Urinal Partitions for Fayette County Public S.pdf

Fayette County Public Schools Purchasing Department

205 LaFayette Ave., Building A, Fayetteville, GA 30214

(770) 460-3535 ext 1043

Urinal Partitions for Fayette County Public Schools Request for Quote No. 25-002-075 Georgia Procurement Registry Event No. PE-65615-NONST-2025-000000038

Objective

The Fayette County Public Schools Purchasing Department (hereinafter FCPS) invites you to participate in a request for quote (RFQ). This RFQ will consist of providing, delivering, and installing new urinal partitions at multiple locations within the school district. The most responsive and responsible respondent will provide installation and demonstration upon delivery to each facility.

Responses Due

Responses to this request for quote are due no later than the date and time specified in the timeline of events either physically or electronically to the FCPS Purchasing Department located at Facilities Services, 939 Goza Road, Fayetteville, Georgia 30215. Quotes received after the specified date and time will not be considered.

Vendors are instructed to carefully read all items, conditions, terms, specifications, and attachments herein and referenced before completing their quote. Failure to comply with any requirements of the RFQ may be a cause for rejection.

Section A: Instructions to Respondents

1. Respondent Registration

1.1. Respondents are encouraged to register with the issuing agent, Jamie Marrero, by sending an email to marrero.jamie@fcboe.org after reviewing this solicitation. Respondents who register will automatically receive an email update with additional documents such as addenda and be notified of award issuance, even if they choose not to submit a response.

pg. 1 mailto:marrero.jamie@fcboe.org

Urinal Partitions for Fayette County Public Schools (RFQ 25-002-075)

2. Schedule of Events

2.1. RFQ Released: Monday, July 15, 2024

2.2. Respondent Questions Due: Wednesday, July 24, 2024

2.3. Addenda Issued (if applicable): Friday, July 26, 2024

2.4. Respondent Quotes Due: Before 10:00AM (EST), Monday, July 29, 2024

2.5. Anticipated Project Start: August 2024

3. Project Documents and Forms

3.1. Documents and forms required for submission as part of this RFQ can be found on the FCPS Purchasing Department website. Failure to include required submissions listed herein may result in a rejection of the response. A list of required forms is contained herein and additional submissions may be required per the specifications contained herein.

4. Response Delivery

4.1. Responses may be submitted electronically, by mail, or hand-delivered to Facilities Services, 939 Goza Road, Fayetteville, Georgia 30215, Attention:

Purchasing Department.

4.2. Quote openings will occur at the date and time specified at the address above.

4.2.1. No faxed or telephone responses will be accepted or considered.

4.3. Responses may be emailed to the issuing agent if meeting the following guidelines:

4.3.1. Emailed responses must be in a consistent, clear, and readable format and complete. (Adobe PDF format is preferred)

4.3.2. All response documents should be bound in one document. Multiple separate documents may result in evaluation score reductions.

5. Attachments

5.1. Any specification listed with “Must Include Attachment” should include a document within the response conforming to standards set forth.

pg. 2

5.2. All attachments must be marked and labeled using the following format:

Attachment #, Solicitation Reference, Respondent Name, Solicitation Title, and Number.

6. Response Format Requirements

6.1. The solicitation document has been carefully organized. All sections, specifications, requirements, and appendices are numbered; therefore responses should be organized in the same manner referencing the solicitation document when necessary.

6.2. All pages should be numbered and contain page headings or footers with the respondent's name and the solicitation title and number.

6.3. Multiple Response from the Same Respondent

6.3.1. Respondents may submit more than one response when offering multiple alternatives.

6.3.2. Responses must be separate and each should conform to all terms and conditions within the solicitation.

6.3.3. Responses must be labeled separately to easily identify differing responses from the same respondent.

Section B: Scope of Work and Specifications

7. Scope of Work

7.1. The purpose and intent of this Request for Quotation is to secure firm pricing to provide, deliver, and install new urinal partitions with continuous stainless steel stirrup brackets in the boys restrooms at multiple locations throughout the school district. Respondent will be responsible for all materials, equipment, shipping/delivery, installation, and labor associated with this project. This project is turn-key.

8. Technical Specifications

8.1. Wall hung urinal screens

8.1.1. Phenolic (black core)

8.1.2. Standard color options

8.1.3. Stainless steel stirrup brackets (continuous)

8.1.4. 24” x 48” partitions

pg. 3

8.2. Each school will need a matched color to the existing partitions in each restroom

8.3. Partitions installs must not impede access to the handicap stalls and must remain ADA compliant

8.4. Installation of urinal screens must be within the manufacturers specifications

8.5. Project must be completed to the satisfaction of Facilities Services Director, Mike Satterfield

8.6. Locations with estimated urinal partition needs: (Once the project is awarded the vendor will confirm final count while at the location to match existing partition color)

8.6.1. Braelinn Elementary School (Qty. 15)

8.6.1.1. 975 Robinson Road, Peachtree City, Georgia 30269

8.6.2. Bennett’s Mill Middle School (Qty. 25)

8.6.2.1. 210 Lester Road, Fayetteville, Georgia 30215

8.6.3. Cleveland Elementary School (Qty. 15)

8.6.3.1. 190 Lester Road, Fayetteville, Georgia 30214

8.6.4. Crabapple Lane Elementary School (Qty. 15)

8.6.4.1. 450 Crabapple Lane, Peachtree City, Georgia 30269

8.6.5. Fayette County High School (Qty. 30)

8.6.5.1. 1 Tiger Trail, Fayetteville, Georgia 30214

8.6.6. Fayette Elementary School (Qty. 15)

8.6.6.1. 490 Hood Avenue, Fayetteville, Georgia 30214

8.6.7. Fayette Life Academy (Qty. 25)

8.6.7.1. 450 Grady Avenue, Fayetteville, Georgia 30214

8.6.8. Flat Rock Middle School (Qty. 25)

8.6.8.1. 325 Jenkins Road, Tyrone, Georgia 30290

8.6.9. Huddleston Elementary School (Qty. 15)

8.6.9.1. 200 McIntosh Trail, Peachtree City, Georgia 30269

8.6.10. Inman Elementary School (Qty. 15)

8.6.10.1. 667 Inman Road, Fayetteville, Georgia 30214

8.6.11. JC Booth Middle School (Qty. 25)

8.6.11.1. 250 Stagecoach Road, Peachtree City, Georgia 30269

8.6.12. Kedron Elementary School (Qty. 15)

8.6.12.1. 200 Kedron Drive, Peachtree City, Georgia 30269

8.6.13. McIntosh High School (Qty. 30)

8.6.13.1. 201 Walt Banks Road, Peachtree City, Georgia 30269

8.6.14. North Fayette Elementary School (Qty. 15)

8.6.14.1. 609 Kenwood Road, Fayetteville, Georgia 30214

8.6.15. Oak Grove Elementary School (Qty. 15)

pg. 4

8.6.15.1. 101 Crosstown Road, Peachtree City, Georgia 30269

8.6.16. Peachtree City Elementary School (Qty. 15)

8.6.16.1. 201 Wisdom Road, Peachtree City, Georgia 30269

8.6.17. Peeples Elementary School (Qty. 15)

8.6.17.1. 153 Panther Path, Fayetteville, Georgia 30215

8.6.18. Rising Starr Middle School (Qty. 25)

8.6.18.1. 183 Panther Path, Fayetteville, Georgia 30215

8.6.19. Robert J Burch Elementary School (Qty. 15)

8.6.19.1. 330 Jenkins Road, Tyrone, Georgia 30290

8.6.20. Sandy Creek High School (Qty. 30)

8.6.20.1. 360 Jenkins Road, Tyrone, Georgia 30290

8.6.21. Sara Harp Minter Elementary School (Qty. 15)

8.6.21.1. 1650 Highway 85 South, Fayetteville, Georgia 30215

8.6.22. Spring Hill Elementary School (Qty. 15)

8.6.22.1. 100 Bradford Square, Fayetteville, Georgia 30214

8.6.23. Starr’s Mill High School (Qty. 30)

8.6.23.1. 193 Panther Path, Fayetteville, Georgia 30215

8.6.24. Whitewater Middle School (Qty. 25)

8.6.24.1. 1533 Highway 85 South, Fayetteville, Georgia 30215

8.6.25. Whitewater High School (Qty. 30)

8.6.25.1. 100 Wildcat Way, Fayetteville, Georgia 30215

Section C: General Terms and Conditions

FCPS’s General Terms and Conditions are posted on the Purchasing Department website under the heading of Vendor Terms, Conditions, and Forms at www.fcboe.org. By submission of a response, the respondent acknowledges they have read and understood these General Terms and Conditions as well as any terms and conditions contained herein.

Section D: Special Terms and Conditions

9. Quote Opening

9.1. Quotes will be opened at the date and time provided in the schedule of events. All results will be publicly posted on the FCSD website once an award recommendation is made.

9.2. Quote openings are open to the public.

9.3. Quotes must be marked with the RFQ number.

9.4. Electronically delivered quotes will utilize the timestamp generated on the email.

9.5. Quotes must conform to the guidelines listed herein.

pg. 5 https://www.fcboe.org/Page/2707

9.6. Quotes received late will be marked “non-responsive” and may not be considered at the sole discretion of the FCPS Purchasing Department.

10. Questions

10.1. All questions concerning this solicitation must be submitted in writing by email to the issuing agent.

10.2. No questions other than written will be accepted and only answers provided via addenda shall be binding.

11. Award Oversight

11.1. The awarded respondent will report to Mike Satterfield, Director of Facilities Services, or their designee.

12. Cooperative Purchasing

12.1. This solicitation allows for other Fayette County, Georgia government entities, including local municipalities, to purchase from the awarded contract at the same prices quoted during the effective term pending an agreement between the awarded respondent(s) and the third party.

13. Quote Evaluations

13.1. According to the Fayette County Board of Education policy, DJE “lowest price alone will not be the sole determining criteria in the selection process”.

13.2. Factors that may be used in evaluating responses may include but are not limited to, the following: price/cost, warranty, service guarantees or past performance, costs of ownership analysis, business capabilities analysis, delivery schedules and methods, and product-specific manufacturer/quality standards.

13.3. Respondents may inquire as to specific evaluation methods and may request in writing an explanation of evaluation methods used to determine an award.

See General Terms and Conditions regarding award protests.

14. Delivery

14.1. Delivery is expected on or about the date requested ARO.

14.2. Freight is FOB destination, freight prepaid (allowed).

14.3. The respondent must contact the end-user listed on purchase orders at least 24 hours before delivery to confirm the delivery date and time.

pg. 6

14.4. FCPS standard hours of operation are 7:30 AM to 3:30 PM (EST), Monday through Friday, except for school holidays.

14.5. The delivery location does not have a loading dock; therefore, all deliveries must be made as a tailgate or inside delivery as defined in the solicitation, any resulting purchase order, or resulting contract.

14.5.1. Tailgate delivery will be defined as follows: the driver will be required to move the pallets from the interior bed of the truck to the edge of the bed. The FCSD will use a forklift to move the pallets from the edge of the truck bed to the warehouse.

14.5.2. Inside-delivery will be defined as follows: the driver will be required to move the material from the interior bed of the truck to the interior of the facility.

14.6. Any pallets must be covered or shrink-wrapped to protect cartons from dirt and moisture during shipment and pallet construction should allow for four-way entry of handling equipment and surface/platform board approximately one inch apart minimizing carton damage.

14.7. Failure to deliver per the response could result in the awarded respondent being declared in default.

14.8. The awarded respondent shall be responsible for the delivery of items in good condition at the point of destination.

14.9. Respondent shall file with the carrier all claims for breakage, imperfections, and other losses, which will be deducted from invoices.

14.10. Back Orders: Back orders may be made only when specifically authorized to do so by the project administrator. The necessity to back-order may be deemed a breach of contract.

15. Cost Escalation/Price Change

15.1. The Purchasing Department recognizes that independent market factors may result or necessitate the need for price changes. Through the submission of a quote, the respondent agrees to the following:

15.2. All price increases must be based upon product cost ONLY, and documentation of the price increase is required.

15.3. Quote prices must be held firm for the term of the solicitation or December 31st of the issuing year, after which an escalator can be invoked.

pg. 7

15.4. The awarded respondent must provide the FCPS Purchasing Department written notification at a minimum of 30 days before a price escalation change.

15.5. Single changes of no more than 10% are allowed. There are exceptions only when market conditions dictate a revised escalator for a particular commodity.

15.6. FCPS reserves the right to accept or reject any price escalation. A rejection of a price escalation may result in the termination of any agreement, contract, purchase order, or other agreement without fault or obligation.

16. Installation

16.1. Vendor must schedule installation at least 72 hours in advance with the Director of Facilities Services, Mike Satterfield.

16.2. Vendor is responsible for the completion of this project from start to finish

16.2.1. If a subcontractor will be utilized to complete this project, said subcontractor must adhere to all specifications listed within this solicitation and Fayette County Public Schools General Terms and Conditions

16.3. Storage of installation materials will not be provided by Fayette County Public Schools

16.3.1. Job related materials must be brought in with the installing vendor on the day of installation

16.3.2. No storage will be provided at any of the Fayette County Public Schools locations

16.3.3. Any and all job related debris must be removed and disposed of off Fayette County Public School grounds

16.3.3.1. Containers and dumpsters on school property can not be used to dispose of any of these debris

17. Quantities

17.1. Projects listed within this solicitation are not guaranteed to be purchased.

Purchase orders will be issued, as needed, for the term of this solicitation.

The Fayette County School District anticipates that these projects will be completed. But, the approval will be determined by the available budget allotment.

pg. 8

18. Term

18.1. The term of this RFQ and resulting agreement is from the date of resulting award issuance until December 31, 2024, with no option to renew.

18.2. Per the General Terms & Conditions, should the Fayette County Board of Education fail to appropriate funding for each fiscal year beginning July 1st, this solicitation and resulting contract or purchase orders will be canceled with no-fault or obligation beyond products or services already received and properly invoiced.

18.2.1. FCPS may notify the awarded bidder in writing thirty (30) days prior to cancellation for non-appropriation.

19. Required Forms

19.1. The forms listed below are required for submission and included as attachments. They may also be located on FCPS’s Purchasing Department website at www.fcboe.org.

19.1.1. Solicitation Response Form

19.1.2. Reference Form

19.1.3. Cost Proposal

19.1.4. Business Capability Form

19.1.5. W-9 Document

19.1.6. Certificate of Insurance (Meeting the minimum requirements outline in our General Terms and Conditions)

19.1.7. E-Verify Documentation

19.2. Failure to include any form may result in a reduction in evaluation scoring or the submitted quote being declared non-responsive at the sole discretion of the FCPS Purchasing Department.

19.3. This request for quote, any addenda, and the awarded quote will be incorporated into any resulting contract and/or purchase order.

pg. 9 https://www.fcboe.org/Page/2707

Cost Proposal

**Final quantity will be confirmed once the project is awarded. Vendor can collect this information from each site while confirming color match to existing restroom partitions**

Location Estimated Qty. Project Cost

Braelinn Elementary School 15 $

Bennett’s Mill Middle School 25 $

Cleveland Elementary School 15 $

Crabapple Lane Elementary School 15 $

Fayette County High School 30 $

Fayette Elementary School 15 $

Fayette Life Academy 25 $

Flat Rock Middle School 25 $

Huddleston Elementary School 15 $

Inman Elementary School 15 $

JC Booth Middle School 25 $

Kedron Elementary School 15 $

McIntosh High School 30 $

North Fayette Elementary School 15 $

Oak Grove Elementary School 15 $

Peachtree City Elementary School 15 $

Peeples Elementary School 15 $

Rising Starr Middle School 25 $

Robert J Burch Elementary School 15 $

Sandy Creek High School 30 $

Sara Harp Minter Elementary School 15 $

pg. 10

Spring Hill Elementary School 15 $

Starr’s Mill High School 30 $

Whitewater Middle School 25 $

Whitewater High School 30 $

Total Combined Project Cost: $___________________________

**Cost per unit (including partition, bracket, delivery, installation, etc.) $_________________

Company Name Date

Printed Name Signature

pg. 11

Respondent Information Form

Place this form on top of your response.

Urinal Partitions for Fayette County Public Schools (RFQ 25-002-075)

Company Name:

Point of Contact:

Street Address:

City:

State:

Zip Code:

Telephone:

Email:

Website:

Authority to Act The undersigned states that he/she has the requisite authority to act on behalf of his/her employer in these matters and has offered to provide the products/services in accordance with the terms and conditions herein.

Terms, Conditions, and Specifications Through the submission of response and signature below, the respondent verifies that their solution, if applicable, complies fully, or complies with an exception, to all stated general and special terms, conditions, and specifications. See the FCPS General Terms and Conditions for further information and directions on notating exceptions to stated specifications.

Addenda Through the submission of response and signature below the respondent verifies that they have read and understood any addenda issued for this solicitation if issued.

Signature: _____________________________________Date: _______________________

Reference Form

Requested Information Response

Reference Name

Contact for Reference

Street Address

City, State, Zip

Phone Number

Email

Requested Information Response

Reference Name

Contact for Reference

Street Address

City, State, Zip

Phone Number

Email

Requested Information Response

Reference Name

Contact for Reference

Street Address

City, State, Zip

Phone Number

Email

Business Capability and Respondent Qualification Questionnaire

Please answer all questions fully. Additional pages for responses must be clearly marked to identify the respondent’s name and solicitation number.

1) How long has your company been in business?

2) What was your annual gross revenue in 2023?

3) Please indicate current contracts in hand similar to the scope of this project and attach a separate document indicating the name, telephone, and email of each owner/controlling firm; and the status and completion date of each. (Must Include Attachment).

4) Does your company have experience in public school services? List all public school projects completed in Georgia since 2015.

5) Has your company ever completed a project more than one month behind schedule? If so, please identify the project and explain the circumstances. (If applicable, must include an attachment.)

6) Has your company ever failed to complete any work awarded to it? If so, please explain.

(If applicable, must include an attachment.)

7) Has your company ever defaulted on a contract? If so, please explain. (If applicable, must include an attachment.)

8) Please indicate your company’s bonding capacity.

9) Please indicate your company’s insurance carrier.

10) Please indicate whether any insurance claim has been made against or by your company in the past seven (7) years, the circumstances surrounding such claims, and the outcome.

(If applicable, must include an attachment.)

11) Please indicate whether any legal claim, administrative hearings and/or procedings has been made against your company in the past seven (7) years (including starte and federal Department of Labor as well as OSHA), the circumstances surrounding such claims, and the adjudicated outcome. (If applicable, must include an attachment.)

12) Please list bank reference:

13)Has your company ever had a bankruptcy petition, arbitration demand, or lien filed against it in the previous seven (7) years? If so, please explain. (If applicable, must include an attachment.)

14)Has your company, any principal officers, or project managers had any criminal investigations or proceedings brought against them in the previous ten (10) years? If so, please explain. (If applicable, must include an attachment.)

15) Please attach a separate list of all employees who will be assigned to work on the project described herein and include any professional licenses or certifications they hold. (Must Include Attachment)

The respondent attests that the information included as attachments and responses are true and accurate as of the date of submission. Respondent also agrees by submission to allow Fayette County Public Schools to review or investigate any response contained herein. Respondent may be required to submit recent financial statements/reports and should indicate any objection herein. Failure to indicate or answer questions may deem the proposal non-responsive.

Notarized

FAYETTE COUNTY PUBLIC SCHOOLS - PURCHASING DEPARTMENT

GEORGIA SECURITY & IMMIGRATION COMPLIANCE ACT FORM

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT OF 2006, AS AMENDED BY

THE ILLEGAL IMMIGRATION REFORM ACT OF 2011, OCGA 13-10-90, ET SEQ.

TO ALL PROSPECTIVE CONTRACTORS:

If you are providing services to Fayette County Public Schools, this completed document, as well as the applicable Georgia Security and Immigration Compliance forms and affidavits referenced herein must be completed, signed, notarized and submitted with your bid, proposal or contract.

Fayette County Public Schools shall comply with the Georgia Security and Immigration Compliance Act, as amended, O.C.G.A.,~13-10-90 et seq. In order to ensure compliance with the Immigration Reform and Control Act of 1986 (IRCA,P.L.99-603 and the Georgia Security and Immigration Compliance Act of 2006, as amended by the Illegal Immigration Reform Act of 2011,O.C.G.A ~ 13-10-90 et seq. (collectively the “Act”) the contractor (“Contractor”) MUST INITIAL the statement applicable to Contractor below:

INITIAL ONLY ONE CHOICE BELOW

____ (Initial here) Contractor represents and warrants that Contractor has registered at https://e-verify.uscis.gov/enroll/ to verify information of all new employees in order to comply with the Act; Is authorized to use and uses the federal authorization program; and will continue to use the authorization program throughout the contract period. Contractor further represents, warrants and agrees that it shall execute and return any and all affidavits required by the Act and the rules and regulations issued by the Georgia Department of Labor as set forth at Rule 300-10-1-01 et.seq. In accordance with the terms thereof; (Complete and submit the Contractor Affidavit and Agreement); OR

____ (Initial here) Contractor represents and warrants that it has no employees and does not intend to hire employees to perform contractual services, and that Contractor has therefore provided a U.S. state-issued Driver’s license or ID card in lieu of an affidavit and that such license or ID card was issued by a State that verifies lawful Immigration status before issuing the license or ID card. If my status changes I will, before hiring any employees, immediately notify the School District in writing and provide all affidavits required under the Act; OR

____ (Initial here) Contractor represents and warrants that it does not physically perform any service within the State of Georgia as defined in the Act and thus does not have to comply with foregoing Georgia law; OR

_____(Initial here) Contractor is a foreign company and therefore not required to provide the affidavit as required by the Act. The Contractor must comply with any other laws required to perform services in the United States, including but not limited to having an appropriate visa.

USE OF SUBCONTRACTOR(S) and COMPLIANCE AS ABOVE

___(Initial here) Contractor will not employ or contract with any subcontractor in connection with a covered contract unless the subcontractor is registered, Is authorized to use, and uses the Federal Work Authorization Program and provides Contractor with all affidavits required by the Act and the rules and regulations issued by the Georgia Department of labor as set forth at Rule 300-10-01 et seq.

____(Initial here) Contractor covenants and agrees that, if Contractor employs or contracts with any Subcontractor in connection with the covered contract under the Act and DOL Rule 300-10-1-02, then in such event Contractor will secure from each subcontractor at the time of the subcontract, the subcontractor’s name and address, the employer identification number/taxpayer identification number applicable to the subcontractor; the date the authorization to use the Federal Work Authorization Program was granted to subcontractor; the subcontractor’s attestation of the subcontractor’s compliance with the Act and Georgia Department of Labor Rule 300-10-1-.2.; and the subcontractor’s agreement not to contract with subcontractors unless the subcontractor is registered, authorized to use, and uses the Federal Work Authorization Program; and provides subcontractor with all affidavits required by the Act and the rules and regulations issued by the Georgia Department of Labor as set forth at Rule 300-10-1-01 et seq. (Complete and submit the Subcontractor Affidavit and Agreement)

_____(Initial here) Contractor agrees to provide Fayette County Public Schools with all affidavits of compliance as required by the Act and Georgia Department of Labor Rule 300-10-1-02, 300-10-1-03, 300-10-1-07 and 300-10-1-08 within five (5) business days of its receipt of any such documents.

Company Name: _____________________________________________________________

SIGNATURE: __________________________________________________________________

DATE: __________________________________________

CONTRACTOR AFFIDAVIT PROVIDED PURSUANT TO O.C.G.A. § 13-10-91(b)(2)

(Rev. 4/18/2019)

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 under a contract with Fayette County Public Schools, 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 covenants that it will continue to use the federal work authorization program throughout the contract period, that the undersigned contractor will contract for the physical performance of services in the performance 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), and that the contractor shall forward any subcontractor’s affidavit to the School District within five (5) days of its receipt of the same.

Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

EEV User Identification Number (4 to 6 Digit Number)

Date of Authorization

Contractor/Company

Email Address

Telephone Number

Name of Project

Project Number

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 of Authorized Officer or Agent Title of Authorized Officer or Agent

NOTARY INFORMATION

Sworn to before me this day of , 20 .

Notary Public Signature

My Commission Expires: ____________________________

SUBCONTRACTOR AFFIDAVIT PURSUANT TO O.C.G.A. § 13-10-91(b)(3)

(Rev. 4/18/2019)

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 ___________________, which has a contract with Fayette County Public Schools, 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 covenants that it will continue to use the federal work authorization program throughout the contract period, that the undersigned subcontractor will contract for the physical performance of services in the performance 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), and that the subcontractor shall forward any sub-subcontractors affidavit to the contractor and School District within five (5) days of its receipt of the same.

Subcontractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

EEV User Identification Number (4 to 6 Digit Number)

Date of Authorization

Subcontractor/Company

Email Address

Telephone Number

Name of Project

Project Number

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 of Authorized Officer or Agent Title of Authorized Officer or Agent

NOTARY INFORMATION

Sworn to before me this day of , 20 .

Notary Public Signature

My Commission Expires: ____________________________