| Agency: | State Government of Georgia |
|---|---|
| State: | Georgia |
| Type of Government: | State & Local |
| Posted Date: | Apr 16, 2026 |
| Due Date: | May 19, 2026 |
| Solicitation No: | PE-77023-NONST-2026-000000574 |
| Original Source: | Please Login to View Page |
| Contact information: | Please Login to View Page |
| Bid Documents: | Please Login to View Page |
| Event ID | Event Title | Government Entity | Start Date (ET) | End Date (ET) |
| PE-77023-NONST-2026-000000574 | BL079-26 Purchase of Stormwater Pipe on an Annual Contract | Gwinnett County Government |
Apr 16, 2026 @ 03:11 PM
|
May 19, 2026 @ 02:50 PM
|
Start Date: Apr 16, 2026 @ 03:11 PM ET
End Date:
May 19, 2026 @ 02:50 PM ET
BL079-26 Purchase of Stormwater Pipe on an Annual Contract
Please Note:
Ineligible Source List
During the period for which a person/firm has been debarred or suspended, or placed on the Gwinnett County ineligible source list, that person/firm shall not submit or cause to be submitted offers, quotes, bids, or proposals, etc. to Gwinnett County, even when automatically or electronically distributed a notification or notified of a solicitation request. Submittals from firms currently on the Gwinnett County ineligible source list will not be considered.
| Code | Description |
| 65890 | Tubing: Iron, Lead, Magnesium |
| 65895 | Tubing, Steel (Inactive, please see commodity code 658-94 effective January 1, 2016) |
| 65981 | Tubing Fittings, Steel |
| 65880 | Pipe, Steel, Stainless Steel and Wrought Steel |
| 65882 | Pipe, Steel, Wrought (Inactive, please see commodity code 658-80 effective January 1, 2016) |
| 65894 | Tubing, Stainless Steel (See 570-91 for Structural Tubing) |
| 65834 | Pipe, Concrete (Inactive, please see commodity code 658-18 effective January 1, 2016) |
| 65856 | Pipe, Plastic, Including Fiber Reinforced Plastic Pipe, Polybutylene Pipe, PVC |
| 65877 | Pipe, Stainless Steel (Inactive, please see commodity code 658-80 effective January 1, 2016) |
| 21072 | Risers and Cones, Reinforced Concrete |
| 57070 | Steel, Galvanized: Bars, Pipes, Not Plumbing, Plates, Rods, Sheets, Strips, etc. |
| 65805 | Pipe, Aluminum (Inactive, please see commodity code 658-09 effective January 1, 2016) |
| 15059 | Setting Compounds, Pole, Post and Pipe |
| 21027 | Connecting Bands, Corrugated Metal |
| 21029 | Culverts, Corrugated Metal, Including Well Casing Pipe |
Jordan Mitchell
Jordan.Mitchell@GwinnettCounty.com
770-822-5491
April 16, 2026
INVITATION TO BID
BL079-26
The Gwinnett County Board of Commissioners is soliciting competitive sealed bids from qualified
suppliers for the Purchase of Stormwater Pipe on an Annual Contract for the Department of Water
Resources.
Bids should be typed or submitted in ink and returned in a sealed container marked on the outside with the
BL# and Company Name. Bids will be received until 2:50 P.M. local time on May 19, 2026, at the Gwinnett
County Financial Services - Purchasing Division - 2nd Floor, 75 Langley Drive, Lawrenceville, Georgia
30046. Any bid received after this date and time will not be accepted. Bids will be publicly opened and read
at 3:00 P.M.
The bid opening will be virtual ONLY. To access the bid opening virtually, visit the following link:
https://gwinnettgov.webex.com/gwinnettgov/j.php?MTID=m23694808852d07eb3e187a6fe679d520
or dial 408-418-9388 and enter Meeting Number 23434712951##. Apparent bid results will be available
the following business day on the website www.GwinnettCounty.com.
