Southern Bulloch Wastewater _ Septage RFQ.pdf

Bulloch County Board of Commissioners Request for Qualifications

To Provide

Engineering Design Professional Services

For

Southern Bulloch County Wastewater and

Septage Receiving Project

Solicitation Issue Date: 7/30/2026

Qualifications Packages Due: 9/1/2026

TABLE OF CONTENTS

PHASE I – REQUEST FOR QUALIFICATIONS (RFQ)

1. GENERAL PROJECT INFORMATION

2. DESIGN PROFESSIONAL SERVICES REQUIREMENTS

3. SCOPE OF SERVICES

4. QUALIFICATIONS REVIEW PROCESS

5. SCHEDULE OF EVENTS (PHASE I)

6. SUBMITTAL OF QUESTIONS AND REQUESTS FOR QUALIFICATIONS

7. INSTRUCTIONS FOR PREPARING STATESMENTS OF QUALIFICATIONS

8. SUBMITTAL OF STATEMENTS OF QUALIFICATIONS

9. FINALIST NOTIFICATION

10. MANDATORY FORMS

a. Form A: Non-collusion Affidavit

b. Form B: Bidder Declaration

c. Form C: Contractor Affidavit

d. Form D: Sub-contractor Affidavit (if applicable)

PHASE 1

REQUEST FOR QUALIFICATIONS

Engineering Design Professional Services for Southern Bulloch County Wastewater and Septage Receiving Project

The Bulloch County Board of Commissioners (hereinafter referred to as the “County”) is conducting a two (2) phase procurement for engineering design professional services (“Services”) for its Southern Bulloch County Wastewater and Septage Receiving Project (“Project”). In this Phase I, the County is soliciting statements of qualifications (SOQs) from firms interested in providing the Services. This Request for Qualifications (RFQ) seeks to identify potential qualified providers of the above-mentioned Services. Some firms that respond to this RFQ who are determined by the County to be especially qualified may be deemed eligible and may be invited to interview and offer proposals (“Proposals”) for these Services in Phase II of this procurement pursuant to a Request for Proposals (“RFP”). Each firm responding to this RFQ (“Respondent”) is subject to instructions communicated in this document and is cautioned to completely review the entire RFQ and follow instructions carefully. The County reserves the right to reject any or all Responses or Proposals, and to waive technicalities and informalities at its discretion. The County is an equal opportunity provider and does not discriminate against any vendor regardless of race, color, religion, age, sex, or national origin.

The written RFQ documents supersede any verbal or written prior communications between the parties.

TERMS AND CONDITIONS

Disqualification: Submissions may be disqualified for: a) receipt of the submission by the County past the stated deadline;

b) any irregularities; c) failure to complete requested information correctly; or d) failure to comply with restrictions to firms.

If in the opinion of the Bulloch County Board of Commissioners, the firm is not in a position to fulfill the contract, the statement may be disqualified. The County reserves the right to waive any minor informality or irregularities.

Restrictions to Firms: No employee of Bulloch County shall have a financial interest either directly or indirectly in the purchase of or contract for any goods or services, nor in any firm, corporation, partnership, limited liability company, or any other legal entity furnishing any goods or services to Bulloch County or any of its departments. For the purposes of this provision, indirect financial interest includes, but is not necessarily limited to, the financial interest of an employee’s spouse.

Contact: Please submit all questions or concerns for this RFQ to Peyton Fuller, Procurement Director, pfuller@bullochcounty.net. All email correspondence during the question & response period must include the project identifier in the subject line of the email.

Firms are required to communicate with Bulloch County using only the email address mentioned above to clarify any part of this RFQ. Firms are forbidden from contacting elected or appointed officials or any other employee of Bulloch County. Firms shall not contact the aforementioned individuals with the intent of discussing this RFQ without the express written consent of the Bulloch County Manager. Any unauthorized contact shall not be used as a basis for responding to this RFQ and will result in the rejection of the Firm’s submittal. Questions must be received by August 13, 2026, by 2:00 PM EST. Responses will be issued August 18, 2026, by 5:00 PM EST.

Firms who obtain this RFQ from Georgia Procurement Registry website: https://doas.ga.gov/state-purchasing/georgia-procurement-registry-local-governments/gpr-overview or Bulloch County website: https//bullochcounty.net/bid-opportunities/ or from other procurement website providers are advised to re-visit the above websites to obtain any addenda which may be issued prior to the RFQ closing date of September 1, 2026 @ 3:00 PM EST. The County assumes no responsibility for Respondent’s failure to acknowledge all addenda issued.

Non-Discrimination: Bulloch County, in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 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 mailto:pfuller@bullochcounty.net https://doas.ga.gov/state-purchasing/georgia-procurement-registry-local-governments/gpr-overview https://doas.ga.gov/state-purchasing/georgia-procurement-registry-local-governments/gpr-overview https://bullochcounty.net/bid-opportunities/ https://bullochcounty.net/bid-opportunities/ 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, or sex in consideration for an award.

Lawsuits/Bribery: Prospective Consultants shall disclose any record of pending lawsuits, criminal violations and/or convictions, etc., conflicts of interest, or contract defaults.

Liability: The County is not liable for any cost incurred in the preparation of the submission. Nor is the County bound by any information provided unless reduced to writing and distributed as a written addendum.

Reservations: The County reserves the right to reject any or all submissions, to award in whole or in part and to waive minor immaterial defects in submissions. Negotiations will be necessary to complete the contract.

Exceptions: Conditional submissions or those that take exception to the specifications will be considered only at the discretion of the Project Manager.

Indemnification: The Firm agrees to indemnify, hold harmless, and defend Bulloch County, its officials, and employees (hereinafter collectively “the indemnitees”) from and against any and all claims, damages, liabilities, suits, proceedings, costs, and expenses of litigation (including, without limitation, reasonable attorney’s fees) related to or arising in any way out of the performance of this RFQ, unless such is attributable to the sole negligence of the indemnitees. The indemnity obligation of the Consultant will survive the expiration or termination of this RFQ.

Correction or withdrawal of submissions, cancellation of awards: Correction or withdrawal of submissions before or after opening, or cancellation of awards or contracts may be permitted only to the extent that the Firm can show by clear and convincing evidence that a mistake of non-judgmental character was made, or where the award or cancellation is in the best interest of Bulloch County.

County Obligations: Bulloch County has a standing policy to disqualify or withhold compensation to vendors, contractors and design professionals from compensation or doing business with the County if there are existing obligations to Bulloch County for any liens, ad valorem taxes, licenses or other financial remittances due to Bulloch County.

Award: Award, if made, may be with the Firm that is selected by the technical review committee based on scoring using the evaluation criteria set forth herein; however, the County reserves the right to reject any and all submissions and to waive technicalities or informalities associated with the submission, and to make the award that it deems is in the best interest of the County. The firm to whom the award is made will be notified at the earliest possible date. The County reserves the right to reject any submission from a Firm who has previously failed to perform properly, or to complete on time contracts of a similar nature.

1. GENERAL PROJECT INFORMATION

Bulloch County is planning the development of a regional wastewater conveyance system to provide reliable and sustainable wastewater infrastructure for the southern portion of the county. As growth and development continue throughout the region, the County recognizes the need for a long-term wastewater solution that will support existing needs while accommodating future residential, commercial, and industrial expansion.

The Southern Bulloch Wastewater and Septage Receiving Project will consist of the planning and design of gravity sewer lines, force mains, and associated infrastructure necessary to connect southern Bulloch County to the Bryan County Regional Wastewater Treatment Plant. The project will evaluate the most feasible and cost-effective conveyance alternatives while ensuring that all proposed infrastructure is appropriately sized to meet current demands and projected future growth.

In addition to the regional wastewater conveyance system, the project will include the identification and evaluation of potential sites for a county septage receiving facility. The selected engineering consultant will assess suitable locations based on engineering, environmental, operational, and permitting considerations and provide recommendations for a preferred site.

The County intends for this project to establish a scalable and resilient wastewater system that enhances regional cooperation, supports economic development, protects public health and the environment, and provides long-term utility infrastructure for southern Bulloch County. The selected consultant will work closely with County staff, Bryan County representatives, regulatory agencies, and other stakeholders throughout the planning and design process to develop a comprehensive and implementable solution.

2. DESIGN PROFESSIONAL SERVICES REQUIREMENTS

The County is seeking a Design Professional to provide all design services, including the development of plans and specifications. The Design Professional will provide complete schematic, design development, and construction documents.

The Design Professional will contract with the County in a timely manner. The Design Professional shall be an individual firm fulfilling all contractual obligations and performing a minimum of seventy-five percent (75%) of the design services (exclusive of engineering and specialty consultants) in-house. An associated firm (if desired) may provide up to twenty-five percent (25%) of the design services, allowing two (2) or more firms to share in the design effort.

3. SCOPE OF SERVICES

Bulloch County seeks a qualified firm with demonstrated experience in regional wastewater collection systems, force main design, wastewater master planning, intergovernmental utility coordination, and septage receiving facility planning.

The selected consultant will be expected to provide innovative, cost-effective, and sustainable solutions that support the County's long-term infrastructure and economic development objectives while maintaining compliance with all applicable federal, state, and local regulations.

Services are anticipated to include, but are not limited to:

• Evaluation and design of gravity sewer lines and force mains necessary to provide regional wastewater service.

• Hydraulic analysis and sizing of all proposed conveyance infrastructure to accommodate current demand while ensuring sufficient capacity for projected future growth and development.

• Identification and evaluation of suitable locations for a county septage receiving facility, including site selection recommendations based on engineering, environmental, operational, and permitting considerations.

• Development of preliminary and final engineering plans, specifications, cost estimates, and supporting documentation required for permitting and construction.

• Coordination with Bulloch County, Bryan County, applicable utility providers, regulatory agencies, and other project stakeholders throughout the design process.

The County reserves the right to modify the scope of services during contract negotiations.

The final scope of services will be delivered by the County and communicated to eligible firms(s) prior to actual agreement. The County will provide additional details and a list of general duties required for this Project to eligible finalists.

Project Delivery Method

The delivery method for this Project will be Design-bid-build (DBB) method.

Project Budget

The preliminary Stated Cost Limitation (SCL) or construction cost of the Project is estimated at $13,000,000. The final SCL may be revised by the County due to final programmatic requirements, funding availability, or other circumstances.

Project Schedule

The Services are anticipated to commence by October 2026 with construction documents anticipated for completion in January 2027. The start of construction is contingent on the availability of funding. (The dates above are estimates which are subject to change. The fee structure for design professional services relative to the schedule and fee amounts will be agreed upon by the County and the firm selected to perform the Services (“Design Professional”) prior to the start of performing the Services.)

4. QUALIFICATIONS REVIEW PROCESS

Selection of the Design Professional will be a multi-step process generally following the steps outlined in RFQ and RFP.

Phase I – Qualifications Review. This RFQ is initiated for the purpose of acquiring Statements of Qualifications (SOQs) from prospective design professional firms. A selection of finalist firms will be made by an evaluation team consisting of representatives of the County and may include other qualified individuals as deemed appropriate by the County, in its sole discretion. The Evaluation Team will receive and review Responses and then evaluate the submittals based on the criteria for evaluation listed below.

Criteria for Evaluation of Statements of Qualifications

25% Factor: Stability of the firm, including the firm’s corporate history, growth, resources, form of ownership, litigation history, financial information, and other evidence of stability.

45% Factor: Firm’s relevant project experience and qualifications, including the firm’s demonstrated ability in effective Consulting Services of facilities comparable in complexity, size, and function. This includes relevant experience and qualifications of the principal Engineering Design Professional(s) and lead staff, and evidence of relevant competencies for this Project.

30% Factor: Firm’s apparent suitability to provide services for the Project, including past performance and firm’s apparent fit to the project type and/or needs of the owner of the project, performance on past work and any special or unique qualifications for the project, current and projected workloads, the proximity of office to project location, and services offered by the firm. The firm’s non-discrimination policies, any affirmative action policies and/or stated efforts for the inclusion of Minority-Owned Business Enterprises and/or Woman-Owned Business Enterprises will be a part of this evaluation.

5. SCHEDULE OF EVENTS (PHASE I)

The following Schedule of Events represents the County’s best estimate of the schedule that will be followed.

All times indicated are prevailing times in Statesboro, Georgia. The County reserves the right to adjust the schedule as it deems necessary.

STEP I (RFQ) Estimated Timeline

Event Projected Date

Projected Time

a. County issues public advertisement of RFQ 7/30/2026 -----

b. Deadline for written questions/requests for clarification (see Section 6). 8/13/2026 2:00pm

c. Responses to written questions/requests posted to County’s website 8/18/2026 5:00pm

d. Deadline for submission of Statements of Qualifications to Bulloch County Board of Commissioners, 115 N Main Street, Statesboro GA 30458

9/1/2026 3:00pm

e. County completes evaluation, post results, and issues notification to finalist firms

9/15/2026

6. SUBMITTAL OF QUESTIONS AND REQUESTS FOR CLARIFICATION

It is the Respondent’s responsibility to examine the entire RFQ, seek clarification in writing, and review its submittal for accuracy before submitting the Response document. Once the submittal deadline has passed, all submissions will be final. The County will not request clarification from individual Respondents regarding their submissions but reserves the right to ask for additional information from all parties who have submitted Responses. Questions about any aspect of the RFQ, or the Project, shall be submitted via email, and the project identifier __FY27-SBC-WATER_ must appear in the subject line, to:

Peyton Fuller Bulloch County Procurement Director Email: pfuller@bullochcounty.net

The deadline for submission of questions relating to the RFQ is the time and date shown in the Schedule of Events (Section 5). All relevant questions and requests for clarification received by the County in writing prior to the deadline will be compiled, and answers will be posted on the County’s procurement page as an addendum to the original solicitation for services at https://bullochcounty.net/bid-opportunities/

7. INSTRUCTIONS FOR PREPARING STATEMENTS OF QUALIFICATIONS

Interested firms shall submit one (1) Original and four (4) copies of the complete Response package to Peyton Fuller, Procurement Director at 115 N Main Street, Statesboro GA 30458. Submittals must be prepared in a manner that fits a standard 8 ½” x 11” paper format. Responses are limited to using a minimum of an 11- point font. The entire Response shall not exceed twenty (20) pages, including exhibits, affidavits or other enclosure information that may be included in an appendix. All pages count regardless of content.

Submittals that include qualifications of more than one firm shall not exceed page limits. Submittals that exceed the page limit will be deemed non-responsive and will not be considered by the Evaluation Team.

STATEMENT OF QUALIFICATIONS

(DELIVERABLES “A”,”B,” AND “C” FOR ALL FIRMS)

Emphasis should be on completeness, relevance, and clarity to content. The content of all Responses must be categorized and numbered as outlined below, and responsive to all requested information.

A. Stability

A1. Provide basic firm information: firm’s legal name, address, name of primary contact, telephone number, fax number, email address, and firm’s website (if available). If the firm has multiple offices, the Response shall include information about the parent company and branch office separately. Identify the office from which the Project will be managed and this office’s proximity to the Project site. Indicate the year the local office was established and the number of people staffing that office and their disciplines. Provide form of ownership (sole proprietorship, partnership, corporation, limited liability corporation (LLC), or other structure), including state of residency or incorporation, and number of years in business.

A2. Briefly describe the history and growth of your firm(s). Provide general information about the firm's personnel resources, including disciplines and numbers of employees and locations and staffing of offices.

A3. Has the firm been involved in any litigation in the past five (5) years? Describe the firm’s experience in litigation with owners and/or contractors. List any active or pending litigation and explain. List any claims against your firm or against owners where your firm is named.

A4. Provide the name of the insurance carrier, types of coverage and deductible amounts per claim.

A5. List the firm’s annual gross revenue for the past five (5) years. List the parent office and the local office revenues separately, if applicable.

A6. Supply financial references and main banking references.

A7. Has the firm ever been removed from a services contract or failed to complete a contract as assigned? If yes, provide an explanation.

A8. Complete the Non-Collusion Affidavit Form (Form A provided with RFQ) and provide a notarized copy with the firm’s Statement of Qualifications.

A9. Complete the Respondent’s Declaration Form (Form B provided with RFQ) and provide a notarized copy with the firm’s Statement of Qualifications.

A10. Complete the Contractor Affidavit Form (Form C provided with RFQ) and provide a notarized copy with the firm’s Response in compliance with the Georgia Security and Immigration Compliance Act.

NOTE: “Contractor” in the referenced Affidavits shall mean “General Contractor”/”Contractor” for the purpose of compliance with O.C.G.A. § 13-10-91, (b).

For the purpose of completing the referenced Affidavits, please insert the following:

• “Name of Public Employer” shall mean “Bulloch County Commissioners, Owner, for the use and benefit of the Citizens of Bulloch County.

• “Name of Project” shall mean “Southern Bulloch County Wastewater and Septage Receiving Project.”

B. Experience and Qualifications B1. Provide professional qualifications and description of experience for principal Consulting Services personnel. (At this stage, firms are asked for information on lead staff only but may list qualifications and experience on more than one lead individual who is qualified and available for proposed Project. If the firm is selected as a finalist, the County will request detailed information on the exact proposed expanded team for the Project and their relevant experience during the RFP process.)

B2. Provide information on the firm’s experience on projects of similar type, size, function, and complexity. Describe no more than five (5) and no less than (3) projects, in order of most relevant to least relevant, which demonstrate the firm’s capabilities to perform the Project at hand. For reach reference project, the following information should be provided:

A. Project name, location, and dates during which services were performed.

B. Project delivery method (e.g., construction manager at risk, design-build, or design-bid-build).

C. Brief description of project and physical description.

D. Services performed by your firm.

E. If your firm has more than one office, indicate which office is responsible for each of the reference projects.

F. Respective owner’s stated satisfaction in design and service of your firm.

G. Project owner’s current contact information.

H. Contractor’s current contact information.

C. Statement of Suitability C1. Provide any information that may serve to differentiate your firm from other firms in suitability for the project.

Provide evidence of the firm’s fit to the Project and/or needs of the County, any special or unique qualifications for the Project. Provide current and projected workloads, the proximity of office to Project location, and any services offered by the firm that may be particularly suitable for this Project.

C2. Provide evidence and proficiency with design of public facilities regarding the areas of public safety, environmental, accessibility for persons with disabilities and special needs, or other related concerns.

C3. Provide information on any special services offered by the firm that may be relevant and available for this Project.

8. SUBMITTAL OF STATEMENTS OF QUALIFICATIONS

The SOQ must be submitted in a sealed envelope to the following address:

Bulloch County Commissioners 115 N Main St.

Statesboro, GA 30458

The outside of the sealed envelope shall contain the wording: Southern Bulloch Wastewater and Septage Project SOQ Phase I; Due Date: September 1, 2026 @ 3:00pm; Attn: Procurement Director.

Respondents will be fully responsible for the delivery of their SOQs by due date and time as stated in the RFQ Estimated Timeline Schedule. Reliance upon U.S. Mail or other carriers is at the respondent's risk. No faxes or emails will be accepted. Late submittals will not be considered.

All expenses for preparing and submitting Responses are the sole cost of the firm submitting the Response.

The County is not obligated to any party to reimburse such expenses.

All submittals upon receipt become the property of the County. Labeling information provided in submittals “proprietary” or “confidential” or any other designation of restricted use may not protect the information from public view. Subject to the provisions of the Open Records Act, the details of the Response documents will remain confidential until final award. All Responses shall be documents subject to the Georgia Open Records Act and public documents. Any information constituting trade secrets contained in the Response shall be so indicated with an affidavit in compliance with Section 50-18-72(a)(34) of the Official Code of Georgia Annotated; however, a general indication that the entire contents, or a major portion, of the Response is trade secrets will not be honored. A final decision as to the exemption of documents identified as trade secrets from the Open Records Act shall be in the full discretion of the County.

9. FINALIST NOTIFICATION

Once the Evaluation Team has completed the evaluation of the SOQs and has selected finalists, the finalist firms will be notified in writing and will be sent the RFP for completion. The shortlisted firms will also appear on the County’s website at https://bullochcounty.net/bid-opportunities/.

Phase II- Design Professional Selection will be initiated by invitation to finalists to submit Proposals and Fee Proposals as instructed in the County’s Request for Proposals (RFP). Finalists will be those firms determined by the Evaluation Team to be especially qualified to perform as the Design Professional for this Project in accordance with the qualification criteria herein. The County will issue a notice to finalists to participate in an oral presentation/interview. The successful Design Professional will be determined from Responses, Proposals, and interviews. The selected firms shall provide proof of purchase from and maintain with a company or companies authorized to do business in the state of Georgia the following types of insurance:

A. Statutorily required workers’ compensation insurance.

B. Commercial general liability insurance, with an endorsement naming the County as an additional insured, and with limits of not less than $1,000,000.00 per occurrence and $2,000,000.00 aggregate.

C. Motor vehicle liability insurance with limits of not less than $1,000,000.00 for bodily injury to or death of one person in any one accident, and not less than $2,000,000.00 because of bodily injury to or death of two or more persons in any one accident; and not less than $250,000.00 because of injury to or destruction of property.

Mandatory Forms

The following pages are the forms that must be submitted in the RFQ along with all other information asked for in this RFQ. All items requiring signatures must be signed and all items requiring a notary must be notarized. Failure to return any of the items or incorrectly completed items on the following pages will be justification for non-acceptance of the SOQ as non-responsive.

FORM A: NON-COLLUSION AFFIDAVIT

STATE OF:

COUNTY OF:

Owner, Partner, or Officer of Firm:

Company Name, Address, County and State:

Being of lawful age and being first duly sworn, the above-named individual on oath says that he/she is the agent authorized by the vendor to submit the attached proposal. Affiant further states that neither the vendor nor any of its employees or agents has prevented or attempted to prevent competition in such bidding by any means whatever; nor has the vendor or any of its employees or agents prevented or endeavored to prevent anyone from making a bid or proposal therefor by any means whatever; nor has the vendor or any of its employees or agents caused or induced another to withdraw a bid or proposal for the work. Affiant further states that neither the vendor nor any of its employees or agents has directly or indirectly violated Section 36-91-21(d) of the Official Code of Georgia Annotated.

FIRM NAME ____________________________________________________________

SIGNATURE ___________________________________________________________

TITLE ___________________________________________________________

Subscribed and sworn to before me this _____ day of _______________ 20____.

NOTARY PUBLIC _____________________________________

FORM B: RESPONDENT’S DECLARATION

The respondent understands, agrees and warrants:

That the respondent has carefully read and fully understands the full scope of the specifications.

That the respondent has the capability to successfully undertake and complete the responsibilities and obligations in said specifications.

That this SOQ shall be valid for 60 days.

That this SOQ may be withdrawn by requesting such withdrawal in writing at any time prior to September 1, 2026, 3:00 PM EDT but may not be withdrawn after such date and time for a period of 60 days.

That Bulloch County reserves the right to reject any or all SOQs and to accept that SOQ which will, in its opinion, best serve the public interest. Bulloch County reserves the right to waive any technicalities or informalities in the solicitation.

That by submission of this SOQ the Respondent acknowledges that Bulloch County has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information supplied by the respondent.

If a partnership, a general partner must sign.

If a corporation the authorized corporate officer(s) must sign and the corporate seal must be affixed to this proposal.

RESPONDENT:

Name Title

Name Title

AFFIX CORPORATE SEAL (if applicable)

Subscribed and sworn to before me this _____ day of _______________ 20____.

NOTARY PUBLIC _____________________________________

FORM C: 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 Bulloch County, Georgia 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 the 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 E-Verify Company ID# Date of Authorization

Name of Company

Name of Contractor

Southern Bulloch County Wastewater and Septage Receiving Project Name of Project

__Bulloch County, Georgia___________ 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:

* As of the effective date of O.C.G.A. § 13-10-91, the applicable federal work authorization program is the "EEV/Basic Pilot Program" operated by the U.S. Citizenship and Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA).

FORM D: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3)

By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with (enter name of contractor) on behalf of Bulloch County, Georgia 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 subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the subcontractor with the information required by O.C.G.A. § 13-10-91(b). Additionally, the undersigned subcontractor will forward notice of the receipt of an affidavit from a sub-subcontractor to the contractor within five business days of receipt. If the undersigned subcontractor receives notice that a sub-subcontractor has received an affidavit from any other contracted sub-subcontractor, the undersigned subcontractor must forward, within five business days of receipt, a copy of the notice to the contractor. Subcontractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization E-Verify Company ID# Date of Authorization

Name of Subcontractor

Southern Bulloch County Wastewater and Septage Receiving Project Name of Project

Bulloch County, Georgia 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: