RFQ_P_City of Canton PS_Roof Replacement.pdf

City of Canton 110 Academy Street Canton, Georgia 30114

(770)704-1500 www.cantonga.gov

REQUEST FOR

QUALIFICATIONS / PROPOSALS

for

CONTRACTOR SERVICES FOR REPLACEMENT OF

THE CANTON PUBLIC SAFETY BLDG ROOF

66114-26-RFP-0401

Issued on: April 1, 2026

Mandatory Pre-Bid Meeting: April 15, 2026, 9:00am

Deadline for Questions: April 22, 2026, 5:00pm

Deadline for Responses: April 24, 3:00pm

Due Date: May 6, 2026, 3:00pm

Request for Qualifications / Proposals for Contractor Services for the Replacement of the Canton Public Safety Building Roof

April 1, 2026

I. GENERAL INFORMATION / OVERVIEW

Project Background

The Canton Public Safety & Municipal Court Building is located at 151 Elizabeth Street in Canton, GA.

The historic two-story brick building has undergone multiple additions and renovations over its lifespan and is in need a complete roof replacement. The facility currently serves as the City of Canton Police Department Headquarters and the Municipal Courts for the City of Canton. A complete roof replacement was completed in 2024 to replace the aged roof; however, the roof has endured substantial leaks causing damage to the interior of the building in multiple areas. The recently installed roof is leaking in multiple areas and requires total replacement with new materials installed using the roofing industry and manufacturer’s standard detailing and installation instructions.

Project Description

1. The City of Canton (herein referred to as the City) is requesting qualifications and proposals from qualified contractors to replace the existing roof on its Public Safety Building located at 151 Elizabeth Street, Canton, Georgia.

2. This Request for Qualifications / Proposals (RFQ/P) describes the project in general, the required scope of services, the selection process, and the minimum information that must be included with the proposal. Failure to submit information in accordance with the requirements and procedures listed herein may cause disqualification.

3. The information contained in this RFQ/P is the City’s best understanding of the current needs and approach on how to address them, but the City may be open to modifications to the scope of services described herein based on the contractor’s professional expertise in these subject areas.

If the consultant believes there is a better way to achieve the City’s goals, then that should be reflected in their proposal.

4. To address deficiencies in the recently installed roofing systems and to ensure the facility functions and performs as intended, the City of Canton intends to completely replace the existing roof systems on the Canton Public Safety and Municipal Court Building. See Figure 1 below (areas 1 thru 13).

5. Prior to commencing with services, immediate temporary repairs to the existing roofing may be required in a few key areas to minimize further damage to the interior of the building. Upon award, the contractor shall immediately coordinate with the owner to identify the most substantial roof leak entry points (at a minimum addressing active roof leaks in: Area 1, Area 3 and 4, Area 9, and Area 12 per Figure 1 below). The temporary repairs may require in-person assessments and investigations, and partial temporary repairs to reduce water intrusion, where possible. The intent is not to permanently repair roof leaks, but using industry expertise to identify, and stabilize the roofing system, and minimize further water damage within the roof envelope during seasonal rain events while the design and roof replacement construction work is being performed.

6. Upon stabilization of the roof leaks and completion of temporary emergency repairs, the contractor shall proceed with the scopes of work outlined below for the complete roof replacement.

Figure 1

Project Delivery Method

The delivery method for this Project will be Design-Build. The Owner will contract with a General Contractor/Construction Manager, as the lead, who has teamed with a Design professional, in order to perform the Design-Build Services.

Project Budget

The preliminary construction cost of the Project has not been disclosed at this time (this amount includes cost of the design professional services component of the design-build team for the design and construction phase administration services). The final cost be revised by the City due to final programmatic requirements, funding availability or other circumstances.

Project Schedule

It is anticipated that the Design-Builder services will commence in June, 2026. Design phase and pre-construction services are expected to begin immediately upon execution of the contract. The start of construction is contingent on the availability of funding (All of the dates noted are estimates which are subject to change.)

Work will not be permitted above spaces when court is in session. Adjacent spaces including adjacent office spaces and public areas may also be affected. The court arraignment and Trial schedule is provided on the City of Canton Website ( www.cantonga.gov ). Contractor shall coordinate construction schedule with the City for work being done over or near the Municipal Courtroom. It is the City’s desire to expedite completion of the project and would encourage consideration of working on multiple areas of the facility simultaneously as a means of shortening the overall schedule.

Project Management Software

Design-Builder shall be required to use either Procore or Smartsheet Project Management Software, for contract administration processes including, but not limited to, Document Management, Scheduling, Requests for Information, Submittals, and Communications. Preference will be given to Proposers using Smartsheet.

Contract Information

The contract for Design-Build services will be the AIA A141 Agreement Between Owner and Design- Builder for a Traditional Design-Build Project. The corresponding document A441 Standard Form of Agreement Between Design-Builder and Subcontractor for a Design-Build Project should be used as the companion document to the AIA A141 Agreement. Firms are encouraged to become familiar with the terms and conditions of these agreements.

II. SCOPE OF SERVICES

Design-Build Services

1. The Design-Builder shall provide all design, preconstruction and construction services necessary for the Project. These services shall include a Due Diligence Phase, Design Phase, a Preconstruction Phase, and a Construction Phase.

2. Due Diligence Phase - Prior to beginning permanent work on the roof, contractor shall:

a. Coordinate with the City on priority and sequencing of roof replacement so that the areas that the City deems a priority are taken into consideration with the sequencing of the roof replacement.

b. Obtain and review City’s roof evaluation reports.

c. Building Interior - investigate, assess, and photo document where water has, and is actively transferring into the building’s interior.

d. Building Exterior – investigate and identify areas of significant roof or structural damage, and photo document where known roofing deficiencies are causing active roof leaks.

e. Provide Report of Findings to the City and/or City’s designated representative(s).

3. Design Phase – During the Design Phase, the Design-Builder shall provide design documents through its Design professional. Design Professional must:

a. Be a current Registered Architect (RA) in the state of Georgia, or possess a current

Registered Roof Consultant (RRC) certification with the International Institute of Building Enclosure Consultants (IIBEC).

b. Provide design solutions and documents that comply with the required building codes appropriate for existing buildings and the projects scope of services.

c. Shall prepare roof plan drawing and details for submission with sufficient clarity to convey design intent of proposed roof systems, materials and installation methods, and construction adjacencies to ensure sound construction.

d. Prepare roof details at 1-1/2” = 1’-0” scale and 3” = 1’-0” scale where appropriate to depict level of detail necessary for technical review.

e. Propose designs shall comply with roofing industry standards including but not limited to: the National Roofing Contractors Association (NRCA) and the Sheet Metal and Air Conditioning Contractors National Association (SMACNA). Manufacturers’ standard details may be used where appropriate to provide roof system manufacturers’ warranties.

f. The Design-Builder’s Design professional shall perform the construction contract administration duties required by the Design-Build Contract.

4. Preconstruction Phase – During the Preconstruction Phase, the Design-Builder will provide cost estimates and cost evaluation. Additionally, the Design-Building will provide:

a. Special recommendations, design analysis, constructability reviews and technical input on methods of construction, materials, details, and bidding formats and types of separate bidding packages when required.

b. Provide assistance in studying options where necessary at specialty roofing conditions and details.

5. Construction Phase - During the Construction Phase, the Design Builder shall be responsible for construction of the Project. During this phase, the Design-Builder is responsible for, though not limited to the following:

a. Manage Project Schedule.

b. Oversee jobsite and Subcontractors.

c. Maintain Communication with City and Coordination with the City’s Representatives.

d. Means & methods of construction, compliance and safety.

e. Monitor Work quality control and manage materials and equipment.

f. Competitively select all construction subcontracts in accordance with the terms of the

Design-Build Contract.

g. Managing Site Logistics.

h. Documenting Daily Progress.

i. Address issues promptly.

Preparation, Protection & Documentation

1. Preparation of Building and Site:

a. Coordinate with City prior to commencement of construction activities.

b. Provide preventative measures to protect the occupants, building contents, building interior, building exterior, and surrounding site prior to the commencement of demolition activities.

c. Provide hazard tape, cones, and barriers as required to isolate work areas from pedestrians.

d. Protect all exits, entrances, and site access paths during roof removal and installation.

2. Protection Measures:

a. Worker Safety – Comply with OSHA safety methods for all workers during roof replacement.

b. Historic Property Protection - Protect all historic brickwork, cornices, windows, doors, stonework, hardscape and landscaping. Refer to “Historic Masonry & Detail Work” listed below.

c. Protection of Building Interior from weather events during Construction, including providing durable weather mitigation measures.

3. Demolition of Existing Roofing:

a. Remove all existing roof layers (Metal Roofing, Membrane Roofing, flashings and underlayment.

b. Inspect existing cover board, insulation and decking for damage. If existing cover board, insulation or decking is damaged, rotted or structurally unsound, contractor shall provide unit costs for replacement in kind using matching materials:

a. Provide Unit Costs as follows where damage is present:

i. Roof Coverboard

ii. Roof Insulation

iii. Roof Decking

b. Where damage is present, contractor shall remove coverboard and insulation to 2’-0” beyond where damage is present on all sides. Decking shall be replaced where damaged all the way back to nearest structural member.

c. Notify owner immediately of any uncovered conditions that are not included in unit costs above.

d. Cleanup: Remove all demolition and construction debris daily.

Roof Replacement

The roof replacement will consist of the replacement of standing seam metal roof systems, thermoplastic roof systems (TPO) and necessary flashings and accessories to ensure a new complete, structurally sound, weathertight, and warrantable roofing system.

1. Standing Seam (SS) Metal Roofing (Steep-Sloped Areas):

a. System Type: 24-gauge prefinished Kynar 500 galvalume steel standing seam roof, 16” wide panels (intent is to match existing)

b. Profile: Mechanically seaming of panels required.

c. Fasteners: Concealed clips fastened directly to wood decking or purlins. No exposed fasteners in the main roof panels.

d. Underlayment: High-temperature self-adhering ice and water shield.

e. Finish/Color: Selected by Owner from manufacturer’s standard Kynar color options.

f. Flashings: All new Kynar prefinished 24ga steel flashings, ridge, rake, eave, copings, and wall flashings.

2. Thermoplastic (TPO) Roofing System (Low-Sloped Areas):

a. Insulation: Install tapered ISO insulation to improve roof slope and drainage.

Insulation thickness (and existing R-value) shall be replaced in-kind to meet existing thermal properties while protecting historic character of building.

b. Membrane: 60-mil reinforced thermoplastic polyolefin (TPO) membrane (white).

c. Installation: Fully adhered, based on wind load requirements and deck type.

d. Seams: All membrane seams shall be hot-air welded and tested for a 360-degree bond.

e. Perimeter/Penetrations: Install TPO-coated metal edge detail and prefabricated pipe boots by same manufacturer.

3. Historic Masonry & Detail Work:

a. Counter-Flashing: Remove and replace existing brick counterflashing. Rake out mortar joints and install new lead-coated copper counterflashing, sealed with high-grade polyurethane sealant.

b. Brick Repair: Repoint any damaged masonry joints affected by improper flashing installation with mortar matching the historic mix.

c. Roof Penetrations: Seal around chimneys, equipment curbs, and dormers with compatible flashings and roofing components as approved by NRCA.

4. Materials and Quality Control:

a. Warranty: Minimum 2-year general workmanship warranty and 20-year manufacturer’s material warranty (SS and TPO systems).

b. Experience: Work shall be performed by a contractor with a minimum of 3 years in historic restoration.

c. Submittals: Contractor to submit shop drawings, manufacturers product data, warranty, and color samples for approval before ordering materials.

d. Coordinate with City’s Daily, or Periodic onsite inspection agency.

e. Roof System Manufacturer shall be present at time of roof installation as required for inspections and roof warranties.

f. Testing: Coordinate with Owner’s third-party testing agency. Some tests to be completed may include, but will not limited to the following:

i. Standing Seam Metal Roofing System –

1. ASTM E1592 For wind uplift.

2. ASTM E1646 For water penetration.

3. Thermal Movement Assessment.

4. Fastening Pattern Verification.

5. Panel Alignment Inspection.

ii. TPO Roof System Testing -

1. Pre-Installation Tests.

2. Installation Tests.

3. Post-Installation Tests.

III. PROCUREMENT PROCESS

Selection of the Design-Builder will be a two-step process.

Request for Qualifications / Proposals (RFQ/P)

The RFQ/P process consists of a Qualifications portion and a proposal portion. Proposers shall submit a Statements of Qualifications and a Cost Proposal at the same time in response to the RFQ/P. The Cost Proposals shall be submitted in a sealed envelope. Proposers meeting the Minimum Qualifications outlined in the RFQ will have their Statements of Qualifications reviewed by Selection Committee consisting of representatives of the City of Canton, and possibly a third-party representative (i.e. Architect or Technical Expert). The Selection Committee shall score each Statement of

Qualifications to create a shortlist of the Proposers with the most appropriate qualifications for the Project (“Finalist Proposers”). The Selection Committee will review the Qualifications Proposals and will score each Proposer based upon the Qualifications Proposals and their subsequent Interviews.

Each Proposer will be awarded a Qualifications Score that is equal to the average score awarded by each of the Selection Committee Members. All proposers that were not selected for the shortlist will have their cost proposals returned to them still sealed in the original envelope.

Interviews and Finalist Selection

The finalist proposers will be notified of a date and time for in-person interviews. The City of Canton will review the Pricing Proposals after interviews and scoring is complete and calculate a proportionate Price Score for each Proposer as outlined in the RFQ/P. The Price Score will be added to the Qualifications Score to equal the Proposers Total Score. The Proposer with the highest Total Score shall be selected for recommendation to the City Council.

Questions and Clarifications

Any questions concerning this Request for Qualifications/Proposals should be directed to the person listed below. No interpretation or clarification of the meaning of the instructions or scope of services will be made orally except for general information that does not require clarification. Every request for such interpretation should be in writing, submitted by e-mail, and addressed to rfp.review@cantonga.gov shown below. Questions must be submitted by the date/time as listed in this document. All clarifications and any supplemental instructions will be posted on the City of Canton website at the following address: http://www.cantonga.gov. Firms should periodically check the website for updates to this Request for Proposals.

Address requests to:

RFP Review Committee City of Canton 110 Academy Street Canton, GA 30114 rfp.review@cantonga.gov

Schedule of Events for RFQ/P

1. Owner issues public advertisement of RFQ/P – April 1, 2026

2. Mandatory Pre-Bid Meeting

a. On Wednesday, April 15, 2026 @ 9:00am local time, the City will host a Mandatory Pre- Bid meeting on location at 151 Elizabeth Street, Canton, Georgia. Only those interested parties that attend the pre-bid meeting will be eligible to propose on the project. Those proposals received from contractors that did not attend the mandatory pre-bid meeting will be disqualified and returned to the proposer unopened. The meeting will include:

a. Explanation of the timeline

b. Site walk-through

c. Q&A with staff and Architect (Questions & Responses will be recorded and distributed to all attendees)

3. Submission of written questions and requests for clarification deadline – April 22, 2026

4. Deadline for City responses to requests for clarification – April 24, 2026, 3:00pm

5. Statement of Qualifications and Cost Proposals deadline – May 6, 2026 (3:00p)

6. Shortlist Interview (Finalist Proposer’s) – May 13, 2026 (beginning at 9:00am)

7. Provide Final Recommendation for Council Approval – May 21st (6:00pm)

Qualifications Proposal Submittal Requirements / Format

1. One (1) hard copy of the Statement of Qualifications and one (1) electronic copy (pdf) on a flash drive must be received by the City of Canton Main Office no later than the date/time as indicated on the coversheet of this document. The City will not be responsible for the lack of receipt of proposals by the date and time specified.

2. The Project name and Firm’s name and address must be shown on the outside of the sealed envelope, addressed to and delivered to:

RFQ/P Review Committee Public Safety Roof Replacement Project

RFP# 66114-26-RFP-0401

City of Canton 110 Academy Street Canton, GA 30114

3. Submittals will NOT be accepted or considered after the deadline. Paper copies of submission must be physical paper copies, appropriately bound; e-mailed copies will not be accepted.

Electronic copies of Statement of Qualifications shall be submitted on a flash drive. Do not submit cost proposals on flash drives with Qualifications (only in separate sealed cost proposal).

4. The Qualifications Proposal must demonstrate specific expertise in the elements of work described herein. Proposals should be bound with the name of the Firm or firms and name of the Project visible on the outside cover. To allow the selection committee sufficient time to properly review all documents in their entirety, each proposal will be limited to 30 pages. The Title Page, Table of Contents, Letter of Transmittal, Section Dividers, and Resumes will not count against the page limits. The Proposal shall contain the following:

a. SECTION 1 ‐ INFORMATION: The Proposal shall include background information about the firm including its history, size, services offered and related information.

b. SECTION 2 - IDENTIFICATION OF PROPOSER: The Proposal shall include the names, offices, addresses, email addresses and phone numbers for Contractor and any subcontractor(s) that are proposed to be involved in the project.

c. SECTION 3 - PROJECT OVERVIEW AND APPROACH: The Proposal shall demonstrate the Contractor’s understanding of the Project and include a statement acknowledging the Scope of Services. The Proposal shall also include a detailed description of the proposed approach to the Project. The description shall include details to implement the tasks described in the Scope of Services. The Contractor is encouraged to provide comments and enhancements to the scope provided in the RFP.

d. SECTION 4 – PROJECT TEAM: The Proposal shall include a team member organizational chart and a listing and biography of key individuals proposed to be assigned to the project. The Proposal shall clearly indicate who will be in responsible charge of the project. At least three client references, including name, description of past working relationship, and current contact information, shall be provided for each key individual who is proposed in the organizational chart.

e. SECTION 5 ‐ RELATED PROJECT EXPERIENCE: The Proposal shall include profiles of five (5) similar projects that the firm has completed in the last five (5) years including project name, date, description and location, executive summary of project and project cost, and client reference including phone number.

f. SECTION 6 ‐ PROJECT SCHEDULE: The Consultant shall prepare a schedule, showing all major project tasks, milestones, and deliverables required to complete all work.

g. SECTION 7 – ADDITIONAL ITEMS: The following items must be included with each proposal received. Failure to include these items may be cause for disqualification.

i. Copy of current business license;

ii. Completed Contractor Information Form, Conflict of Interest Certification, E-Verify

Federal Work Authorization, and Vendor Statement of Tax Status (found at end of this RFP);

iii. Proof of commercial insurance, covering bodily injury, death, and property damage with a single limit not less than one million ($1,000,000) dollars;

iv. Prior to receiving a “Notice to Award”, the City will require the awardee to submit a performance bond in an amount sufficient to cover the estimated cost of this project.

v. Prior to receiving a “Notice to Award”, the City will require the awardee to submit a Certification of Insurance and Workers Compensation.

Cost Proposal / Contract Fees

1. Submit one copy of your cost proposal in a separate sealed envelope, clearly marked.

Proposals that do not provide costs in a sealed envelope may be considered non-responsive and subject to disqualification. Do not include cost proposals in electronic format on flash drives. Include itemized costs for all services to be delivered. The City reserves the right to contact proposers on cost and scope clarification at any time throughout the selection and/or negotiation process.

2. Upon review of the qualification package from each proposer, unopened cost proposals will be returned to those firms deemed ‘unresponsive’ or fail to meet qualification requirements as provided by the City.

Evaluation Procedure

A. The City of Canton will review and evaluate Qualification proposals based on the following factors:

1. Qualifications of Firm and Personnel (35 Points)

a. Firm’s and personnel’s experience within the past five (5) years of completed projects of at least five (5) similar or comparable projects.

b. Organizational chart with qualifications, experience, and responsibilities of the key project personnel.

c. Experience and successful project delivery history of the Project Manager responsible for delivery of project scope on similar projects.

2. Project Approach and Understanding (30 Points)

a. Suggested approach and understanding of the project.

b. Innovative suggestions and identifying challenges.

c. Internal QA/QC process on this project.

3. Capacity and Capability of Firm (25 Points)

a. Proposed schedule to perform the work with sufficient detail to understand the timing of the project deliverables.

b. Present and projected workloads.

c. Management Control Program-Approach, cost control system used to track expenses and labor, method for project status reporting, and schedule control methodology.

d. Past record of performance on contracts for delivery of work relevant to the project scope, including such factors as, control of costs, quality of work, ability to meet schedules.

4. Overall Quality of Proposal (1 0 Points)

a. The organization, structure and quality of the proposal will be factored into the scoring criteria.

B. The evaluation scoring summary is outlined below.

Evaluation Criteria Maximum Points

Qualifications of Firm and Personnel

Project Approach and Understanding

Capacity and Capability of Firm

Overall Quality of Proposal

C. Selection Process:

1. Proposals will be evaluated on the criteria above as well as the cost proposals provided.

After receipt and review of qualification proposals, the City may elect to conduct interviews for some or all firms. The cost of the proposal, although not the sole determining factor, will be a significant determining factor regarding the final recommendation for award.

2. It is anticipated that a contract for the prescribed services will be entered into with the contractor that in the opinion of the City offers the most favorable combination of qualifications, approach, and capability.

3. The City will select the most qualified firm, in its opinion based on the evaluation criteria, and conduct negotiations for the final scope of services and associated costs.

D. Award of Contract

1. The City anticipates recommending to City Council, the award of this contract in May of 2026. The City reserves the right to reject any and all proposals submitted, to waive any informalities in the proposals submitted, and to award a contract only when it appears to be in the best interest of the City.

IV. Relevant Studies and Plans (Attached)

Inspection reports are available upon request. Please email rfp.review@cantonga.gov, if you would like a copy.

V. SPECIAL CONDITIONS

a. This RFQ/P does not commit the City to procure or award a contract for work or to compensate Proposers for proposal preparation expense. All costs to prepare a response to this RFP shall be borne by the proposer.

b. All information submitted in response to this RFP shall become the property of the City, and as such, may be subject to public review as public record.

c. The City reserves the right to cancel, modify, supplement, add to, delete from or change any part or aspect of this project if it is believed to be in the best interest of the City.

d. The City reserves the right to request additional data, information or clarification pertinent to this solicitation after the submittal date, provided that such information is germane to evaluation of the firm’s qualifications from any or all members of submitting consultants.

However, the City shall not be required to request missing information from the submittal which may cause them to be considered non-responsive.

e. The City shall provide the release of all public information concerning the project, including selection announcements and contract awards. Those desiring to release information to the public must receive prior written approval through the City.

f. Members of the consultant teams, their agents, lobbyists, attorneys and others shall not contact members of the City Council, any employee of the City other than the contact person or any member of the Selection Committee regarding this project or process. Any such contact shall be grounds for automatic disqualification of the consultant team submittal.

g. The City, at its sole discretion, reserves the right to reject any and all submittals, waive any and all irregularities, and disregard any and all non- conforming or counter submittals.

h. The City may accept or reject any or all information submitted as part of the RFP.

i. All proposals will be held in confidence until award.

VI. EQUAL EMPLOYMENT OPPORTUNITY

a. The City of Canton is an equal employment opportunity employee. The City endeavors to do business with firms sharing the City’s commitment to equal opportunity and will not do business with any firm that discriminates on the basis of race, religion, color, ancestry, age, gender, sexual orientation, disability, medical condition or place of birth.

VII. ATTACHMENTS

a. Contractor Information Form

b. Vendor Conflict of Interest Certification

c. Vendor Statement of Tax Status

d. E-Verify Form

e. Inspection Report

City of Canton

Contractor Information

1. Company Name

2. Address

3. Phone Number

4. Name of contact person

5. E-mail Address:

6. Number of years in business

7. Number of people employed on a regular basis.

8. List at least three (3) references in which your company has provided the services requested within the past two (2) years.

Company Name: ________________________________________________

Address: ______________________________________________________

Phone No.: _____________________________________________________

Contact Name: _________________________________________________ e-mail: _______________________________________________________

Phone No.: _____________________________________________________

Phone No.: _____________________________________________________

Phone: 770.704.1500 | Fax: 770.704.1538 | 110 Academy Street | Canton, Georgia 30114 cantonga.gov

VENDOR CONFLICT OF INTEREST CERTIFICATION

The City of Canton, Georgia seeks to avoid business relationships which might conflict, or appear to conflict, with the best interests of the City. The purpose of this form is to identify such potential relationships with vendors.

Note that responses in the affirmative to the questions below do not automatically preclude a vendor from doing business with the City. Evaluations of the responses will be made by the appropriate City personnel on a case-by-case basis. Steps to mitigate the conflict or perceived conflict may be required by the vendor and/or City personnel as appropriate.

1. Does any current or former employee of the City of Canton, Georgia hold a financial interest of greater than 5% in your organization?

Yes No Unsure

2. Does any immediate family member of a current or former employee of the City of Canton, Georgia hold a financial interest of greater than 5% in your organization?

3. Has this organization or any of its principals been debarred, suspended or otherwise excluded by a duly authorized regulatory agency or had a transaction with any such agency terminated for any reason?

If your response to any of the questions above is yes or unsure, please attach a separate sheet describing the situation.

CERTIFICATION

I do hereby certify that all responses herein are true and correct to the best of my knowledge. I understand that the City of Canton, Georgia reserves the right to modify or terminate immediately any vendor or employee relationship (as appropriate) should it be discovered that the information provided herein was known to be false at the time of this certification.

Signature: _______________________________ Date: __________________

Printed Name and Title: ____________________________________________

City of Canton

2525 Ridge Road

Canton, Georgia 30114

Vendor’s Statement of Tax Status

(For Internal Financial Control Purposes)

Vendor:

D.U.N.S. #:

Remittance Address:

Street Address

City, State & Zip Code

Phone Number:

Fax Number:

Contact Information:

As an authorized representative to the above entity; I hereby certify to the best of my knowledge; no outstanding delinquent taxes are owed by said entity to the City of Canton, Georgia or any other government in the United States of America including but not limited to the United States Federal Government.

Name:

Title:

Date:

Contractor Affidavit under O.C.G.A. § 13-10-91(b)(l)

The undersigned contractor ("Contractor") executes this Affidavit to comply with O.C.G.A § 13-10-91 related to any contract to which Contractor is a party that is subject to O.C.G.A. § 13-10-91 and hereby verifies its compliance with O.C.G.A. § 13-10-91, attesting as follows:

a) The Contractor has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program;

b) The Contractor will continue to use the federal work authorization program throughout the contract period, including any renewal or extension thereof;

c) The Contractor will notify the public employer in the event the Contractor ceases to utilize the federal work authorization program during the contract period, including renewals or extensions thereof;

d) The Contractor understands that ceasing to utilize the federal work authorization program constitutes a material breach of Contract;

e) The Contractor will contract for the performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the Contractor with the information required by O.C.G.A. § 13-10-91(a), (b), and (c);

f) The Contractor acknowledges and agrees that this Affidavit shall be incorporated into any contract(s) subject to the provisions of O.C.G.A. § 13-10- 91 for the project listed below to which Contractor is a party after the date hereof without further action or consent by Contractor; and

g) Contractor acknowledges its responsibility to submit copies of any affidavits, drivers' licenses, and identification cards required pursuant to O.C.G.A. § 13-10-91 to the public employer within five business days of receipt.

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 _________, _____, 20_____ 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 _____________, 20______.

NOTARY PUBLIC

My Commission Expires: _____________________________