Questions regarding bids should be directed to Jordan Mitchell, Purchasing Associate II, at
Jordan.Mitchell@GwinnettCounty.com or by calling 770-822-5491, no later than May 12, 2026. Bids are
legal and binding upon the vendor when submitted. All bids should be submitted in duplicate.
Gwinnett County does not discriminate on the basis of disability in the admission or access to its programs
or activities. Any requests for reasonable accommodations required by individuals to fully participate in
any open meeting, program or activity of Gwinnett County Government should be directed to the ADA
Coordinator at the Gwinnett County Justice and Administration Center, 770-822-8165.
The written bid documents supersede any verbal or written prior communications between the parties.
Award will be made to the supplier(s) submitting the lowest responsive and responsible bid. Gwinnett
County reserves the right to reject any or all bids to waive technicalities and to make an award deemed in
its best interest. Bids may be split or awarded in entirety. Gwinnett County reserves the option to negotiate
terms, conditions and pricing with the lowest responsive, responsible supplier(s) at its discretion.
Award notification will be posted after award on the County website, www.GwinnettCounty.com and
companies submitting a bid will be notified via email.
We look forward to your bid and appreciate your interest in Gwinnett County.
Jordan Mitchell
Purchasing Associate II
JM/km
The following pages should be returned in duplicate as your bid: Bid Schedule, Pages 5-8
References, Page 9
Contractor Affidavit, Page 10
Code of Ethics, Page 11
BL079-26 Page 2 of 21
I. GENERAL SPECIFICATIONS
A. Award for this contract may be divided into four (4) Sections to the lowest responsive and responsible bidder of
each section.
B. Unless otherwise specified, all items shall be in accordance with the Georgia Department of Transportation
Standard Specifications - Construction of Transportation Systems - 2013 Edition (or latest version) and all
supplements thereto and manufactured at Georgia D.O.T. certified plants. However, Gwinnett County reserves the
right to purchase products that may not strictly conform to the Georgia Department of Transportation
Specifications, provided they meet the specified ASTM requirements.
C. A contract, if awarded, will be on an "Open-End" type to provide for the requirements of Gwinnett County on an "as
needed" basis. It is impossible to determine the exact quantities of items that will be required during the term of
this contract. Unit prices shall include delivery to designated locations within the County.
D. Any defective items delivered to the designated sites will be rejected. The supplier shall remove such defective
items from the site and replace them, at no additional cost to the County, with acceptable items within the same
time frame as specified for original delivery.
E. For the items to be delivered in the most economical manner, the County reserves the right to make multiple awards,
utilizing the supplier that will be most advantageous to the County, price and other factors considered. Supplier
must include a packing slip and request signature of Gwinnett County employee at delivery.
F. The apparent silence of this specification and any supplemental specifications as to any details or the omission
from it of a detailed description concerning any point shall be regarded as meaning that only the best commercial
practices shall prevail, and that only first quality materials are to be utilized. All interpretations of this specification
shall be made upon the basis of this statement: The County interpretation to prevail.
G. Deliveries beyond the Contractual Period - Placing of orders: This contract covers all requirements that may be
ordered, as distinguished from delivered, during the contract term. This is for the purpose of providing continuity
by permitting the County to place orders as requirements arise in the normal course of operations. Accordingly,
any order e-mailed (or received, if forwarded by other means) to the supplier on or before the expiration date of the
contract and providing for delivery within the number of days specified in the contract, shall constitute a valid order.
H. The supplier is required to maintain complete records and make available to County auditors for the life of the
contract.
I. At the time of delivery, a "Certificate of Inspection" shall be submitted to the County certifying that all products and
materials have been inspected at the plant and meet the specifications in item # 1, above.
J. Successful supplier to notify Gwinnett County four (4) hours prior to delivery. For early morning deliveries,
notifications must be made on the afternoon before. Deliveries must be made during normal working hours for
County employees, 7:00 A.M. to 4:00 P.M. (with enough time allowed to unload).
II. PRODUCT SPECIFICATIONS
A. REINFORCED CIRCULAR CONCRETE PIPE
1. Pipe shall be delivered to the designated locations within fourteen (14) days from time order is placed. (With
the exception of Saturdays, Sundays, and holidays).
2. Unit prices shall include sufficient joint bitumastic material or rubber gasket and lubricant for the installation
for each length of pipe delivered.
3. Manufacturer shall provide 3" diameter lifting holes in all concrete pipe 24" diameter (or equivalent) and larger
when given a minimum seven (7) day notice by Gwinnett County. Lifting holes shall be present whenever
practical.
BL079-26 Page 3 of 21
4. Important: All concrete pipe sections must be interchangeable and compatible on both ends of each 8-foot
section with all other CRP, and existing pipe currently in Gwinnett County's drainage system.
5. Pipe shall be Class 3 rated
B. HIGH DENSITY POLYETHYLENE PIPE (HDPE)
1. Pipe shall be delivered to the designated locations within fourteen (14) days from time order is placed. (With
the exception of Saturdays, Sundays, and holidays).
2. Pipe shall comply with AASHTO M294 - 12-30" (300-750 mm).
3. Pipe shall comply with ASTM F2648 - 4-30" (100-750 mm).
4. Ends shall be Watertight (ASTM D3212) Reinforced Integral Bell & Gasketed Spigot
5. Pipe shall be furnished with dual walls, interior shall be smooth walled, and exterior shall be corrugated.
6. Unit prices shall include sufficient high-performance pipe joint lubrication for installation for each segment of
pipe delivered.
C. CORRUGATED (Aluminized) STEEL PIPE AND BANDS SPECIFICATIONS
1. Pipe shall be delivered to the designated locations within fourteen (14) days from time order is placed (with the
exception of Saturdays, Sundays and holidays).
2. All pipe shall be furnished with one or two-piece connector bands of the same material (ie. aluminized pipe will
be furnished with aluminized bands), 14 gauge minimum, meeting the requirements of section 844 of the
standard specifications of the Georgia Department of Transportation. All pipes will be aluminized. No quote for
galvanized pipe will be accepted and will be considered non-responsive to the solicitation. Bituminous coated
bands shall be furnished. The successful bidder will furnish bands and hardware necessary for joining pipe at
no additional charge to Gwinnett County.
III. GDOT SPECIFICATIONS
All pipe must meet the following GDOT specifications:
844.2.01 Corrugated Steel Culvert Pipe and Pipe Arches
Corrugated Steel Culvert Pipe and Pipe Arches shall conform to the requirements of Type I or II culvert
pipe, AASHTO M 36, for the specified sectional dimensions, and thickness. Shop-formed elliptical pipe
and shop strutted pipe shall be furnished where specified.
844.2.02 Bituminous Coated Corrugated Steel Culvert Pipe
Bituminous Coated Corrugated Steel Pipe shall conform to the requirements of AASHTO: M190 for the
specified sectional dimensions, plate thickness and type of bituminous coating. Coupling bands shall
be fully coated with bituminous material. Shop-formed elliptical pipe and shop-strutted pipe shall be
furnished where specified.
844.2.06 Aluminum-Coated (Type 2) Corrugated Steel Pipe
Corrugated steel pipe shall conform to the fabrication requirements of AASHTO: M-36. The steel sheet
used in the fabrication shall conform for the requirements of AASHTO: M-274.
| ITEM # | PIPE SIZE (IN INCHES) | APPROX. | UNIT PRICE (PER LINEAR FT.) (B) | TOTAL PRICE (A * B = TOTAL PRICE) | ||
|---|---|---|---|---|---|---|
| ANNUAL | ||||||
| QTY | ||||||
| (A) | ||||||
| Section A: Reinforced Circular Concrete Pipe | ||||||
| 1 | 15" (8 ft. laying length) | 160 LF | $ /lf | $ | ||
| 2 | 18" (8 ft. laying length) | 672 LF | $ /lf | $ | ||
| 3 | 24" (8 ft. laying length) | 416 LF | $ /lf | $ | ||
| 4 | 30" (8 ft. laying length) | 48 LF | $ /lf | $ | ||
| 5 | 36" (8 ft. laying length) | 48 LF | $ /lf | $ | ||
| 6 | 42" (8 ft. laying length) | 48 LF | $ /lf | $ | ||
| 7 | 48" (8 ft. laying length) | 48 LF | $ /lf | $ | ||
| 8 | 54" (8 ft. laying length | 8 LF | $ /lf | $ | ||
| 9 | 60" (8 ft. laying length) | 8 LF | $ /lf | $ | ||
| 10 | 66" (8 ft. laying length) | 8 LF | $ /lf | $ | ||
| 11 | 72" (8 ft. laying length) | 8 LF | $ /lf | $ | ||
| SECTION A TOTAL | $ | |||||
| Section B: High Density Polyethylene Pipe (HDPE) (in accordance with ASTM STD F2648) | ||||||
| 1 | 12" (20 ft. laying length) | 20 LF | $ /lf | $ | ||
| 2 | 15" (20 ft. laying length) | 200 LF | $ /lf | $ | ||
| 3 | 18" (20 ft. laying length) | 200 LF | $ /lf | $ | ||
| 4 | 24" (20 ft. laying length) | 100 LF | $ /lf | $ | ||
| SECTION B TOTAL | $ |
| UNIT PRICE |
|---|
| (PER LINEAR FT.) |
| (B) |
| ITEM |
|---|
| # |
| PIPE SIZE |
|---|
| (IN INCHES) |
| TOTAL PRICE |
|---|
| (A * B = TOTAL PRICE) |
BL079-26 Page 4 of 21
FAILURE TO RETURN THIS PAGE AS PART OF BID DOCUMENT MAY RESULT IN REJECTION.
BID SCHEDULE
FOB Destination Freight Prepaid & Allowed to:
Gwinnett County Department of Water Resources Central Facility Warehouse 684 Winder Hwy, Lawrenceville, GA 30045 or
Gwinnett County Department of Transportation, 620 Winder Hwy, Lawrenceville, GA 30045
APPROX.
UNIT PRICE
ITEM PIPE SIZE ANNUAL TOTAL PRICE
(PER LINEAR FT.)
# (IN INCHES) QTY (A * B = TOTAL PRICE)
(B)
(A)
Section A: Reinforced Circular Concrete Pipe
1 15" (8 ft. laying length) 160 LF $ /lf $
2 18" (8 ft. laying length) 672 LF $ /lf $
3 24" (8 ft. laying length) 416 LF $ /lf $
4 30" (8 ft. laying length) 48 LF $ /lf $
5 36" (8 ft. laying length) 48 LF $ /lf $
6 42" (8 ft. laying length) 48 LF $ /lf $
7 48" (8 ft. laying length) 48 LF $ /lf $
8 54" (8 ft. laying length 8 LF $ /lf $
9 60" (8 ft. laying length) 8 LF $ /lf $
10 66" (8 ft. laying length) 8 LF $ /lf $
11 72" (8 ft. laying length) 8 LF $ /lf $
SECTION A TOTAL $
Section B: High Density Polyethylene Pipe (HDPE) (in accordance with ASTM STD F2648)
1 12" (20 ft. laying length) 20 LF $ /lf $
2 15" (20 ft. laying length) 200 LF $ /lf $
3 18" (20 ft. laying length) 200 LF $ /lf $
4 24" (20 ft. laying length) 100 LF $ /lf $
SECTION B TOTAL $
COMPANY NAME
| ITEM # | PIPE SIZE (IN INCHES) | APPROX. | UNIT PRICE | TOTAL PRICE (A * B = TOTAL PRICE) | ||||
|---|---|---|---|---|---|---|---|---|
| ANNUAL QTY | (PER LINEAR FT.) | |||||||
| (A) | (B) | |||||||
| Section C: Corrugated Metal Full Round Pipe 2 2/3" X 1/2" Corrugation - Annular End - Aluminized | ||||||||
| 1 | 12" - 14 Guage | 40 LF | $ /lf | $ | ||||
| 2 | 15" - 14 Guage | 620 LF | $ /lf | $ | ||||
| 3 | 18" - 14 Guage | 1,320 LF | $ /lf | $ | ||||
| 4 | 21" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 5 | 24" - 14 Guage | 660 LF | $ /lf | $ | ||||
| 6 | 30" - 14 Guage | 60 LF | $ /lf | $ | ||||
| 7 | 36" - 14 Guage | 200 LF | $ /lf | $ | ||||
| 8 | 42" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 9 | 48" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 10 | 15" CMP Flared End Section | 18 EA | $ /ea | $ | ||||
| 11 | 18" CMP Flared End Section | 28 EA | $ /ea | $ | ||||
| 12 | 24" CMP Flared End Section | 16 EA | $ /ea | $ | ||||
| SECTION C TOTAL | $ |
| ITEM |
|---|
| # |
| PIPE SIZE |
|---|
| (IN INCHES) |
| TOTAL PRICE |
|---|
| (A * B = TOTAL PRICE) |
BL079-26 Page 5 of 21
FAILURE TO RETURN THIS PAGE AS PART OF BID DOCUMENT MAY RESULT IN REJECTION.
BID SCHEDULE (CONTINUED)
APPROX. UNIT PRICE
ITEM PIPE SIZE TOTAL PRICE
ANNUAL QTY (PER LINEAR FT.)
# (IN INCHES) (A * B = TOTAL PRICE)
(A) (B)
Section C: Corrugated Metal Full Round Pipe 2 2/3" X 1/2" Corrugation - Annular End - Aluminized
1 12" - 14 Guage 40 LF $ /lf $
2 15" - 14 Guage 620 LF $ /lf $
3 18" - 14 Guage 1,320 LF $ /lf $
4 21" - 14 Guage 20 LF $ /lf $
5 24" - 14 Guage 660 LF $ /lf $
6 30" - 14 Guage 60 LF $ /lf $
7 36" - 14 Guage 200 LF $ /lf $
8 42" - 14 Guage 20 LF $ /lf $
9 48" - 14 Guage 20 LF $ /lf $
10 15" CMP Flared End Section 18 EA $ /ea $
11 18" CMP Flared End Section 28 EA $ /ea $
12 24" CMP Flared End Section 16 EA $ /ea $
SECTION C TOTAL $
COMPANY NAME
| ITEM # | PIPE SIZE (IN INCHES) | APPROX. | UNIT PRICE | TOTAL PRICE (A * B = TOTAL PRICE) | ||||
|---|---|---|---|---|---|---|---|---|
| ANNUAL QTY | (PER LINEAR FT.) | |||||||
| (A) | (B) | |||||||
| SECTION D: Corrugated Metal Full Round Pipe 3" X 1" or 5" X 1" Corrugation - Annular End - Aluminized | ||||||||
| 1 | 54" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 2 | 60" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 3 | 66" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 4 | 72" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 5 | 78" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 6 | 84" - 14 Guage | 20 LF | $ /lf | $ | ||||
| 7 | 90" - 14 Guage | 20 LF | $ /lf | $ | ||||
| SECTION D TOTAL | $ | |||||||
| OVERALL TOTAL (SECTIONS A + B + C + D) | $ |
| ITEM |
|---|
| # |
| PIPE SIZE |
|---|
| (IN INCHES) |
| TOTAL PRICE |
|---|
| (A * B = TOTAL PRICE) |
BL079-26 Page 6 of 21
FAILURE TO RETURN THIS PAGE AS PART OF BID DOCUMENT MAY RESULT IN REJECTION.
BID SCHEDULE (CONTINUED)
APPROX. UNIT PRICE
ITEM PIPE SIZE TOTAL PRICE
ANNUAL QTY (PER LINEAR FT.)
# (IN INCHES) (A * B = TOTAL PRICE)
(A) (B)
SECTION D: Corrugated Metal Full Round Pipe 3" X 1" or 5" X 1" Corrugation - Annular End - Aluminized
1 54" - 14 Guage 20 LF $ /lf $
2 60" - 14 Guage 20 LF $ /lf $
3 66" - 14 Guage 20 LF $ /lf $
4 72" - 14 Guage 20 LF $ /lf $
5 78" - 14 Guage 20 LF $ /lf $
6 84" - 14 Guage 20 LF $ /lf $
7 90" - 14 Guage 20 LF $ /lf $
SECTION D TOTAL $
OVERALL TOTAL (SECTIONS A + B + C + D) $
COMPANY NAME
BL079-26 Page 7 of 21
FAILURE TO RETURN THIS PAGE AS PART OF BID DOCUMENT MAY RESULT IN REJECTION.
BID SCHEDULE (CONTINUED)
NOTE: Pricing for freight shall be included in unit pricing.
Gwinnett County requires pricing to remain firm for the duration of the initial term of the contract. Failure to hold firm pricing
for the initial term of the contract will be sufficient cause for Gwinnett County to declare bid non-responsive. Contract to
begin August 24, 2026 or upon Board of Commissioners approval.
Unless otherwise noted, quoted prices will remain firm for four (4) additional 12-month periods. If a percentage
increase/decrease is a part of the renewal options, please note this in the space provided together with an explanation.
Renewal Option 1: % Increase % Decrease Explanation
Renewal Option 2: % Increase % Decrease Explanation
Renewal Option 3: % Increase % Decrease Explanation
Renewal Option 4: % Increase % Decrease Explanation
Termination for Cause: The County may terminate this agreement for cause upon ten days prior written notice to the
contractor of the contractor's default in the performance of any term of this agreement. Such termination shall be without
prejudice to any of the County's rights or remedies by law.
Termination for Convenience: The County may terminate this agreement for its convenience at any time upon 30 days
written notice to the contractor. In the event of the County's termination of this agreement for convenience, the contractor
will be paid for those services actually performed. Partially completed performance of the agreement will be compensated
based upon a signed statement of completion to be submitted by the contractor, which shall itemize each element of
performance.
Bidder has examined Bid Document Package and following addenda:
No. Dated No. Dated
No. Dated No. Dated
Certification Of Non-Collusion In Bid Preparation
Signature Date
In compliance with the attached specifications, the undersigned acknowledges all requirements outlined in the
"Instructions to Vendors" and all documents referred to therein, if this bid is accepted by the Board of Commissioners
within ninety (90) days of the date of bid opening, to furnish any or all of the items upon which prices are quoted, at the
price set opposite each item, delivered to the designated point(s) within the time specified in the fee schedule. By
submission of this bid, I understand that Gwinnett County uses Electronic Payments for remittance of goods and services.
Vendors should select their preferred method of electronic payment upon notice of award. For more information on
electronic payments, please refer to the Electronic Payment information in the instructions to vendors.
Legal Business Name
Address
Does your company currently have a location within Gwinnett County? Yes No
Representative Signature Printed Name
Telephone Number Fax Number E-mail Address
Contact Person (if someone other than the authorized representative listed above)
Telephone Number Fax Number E-mail Address
BL079-26 Page 8 of 21
FAILURE TO RETURN THIS PAGE AS PART OF YOUR BID DOCUMENT MAY RESULT IN REJECTION OF BID.
