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ATTACHMENTS AND REQUIRED INFORMATION Contact Information: Gordon County Board of Commissioners Attn: Charmon VanDyke, Purchasing Manager 215 North Wall Street Calhoun, Georgia 30701 [EMAIL REDACTED] Phone: [PHONE REDACTED] Attachments and Required Information I 1 ---PAGE BREAK--- ATTACHMENT 1-A: OVERVIEW BIDDER INFORMATION Company Company Authorized By (typed or printed Authorized Telephone Email Company’s Web REMITTANCE INFORMATION (where payments should be sent) Remit to Remit to Contact Tax ID: Tax Business Type: □Individual □Business □Misc. MBE/DBE/WBE STATUS (check appropriate box(es)) □African American □Hispanic □Native American □Asian American □Disabled □Veteran □Woman-Owned □Not-Applicable Number of years doing business under this name? Number of permanent employees? Have you ever defaulted on a contract? If so, explain How many contracts has your firm completed under a GMP arrangement as a CM at Risk only within the last five years? What is your firm’s current bonding capacity and bonding rate? Attachments and Required Information I 2 ---PAGE BREAK--- ATTACHMENT 2-A: RELEVANT PROJECTS List all similar projects completed under the firm’s name in the last five years by project name, building type, building size, and project cost. Attachments and Required Information I 3 ---PAGE BREAK--- ATTACHMENT 3-A: SAFETY Provide a copy of your drug use/abuse policy. Who is responsible for your company’s safety program? Describe below your safety program and your safety and experience rating for the past five years. Attachments and Required Information I 4 ---PAGE BREAK--- ATTACHMENT 4-A: PROJECT TEAM Name Position Years with Firm Years of Experience in Construction Attachments and Required Information I 5 ---PAGE BREAK--- ATTACHMENT 5-A: CHANGE ORDERS Provide a list of similar projects and include a listing of the value of the project and a total of all change orders (described) in the last five years. Be sure to include in your description the reason for the change order(s) and all fees and costs that were added to the project due to the change order. Additionally, provide a narrative describing your firm’s approach to change orders and what processes you have in place to either eliminate or decrease the number of change orders needed for a project. Attachments and Required Information I 6 ---PAGE BREAK--- ATTACHMENT 6-A: AFFIDAVIT OF NON-COLLUSION I certify under penalty of perjury: 1. That I am the Responder (if the Responder is an individual), a partner in the company (if the Responder is a partnership), or an officer or employee of the responding corporation having authority to sign on its behalf (if the Responder is a corporation); 2. That the proposal submitted in response to the Gordon County Board of Commissioners has been arrived at by the Responder independently and has been submitted without collusion with and without any agreement, understanding or planned common course of action with, any other Responder of materials, supplies, equipment or services described in the Statement of Work, designed to limit fair and open competition; 3. That the contents of the proposal have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any such persons prior to the official opening of the proposals; 4. That neither I, nor any member or agent of this company or corporation, have or will contact other companies regarding participation in any future reverse auction conducted under this program; and 5. That I am fully informed regarding the accuracy of the statements made in this affidavit. Responder's Name: Firm Name: Authorized Signature: NOTARY Subscribed and sworn to me this of Printed Name of Notary Public: My commission expires: [Notary Seal] Attachments and Required Information I 7 ---PAGE BREAK--- ATTACHMENT 7-A: PROPOSED FEES Please provide figures that are all-inclusive and comprehensive which include all charges. 1. Project Planning/Pre-construction Services: For professional consulting services prior to construction commencement, providing cost estimating services, scheduling services, value engineering constructability and related services described in this Request. The fixed fee for Pre-Construction services is inclusive of all incidental and direct expenses including, but not limited to, travel sustenance, reproduction, salaries, wages, office expenses and fees to trade contractors and vendors assisting the construction manager as defined in this Request. Should the Owner not authorize the Construction Manager to proceed with construction, the fee for Pre-Construction Services is the maximum amount the owner is liable to the Construction Manager. Provide the total fee for the following: a. Project Cost ranging between $10,000.00 and $500,000.000 b. Project Cost ranging between $500,001.00 and $1,000,000.00 c. Project Cost ranging between $1,000,001.00 and $3,000,000.00 d. Project Cost ranging between $3,000,001.00 and $5,000,000.00 2. Bidding and Award/Construction Services: If authorized by the Owner to proceed with construction, the Construction Manager will execute the work and be reimbursed for the actual costs as defined in the proposed Construction Management Agreement, and a Construction Manager’s fee. The fee shall be submitted as a percentage of the actual construction costs including General Conditions. If the Owner and Construction Manager agree upon a Guaranteed Maximum Price, the Construction Manager’s fee shall be converted to a fixed dollar amount and will include any unpaid Pre-Construction service fees. Provide the total fee per month for the following: a. Project Cost ranging between $10,000.00 and b. Project Cost ranging between $500,001.00 and c. Project Cost ranging between $1,000,001.00 and d. Project Cost ranging between $3,000,001.00 and Provide any notes and/or clarifications in the space below: Attachments and Required Information I 8 ---PAGE BREAK--- REFERENCES Please list references of contracts that are similar to this project. Please provide the name of the project, the date of construction, location of project, contact person, and a contact phone number and email address. Attachments and Required Information I 9 ---PAGE BREAK--- INSURABILITY STATEMENT Please check appropriate item(s): [ ] By submission of this form, this firm confirms the ability to acquire and maintain the required levels of insurance as outlined in the bid document. It is the understanding of this firm that proof of Insurance must be provided prior to contract execution and maintained throughout the entire term of the contract. Company Name: Authorized By: Authorized Signature: NOTARY Subscribed and sworn to me this of Printed Name of Notary Public: My commission expires: [Notary Seal] Attachments and Required Information I 10 ---PAGE BREAK--- CONTRACTOR’S AFFIDAVIT AND AGREEMENT 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 on behalf of Gordon County Board of Commissioners 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). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows: Federal Work Authorization User ID Number Date of Authorization Name of Contractor Name of Project GORDON COUNTY BOARD OF COMMISSIONERS Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent NOTARY Subscribed and sworn to me this of Printed Name of Notary Public: My commission expires: [Notary Seal] Attachments and Required Information I 11