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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 PAGE 1 1F 9 - Page 43- 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 PAGE 2 OF 9 _ Page 44_ 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, PAGE 3 OF 9 - Page 45 - 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 PAGE 4 OF 9 - Page 46 - 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 PAGE 5 OF 9 - Page 47- 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. PAGE6OF9 - Page 48- 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 PAGE 7 OF 9 - Page 49 - 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. PAGE $ OF 9 - Page 50- SOFTWARE LICENSE AGREEMENT Item #6. PAGE 9 OF 9 - Page 51 - 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 - Page 52- 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 - Page 53 -