HomeMy Public PortalAboutgeothinq_signed.pdfSOFTWARE LICENSE AGREEMENT
This SOFTWARE LICENSE AGREEMENT (the "Agreement") is entered into between Thomas and
Hutton Corporation dba geothinQ and its affiliates including but not limited to the licensors of any
of the geothinQ Software as defined herein ("geothinQ") and the customer identified below on this
signature page ("you," "Licensee" or "User") governing the license and use of the geographic
land mapping and data visualization software for the purpose of land analysis (the "geothinQ
Software") which you may download and access and which enables the delivery of certain
content related to land ("Services") (collectively, the Software and Services shall be referred to as
the "geothinQ Property") and made available for license on the website located at
www.c9eothinca.com (the "Website"). This Agreement is effective as of the date of last signature
below (the "Effective Date").
This Agreement consists of (i) this signature page; (ii) the provisions set forth below in Articles 1-10;
(iii) Schedule A;; and/or (iv) the Thomas & Hutton Letter Agreement (if applicable). This Agreement,
along with the End User License Agreement ("EULA") located on the Website, contains the
complete expression of the agreement between the parties with respect to the matters addressed
herein and there are no promises, representations, or inducements except as herein provided.
IN WITNESS WHEREOF, the parties have caused this Agreement to be signed by their respective duly
authorized representatives.
geothinQ
By: C/ A /
fi""" (!U . ( By.
License
Printed Name: Christopher C. Nichols
Title: General Manager
Date: 27 August 2020
Approved to Form:
Edward Hughes
Ellis, Painter, Ratterre & Adams
Item #6.
Printed N me: L-)
Title: 119/9471ege—fry 76%)
Date: /Q L- ) O
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SOFTWARE LICENSE AGREEMENT
ARTICLE 1: USER LICENSE
1.1 User License. geothinQ grants User the
limited, non -transferable, and revocable, in
geothinQ's discretion, right to use the
geothinQ Property on the terms and
conditions set forth herein for the limited
purposes of downloading, accessing and
interacting with the geothinQ Property to
acquire data and information to evaluate
the topography, ownership, and location of
real estate or other internal business
purpose and for copying, reproducing,
transmitting and otherwise using the data
and maps in furtherance of this limited
purpose. Any other use of the geothinQ
Property is strictly prohibited.
1.2 Ownership. User acknowledges that nothing
herein gives it any right, title, or interest in the
geothinQ Property except for those explicitly
set forth in this Section. User shall not contest
or challenge the validity of any part of the
geothinQ Property. All content accessible by
means of the geothinQ Property (the
"Content") is owned and provided by third
parties to geothinQ for delivery to you and
may be protected by various copyrights
and/or other proprietary rights owned by such
third parties.
1.3 Number of Licenses. User may purchase as
many licenses as needed for its business. The
purchase of one license allows User access to
the Website from a single IP address
associated with one desktop and one mobile
device concurrently. At no time shall a user
be permitted to access the Website from
more than one desktop device or more than
one mobile device at the same time. Each
license is unique to one individual and cannot
be shared with other individuals. The amount
of licenses you own is set forth in Schedule A.
1.4 Payment. User shall pay geothinQ for each
license for the amount and term set forth in
Schedule A. Payment Perms may be modified
by geothinQ by notifying User of the change
in writing prior to the beginning of the next
term. Failure to make timely payments can
result in loss of access to the geothinQ
Property and/or termination of this
Agreement.
Item #6.
1.5 Scope of License. geothinQ offers various
levels of access to the geothinQ Property and
each level is priced accordingly. User's
access level is set forth in Schedule A.
1.6 Use Restrictions. You acknowledge and
agree that you may not (i) reproduce the
geothinQ Property, or any portion thereof, in
any way or in any format now known or
hereafter developed other than making
copies of the Content for internal business
purposes; (ii) provide any other person with
access to the geothinQ Property not expressly
allowed in this Agreement or by geothinQ in
writing; (iii) sublicense the use of the geothinQ
Property; (iv) make derivative works from the
geothinQ Property; (v) resell, relicense, or
redistribute the geothinQ Property or any
portion thereof, in any way or in any format
now known or hereafter developed; (vi)
attempt to, or encourage or assist any other
person to, circumvent or modify any security
technology or software that is part of the
geothinQ Property or used to administer these
use restrictions; (vii) use the geothinQ Property
in any way that would cause it to constitute a
"consumer report" under the Fair Credit
Reporting Act, 15 U.S.C. § 1681 et seq. or
similar statute; or (viii) use the geothinQ
Property in any manner other than set forth
herein. User shall not directly or indirectly
modify, translate, decompile, create or
attempt to create, by reverse engineering or
otherwise, the object or source code of the
geothinQ Software. User acknowledges that it
will only be permitted to utilize the geothinQ
Software for its intended purpose and access
the geothinQ Property through platforms
designated by geothinQ from time to time.
You may not export more than 10,000 points
of interest in one calendar year. Violation of
this requirement will result in immediate
termination of this Agreement. While the
geothinQ Property should not allow you to do
so, you may not create a workaround and
access or export data elements relating to
more than 1,000 parcels at one time nor more
than 100 points of interest at one time. You
may export all data layers in PDF format. In
accordance with restrictions integrated in the
geothinQ Property, parcel data and points of
interest data relating to geography may be
exported also in KML format. Parcel data
attributes and points of interest data
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SOFTWARE LICENSE AGREEMENT
attributes {excluding latitude and longitude)
may be exported in CSV format. You are
expressly prohibited from exporting parcel
data and points of interest data in SHP format
and DWG format and you are expressly
prohibited from exporting transmission lines,
substations and electric service territories in
any format other than PDF.
1.7 Ownership Representation. You represent
that you are not one of the following entities,
their affiliates or subsidiaries, nor their
successors in interest: Acxiom, America
Online, Inc. (AOL), Black Knight, CBClnnovis,
CD -Data, Collateral Analytics, Costar Group,
Courthouse Retrieval System Inc., Data
Solutions, Datamyx, Data Verify, Digital Map
Products, Digital Risk, Experian, Equifax, Fair
Isaac Corporation, Fidelity National Financial
(FNF), Fidelity National Information Services
(FNIS), Fidelity National Insurance Company,
Fidelity National Title Group, First American
Financial Corporation, First Data Solutions,
FiServ, FNC, Google, Haines, InfoUSA,
Insurance Service Office (ISO), International
Data Management (IDM), Interthinx, iPlace,
ISGN, Land America, Lender Processing
Services, Lending Tree, Lexis/Nexis,
MacDonald-Detweiler, Maponics,
MasterFiles, Merlin Data, Microsoft, Myriad
Development. National Data Cooperative,
National Information Services, New Reach,
Onboard Informatics, Real Ingo, Real Net,
Rentwood RealtyTrac LLC, RJ Peters,
Sedgwick CMS, Stewart Information Services
Corporation, SW Financial, TPG Capital,
Thompson -West Group, TransUnion, Verisk,
Veros, Yahoo!, Zaio and Zillow.
ARTICLE 2: SERVICES
2.1 Engagement. Licensee may retain Licensor to
create customized GIS software (the "GIS
Custom Services") and, when so retained, the
performance of such GIS Custom Services
shall be governed by, and Licensor agrees to
perform such Services in accordance with,
the terms and conditions of this Agreement
and the applicable Statement of Work
negotiated and executed by Licensor and
Licensee in a similar format to Schedule B
attached hereto.
Item #6.
2.2 GIS Custom Services. Licensor represents and
warrants that it and its employees will perform
the GIS Custom Services in a manner
consistent with that degree of care and skill
ordinarily exercised by members of the same
profession currently practicing under similar
circumstances at the same time and in fhe
same or similar locality.
2.3 Priority. In the event of a conflict or
inconsistency between the terms and
conditions of this Agreement and the terms
and conditions of any Statement of Work
promulgated hereunder, the terms and
conditions of this Agreement shall control
unless the applicable clause in the applicable
Statement of Work expressly references the
conflicting term of this Agreement.
2.4 Work Product Testing and Acceptance.
Licensor shall notify Licensee of the readiness
of the software created with the GIS Custom
Services (the "Work Product") for testing by
Licensee (the date of such notification
hereinafter being referred to as the "Delivery
Date"). Notice shall be provided in written
form including but not limited to email. Unless
otherwise set forth in the applicable
Statement of Work, Licensee shall have thirty
(30) business days after the Delivery Date to
complete testing of the Work Product. If this
test establishes that the Work Product does
not materially perform to the applicable
specifications or Licensee's reasonable
requirements that had been communicated
to Licensor, Licensee shall immediately notify
Licensor and Licensor shall, within a
reasonable time, not to exceed ten (10)
business days unless otherwise set forth in the
applicable Statement of Work, modify or
otherwise improve the Work Product in an
effort to make the Work Product conform to
Licensee's reasonable requirements. If no
written notification of material non-
conformance is received by Licensor within
such thirty (30) days following the Delivery
Date of the Work Product, such Work Product
shall be deemed accepted by Licensee.
ARTICLE 3: TRANSFER
No transfer of any right or interest of User under
this Agreement, in whole or in part (whether
voluntarily or by operation of law), directly,
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SOFTWARE LICENSE AGREEMENT
indirectly or contingently, shall be permitted
without the prior written consent of geothinQ
unless it has been reassigned by a former User to
a new User who has replaced the former User's
position. geothinQ may assign this Agreement
without the consent of User.
ARTICLE 4: ACCOUNT INFORMATION AND DATA
geothinQ does not own any data, information, or
material ("Your Data") that you submit to the
Service in the course of using the Service. You, not
geothinQ, shall have sole responsibility for the
accuracy, quality, integrity, legality, reliability,
appropriateness, and intellectual property
ownership or right to use of all Your Data, and
geothinQ shall not be responsible or liable for the
deletion, correction, destruction, damage, Toss or
failure to store any of Your Data. geothinQ will not
use Your Data for any purpose other than its
internal business purposes. In the event this
Agreement is terminated (other than by reason of
User's breach), geothinQ will make available to
you a file of Your Data within 30 days of
termination if so requested at the time of
termination. User shall be provided a 15 day
period to cure any breach, including non-
payment. If the breach is not cured within the
allotted 15 day period, geothinQ reserves the
right to withhold or remove Your Data with 5 days
notice.
In the event of an alleged breach by Licensee
which is contested by Licensee, no Licensee Data
will be withheld or removed from Licensee until
the dispute is resolved. Disputes hereunder shall
be mediated in good faith within 10 business days
of the notice of dispute by Licensee to geothinQ
and the parties shall agree on a mediator. In the
event the parties are unable to agree on a
mediator, the parties agree to mediate using a
mediator on the list of mediators for Chatham
County Courts as designated by either party to
first designate a mediator from the list..
ARTICLE 5: LOGO
On sites that Zink to geothinQ's Website, a
geothinQ logo must be included at the bottom
right corner of all pages from the use of the
Service. This logo must also link to the Website.
You agree not to tamper with the logo and
display the logo in all documents emanating from
geothinQ. geothinQ is a trademark owned by
Item #6.
geothinQ. All other trademarks which may
appear in the geothinQ Property are property of
their respective owners. This Agreement does not
grant you the right to use these trademarks
except as set forth in this Agreement. You may
not contest the ownership or validity of any
trademarks appearing in the geothinQ Property.
ARTICLE 6: DISCLAIMER OF WARRANTIES AND
LIABILITY
6.1 General Disclaimer. geothinQ is making the
geothinQ Property available to you on an "as
is" and "as available" basis and you agree
that your use of the geothinQ Property is at
your own risk.
6.2 Warranty Disclaimer. GEOTHINQ DISCLAIMS
ALL WARRANTIES THAT RELATE IN ANY WAY TO
THE GEOTHINQ PROPERTY, EITHER EXPRESS OR
IMPLIED, INCLUDING WITHOUT LIMITATION ANY
WARRANTY FOR INFORMATION, AVAILABILITY,
ACCURACY, ADEQUACY, QUIET ENJOYMENT,
NON -INFRINGEMENT, MERCHANTABILITY, OR
FITNESS FOR A PARTICULAR PURPOSE.
6.3 Limitation of Liability. UNDER NO
CIRCUMSTANCES WILL GEOTHINQ BE LIABLE
FOR ANY DAMAGE CAUSED BY YOUR USE OF
THE GEOTHINQ PROPERTY. UNDER NO
CIRCUMSTANCES, INCLUDING BUT NOT
LIMITED TO NEGLIGENCE, SHALL GEOTHINQ
OR ITS EMPLOYEES BE LIABLE FOR ANY SPECIAL
OR CONSEQUENTIAL DAMAGES THAT RESULT
FROM YOUR USE OR MISUSE OF, OR THE
INABILITY TO USE THE GEOTHINQ PROPERTY
EVEN IF GEOTHINQ OR ITS AUTHORIZED
REPRESENTATIVE HAS BEEN ADVISED OF THE
POSSIBILITY OF SUCH DAMAGES. UNDER NO
CIRCUMSTANCES WILL GEOTHINQ BE LIABLE
FOR ANY DAMAGE CAUSED BY YOUR USE OF
OR ACCESS TO THE GEOTHINQ PROPERTY. IN
NO EVENT SHALL GEOTHINQ'S TOTAL LIABILITY
TO YOU FOR ALL DAMAGES, LOSSES, AND
CAUSES OF ACTION (WHETHER IN CONTRACT,
TORT, OR OTHERWISE) ARISING UNDER OR
RELATED TO THIS AGREEMENT OR YOUR USE OF
THE GEOTHINQ PROPERTY EXCEED THE
AMOUNT PAID BY YOU TO GEOTHINQ FOR THE
SOFTWARE IN THE PRECEDING TWELVE
MONTHS. THIS ALLOCATION IS REFLECTED IN
THE ECONOMIC TERMS OF THIS AGREEMENT
AND IS AN ESSENTIAL ELEMENT OF THE BASIS OF
THE BARGAIN BETWEEN THE PARTIES. EACH OF
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SOFTWARE LICENSE AGREEMENT
THE LIMITATIONS OF LIABILITY SET FORTH ABOVE
ARE INDEPENDENT OF, AND SHALL SURVIVE THE
FAILURE OF, ANY OTHER PROVISION IN THIS
AGREEMENT (INCLUDING EXCLUSIVE
REMEDIES).
6.4 Errors; Accuracy; Security. Though geothinQ
uses reasonable efforts to ensure otherwise,
the geothinQ Property may contain errors or
other inaccuracies and may not be
complete, accurate, or current. geothinQ
does not guarantee, represent, or warrant
that (i) the geothinQ will be error -free,
accurate, or current, or lii) your use of the
geothinQ Property will be uninterrupted,
error -free, or free from loss corruption, attack,
viruses, interference, hacking, or other
security intrusion, and geothinQ disclaims any
liability relating thereto. USER AGREES THAT
FROM TIME TO TIME GEOTHINQ MAY REMOVE
OR DISABLE ACCESS TO THE GEOTHINQ
PROPERTY FOR INDEFINITE PERIODS OF TIME,
OR CANCEL THE GEOTHINQ PROPERTY, OR
ANY PORTION THEREOF, AT ANYTIME, WITHOUT
NOTICE TO USER. In the event that the
geothinQ Property is inaccessible, geothinQ
will return a pro -rated amount of licensing fee
to the User based on the inaccessible time.
6.5 Good Faith Notification of Access Breach. If
User's access to the Website has been
compromised, User agrees to notify geothinQ
of the breach.
6.6 User's Reliance on Content Accuracy. User
understands and acknowledges that the
Content is derived from sources which are not
updated on a daily basis. Some of the
Content is updated on a quarterly basis and
other parts of the Content could be updated
on a biennial basis or longer. Consequently,
you understand and acknowledge that you
should consult the appropriate professionals
to confirm or deny the accuracy of the
information contained in the Content and
should not rely exclusively on the information
contained in the Content. You agree and
acknowledge that you will rely on
professionals to evaluate the subject property
through appraisals, title searches, and
physical inspections and the Content cannot
substitute for this professional advice.
ARTICLE 7: TERM
Item #6.
7.1 Term. This Agreement shall remain in effect for
a period of one (1) month, one (1) quarter, or
one (1) year from the Effective Date in
accordance with User's specific license of the
geothinQ Property set forth in Schedule A.
7.2 Termination. If you fail, or if geothinQ has
reason to suspect that you have failed, to
comply with any of the provisions of this
Agreement and/or the EULA, including but
not limited to your payment obligations or the
usage restrictions on the geothinQ Property,
user shall be provided a 15 day period to cure
the default. If the default is not cured within
the allotted 15 day period, geothinQ may, in
its sole discretion, with or without notification
to you, terminate this Agreement and disable
your access to the Website. User may
terminate this Agreement for convenience by
providing geothinQ fifteen {15} days prior
notice.
ARTICLE 8: INDEMNITY
geothinQ, nor the User shall be obligated to
defend, indemnify, and hold harmless the other
party, other party's employees and agents, from
and against any and all suits, proceedings,
claims, losses, and damages (including
reasonable attorneys' fees) related to: (i) any
breach by User of this Agreement (ii) any claim
by a third party that arises from User's use or
misuse of the geothinQ Property and (iii) any
claim by a third party that arises from use or
misuse of Your Data.
ARTICLE 9: CONFIDENTIALITY
9.1 Definition. "Confidential Information" shall
mean any information, written or verbal,
owned by geothinQ, its licensors and others
related to its confidential or proprietary
matters including, without limitation, all
information related to inventions, processes,
algorithms, software schematics, code and
source documents, data, formulas, trade
secrets, technical data and know-how,
customer lists, pricing, pricing policies,
operational methods, accounting and
financial information and materials,
marketing information, and other business
affairs. Confidential Information also includes
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SOFTWARE LICENSE AGREEMENT
usernames, passwords, or registration
information received from geothinQ.
9.2 Obligation of Confidence. Except as required
by law, you shall: (a) maintain the
Confidential Information in strict confidence
and take all reasonable steps to prevent its
disclosure to third parties; (b) use at least the
same degree of care as you use in
maintaining the secrecy of your own
Confidential information (but no less than a
reasonable degree of care); and (c) prevent
the removal of any proprietary, confidential,
or copyright notices placed on the
Confidential Information. You may use the
Confidential Information only in connection
with the geothinQ Property. You shall not, at
any time, make any use of the Confidential
Information for any other purpose. You shall
keep the Confidential Information
confidential at all times and shall not disclose
the Confidential Information to any person
including your employees except to your
employees, representatives, advisors, and
agents who have a need to know such
information in connection with assisting you
with the geothinQ Property and who are
required to keep such information
confidential. You shall not acquire any rights,
title, or ownership to the Confidential
Information, except the limited rights to use it
as described in this Agreement. Your
obligations to maintain the confidentiality of
the Confidential Information shall continue
until the end of the Agreement.
9.3 Termination. Upon termination of this
Agreement, you must cease use of
Confidential Information and return or destroy
it. You shall not use the Confidential
Information other than in the course of the
activities permitted hereunder.
ARTICLE 10: MISCELLANEOUS
Nothing herein shall be construed or deemed to
create a joint venture, contract of employment,
or partnership between the parties. geothinQ
reserves the right, at any time and from time to
time, to update, revise, supplement, and
otherwise modify this Agreement and to impose
new or additional rules, policies, terms, or
Item #6.
conditions on User's use of the geothinQ Property.
This Agreement, along with the EULA found on
the Website, contains the complete expression of
the agreement between the parties with respect
to the matters addressed herein and there are no
promises, representations, or inducements
except as herein provided. geothinQ reserves the
right, at any time and from time to time, to
update, revise, supplement, and otherwise
modify this Agreement and to impose new or
additional rules, policies, terms, or conditions on
User's use of the geothinQ Property. Such
updates, revisions, supplements, modifications,
and additional rules, policies, terms, and
conditions (collectively, the "Additional Terms")
will be effective upon written agreement by the
User. If the User does not agree to the new
agreement, geothinQ shall have the right to
terminate this agreement. All Additional Terms
are hereby incorporated into this Agreement by
this reference. geothinQ reserves the right, in its
sole discretion, and from time to time, to change
the format or content of the geothinQ Property
or update, modify or enhance the geothinQ
Property whether or not such changes, updates,
modifications or enhancements would require
changes to User's equipment or computer
systems. All terms and provisions of this
Agreement shall be binding upon and inure to
the benefit of and be enforceable by the
respective successors and permitted assigns of
the parties hereto. Failure by geothinQ to enforce
at any time or for any period of time any provision
or right hereunder shall not constitute a waiver of
such provision or of the right of such party
thereafter to enforce each and every such
provision. This Agreement shall be governed by
and construed and enforced in accordance with
the laws of the state of Georgia. Chatham
County, Georgia, shall be the only proper place
of venue for all suits arising from or related to this
Agreement, and any legal proceedings to
enforce the provisions hereof shall be brought in
the federal or state courts located in Chatham
County, Georgia.
Notwithstanding any other provisions herein or in
the EULA, in the event of any inconsistency with
the terms of this agreement and the EULA , the
terms of this agreement shall control.
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Item #6.
SOFTWARE LICENSE AGREEMENT
Schedule A
Licensee: City of Tybee
Licensee Address: P.O. Box 2749
Tybee Island, GA 31328
Licensee Contact: Peter Gulbronson
Project Description: geothinQ Custom GIS application for City of Tybee
Package: Savannah Metro
City of Tybee GIS Layers:
• Savannah Area Geographic Information System Data - Tybee
o Tybee Short Term Vacation Rentals
o Facilities
o Infrastructure Operations
Land Use Planning
o Lifeguard Stands
o Community Facilities
a Zoning
o Utilities
• Sewer
• Water
• Stormwater
Savannah Metro GIS layers:
• Parcels/Ownership
o Large Land Ownership Boundaries
o Value Per Acre
o Commercial and Residential Sales
o Vacant Land/Vacant Land Transactions
• Zoning
• Points of Interest
• National Wetlands Inventory
• Sea Level Rise and Storm Surge
• Topographic Contours
• NRCS Soils
• FEMA National Flood Hazard Layer
• Census
• USA Data
o Building Footprints
c Civic Boundaries
Conservation Easements and Protected Areas
o EPA Facilities and Non -Attainment Areas
o Economic Opportunity Zones
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Item #6.
SOFTWARE LICENSE AGREEMENT
o Education
o Municipal Boundaries
▪ Protected Areas
o Military Sites
• Transportation
Major Roads
o Ports and Airports
o Traffic Counts
Number of Licenses: Up to 10 Users
License Level: Custom
Duration of License: 1 year
License Start Date: September 1, 2020
License Fee: $12,000
Billing Cycle: Annual
Notes:
geothinQ Custom annual term beginning September 1, 2020
Services shall renew automatically unless written notice to cancel is provided
prior to monthly renewal date.
geothinQ File Share document management capability
Data storage for file and document sharing up to 25 Gigabytes (GB) is included.
Data transfer for file and document sharing up to 100 GB per month is included.
Utility GIS layers are sourced directly from City of Tybee's existing GIS Inventory
which originated from Coastal Regional Commission of Georgia.
All other City of Tybee layers will be obtained on behalf of the City of Tybee from
Savannah Area Geographic Information System.
geothinQ Recommendations to the City of Tybee: It is understood that the City
of Tybee would like to improve the accuracy and expand the attributes of the
water, sewer and storm utility layers. We recommend developing a field
collection workflow where City of Tybee users employ esri's geocollector
application and a Trimble R2 unit. In this scenario, City of Tybee users would
connect directly to the geothinQ layers and create/edit new utility features. It is
also recommended that the City of Tybee consult with Thomas & Hutton for field
collection of storm sewer system to jumpstart the effort. We also recommend
digitizing pipes between these utility features using geothinQ and georectified
City of Tybee as-builts. Georectifying existing as-builts would require a detailed
scope and fee.
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SOFTWARE LICENSE AGREEMENT
Item #6.
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Contractor Affidavit ander O.C.G.A. § 1340-91(b)(3)
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 the City
of Tybee Island, 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). Additionally, the
undersigned contractor will forward notice of the receipt of an affidavit from a
subcontractor to the City of Tybee Island within five business days of receipt. If the
undersigned contractor receives notice of receipt of an affidavit from any sub -
subcontractor that has contracted with a subcontractor to forward, within five business
days of receipt, a copy of such notice to the City of Tybee Island. Contractor hereby
attests that its federal work authorization user identification number and date of
authorization are as follows:
Federal Work Authorization User Identification Number
Date of Authorization
Name of Subcontractor
Name of Project
Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on , , 201 in (city), (state).
Signature of Authorized Officer or Agent
Printed Name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE DAY OF
NOTARY PUBLIC
My Commission Expires:
Item #6.
,201.
CONTRACTOR AFFIDAVIT
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O.C.G.A. § 50-36-1(e)(2) Affidavit
By executing this affidavit under oath, as an applicant for a(n)
contract for a public benefit as referenced in O.C.G.A. § 50-36-1, from the City of Tybee
Island, Georgia, the undersigned applicant verifies one of the following with respect to
my application for a public benefit:
1) I am a United States citizen.
2) I am a legal permanent resident of the United States.
3)
I am a qualified alien or non-immigrant under the Federal Immigration and
Nationality Act with an alien number issued by the Department of
Homeland Security or other federal immigration agency.
My alien number issued by the Department of Homeland Security or other
federal immigration agency is:
The undersigned applicant also hereby verifies that he or she is 18 years of age or older
and has provided at least one secure and verifiable document, as required by O.C.G.A.
§ 50-36-1(e)(1), with this affidavit.
The secure and verifiable document provided with this affidavit can best be classified as:
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 O.C.G.A. § 16-10-20, and
face criminal penalties as allowed by such criminal statute.
Executed in
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
DAY OF , 20
NOTARY PUBLIC
My Commission Expires:
Item #6.
(city), (state).
Signature of Applicant
Printed Name of Applicant
SAVE AFFIDAVIT
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