REFERENCES
Gwinnett County requests a minimum of three (3) references where work of a similar size and scope has been
completed.
Note: References should be customized for each project, rather than submitting the same set of references for
every project bid. The references listed should be of similar size and scope of the project being bid on. Do not
submit a project list in lieu of this form.
1. Company Name
Brief Description of Project
Completion Date
Contract Amount $ Start Dates
Contact Person Telephone
E-Mail Address
2. Company Name
Brief Description of Project
Completion Date
Contract Amount $ Start Date
Contact Person Telephone
E-Mail Address
3. Company Name
Brief Description of Project
Completion Date
Contract Amount $ Start Date
Contact Person Telephone
E-Mail Address
Company Name
BL079-26, Purchase of Stormwater Pipe on an Annual Contract
CONTRACTOR AFFIDAVIT AND AGREEMENT
(THIS FORM SHOULD BE FULLY COMPLETED AND RETURNED WITH YOUR SUBMITTAL)
By executing this affidavit, the undersigned contractor verifies its compliance with The Illegal Immigration Reform
Enhancements for 2013, stating affirmatively that the individual, firm, or corporation which is contracting with the Gwinnett County
Board of Commissioners 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 United States Department of Homeland Security] to verify information of newly
hired employees, pursuant to the Immigration Reform and Control Act, in accordance with the applicability provisions and
deadlines established therein.
The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the
physical performance of services or the performance of labor pursuant to this contract with the Gwinnett County Board of
Commissioners, contractor will secure from such subcontractor(s) similar verification of compliance with the Illegal Immigration
Reform and Enforcement Act on the 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 Gwinnett
County Board of Commissioners at the time the subcontractor(s) is retained to perform such service.
_________________________________________ _____________________________________
E-Verify * User Identification Number Date Registered
_________________________________________
Legal Company Name
_________________________________________
Street Address
_________________________________________
City/State/Zip Code
_____________________________________ _____________________________________
BY: Authorized Officer or Agent Date
(Contractor Signature)
For Gwinnett County Use Only:
__________________________________________
Title of Authorized Officer or Agent of Contractor
Document ID #________________
___________________________________________ Issue Date: ___________________
Printed Name of Authorized Officer or Agent
Initials: ______________________
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
_______ DAY OF ______________________, 20_______
________________________________________________
Notary Public
My Commission Expires: ___________________________
* As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is "E-Verify" operated by the U.S. Citizenship and
Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA).
BL079-26, Purchase of Stormwater Pipe on an Annual Contract
CODE OF ETHICS AFFIDAVIT
PLEASE RETURN THIS FORM COMPLETED WITH YOUR SUBMITTAL. SUBMITTED FORMS ARE REQUIRED PRIOR TO
EVALUATION.
In accordance with Section 54-33 of the Gwinnett County Code of Ordinances the undersigned bidder/proposer makes
the following full and complete disclosure under oath, to the best of their knowledge, of the name(s) of all elected
officials whom it employs or who have a direct or indirect pecuniary interest in or with the vendor, its affiliates or its
subcontractors:
1. __________________________________________________________________________________________
Company Submitting Bid/Proposal
2. Please select one of the following:
No information to disclose (complete only section 4 below)
Disclosed information below (complete section 3 & section 4 below)
3. If additional space is required, please attach list:
Gwinnett County Elected Official Name Gwinnett County Elected Official Name
Gwinnett County Elected Official Name Gwinnett County Elected Official Name
4. BY:
Authorized Officer or Agent Signature Sworn to and subscribed before me this
day of , 20
Printed Name of Authorized Officer or Agent
Title of Authorized Officer or Agent of Contractor Notary Public
(seal)
Note: See Gwinnett County Code of Ethics Ordinance EO2011, Sec. 54-33. The ordinance
will be available to view in its' entirety at GwinnettCounty.com
With Free Trial, you can:
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