Bridge Repairs

BIDDER'S CHECKLIST
Company Name _________________________________________________________________________________
Please indicate you have completed the following documentation and submit in the following order.
Bidder's Checklist
Bidder's Information
Bid Response Form
References
Addenda Acknowledgement
Certificate of Non-Collusion
Georgia's Security & Immigration Compliance Act Contractor A(cid:431)idavit (E-Verify)
_________________________________
Signature
__________________
Date
THIS PAGE MUST BE COMPLETED & SUBMITTED AS PART OF YOUR BID

BIDDER'S INFORMATION
Legal Business Name ____________________________________________________ TIN No. ________________
Type of Business: Corporation Partnership Individual Other (specify) _________________
Years in Business under Name stated above ______________________
Physical Address ______________________________________________________________________________
Street City State ZipCode
Billing Address ______________________________________________________________________________
Street City State ZipCode
Primary Contact Name __________________________________ Title ___________________________________
Email _____________________________________________________ Phone No. _________________________
Alt. Contact Name __________________________________ Title ___________________________________
Email _____________________________________________________ Phone No. _________________________
Company Website ___________________________________________________________________________________
Do you have an occupational tax license in the state of Georgia? Yes No
Licensed by City/State? ____________________ Occupational Tax License No. ________________
General nature of work performed by your Company
THIS PAGE MUST BE COMPLETED & SUBMITTED WITH BID

ITB# 26-05-014
Bridge Repairs
Bid Response Form
Please use this Bid Schedule to indicate the cost for this project. Your total cost must include ALL fees, travel, and any other
costs needed to complete this project.
I cer(cid:415)fy that the proposed cost(s) are accurate and reflect any applicable discounts, and that the company I represent will
deliver the services and related items for this proposed amount.
By submission of this response, I also cer(cid:415)fy that the RESPONDENT has read and understands all the requirements
contained in this solicita(cid:415)on and agrees to be bound by all terms and condi(cid:415)ons contained in this solicita(cid:415)on without
excep(cid:415)on.
We have included all documents required per the RESPONDENT Instruc(cid:415)ons and Specifica(cid:415)ons.
The RESPONDENT has availed itself of every opportunity to understand the requirements of this solicita(cid:415)on. Therefore,
the undersigned respec(cid:414)ully submits this BID and any a(cid:425)achments, if required.
Therefore, the undersigned respec(cid:414)ully submits this response and any a(cid:425)achments, if required.
Simonton Bridge Road at Middle Oconee River Bid Price
Clean & paint beams & bearings $ __________________
Repair scour at bent 4 column 1 footing exposed $ __________________
Repair spall with exposed rebar in cape at Bent 3 $ __________________
Repair spalling in the edge seams with exposed rebar in span 4 $ __________________
Replace expansion joint seams $ __________________
Traffic Control/Mobilization $ __________________
Total Price $ __________________
Barnett Shoals Road at Oconee River Bid Price
Repair scour around footings at bents 2,3 & 4 $ __________________
Replace expansion joint seams $ __________________
Traffic Control/Mobilization $ __________________
Total Price $ __________________
________________________________________ ______________________
Signature Date

REFERENCES
Please list three (3) references of current customers who can verify the quality of service your company
provides. The County prefers customers of similar size and scope of work to this project/contract.
Reference 1
Government/Company Name _________________________________________________________
Contract Period _______________________
Contract Person ____________________________ Contact Title _________________________
Phone No. ___________________ Email ____________________________________________
Scope of Work ____________________________________________________________________
Reference 2
Government/Company Name _________________________________________________________
Contract Period _______________________
Contract Person ____________________________ Contact Title _________________________
Phone No. ___________________ Email ____________________________________________
Scope of Work ____________________________________________________________________
Reference 3
Government/Company Name _________________________________________________________
Contract Period _______________________
Contract Person ____________________________ Contact Title _________________________
Phone No. ___________________ Email ____________________________________________
Scope of Work ____________________________________________________________________
THIS PAGE MUST BE COMPLETED & SUBMITTED AS PART OF YOUR BID

ADDENDA ACKNOWLEDGEMENT
The Respondent has examined and carefully studied the Invitation to Bid and the following Addenda,
receipt of all of which is herby acknowledged:
Addendum Number _____________________________ Date ____________
Addendum Number _____________________________ Date ____________
Addendum Number _____________________________ Date ____________
Addendum Number _____________________________ Date ____________
Authorized Signature Date
Printed Name
Respondent must acknowledge any issued addenda. Bids which fail to acknowledge the Respondent's receipt of any
addenda may result in the rejection of the bid if the addendum contains information that substantively changes the
Owner's requirements.
THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH BID

CERTIFICATE OF NON-COLLUSION
BRIDGE REPAIRS
ITB# 26-05-014
STATE OF GEORGIA
OCONEE COUNTY BOARD OF COMMISSIONERS
Being first duly sworn, deposes and says that he is
(sole owner, partner, president, secretary, etc.)
the party making the forgoing Proposal or Bid; that such ITB is genuine and not collusive or sham; that said Respondent
has not colluded, conspired, connived, or agreed, directly or indirectly, with any Respondent or person, to put in a sham
Response, or that such other person shall refrain from Responding, and has not in any manner, directly or indirectly sought
by agreement or collusion, or communication or conference, with any person, to fix the Response price of affiant or any
other Respondent, or to fix any overhead, profit or cost element of said Response Price, or of that of any other Respondent,
or to secure any advantage against Oconee County, or any other person interested in the proposed Agreement; and all
statements in said Proposal or Bid are true; and further, that such Respondent has not, directly or indirectly, submitted
this Response, or the contents thereof, or divulged information or data relative thereto any association or to any member
or agent thereof.
(Affiant)
Subscribed and Sworn to before me this _______ Day of ___________, 20_____.
(Notary Public in and for)
(County)
My Commission expires ___________, 20_____.
(SEAL)
THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH BID

Contractor Affidavit under O.C.G.A. 13-10-91(b)(1)
The undersigned contractor ("Contractor") executes this affidavit to comply with O.C.G.A. 13-10-91 related to
any contract to which Contractor is a party that is subject to O.C.G.A. 13-10-91 and hereby verifies its compliance
with O.C.G.A. 13-10-91, attesting as follows:
a)The Contractor has registered with, is authorized to use and uses the federal work authorization program
commonly known as E-Verify, or any subsequent replacement program;
b) The Contractor will continue to use the federal work authorization program throughout the contract period,
including any renewal or extension thereof;
c)The Contractor will notify the public employer in the event the Contractor ceases to utilize the federal work
authorization program during the contract period, including renewals or extensions thereof;
d) The Contractor understands that ceasing to utilize the federal work authorization program constitutes a
material breach of contract;
e) The Contractor will contract for the 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(a), (b), and (c);
f) The Contractor acknowledges and agrees that this affidavit shall be incorporated into any contract(s) subject
to the provisions of O.C.G.A. 13-10-91 for the project listed below to which Contractor is party after the
date hereof without further action or consent by Contractor; and
g) Contractor acknowledges its responsibility to submit copies of any affidavits, drivers' licenses, and
identification cards required pursuant to O.C.G.A. 13-10-91 to the public employer within five business
days of receipt.
___________________ ___________________
Federal Work Authorization User Identification Number Date of Authorization
________________________________________ ________________________________________
Name 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 ___________, ____ 202__ in __________________ (city), ______________ (state).
_____________________________________ ________________________________________
Signature of Authorized Officer or Agent Printed Name & Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME ON THIS ________ DAY OF _________________, 202__.
_____________________________________
Notary Public
My Commission Expires:
____________________________
THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH BID