Common use of GEORGIA INSTITUTE OF TECHNOLOGY Clause in Contracts

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day) of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3) By executing this affidavit, the undersigned subcontractor 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 (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 Name of Subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia For the use and benefit of Georgia Institute of Technology Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(4) By executing this affidavit, the undersigned sub-subcontractor 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 for (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract) and (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 sub-subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned sub-subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b). The undersigned sub-subcontractor shall submit, at the time of such contract, this affidavit to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Additionally, the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a sub-subcontractor to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Sub- 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 Name of Sub-subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day) of (month), 20 (year) 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 ,20 20___ NOTARY PUBLIC My Commission Expires: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3) By executing this affidavit, the undersigned subcontractor 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 (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 __ Name of Subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia For the use and benefit of Georgia Institute of Technology Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of _(month), 20 20_ _(year) 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 ,20 20_ __ NOTARY PUBLIC My Commission Expires: Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(4) By executing this affidavit, the undersigned sub-subcontractor 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 for (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract) and (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 sub-subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned sub-subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b). The undersigned sub-subcontractor shall submit, at the time of such contract, this affidavit to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Additionally, the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a sub-subcontractor to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Sub- 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 Name of Sub-subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day) of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3) By executing this affidavit, the undersigned subcontractor 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 (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 Name of Subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia For the use and benefit of Georgia Institute of Technology Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(4) By executing this affidavit, the undersigned sub-subcontractor 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 for (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract) and (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 sub-subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned sub-subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b). The undersigned sub-subcontractor shall submit, at the time of such contract, this affidavit to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Additionally, the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a sub-subcontractor to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Sub- 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 Name of Sub-subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of GeorgiaGeorgia For the use and benefit of Georgia Institute of Technology Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: NON-INFLUENCE AFFIDAVIT NON-INFLUENCE AFFIDAVIT COUNTY OF STATE OF I do solemnly swear on my oath that as to the Contract dated , 20 , between (NAME OF CONTRACTOR) and the Owner, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by any employee, officer, or agent of the Owner, or any person connected with the State Government of Georgia in any way whatsoever. This day of , 20 . (L.S.) Signature Title Firm COUNTY OF STATE OF Personally before me, the undersigned authority, appeared (NAME OF PERSON SIGNING THE AFFIDAVIT) who is known to me to be an official of the firm of , (NAME OF CONTRACTOR) and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct. Notary Public My Commission expires This day of , 20 . STATUTORY AFFIDAVIT STATUTORY AFFIDAVIT COUNTY OF STATE OF FROM: Contractor TO: Owner Re: Contract entered into the day of , 20 , between the above-mentioned parties for the construction of Project No. located at KNOW ALL MEN BY THESE PRESENTS:

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day) of (month), 20 (year) 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 ,20 20___ NOTARY PUBLIC My Commission Expires: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3) By executing this affidavit, the undersigned subcontractor 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 (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 __ Name of Subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia For the use and benefit of Georgia Institute of Technology Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of _(month), 20 20_ _(year) 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 ,20 __ NOTARY PUBLIC My Commission Expires: Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(4) By executing this affidavit, the undersigned sub-subcontractor 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 for (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract) and (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 sub-subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned sub-subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b). The undersigned sub-subcontractor shall submit, at the time of such contract, this affidavit to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Additionally, the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a sub-subcontractor to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Sub- 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 Name of Sub-subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day) of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3) By executing this affidavit, the undersigned subcontractor 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 (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 Name of Subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia For the use and benefit of Georgia Institute of Technology Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of (month), 20 (year) 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 ,20 NOTARY PUBLIC My Commission Expires: Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(4) By executing this affidavit, the undersigned sub-subcontractor 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 for (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract) and (name of contractor) on behalf of Board of Regents of the University System of Georgia for the use and benefit of Georgia Institute of Technology, Using Agency (public employer) 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 sub-subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned sub-subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b). The undersigned sub-subcontractor shall submit, at the time of such contract, this affidavit to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Additionally, the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a sub-subcontractor to (name of subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract). Sub- 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 Name of Sub-subcontractor All Georgia Tech Projects Name of Project Board of Regents of the University System of Georgia