall be provided by the designer at the 65%

Design Development stage and updated as necessary through project completion.

The successful Respondent shall prepare a Project Manual to accompany the Construction

Documents, including complete specifications, general and supplemental conditions, and required bid forms.

Interviews with Fire Department personnel and relevant City staff to confirm operational needs, and coordination with applicable planning, zoning, and permitting agencies.

Architectural design and documentation shall include coordination of all professional disciplines—architectural, structural, mechanical, electrical, plumbing, fire protection, and technology—to ensure a complete and fully coordinated design. The Architect shall provide design deliverables that:

Reflect the City’s functional, operational, and aesthetic goals;

Meet all applicable codes and standards; and

Are sufficient for public bidding, permitting, and construction administration.

The successful Respondent shall support the City through the bidding phase by responding to contractor inquiries, issuing addenda, and assisting with the evaluation of bids for conformance with the design documents

Section III - Pre-Submittal Inquiries and Responses

From the date this RFQ is issued until a contract is awarded, Respondents are prohibited from contacting any City of Madison staff or elected officials regarding this solicitation, except through the authorized point of contact identified below.

Any unauthorized communication may result in disqualification from further consideration.

Primary Contact:

Procurement Agent: Laurinda Mason

Address: 132 N Main St. Madison, GA 30650

Telephone Number: 706-752-5596

Email: lmason@madisonga.com

A. Inquiries

Respondents with questions, requests for clarification, or interpretation of any portion of this RFQ must submit such requests in writing. All questions shall clearly reference the RFQ section, page number, and item in question. Questions must be received no later than November 14th, 2025.

Questions received after the deadline may not be considered.

B. Answers

Responses to inquiries and requests for clarification will be issued by the City in the form of a written addendum by November 21st, 2025.

It is the responsibility of each Respondent to check regularly for any updates or additional information related to this RFQ.

C. Addenda

The City may revise this RFQ by issuing an addendum prior to the submission deadline. All addenda will be posted on the state and City’s procurement websites no later than

November 21st, 2025 and shall become part of the official RFQ documents.

Respondents must acknowledge receipt of each addendum with their submission. Failure to comply with any issued addendum may result in rejection of the Response.

In the event of a significant revision, the City may extend the submission deadline to allow

Respondents adequate time to adjust their proposals.

All addenda, schedule changes, and other important updates related to this solicitation will be published in the local newspaper and posted on the State of Georgia Procurement Registry and the City of Madison’s procurement website:

https://www.madisonga.com/Bids.aspx

Section IV - Qualification and Submittal

Requirements

The RFQ and subsequent responses will allow the City to collect detailed information and identify the most qualified firms to perform the services described in Section II – Scope of Work and accompanying specifications. The City will conduct a comprehensive, fair, and impartial evaluation of all submissions.

An Evaluation Committee, appointed by the City, will review and score each response in accordance with the established criteria listed in Section VI – Selection Process and Evaluation

Criteria. The City reserves the right to determine that no responses meet the minimum qualifications and to reject any or all submissions if deemed in the City’s best interest.

Following the evaluation process, the Evaluation Committee will shortlist up to five (5) firms to review submitted detailed pricing proposals for final consideration.

All submittals must be submitted according to the instructions listed under “Section V - Submission Instructions”.

Submittal Part 1: RFQ Submittals must include the following:

Cover Letter signed by an authorized firm representative including firm name, address, and contact information.

Firm Overview – a brief history, organizational structure, and areas of specialization (one page)

Project Team – names and resumes of proposed team members (two pages)

Team member’s roles on Project (two pages)

Examples of three (3) to five (5) similar (in type, scope and size) projects the firm and/or team members have worked on in the past seven (7) years and client reference contact information (one (1) page for each similar project). Include five (5) client reference contact information shall include agency name and address, contact name, contact phone number and contact e-mail address

All proposed subcontractors, if any, with company description and involvement in example projects, if any (one (1) page each)

Brief discussion of Respondent’s approach to the work to meet Project goals. The City welcomes suggestions for any innovative delivery approaches that can expedite the schedule or reduce Project costs (five (5) to seven (7) pages)

Proof of Professional Licensure in Georgia and firm’s E-Verify number.

Information regarding the firm’s financial history and stability. Please submit the most recent two (2) years of audited financial statements (include in appendix – no page limit)

Disclose whether the firm has ever been involved in any litigation, arbitration, or legal proceedings. If yes, provide a brief explanation of the nature, date, and outcome (or status) of each case.

