Invitation to bid (itb)/Request for Quote (rfq) Form

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Cabinet

Striping

Pedestrian

Striping

Description	Yes	No	N/A
Correct pushbutton/ sign installed at correct height and operational	☐	☐	☐
Inserts installed and the count down operates correctly	☐	☐	☐

Miscellaneous

Striping

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Intersection Diagram

Street name

North Arrow

Street name

Notes:

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Signal Head Key

welcome to the gdot

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT

Contractor’s Name:
Address:
Solicitation/Contract No.:	Click here to enter text.
Solicitation /Contract Name:	Click here to enter text.

CONTRACTOR AFFIDAVIT
By executing this affidavit, the undersigned Contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, entity or corporation which is engaged in the physical performance of services on behalf of the Georgia Department of Transportation 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 sub-Contractors who present an affidavit to the Contractor with the information required by O.C.G.A. § 13-10-91(b). 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

(EEV/E-Verify Company Identification Number)

___________________________________________

Name of Contractor
I hereby declare under penalty of perjury that the
foregoing is true and correct
____________________________________________ _______________________________________

Printed Name (of Authorized Officer or Agent of Title (of Authorized Officer or Agent of

Contractor) Contractor)
____________________________________________ ___________________________

Signature (of Authorized Officer or Agent) Date Signed

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE
_____ DAY OF ______________________, 201_

________________________________________ [NOTARY SEAL]

Notary Public
My Commission Expires: ___________________
welcome to the gdot

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT

Contractor’s Name:

Sub-Contractor’s (Your) Name

Sub-Contractor’s Address:

Solicitation/Contract No.:

Click here to enter text.

Solicitation /Contract Name:

Click here to enter text.

SUB-CONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. §13-10-91, stating affirmatively that the individual, entity or corporation which is engaged in the physical performance of services under a contract with ___________________________ (name of Contractor) on behalf of the Georgia Department of Transportation 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 subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the subcontractor with the information required by O.C.G.A. § 13-10-91(b).

Additionally, the undersigned subcontractor will forward notice of the receipt of an affidavit from a sub-subcontractor to the contractor within five business days of receipt. If the undersigned subcontractor receives notice that a sub-subcontractor has received an affidavit from any other contracted sub-subcontractor, the undersigned subcontractor must forward, within five business days of receipt, a copy of the notice to the contractor. Subcontractor 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

(EEV/E-Verify Company Identification Number)

___________________________________________

Name of Sub-Contractor
I hereby declare under penalty of perjury that the foregoing is true and correct
____________________________________________ _______________________________________

Printed Name (of Authorized Officer or Agent of Title (of Authorized Officer or Agent of

Contractor) Contractor)
____________________________________________ ___________________________

Signature (of Authorized Officer or Agent) Date Signed

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE
_____ DAY OF ______________________, 201_

________________________________________ [NOTARY SEAL]

Notary Public
My Commission Expires: ___________________

DEPARTMENT OF TRANSPORTATION

FORM GDOT–SP402 ITB Bid Bond

STATE OF GEORGIA

BID BOND

PRINCIPAL (BIDDER)

SURETY

INVITATION TO BID:

COUNTY(IES)

b-w gdot seal

AMOUNT OF BOND

DATE BOND EXECUTED

$1000.00

KNOW ALL MEN BY THESE PRESENTS: That we, the Principal (Bidder) and Surety named above are held and firmly bound unto the DEPARTMENT OF TRANSPORTATION, STATE OF GEORGIA, hereinafter called the Obligee in the full and just sum of the amount stated above in lawful money of the United States of America, to be paid to the Obligee, to which payment well and truly to be made we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally and firmly by these presents.

WHEREAS, the Principal named above is herewith submitting a Proposal to the Obligee for the work identified by the project number(s) stated above and located in the county (ies) stated above.

UNLESS SPECIFICALLY MODIFIED BY A SPECIAL PROVISION, NOW, THEREFORE, THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, that if the said Principal is awarded the contract for which the proposal is submitted, said Principal shall, pursuant to Paragraph #104 of the Maintenance Master Services Agreement, after contract award, within ten (10) days after the contract forms for the above noted Invitation to Bid have been mailed to the Principal execute said contract and shall give satisfactory contract bond (on forms supplied by Obligee) which guarantees complete performance under the contract and the payment of all legal debts. Otherwise, the Bid Bond shall remain in full force and effect.

IN WITNESS WHEREOF THE PARTIES HAVE SET THEIR HANDS AND AFFIXED THEIR SEALS:

ATTEST BY SECRETARY OR ASST. SECRETARY (1)

CORPORATE PRINCIPAL (1)

(SEAL)

(SEAL)

(SEAL)

ATTEST BY SECRETARY OR ASST. SECRETARY (2)

CORPORATE PRINCIPAL (2)

(SEAL)

(SEAL)

(SEAL)

WITNESS (1)

INDIVIDUAL OR PARTNERSHIP PRINCIPAL (1)

(SEAL)

WITNESS (1)

BY OWNER OR PARTNER (1)

(SEAL)

WITNESS (2)

INDIVIDUAL OR PARTNERSHIP PRINCIPAL (2)

(SEAL)

WITNESS (2)

BY OWNER OR PARTNER (2)

(SEAL)

NOTARY PUBLIC

SURETY

(SEAL)

BY AGENT OR ATTORNEY-IN-FACT

MY COMMISSION EXPIRES:

NOTE: Surety must be company acceptable as Surety on Federal Bonds. Power of Attorney showing authority of Surety’s Agent or Attorney-in-Fact shall be furnished. Affix Corporate Seals of Bidder (if a corporation) and Surety. Secretary or Assistant Secretary must attest signature of corporate officer.

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