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HomeMy Public PortalAboutCampgroundLandscaping RFPPage 1 of 15 RFP # 2014-646 CITY OF TYBEE ISLAND TYBEE ISLAND, GEORGIA IS ISSUING THIS REQUEST FOR BID FOR THE FOLLOWING DESCRIBED HEREIN: LANDSCAPE MANAGEMENT FOR RIVERS END CAMPGROUND The City of Tybee Island is requesting proposals for Landscape Management Services at River’s End Campground & RV Park, 5 Fort Avenue, Tybee Island, GA. Bidders shall offer services and materials which may be upgraded with optional services and materials which may not be purchased at time of bid award. Bidder shall specify in the proposal the delivery schedule for the products and services from time of notification of award of bid. BIDS ARE TO BE RETURNED NO LATER THAN: JUNE 11, 2014 AT 10:00AM BIDS WILL BE OPENED ON JUNE 11, 2014 AT 11:00 AM AT CITY HALL. ALL RESPONDENTS ARE INVITED TO ATTEND. The City is seeking a total bid package for service/materials equal to or exceeding specifications set forth on the attached pages which must meet or exceed stated specifications. Those not meeting these standards will be rejected. The attached material specifications become and remain a part of this request for proposal All responses, inquiries, or correspondence relating to, or in reference to, this request for proposals, and all reports, charts, displays, schedules, exhibits and other documentation by the bidders shall become the property of the City when received. All proposals submitted in response to this invitation for bid shall become the property of the City. The City retains the right to use any or all ideas presented in any proposal to the invitation to bid, whether amended or not. Selection or rejection of the proposal does not affect this right. Mail proposal to: BID NUMBER 2014/646 MELISSA FREEMAN CITY OF TYBEE ISLAND 403 BUTLER AVE PO BOX 2749 TYBEE ISLAND, GA. 31328 Inquiries or other need for clarification in this document should be submitted no later than JUNE 9, 2014. Page 2 of 15 Questions to: Woody Hemphill 912-472-5016 Cell (912) 257-9890 Email: whemphill@cityoftybee.org METHOD OF AWARD: Contracts shall be awarded to the lowest, responsive, and responsible bidder. Bidders must respond completely by filling in all applicable blanks. Bids are subject to the terms and conditions of this Request for Proposal. Bids shall be submitted in a sealed envelope, clearly marked on the outside of the envelope, to the office of the above address prior to the time specified. Signature of bidder indicates that bidder understands and will comply with attached terms and conditions and all other specifications made a part of this invitation for bid and any subsequent award or contract. All terms, conditions and representations made in this invitation will become an integral part of the contract. Nothing contained within this RFP is indicative of intent by the City of Tybee Island to reimburse the bidder, in whole or in part, for any costs associated with preparation, submission, or presentation of proposals. WAIVER: The City of Tybee Island reserves the right to reject any or all bids received. The City reserves the right to waive any variances from original bid specifications in cases where the variances are considered to be in the best interest of the City. SUBMISSION OF BIDS AND SUPPLEMENTAL MATERIALS Bids and all required or requested supplemental materials in compliance with the attached specifications shall be submitted to the above address. Supplemental materials will not be accepted after the bids have been opened, unless requested by the City. Please include a bid sheet, W-9, vendor application, affidavit verifying status, and contractor affidavit which can be found at the end of this request. SERVICES TO BE PROVIDED The successful bidder shall perform the following work for the City: Scope:  To provide compartmentalized pricing on landscape management components, as specified within this RFP. Individualized pricing is requested for the following: o mowing/edging  Contractor will provide number of visits per month in accordance with summary of conditions  The season will span March 1st- November 30th each year Service Area:  Mowing & line trimming around all storm drainage ditches, poles, trees, buildings, hardscapes, and camp sites. Includes:  Paver Pads  Sidewalks  Driveways/Roads  Light/Service poles  Site service poles  (3) storm drainage ditches Page 3 of 15  Campfire rings/Picnic Tables  Trees  Fences  Walls  Dumpster enclosures  All Buildings on site  Contractor will be responsible for blowing all roads, sidewalks etc. affected by weed trimming Mowing:  Cut all grass in all areas of the campground: Included but not limited to are:  Behind/around Manager residence  Field tent sites  Road frontage  Open grassy areas of park  Pool Area  Between Camp Sites  Tent Field from chain link fences-entrance road, & Fort Avenue – Dog Park  Contractor will be responsible for blowing all roads, sidewalks etc. affected by mowing  Lawn areas shall be mowed at a finished height of three-to-four inches for cool season turf and one-and-a-half-to-two-and-a-half inches for warm season turf throughout the mowing season  During the mowing season, all lawn areas shall be mowed bi-weekly or as weather conditions dictate and according to the frequency stipulated in the Grounds Maintenance Service Schedule which has been derived based on Park Manager and Contractor discussions in an effort to manage the cost of landscape management services.  Prior to each mowing, all reasonable trash, sticks and other unwanted debris will be removed from lawns, plant beds and paved areas.  The mowing operation includes trimming around all obstacles and removing debris from walks, curbs and parking areas. Grass clippings will be kept out of beds and tree pits. Mowing patterns will be established and changed on a regular basis to present the most aesthetically pleasing appearance. Summary of conditions:  Contactor must meet all requirements as defined by the City of Tybee Island to be eligible for this RFP  Contractor will provide all equipment, supplies and materials to administer this contract  Items to be included, but not limited to, are:  Gas/Oil  Mowers or other small engine equipment  Supplies & Materials  Sprayers  Hand Tools  Chemicals  Pruning/ Cutting equipment  Safety/Personal Protective Equipment (PPE)  Staff Liability/Damages: Page 4 of 15  Any damages incurred to property; public or private, will be the sole responsibility of the service provider Scheduling of Work:  Contractor will coordinate work as to not interfere with any campground occupancies/events.  Contractor is limited to operate gas-powered equipment between the hours of: 10:00 A.M. – 6:00 P.M on Sunday–Wednesday  Contractor will be required to submit an invoice after each mowing, and/or monthly for service levels outside of mowing, as season may be extended, or shortened due to weather conditions. This will be determined by park management and staff  ***Number of visits required to administer contract is undefined due to occupancy fluctuations. Contractor will set visit schedule based on these variables, while adhering to the Scope, Details, and Summary of Conditions outlined in this RFP Termination/Continuation  Termination/Continuation of this contract can be administered by either party, at any time. Party must give 45 days prior notice, of any Termination/Continuation in order the render contract status valid Addendum LANDSCAPE MANAGEMENT SPECIFICATIONS  A separate, compartmentalized, quote is also requested for each of the following: o fertilization, o pruning, o integrated pest management (IPM), o weed control, o turf fertilization, o turf herbicides, o turf insect & disease control, o leaf removal Comprehensive Park-Wide Spray Program  Implement weed control through application of pre–emergent, selective, and non–selective herbicides Areas to be included are:  Fort Avenue Entrance sign bed  All beds around the office area  Along poolside beds and pool fence line  Managers residence  Pavilion beds  The Workshop  Propane enclosure  Upper/Lower Bath houses & service enclosure  Cabin Area/ managers backyard  Crow’s Nest Fencing & around Storage building  Sidewalks  Driveways/ Roads  Paver pads  Fences Page 5 of 15  Sites/Site pads Fertilization: Trees and Shrubs All ornamental trees up to six-inch caliper will be fertilized with 10-6-4 analysis fertilizer at the rate of one pound-per-inch of trunk caliper. Shrubs and groundcover shall be fertilized with 10-6-4 analysis fertilizer at the rate of four pounds per 100 square feet of bed area once in the spring. Acid-loving plant material shall be fertilized with an ericaceous fertilizer, i.e., Hollytone, at the manufacturer’s recommended rate. Pruning Shrubs Shrubbery that requires shearing to maintain a formal appearance will be sheared two times per year unless otherwise indicated differently on the Grounds Maintenance Service Schedule. Informal shrubbery will be pruned twice per year unless otherwise indicated on the Grounds Maintenance Service Schedule, approximately in June and in early September. Flowering shrubs shall be pruned after blooming. Hand- pruning of shrubs will not include rejuvenative pruning on overgrown plants, neglected plants or plants that have been improperly pruned or sheared in past years. Groundcovers shall be edged and pruned as needed to contain them within their borders according to frequency set forth in Grounds Maintenance Service Schedule. Standard pruning practices will be observed and all resulting debris will be removed. Perennials will be cut back and pruned at the appropriate times according to frequency set forth in Grounds Maintenance Service Schedule. In general, perennials will be cut back in late fall unless otherwise requested. Pruning Trees Pruning of the deciduous trees will be done in the months of January and February, during the dormant season and will be limited to a height of 14’ and a branch caliper of 3”, any pruning outside of this specification can be performed at an additional cost, with prior approval of Campground Manager. Structural pruning will be performed and includes removal of crossing branches, or those not consistent with standard form, general thinning for good light penetration and air circulation, elevation of lower branches to achieve consistency between the trees and to maintain safe passage of pedestrians and vehicles. Removal of dead branches will be done where it can be identified; however this is often not detectible in the dormant season. All pruning cuts shall be made to the lateral branches, buds, or flush with the trunk. Stubbing will not be permitted. All debris will be removed from the site. Throughout the growing season, pruning of suckers, water sprouts and low-hanging branches will be performed. Pruning dead branches from trees during the growing season is not included in the scope of this contract. This is an unpredictable task and is considered to be a rejuvenative service. This service can be provided at an additional cost, with prior approval of Campground Manager. Integrated Pest Management (IPM) The contractor shall be responsible for the detection, monitoring and control of plant damaging insects. The contractor shall be aware of the potential pests and shall make regular inspections of the plant material and treat as necessary. These principles will be practiced under an Integrated Pest Management (IPM) program. The goal in implementing an IPM program is to maintain insect and disease problems at acceptable levels. This benefit is enhanced by insuring more frequent inspections by on-site personnel and a safer environment through the use of less pesticide. Pesticides must be applied under the supervision of a certified applicator. Spraying operations will cover all material up to a height of 25 feet. Trees exceeding this height can be serviced under a separate agreement. Page 6 of 15 Dormant oil shall be applied in early March to all plants susceptible to over-wintering insects, to include needled Evergreens, Oaks and Maples. Applications of pesticide shall not be done as calendar scheduled or general cover sprays. Pesticides shall only be applied as needed, when pests are detected through regular inspections. Weed Control Beds and tree wells will be weeded on a continuous basis throughout the growing season to maintain a neat appearance at all times. This will be performed through the use of pre-emergent and post-emergent herbicides as well as hand-weeding. Chemicals will be used according to the product label. A non-selective and/or pre-emergent herbicide will be applied on a continuous basis to all walks, curbs and other paved areas to help prevent the growth of weeds. Turf Fertilization The following turf fertilization schedule shall be followed annually. In the event that a different number of applications are agreed upon by the Campground Manager and Contractor, the number of frequencies shall be listed on the Grounds Maintenance Service Schedule. To help promote early green up, lawn areas will be fertilized in the late winter to provide the equivalent of one-half pounds of nitrogen per 1,000 square feet. A second application of fertilizer will be applied in the spring. This fertilizer will provide the equivalent of one pound of nitrogen per 1,000 square feet of lawn. A third application will be applied in summer for consistent color during the active season. It will be applied at the rate of one pound of nitrogen per 1,000 square feet. A fourth application of fertilizer will be applied in the early fall. This fertilizer will provide balanced color, stem and root growth. It will have one-half pounds of nitrogen per thousand square feet. A fifth application of fertilizer will be applied in late fall for a deep feeding before winter dormancy. Turf Herbicides A pre-emergent herbicide will be applied with the first and second fertilization applications to help control the growth of crabgrass and other annual weeds. For warm season turf, two additional pre-emergents will be applied with the fourth and fifth fertilization. A post-emergent herbicide will be applied in the spring to help prevent the growth of broadleaf weeds. Additional spot treatments will be performed throughout the season to control difficult and seasonal weeds. Additional specialized turf herbicide treatments may be needed for extremely hard to control weeds, especially non-pre-emerge-able weeds such as nutsedge, wild onion, Bermuda grass, wild violet and others. These conditions require special attention and cannot be controlled without additional services and treatments, in some cases several treatments.. For these reasons, we provide this service at an additional cost on an as needed basis with prior approval from management. Turf Insect and Disease Control Insect control is unpredictable and can be performed on a curative basis following regular IPM inspections by Contractor’s on-site personnel at an additional cost with prior approval from the Campground Manager. Treatment of disease problems can be done on a curative basis only. Due to the nature of turf diseases being extremely weather-sensitive and expensive to control, these will be performed on an as-needed basis at an additional cost, with prior approval of Campground Manager. Page 7 of 15 Aeration/Overseeding Per the Grounds Maintenance Service Schedule, aeration of lawn areas will be performed once in the fall for cool season turf and early summer for warm season turf. Aeration will be accomplished utilizing an open-tine coring type aerator with three-eighths of an inch to five eighths on an inch diameter core or a five- point disc with four-inch penetrating skies. Aeration spikes should optimally penetrate the soil to a minimum depth of one-and-one-half inches, depending on existing soil conditions. Over-seeding will be performed for cool season turf using an improved Turf-Type Tall Fescue. Seed shall be applied at a rate of five pounds per 1,000 square feet. Leaf Removal Fallen leaves shall be removed from the site in the fall (October-December) according to the frequency indicated on the Grounds Maintenance Service Schedule. In turf areas, leaves will be mulched with each mowing from October through November. If requested by the owner, supplemental leaf removals shall be performed by the contractor at an additional cost. Winter Clean-Up The frequency of general clean-up visits is indicated on the Grounds Maintenance Service Schedule. Clean-up includes: 1. Seasonal palm and ‘access-trimming’ 2. Dead limbs in high areas made more accessible during low volume periods, coordinated with Campground Manager Inspect grounds PAYMENT The bidder shall specify terms of payment. The City of Tybee Island’s preferred method of payment is by purchasing credit card. INSURANCE REQUIREMENTS Contractor shall provide a Certificate of Insurance naming the City of Tybee Island as also insured, a 30 day cancellation notice, indicating the following minimum coverage: Comprehensive General Liability $2,000,000.00 Automobile Public Liability $2,000,000.00 Workman’s Compensation Insurance equal to the statutory requirements. TAXES The City of Tybee Island, Georgia is not subject to any State or Federal taxes. Documentation will be provided with the invoice at the time of payment, if requested. DELIVERY: F.O.B. DESTINATION 403 Butler Ave, Tybee Island, Georgia 31328 unless otherwise stated. TERMINATION OF CONTRACT Page 8 of 15 The City reserves the right to terminate the contract for reasons of violations by the successful bidder of any term or condition of the contract by giving thirty (30) days written notice, unless otherwise stated herein, stating the reasons therefore and giving the party ample time to remedy the deficiencies. City of Tybee Island TERMS AND CONDITIONS DEFINITIONS. As used herein, the following terms shall have the meanings set forth below, whether or not capitalized. (a) “Purchase Order” or “Order” means this purchase order. (b) “Buyer” means The City of Tybee Island. (c) “Seller” or “Vendor” means the party furnishing the supplies under this order. (d) “Supplies” means what the Seller furnishes the Buyer under this order and includes with limitation, the following; (1) the work; materials; articles; deliverable items, items, data and services, whether tangible or intangible or any combination thereof; and (2) what is leased or licensed, pursuant to the lease(s) or license(s) signed by both the Buyer and the lessor or licensor if attached to and made a part of this order. (e) “Loss” means any or all the following: claims, liabilities, damages, losses, costs, or expenses (including reasonable attorneys’ fees and expenses and other legal costs). ACCEPTANCE. This order constitutes an offer which shall become a binding contract upon the terms and conditions herein set forth upon acceptance by Seller either by acknowledgement of this order or commencement of performance. Buyer objects to any difference, conflicting or additional terms proposed by Seller in the acceptance of this order, and no such terms shall be effective unless expressly accepted by Buyer in writing. Each shipment received by Buyer from Seller shall be deemed to be only upon the terms and conditions contained in this order, except by such written instrument modifying the order, signed by Buyer, notwithstanding any terms and conditions that may be contained in any acknowledgment, invoice, or other form issued by Seller and notwithstanding Buyer’s act of accepting or paying for any shipment, or similar act by Buyer. PRICES. Seller represents that the prices, terms, warranties, and benefits contained in this order are comparable to or better than those offered to any other customer of Seller for items which are the same or substantially similar. Buyer shall receive the benefit prospectively or retrospectively if Seller offers any item or service included in this order to any other customer at a lower price, more favorable terms, more favorable warranties, or more favorable benefits up to one year after completion of this order. PACKING AND SHIPPING. All items shall be suitable packed and prepared for shipment to insure their safe transportation, to secure the lowest transportation cost, and to comply with the requirements of carriers. Buyer’s order number shall appear on all documents and correspondence relating to these items. Packing lists shall accompany the items and shall include the order number, Buyer’s part number, Seller model number, description of items shipped and any other information called for in the order. Buyer’s count or weight shall be final and conclusive on shipments not accompanied by a packing list. Seller shall be liable for all excess transportation or other charges resulting from Seller’s failure to comply with Buyer’s packing, shipping, routing and delivery instructions. DELIVERY. Any delivery schedule made a part of this order is an important, material condition; time is of the essence of the order. Unless otherwise agreed to in writing. Seller shall not make Page 9 of 15 material commitments or production arrangements in excess of the amount or in advance of the time necessary to meet Buyer’s delivery schedule. It is Seller’s responsibility to comply with this schedule, but not to anticipate Buyer’s requirements. In addition to any other rights or remedies, Buyer may cancel all or any part of this order for Seller’s failure to deliver in strict accordance with the delivery terms set forth herein. Seller shall promptly notify Buyer of any anticipated delay in the delivery date and Buyer may require Seller to ship by alternate means in order to expedite delivery. Any additional costs shall be paid by Seller and Seller shall be liable for all resulting damages to Buyer occasioned by the delay. Delivery shall not be deemed to be complete until the items have been received and accepted by Buyer. Advance and excess shipments may at Buyer’s option be rejected and returned to Seller at Seller’s expense. TRANSPORTATION. Except as otherwise provided on the face of this order, transportation charges on Supplies shall be f.o.b. destination, at Seller’s sole cost and expense. Risk of loss from any casualty to supplies ordered hereunder, regardless of cause, shall be Seller’s responsibility until goods have been delivered to Buyer’s designated delivery post. No insurance or premium transportation costs beyond the price listed in this order will be allowed unless authorized by Buyer in writing. If Seller does not comply with Buyer’s delivery schedule, Buyer may, in addition to any other rights that Buyer may have under this order, require delivery by fastest way, and charges resulting from the premium transportation must be fully prepaid and absorbed by Seller. WARRANTY. Seller warrants that all supplies delivered pursuant to this order shall strictly conform to the applicable specifications (including without limitation information or functional performance, material content, size, appearance, response time, etc.), shall be free from all defects and workmanship in materials including latent defects, shall be free from defects in design and suitable for their intended purpose, and shall be free from all claims, encumbrances, and liens. This warranty shall survive inspection, delivery and payments shall run to Buyer, its successors, assigns and the users of the items and shall not be deemed to be exclusive. Seller agrees to indemnify, defend and hold Buyer, Buyer’s employees, and those for whom Buyer may act as agent, harmless from all damages, including consequential and incidental damages, incurred or sustained by Buyer by reason of any breach of any warranty with respect to the supplies purchased. Buyer shall be promptly reimbursed for all expenses incurred in the handling, inspection and return of defective items, and Seller shall bear the risk of loss on all such items. If any of the supplies are found at any time prior to acceptance to be defective in material or workmanship, or otherwise not in conformity with the requirements of this order, Buyer (in addition to any other rights which it may have under warranties or otherwise) may at its option (1) correct or have corrected the nonconformity at Seller’s expense, or (2) reject and return such supplies or other deliverable items at Seller’s expense, such supplies or other deliverable items not to be replaced without suitable written authorization from Buyer. CHANGES. Buyer may at any time request in writing changes to this order in the specifications, packing, shipment, quantities, delivery schedules, and other matters. If any such change causes an increase or decrease in the costs of or the time required for performance, Seller shall immediately notify Buyer. Any request for an equitable adjustment must be made in writing with 30 days from the date of the written request for the change. No additional charge or change in the specifications, packing, shipment, quantities, delivery schedules, and other matters will be allowed unless authorized by Buyer in writing. Page 10 of 15 TAXES. The Buyer, a municipality in the State of Georgia, is exempt from Georgia Sales Tax under the Sales and Use Tax ID # 302 526 178. All sales and use tax due on materials purchased by the city for installation by the seller under this contract are the responsibility of the contractor. ASSIGNMENT. Neither this order nor any interest herein may be assigned, in whole or in part, by Seller without the prior written consent of Buyer. Notwithstanding the above, Seller may assign any monies due or to become due to him hereunder, provided that such assignment shall not be binding upon Buyer until receipt of a copy of the assignment agreement is acknowledged and approved by Buyer in writing. SUBCONTRACTING. Seller shall not enter into a subcontract for any part of this order, including completed or substantially completed items or major components thereof, with Buyer’s written consent. Nothing in this order shall be seen as prohibiting Seller’s purchase of standard commercial articles, raw materials, or other supplies specified in this order if these are typically purchased by Seller in the normal course of business. TERMINATION. Buyer may terminate or suspend performance under this order in whole or in part from time to time by sending written notice to Seller. Upon receiving notice of such action by Buyer, Seller shall immediately comply with its terms and take all reasonable steps to avoid incurring any additional costs under this order. Buyer’s sole liability to Seller shall be for items completed and delivered to Buyer in accordance with this order and for Seller’s reasonable costs to the date of termination, such costs being solely attributable to this order and not being recoverable from other sources. INDEMNIFICATION. Seller agrees to indemnify, defend and hold Buyer, Buyer’s employees, and those for whom Buyer may act as agent harmless from (1) any and all claims and liabilities for injuries or death of persons or damages to or destruction of property; (2) any other Loss caused by or resulting from the acts or omissions of Seller, its agents, subcontractors, suppliers or employees in the performance of this order; (3) any Loss caused by or resulting from the supplies purchased under this order, (4) any intended use of products or materials provided by Seller; (5) any defective products or materials provided by Seller, including without limitation the use or disposal of hazardous and/or toxic materials, such materials to include at minimum all materials recognized by the Environmental Protection Agency as hazardous; or (6) any breach by Seller of any express or implied warranties. If Seller’s work hereunder involves operations by Seller’s agents, subcontractors, suppliers or employees on Buyer’s premises or any place where Buyer conducts operations, Seller shall take all necessary precautions to prevent the occurrence of any injury or damage to persons or property during the progress of such work. Further, Seller shall indemnify, defend and hold Buyer, Buyer’s employees, and those for whom Buyer may act as agent harmless for any injuries occurring to Seller’s agents, subcontractors, suppliers or employees and Seller shall maintain public liability, property damage and employee’s liability and compensation insurance sufficient to protect Buyer from any claims under any applicable law, statute, or regulation. MODIFICATION; WAIVER. No waiver or modification of this order shall be effective unless in writing and signed by both of the parties hereto. Failure of either party to enforce its rights under this order shall not constitute a waiver of such rights or any other rights. Page 11 of 15 ENTIRE AGREEMENT. This order is intended by the parties as a final expression of their agreement and also as a complete and exclusive statement of the terms thereof, any prior or contemporaneous oral or written agreements as to the same subject matter notwithstanding. INVALIDITY. In the event that any provision of this order is declared invalid, illegal, or otherwise unenforceable by any tribunal or law, the remainder of the provisions shall not be affected thereby, and each term and provision not declared invalid, illegal or unenforceable shall be valid and shall be enforced to the fullest extent permitted by law. DRUG FREE WORKPLACE. By accepting this order, the Seller certifies that he shall provide a drug free workplace for his employees in accordance with the laws of the State of Georgia. SPECIFICATIONS, PROPOSALS, BID DOCUMENTS. The documents which form the basis for this order shall include the plans and specifications and bid documents as attached hereto, together with any other documents so listed and enumerated, if any, and it is expressly understood that any special conditions listed and attached hereto are specifically made a part of this contract. APPLICABLE LAW. The provisions and performance of this purchase order shall be governed by the laws of the State of Georgia and applicable federal law. Seller agrees to bring any and all actions relating to this purchase order only in the state and federal courts located within Chatham County in the State of Georgia. APPROPRIATION. Notwithstanding, any other provision hereof , this agreement shall terminate at the end of each calendar year without liability or obligation on the part of the city in any calendar year where the City has not appropriated funds for the obligations hereunder for the next calendar year. Page 12 of 15 QUOTATION SHEET A. Description: $____________ TOTAL COST: $___________ Quotation Expiration date: ___________________________________________________ Page 13 of 15 City of Tybee Island, PO Box 2749, Tybee Island, GA 31328 912-786-4573 | (fax) 912-786-9465 What products/services do you provide to the City of Tybee Island: _________________________________________________________________________ _________________________________________________________________________ To whom shall we direct the Purchase Order? Sales Contact:______________________Email:__________________________________ Phone#______________________________ Fax#________________________________ Location: _________________________________________________________________ To whom shall we direct Payment? A/R Contact: _______________________ Email:_________________________________ Phone#_____________________________ Fax#________________________________ Remittance Address:________________________________________________________ Our terms are Net 30. Page 14 of 15 Affidavit Verifying Status for City Public Benefit Application By executing this affidavit under oath, as an applicant for a City of Tybee Island, Georgia, Business License or Occupation Tax Certificate, Alcohol License, Taxi Permit, Contract, or other public benefit as referenced in O.C.G.A. Section 50-36-1, I am stating the following with respect to my application of a City of Tybee Island:  Business License or Occupational Tax Certificate,  Alcohol License,  Taxi Permit,  Contract  Other public benefit _____________________________________________________________ for _______________________________________________________ (printed name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity). 1) ______ I am a United States citizen. OR 2) ______ I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States. * In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10-20 of the Official Code of Georgia. ___________________________________________ Signature of Applicant ___________________________________________ Date ___________________________________________ Printed Name ___________________________________________ * Alien Registration Number for Non-citizens SUBSCRIBED AND SWORN BEFORE ME ON THIS THE ______ DAY OF ___________________, 20 _____ Notary Public __________________________________ My Commission Expires: ________________________ Note: O.C.G.A. § 50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their alien registration number. Because legal permanent residents are included in the federal definition of “alien”, legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below: _________________________________________________ (circle all that apply) Page 15 of 15 CONTRACTOR AFFIDAVIT AND AGREEMENT 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 contracting with (State Recipient/Sub-recipient), under the Community HOME Investment Program (CHIP), has registered with and is participating in a federal work authorization program* [any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603], in accordance with the applicability provisions and deadlines established in O.C.G.A 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this CHIP-funded contract with (State Recipient/Sub-recipient), contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G. A. 13-10-91 on Subcontractor Affidavit provided in Rule 300-10-01-.08 or a substantially similar form. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the (State Recipient/Sub- recipient) at time the subcontractor(s) is retained to perform such service. ________________________________________________ Federal Work Authorization User Identification Number ________________________________________________ Date of Authorization ________________________________________________ Authorized Officer or Agent 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 of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE ________DAY OF ______________________, 20___ Notary Public: _________________________________________________ My Commission Expires: ________________________________________