Indicate whether the firm has failed to complete any contract or project within the past five

(5) years. If yes, include an explanation detailing the circumstances and resolution

Completed Exhibits and Affidavits as included in this RFQ package.

Submittal Part 2: Proposal Submittals – Pricing Information must include the following:

A detailed Fee Proposal that corresponds directly to the scope of work in the RFQ.

Examples:

o Lump-sum total price for the full project.

o Hourly rate schedule for key personnel and job classifications.

o Cost per phase (e.g., preliminary design, construction documents, construction administration).

o Optional tasks with separate line-item pricing.

A list of allowable reimbursable costs (e.g., travel, printing, mileage) and whether they’re included in the total fee or billed separately.

Sometimes a “not-to-exceed” cap is required.

If the work is time and materials or open-ended (like on-call services), firms submit:

o Hourly rates for all staff categories.

o Equipment rates (if applicable).

o Subconsultant markup rates.

Outline of when payments would be expected (by phase or deliverable).

Sometimes this includes proposed percentages of total fee per phase.

Any clarifying notes that explain what’s included or not included in the proposed price.

(Helpful for transparency and later contract negotiation.)

Firms may include pricing for alternate or optional services (for example: “Cost for expedited schedule” or “Cost for 3D rendering”).

o The Performance and Payment Bonds must be submitted with Proposal

Submittal according to specifications listed in Section VIII - Terms and

Conditions

Section V - Submission Instructions

A. Submission Deadline: All Submissions received after this deadline will not be considered.

Late or misdirected submittals (including those delayed by shipping services) will be rejected and unopened.

B. Each firm shall provide:

1. One (1) sealed envelope containing all Qualifications Materials as required in this RFQ labeled “City of Madison Fire Station – RFQ"

2. One (1) separate sealed envelope clearly marked “City of Madison Fire Station –

Proposal Submittal (Pricing Information)” containing the firm’s Fee Proposal and related pricing documentation

The Proposal Submittal will not be opened during the initial evaluation. The City will first review and score the qualifications to determine up to five (5) of the highest-ranked firms based on technical and professional criteria covered in Section VI – Selection Process and Evaluation

Criteria. Only the Proposal Submittal of the selected firms will be opened and evaluated to determine the final selection.

C. Submit five (5) printed copies and one (1) digital PDF copy on USB Drive of each proposal no later than December 5th, 2025 to:

City of Madison

Attn: Laurinda Mason

132 N. Main St. Madison, GA. 30650 lmason@madisonga.com

706-752-5596

Required Forms (see attachments below):

Bidder Qualification Form

All Exhibits

Primary Contractor/Firm as well as all subcontractors must submit the following:

o Form W-9 o Include current Certificate of Insurance:

Prior to the award of a contract, the Firms must furnish a Certificate of

Insurance or other proof that it has the following insurance with the City of

Madison named as additional insured that must remain in force for a period of at least one year after completion of the work:

Commercial General Liability, Contractual Liability, Products/Complete

Operations Liability, Owners and Contractors Protective Liability, Errors and

Omissions, and Personal Injury Liability Insurance - $1,000,000 Combined

Single Limit Bodily Injury and Property Damage - each occurrence.

Comprehensive Automobile Liability Insurance - $1,000,000 Combined

Single Limit Injury and Property Damage Liability - each occurrence Umbrella - $1,000,000 Workers’ Compensation Insurance - $100,000 Bodily Injury by Accident -each accident; $500,000 Bodily Injury by Disease - policy limit; and $100,000 Bodily Injury by Disease - each employee.

Prior to contract execution, the Consultant shall furnish Certificates of

Insurance (COI) evidencing the required coverage to:

Certificate Holder: City of Madison

PO Box 32

Madison, GA 30650 Georgia Security & Immigration Compliance Act Affidavit In accordance with O.C.G.A. 13-10-91, firms must submit a signed and notarized affidavit attesting that:

The firm is registered and authorized to use the federal E-Verify program.

The affidavit includes the E-Verify user ID and date of authorization.

The firm will use E-Verify for all new hires and subcontractors.

Non-Collusion Affidavit Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Payment and Performance Bonds: Performance Bond (equal to 100% of the total contract value) and Payment Bond (equal to 10% of contract value).

The terms will be as follows:

o The bond must be issued by a reputable, licensed financial institution or surety company acceptable to the Procuring Entity.

o The bond shall remain in full force and effect for the entire duration of the contract, including any authorized extensions or warranty periods.

Section VI - Selection Process and Evaluation Criteria Following the review of submitted Statements of Qualifications, the City will invite a shortlist of firms (up to 5) to participate in interviews. These interviews will provide the Selection Committee with an opportunity to further evaluate the most qualified teams based on project-specific strategies, team dynamics, and the firm’s understanding of the project goals.

A. Interview Format:

Interviews may be conducted virtually (via Zoom, Microsoft Teams, or similar platform) or in person, depending on the availability of the Selection Committee.

Shortlisted firms must be prepared to:

o Share their screen during the interview o Present visual materials (e.g., PowerPoint or PDF slide deck) o Ensure that all key personnel appear on camera or in person and actively participate

B. Interview Duration:

Each shortlisted firm will be allotted up to 60 minutes total, broken down as follows:

30–45 minutes for team presentation

15–30 minutes for Q&A with the Selection Committee

C. Presentation Content:

Firms will be expected to present on the following key topic:

Design Vision and Approach

Articulate your firm’s proposed design approach for the new fire station in the City of

Madison, Georgia. Highlight how your design will meet the operational needs and long-term goals of the City of Madison Fire Department.

Additional guidance or specific questions may be provided to short-listed firms in advance of the interviews.

The selected firm will be required to submit a contract agreement within thirty (30) days of selection notification to be approved by Mayor and Council before commencement.

Award Basis:

Experience and qualifications

(references)

30%

Suitability of proposed design and approach

25%

Financial History/Stability 20%

Price competitiveness and flexibility 15%

Responsiveness and clarity of Proposal

10%

Section VII – Proposed Schedule

RFQ Advertised 10/30/2025

RFQ Deadline for Receipt of Inquiries 11/14/2025

RFQ Deadline for Posting Written Answers to Inquiries

11/21/2025

RFQ Submittal Due Date 12/05/2025

RFQ Evaluations Completed 12/10/2025

Presentations/Interviews 12/18/2025 – 12/19/2025

Final Selection 12/22/2025

Section VIII - Terms and Conditions

All responses, supporting materials, and correspondence submitted in connection with this RFQ become the property of the City of Madison upon receipt.

If a response contains proprietary information, it must be clearly identified; however, blanket designations marking the entire submission as proprietary will not be accepted.

A. Compliance with Laws

All applicable federal, state, and local laws, ordinances, regulations, and licensing requirements shall apply.

Firms or individuals requiring special licenses must be properly licensed in the State of Georgia.

B. Disqualification Criteria

No response will be accepted from any firm or individual who is in default or indebted to the City or otherwise deemed irresponsible or unreliable.

C. Financial Capacity

The City reserves the right to request evidence of a Respondent’s financial stability and ability to perform the required services.

D. Communication Restriction

From the issuance of this RFQ until award, Respondents shall not contact City staff or elected officials regarding this solicitation except through the authorized Procurement Agent.

Unauthorized contact may result in disqualification.

Contact Information:

Procurement Agent – Laurinda Mason Phone:

706-752-5596

Address: 132 N Main St. Madison, GA 30650

E. Cost of Submittal

All costs associated with preparing and submitting a response are the sole responsibility of the

Respondent. The City shall not reimburse any such expenses.

F. City Rights and Reservations

Issuance of this RFQ does not obligate the City to make an award. The City reserves the right to:

1. Cancel or withdraw this RFQ at any time;

2. Reject any or all responses;

3. Waive informalities or irregularities;

4. Request additional information or clarification;

5. Make partial or multiple awards if in the City’s best interest; and

6. Terminate any resulting contract if funding is not available.

G. Contract Requirements

The selected firm will serve as the prime contractor and be fully responsible for the performance of all subcontractors.

All subcontractors must be identified in the response and approved by the City.

Nothing in this RFQ or any resulting contract shall create a contractual relationship between the

City and any subcontractor.

H. Contract Term

The contract term and renewal options shall be as stated in the final agreement executed by the

City of Madison.

RESPONDENT’S RFQ CHECKLIST

Critical Things to Keep in Mind When Responding to an RFQ

1. Read the entire document. Note critical items such as supplies/services required; submittal dates; number of copies required for submittal; contract requirements, if any (e.g. bonding and insurance requirements).

2. Note the Procurement Agent’s name, address, phone numbers, and e-mail address. This is the only person you are allowed to communicate with regarding the

RFQ and is an excellent source of information.

3. Take advantage of the “question and answer” period. Submit your questions to the

Procurement Agent by the due date listed in the RFQ and view the answers given in any formal “addenda” issued for the RFQ.

4. Follow the format required in the RFQ when preparing your Response. Provide point-by-point responses to all sections in a clear and concise manner

5. Provide complete answers/descriptions. Read and answer all questions and requirements. Don’t assume the City or Evaluation Committee will know what your company’s capabilities are or what items/services you can provide, even if you have previously contracted with the City. Responses are evaluated based solely on the information and materials provided in response to the RFQ

6. Use the forms provided, e.g. cover page, reference questionnaire, etc.

7. Review the RFQ document again to make sure that you have addressed all requirements. Your original response and the requested copies must be identical and complete. The copies are provided to the Evaluation Committee members and will be used to rank your response.

8. Submit your response on time. Note all the dates and times listed in this RFQ and be sure to submit all required items on time. Late responses will not be accepted.

Accounts Payable Use Only:

Date:

Processed By:

Approved:

Vendor #

W - 9 Attached YES NO

MADISON

New Vendor Changes to Vendor

VENDOR REQUEST FORM

G E O R G I A

Vendor Type One time vendor

Customer Deposit Refund

Employee

Regular

Contract Labor 1099 Vendor

Vendor Information

Name (Last, First) or Company

Address # 1

Remit to Address

City State Zip Code

Type Of Service Provided (IT, Products, Mechanical)

Federal ID # or Social Security #

Contact Person E-Mail Address

Phone # Fax #

City of Madison 132 N. Main Street P.O. Box 32 Madison, Georgia 30650

(706) 342-1251

CONFIDENTIALITY NOTICE

This document and the information contained herein is provided for the City of Madison and is considered confidential and privileged. The information is only for the use of the City of Madison. Review, disclosure, copying, distribution or any action in reliance upon the contents of the information by person or persons other than the City of Madison is strictly prohibited.

EXHIBIT A

CORPORATE CERTIFICATE

I, , certify that I am the Secretary of the company named as Respondent in the foregoing statement of qualification; that , who signed said statement of qualification on behalf of the Respondent, was then (title) of said company;

that said statement of qualification was duly signed for and on behalf of said company by authority of its Board of Directors, and is within the scope of its corporate powers; that said company is organized under the laws of the State of Georgia or is duly authorized to do business in the State of Georgia.

This day of , 2025.

(Company – Legal Corporate Name)

(Signature)

(Title)

(Seal)

EXHIBIT B

RESPONSE SIGNATURE AND CERTIFICATION

I certify that this Response is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Response (“Respondent”) for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards. I agree to abide by all conditions of this Response and certify that I am authorized to sign this Response for Respondent.

I further certify that the provisions of O.C.G.A. § 45-10-20, et seq. have not been violated and will not be violated in any respect.

Authorized Signature for Respondent:

Print/Type Name:

Print/Type Respondent (Entity) Name Here:

Date:

EXHIBIT C

CERTIFICATION OF CONTRACTOR

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT

I hereby certify that I am a principal and duly authorized representative of (“Contractor”), whose address is , , Contractor hereby agrees to comply with all applicable provisions and requirements of the Georgia Security and Immigration Compliance Act of 2006 (the “Act”), as codified in O.C.G.A. Sections 13-10-90 and 13-10-91 and regulated in Chapter 300-10-1 of the Rules and Regulations of the State of Georgia, "Public Employers, Their Contractors and Subcontractors Required to Verify New Employee Work Eligibility Through a Federal Work Authorization Program," accessed at http://www.dol.state.ga.us, as further set forth below.

Contractor agrees to verify the work eligibility of all of newly hired employees through the U.S. Department of Homeland Security’s Employment Eligibility Verification (EEV) / Basic Pilot Program, accessed through the Internet at https://www.vis-dhs.com/EmployerRegistration, in accordance with the provisions and timeline found in O.C.G.A. 13-10- 91 and Rule 300-10-1-.02 of the Rules and Regulations of the State of Georgia. As of July 1, 2007, the verification requirement applies to contractors and subcontractors with five-hundred (500) or more employees.

Contractor understands that Contractor and subcontractor requirements of the Act apply to contracts for, or in connection with, the physical performance of services within the State of Georgia.

Contractor understands that the following contract compliance dates set forth in the Act apply to the Contract, pursuant to O.C.G.A. 13-10-91:

On or after July 1, 2007, to public employers, contractors, or subcontractors of 500 or more employees;

On or after July 1, 2008, to public employers, contractors, or subcontractors of 100 or more employees; and

On or after July 1, 2009, to all other public employers, their contractors, and subcontractors.

To document the date on which the Act is applicable to Contractor, and to document Contractor’s compliance with the Act, the undersigned agrees to initial one of the three (3) lines below indicating the employee number category applicable to Contractor, and to submit the indicated affidavit with the Contract if Contractor has 500 or more employees.

CONTINUED:

EXHIBIT C

CERTIFICATION OF CONTRACTOR

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT

Contractor has:

500 or more employees [Contractor must register with the Employment/Eligibility Verification/Basic Pilot Program and begin work eligibility verification on July 1, 2007];

100-499 employees [Contractor must register with the Employment Eligibility Verification/Basic Pilot Program and begin work eligibility verification by July 1, 2008]; or

99 or fewer employees [Contractor must begin work eligibility verification by July 1, 2009].

Contractor further agrees to require O.C.G.A. Sections 13-10-90 and 13-10-91 compliance in all written agreements with any subcontractor employed by Contractor to provide services connected with the Contract, as required pursuant to O.C.G.A. 13-10-91.

Contractor agrees to obtain from any subcontractor that is employed by Contractor to provide services connected with the Contract, the subcontractor’s indication of the employee number category applicable to the subcontractor.

Contractor agrees to secure from any subcontractor engaged to perform services under this Contract an executed “Subcontractor Affidavit,” as required pursuant to O.C.G.A. 13-10-91 and Rule 300-10-1-.08 of the Rules and Regulations of the State of Georgia, which rule can be accessed at http://www.dol.state.ga.us.

Contractor agrees to maintain all records of the subcontractor’s compliance with O.C.G.A. Sections 13-10-90 and 13-10- 91 and Chapter 300-10-1 of the Rules and Regulations of the State of Georgia.

CONTRACTOR:

Date: Signature:

Title:

EXHIBIT D

CERTIFICATION OF CONSULTANT

DRUG-FREE WORKPLACE

I hereby certify that I am a principle and duly authorized representative of (“Consultant”), whose address is and I further certify that:

1. The provisions of Section 50-24-1 through 50-24-6 of the Official Code of Georgia Annotated, relating to the

“Drug-Free Workplace Act” have been complied with in full; and

2. A drug-free workplace will be provided for Consultant’s employees during the performance of the Contract; and

3. Each subcontractor hired by Consultant shall be required to ensure that the subcontractor’s employees are provided a drug-free workplace. Consultant shall secure from that subcontractor the following written certification: “As part of the subcontracting agreement with Consultant, certifies to Consultant that a drug-free workplace will be provided for the subcontractor’s employees during the performance of this Contract pursuant to paragraph (7) of subsection (b) of the Official Code of Georgia Annotated, Section 50-24-3”; and

4. The undersigned will not engage in unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana during the performance of the Contract.

CONSULTANT:

Date: Signature:

Title:

EXHIBIT E

AFFIDAVIT VERIFYING STATUS FOR CITY PUBLIC BENEFIT APPLICATION

By executing this affidavit under oath, as an applicant for a City of Madison, Georgia Business License or Occupation Tax Certificate, Alcohol License, Taxi Permit, execution of contract 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 a City of Madison license/permit and/or contract for [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 Code Section 16-10-20 of the Official Code of Georgia.

Signature of Applicant: Date:

Printed Name:

*Alien Registration number for non-citizens:

PLEASE INCLUDE A COPY OF YOUR PERMANENT RESIDENT CARD, EMPLOYMENT AUTHORIZATION, GREEN CARD, OR PASSPORT WITH A COPY OF YOUR DRIVER’S LICENSE IF YOU ARE A LEGAL PERMANENT RESIDENT (#2).

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF .

Notary Public:

My Commission Expires:

*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, provide 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:

EXHIBIT F

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

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of the City of Madison has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to Contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number

Date of Authorization

Name of Contractor

Name of Project

Name of Public Employer

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

Executed on in (City), (State).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE

DAY OF .

NOTARY PUBLIC

My Commission Expires: