HABERSHAM COUNTY Office of County Commissioners 555 Monroe Street, Unit 20, Clarkesville, GA

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1 HABERSHAM COUNTY Office of County Commissioners 555 Monroe Street, Unit 20, Clarkesville, GA REQUEST FOR PROPOSALS Habersham County Office of County Commissioners is soliciting proposals for Aviation Fuel Supplier PROPOSALS DUE: November 7, :00 AM EST SUBMIT PROPOSALS TO: Habersham County Purchasing, Finance Department Aviation Fuel Supplier 555 Monroe Street Unit 20, Clarkesville, GA

2 Office of County Commissioners Aviation Fuel Supplier Proposal Due Wednesday, November 7, :00 AM EST Table of Contents Request for Proposal RFP Timetable Submittal Requirements Qualifications and Experience... 1 Terms & Conditions... 1 Objective 2 Habersham County Airport 2 The Need for Aviation Fuel Supplier 3 Aviation Fuel Specifications 3 Minimum Qualifications 3 Insurance Coverage 4 Selection of Successful Proposer 6 Proposal Deadline 7 Questions and Interpretation 7 Attachment "A" Proposal Form 8 Bidders Declaration 14 Non-Collusion Affidavit 15 Certification of Non-Discrimination 16 W E-Verify Affidavit 18

3 RFP Timetable Description Date RFP released October 10, 2018 Deadline for proposal questions November 2, 2018 at 5:00 PM Submittal deadline Wednesday November 7, 2018 at 10:00 AM EST Tentative award date November 19, 2018 Submittal Requirements Each bidder must submit their proposal, enclosed in a sealed envelope or box, and marked with the bidders name, address and labeled: Aviation Fuel Suppler and addressed to: Habersham County Purchasing, Finance Department 555 Monroe Street, Unit, 20 Clarkesville, GA Proposals shall be received no later than 10:00 AM, Wednesday, November 7, 2018 at Habersham County s Administration Building at 555 Monroe Street, Unit, 20 Clarkesville, GA 30523, at which time and place all proposals will be publicly opened and acknowledged. Qualifications and Experience Proposals must provide the following information to establish the qualifications and experience of the Bidder: 1. Certification that the Bidder or its officers or any predecessor companies are not under any part of the Bankruptcy Act nor ever filed under the Bankruptcy Act within the previous seven years. Terms & Conditions 1. Submittals received after the due date and time will not be considered. Modifications received after the due date will not be considered. Habersham County Government assumes no responsibility for the premature opening of a proposal not properly addressed and identified, and/or delivered to the improper designation. 2. Habersham County reserves the right to reject any and all proposals. The County will not discriminate against any vendor submitting a bid because of race, creed, color, national origin, or handicap. 3. Habersham County reserves the right to exercise discretion and apply its judgment with respect to all bid proposals submitted. The County also reserves the right to reject all proposals, either in part or in its entirety, or to request and obtain, from one or more of consulting firms submitting proposals, supplementary information as may be necessary for County staff to analyze the bids proposals. 1

4 4. Habersham County may elect to award a contract in multiple phases, as is deemed to be in the County s best interest. Should the County award projects in phases, the County reserves the right to award the phases to the same firm. All proposals submitted in response to the RFP become property of Habersham County and public records and will be subject to public view. 5. All proposals shall constitute, for a period of 90 calendar days from date of award, an irrevocable offer to provide the goods/services set forth in the specifications and proposal. 6. At no time shall the successful vendor reproduce Habersham County s logo, return address or any other identifying or proprietary information for any other purpose. Also, the vendor shall not use Habersham County in any advertisements without the written consent of the County. 7. Habersham County Government is tax exempt. The selected vendor will be provided with Habersham County s Sales and Use Tax Certificate of Exemption number upon request. 8. The initial term of a contract award as a result of this RFP shall be from December 1, 2018 through November 30, The contract may be renewed according to the terms stated herein for two (2) additional one (1) year periods. For any of the two (2) potential Contract Agreement Extensions the Vendor may request an increase provided the increase does not exceed ten percent (10%) and must be agreeable to both parties. Additionally, Habersham County has the right to cancel this contract with 60 days written notice upon unsatisfactory service. 9. A complete IRS form W-9 must be submitted with the bid packet to be considered completed. 10. Selected vendor will be required to provide a Certification of Insurance as proof of liability and workman s compensation insurance while under contract with Habersham County. Workman s Compensation Insurance should be as required by the State of Georgia. See Insurance Coverage on page 5-6 of this RFP. Scope of Work Objective Habersham County Board of Commissioners County invites proposals from qualified producers and suppliers of aviation fuel and lubricants to be the sole supplier of aviation fuels for Habersham County Airport located in Baldwin, Georgia. The County is the owner and manager of the Airport which is operated by a FBO, Blue Sky Aviation as directed by the Habersham County Board of Commissioners. Habersham County Airport The Habersham County Airport is located approximately two miles west of Cornelia, just off Highway 441 Bypass on Airport Road. The public airport opened in 1969 and is manned from 8 a.m. until dust each day. The 5,500-foot paved runway at 1,447 feet above sea level is oriented northeast to southwest and is designated Runway 6/24. 2

5 There are approximately 65 aircrafts based on the field, including 54 single-engine airplanes, and 10 multi-engine airplanes. The airport averages about 60 operations a day with 60 percent of the business being local and about 40 percent being transient. There are 44 hangars that are at full occupancy and over 22 tie-downs of which 16 are currently occupied. The Habersham County Airport has one runway and associated taxiway. Runway 6/24 is 5,500 feet long and 100 feet wide. The facility is the gateway airport to the Georgia mountains with its central location in the foothills of the Blue Ridge Mountains. The airport has Jet A and 100LL gasoline. Card readers have now been installed so 100LL gasoline can be purchased outside of normal business hours. Jet A is not self-service and can only be purchased during normal business hours. During Fiscal Year 18, Airport fuel sales totaled 56,364 gallons with 31,200 gallons of Jet Aviation fuel ( Jet A ) and 25,164 gallons of AvGas sold. The Habersham County Airport has an FBO building which is used to provide aeronautical services to pilots, aircraft owners and passengers. There is one fuel farm with a capacity of 22,000 gallons (12,000 gallons of Jet A fuel, and 10,000 gallons of AvGas). There is also a fuel truck with a capacity of 1,800 gallons of Jet A fuel. The Need for Aviation Fuel Supplier The County is presently purchasing and selling fuel based on a month-to-month arrangement with its current aviation fuel supplier. To ensure a continued level of service, uninterrupted fuel supply and facilitate a profitable arrangement for the acquisition of its requirements of aviation fuel, the County needs to contract with an aviation fuel supplier ( Fuel Supplier ). The County intends to select the Fuel Supplier based upon competitive proposals submitted pursuant to the Request for Proposals (RFP). After evaluation of all proposals the County intends to enter into a Fuel Supply Agreement by which the selected Proposer will serve as the County s Fuel Supplier for the term of the agreement. Aviation Fuel Specifications By submitting a proposal, the Proposer will ensure that the aviation fuel delivered meets or exceeds the following minimum specifications: Jet Fuel: Aviation Kerosene Type Jet A fuel received shall conform to ASTM D-1655 specifications, latest revision. AvGas: Fuel received shall conform to ASTM D-910 specifications, latest revision and shall be of the Aviation Gasoline type, 100 Octane, Low Lead (Avgas 100LL) or future replacement. Proposer will provide a certificate of analysis on all aviation fuel shipments. Proposer will also provide traceability on all shipments back to refinery. Minimum Qualifications To be considered for selection as the Fuel Supplier, Proposers should possess the following minimum qualifications: 3

6 1. Proposer must be a refiner and producer or marketer of both Jet A and AvGas meeting standards established from time to time by the Federal Aviation Administration and by manufacturers of the aircraft routinely operated in the United States. 2. Proposer must be able to supply the county with its requirements for aviation fuels for at least five years. 3. Proposer must be a full service general aviation marketer who provides marketing support, including a nationally recognized brand identity. 4. Proposer must agree to indemnify the County from loss arising from damage to property and injury to or death of personals arising from a failure of the quality of its products delivered to the Airport. 5. Proposer must have in place a quality control program that meets or exceeds regulatory and industry standards. 6. Proposer must have in place a customer service program that includes: a. A representative that can answer fueling and quality control questions and provide support in a timely manner; b. Experience with FAA regulations required to support the Airport s requirements for FAA certification; c. A credit card program that utilizes standard POS equipment; either the system currently installed at the Airport, or a system provided by the Proposer as part of the Fuel Supplier Agreement. The POS system must be capable of electronically processing the following cards with moneys returned to the County electronically or via check: Proposer s credit card, Master Card, Visa, American Express, AvCard, Multi-Service Card, Discover, Carte Blanche, Diners, Limited Government Cards, and Voyager; d. Options to participate in advertising programs for promotion of the Airport and fuel sales; e. National advertising that supports its product and the general aviation industry; f. Provision and installation of brand identification as approved by the Airport; and, g. An account manager whose total interest and function is aviation related. Insurance Coverage Without limiting Fuel Supplier s duty of indemnification, Fuel Supplier and any subcontractor shall obtain and maintain continuously during the term of this agreement, Commercial General 4

7 Liability Insurance from an insurance carrier authorized to transact business in the State of Georgia, including coverage for owned and non-owned automobiles, and other insurance necessary to protect Habersham County and the public with limits of liability of not less than $2 million per occurrence, $4 million general aggregate bodily injury and property damage; such insurance shall be primary as to any other insurance maintained by Habersham County. Fuel Supplier and any subcontractor shall obtain and maintain continuously required Workers compensation and Employer s Liability Insurance to cover Fuel Supplier, subcontractor, Fuel Supplier s partner(s), subcontractor s partner(s), Fuel Supplier s employees, and subcontractor(s) employees with an insurance carrier authorized to transact business in the State of Georgia covering the full liability for compensation for injury to those employed by Fuel Supplier or subcontractor. Each such policy shall be endorsed to state that the Workers Compensation carrier waives its right of subrogation against Habersham County, its elected officials, officers, employees, agents, and volunteers which might arise in connection with this agreement Fuel Supplier hereby certifies that Fuel Supplier is aware of the provisions of section 3700 of the Labor Code, which requires every employer to insure against liability for worker s compensation or to undertake self-insurance in accordance with the provisions of the Labor Code, and Fuel Supplier shall comply with such provisions before commencing the performance of the work of the provision of services pursuant to this agreement. Fuel Supplier shall obtain and maintain continuously a policy of Contractor s Pollution Liability, Environmental Impairment Liability, or Hazardous Waste Liability Insurance, with limits of liability of not less than $2 million per occurrence. Fuel Supplier shall maintain continuously a policy of Comprehensive Airport Liability Insurance for bodily injury (including death) and property damage including owned and non-owned aircraft coverage of $1 million per occurrence and $3 million aggregate. All insurance coverage required by this statement should follow the following: 1. Any deductible or self-insured retention exceeding $25,000 for Fuel Supplier or subcontractor shall be disclosed to Habersham County and should be subject to approval prior to the effective date of this agreement. 2. If any insurance coverage required hereunder is provided on a claims made rather than occurrence form, Fuel Supplier or subcontractor shall maintain such insurance coverage with an effective date earlier or equal to the effective date of this agreement and continue coverage for a period of three years after the expiration of this agreement and any extension thereof. In lieu of maintaining post-agreement expiration coverage as specified above, Fuel Supplier or subcontractor may satisfy this provision by purchasing tail coverage for the claims-made policy. Such tail coverage shall, at a minimum, provide the insurance coverage required hereunder for claims received and reported three years after the expiration date of this agreement. 3. All insurance (except workers compensation and professional liability) shall include an endorsement or an amendment to the policy of insurance which names Habersham 5

8 County, its elected officials, officers, employees, agents, and volunteers as additional insureds and provides that coverage shall not be reduced or canceled without 30 days written prior notice certain to Habersham County. The additional insureds coverage shall be equal to Insurance Service Office endorsement CG for on-going operations and CG for completed operations. 4. Each insurance policy (except for workers compensation and professional liability policies), or an endorsement thereto, shall contain a separation of insureds clause which shall read: Separation of Insureds. Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each suit insured against whom a claim is made, or suit is brought. 5. Fuel Supplier shall provide Habersham County with an endorsement or amendment to Fuel Supplier s policy of insurance as evidence of insurance protection before the effective date of this agreement. 6. The insurance coverage required herein shall be in effect at all times during the term of this agreement. In the event any insurance coverage expires at any time during the term of this agreement, Fuel Supplier shall provide, at least 20 days prior to said expiration date, a new endorsement or policy amendment showing insurance coverage as provided for herein for not less than the remainder of the term of this agreement or for a period of not less than one year. In the event Fuel Supplier fails to keep in effect at all times insurance coverage as here in provided and a renewal endorsement or policy amendment is not provided within 10 days of expiration of the endorsement or policy amendment in effect at inception of this agreement, Habersham County may, in addition to any other remedies it may have, terminate this agreement upon the occurrence of such event. 7. If the endorsement or amendment does not reflect the limits of liability provided by the policy of insurance, Fuel Supplier shall provide Habersham County a certificate of insurance reflecting those limits. Selection of Successful Proposer The Fuel Supplier will be selected by the County based upon the County s evaluation of the qualifications of the Proposer, the price basis for the supply of aviation fuels and other petroleum products, the equipment and services to be provided to the County by the Proposer, the contract terms offered by the Proposer in the general aviation facilities of the Habersham County Airport offered by the Proposer. The County will select, in its sole and absolute discretion, the Proposer with which the County wishes to perfect a Fuel Supply Agreement. Under the Fuel Supply Agreement, the Fuel Supplier will provide the Habersham County Board of Commissioners with the Airport s requirements for aviation fuel and lubricants and provide other services in accordance with the Fuel Supplier s 6

9 proposal as it may be modified through negotiations with the county and incorporated into the Fuel Supply Agreement. The Fuel Supply Agreement may vary significantly from the contract terms offered by the Proposer. It is possible that the County and the selected Proposer may agree upon modifications and addendums to the contract terms offered by Proposer may agree upon modifications and addendums to the contract terms offered by Proposer and in such cases such agreements will be incorporated into the Fuel Supply Agreement. If the County and the selected Proposer cannot agree on contract terms or if the selected Proposer fails to promptly execute the Fuel Supply Agreement tendered to it by the County, the County may abandon its discussions with the selected Proposer and select another Proposer as the Fuel Supplier. Proposal Deadline Proposals, as described in this RFP, must be submitted in three counterparts in a manner easily reproducible and must be received by the Habersham County Finance Department no later than 10:00 A.M. on Wednesday, November 7, 2018 (Bid Opening). Proposals must be mailed or hand-delivered to the Finance Department, 555 Monroe Street, Unit 20, Clarkesville, GA Submittals shall be completed and prepared in the format of the Proposal From supplied herein as Attachment A. Cost for developing proposals in response to this RFP are entirely the obligation of the Proposer and shall not be charged in any manner to Habersham County. Questions and Interpretation No inquires or interpretation of meaning concerning this Request for Proposal will be made to any interested party orally. Every inquiry or request for interpretation should be made in writing via . All inquiries and requests for interpretation should be sent via to purchasing@habershamga.com. All questions and all answers will be posted on the website It will be the responsibility of the interested parties to periodically check the website for any new information. Pre-awarded protests should be handled in the same manner as defined in Section 3: Purchases Requiring a Bid, 3) Bid Award; d. of the Habersham County Purchasing Policies and Procedures. 7

10 ATTACHMENT A PROPOSAL FORM PROPOSAL for AVIATION FUEL SUPPLIER at the HABERSHAM COUNTY AIRPORT The undersigned ( Proposer ) hereby proposes to the Habersham County Board of Commissioners that Proposer be selected by the County to serve as fuel supplier ( Fuel Supplier ) to supply the County with its requirements for aviation fuel for resale at the Habersham County Airport as described in the County s Request for Proposals advertised on October 10, If selected by the County as the Fuel Supplier, Proposer will supply the County s requirements for aviation fuels and lubricants and provide other services as described in this proposal and the Fuel Supplier Agreement ( Agreement ) to be made between Proposer and the County as more particularly described below: I. The County, as owner and manager of the Airport, will purchase from the Fuel Supplier and the Fuel Supplier shall provide and sell to the Airport s requirements for aviation fuels and lubricants (collectively the product ) at the Airport. II. The product shall include the following types of fuels: (i.) Aviation Turbine Fuel Jet A; (ii.) Aviation Gasoline, 100 Octane, Low Lead (Avgas) or future replacement. The product delivered to the Airport shall comply with the following specifications: (here describe the current specifications required by the FAA and aircraft manufactures for Jet A and AvGas and aviation lubrications) or such other specification that may be established by applicable governmental regulation or industry standard in the future. Fuel Supplier will supply with each load of product a certificate of the specification of the product and will warrant that each load meets or exceeds applicable specifications and quality control requirements. 8

11 III. Prices for product: The County desires to receive the best possible pricing and in order to facilitate the comparison of proposals, it is necessary that all proposals completely explain their method of pricing. (Here provide an explanation of the pricingmethodology used by Proposer in determining fuel price, timing of price-changes, and method of conveying price-changes to the County. The pricing-methodology may be a guaranteed price, a base price established upon a given date and to be increased or decreased thereafter according to an index such as OPIS, Cost of Crude, Platts, market place, etc., a margin against a pre-defined spot price, or any other methodology that allows the County to compare future cost of product to be obtained from Proposer in comparison with other Proposers. An acceptable alternative methodology is a price that is guaranteed not to be higher than prices being charged by the Proposer to other fuel resellers operating in the same geographic region of the United States at the time of delivery and pricing of the product to the Airport. Include a quote of the price that your proposed pricing methodology would produce for: the date of the Proposal; six months earlier; and twelve months earlier.) November 7, 2018 May 7, 2018 November 7, 2017 AvGas: Jet A : IV. We commit to deliver at the stated date, time, and price the County s requirements of product subject to the following limitations: (Here describe the limitation, if any, on the amount of product the Fuel Proposer shall be obligated to supply to the County at the stated price. Describe the plan to provide continuous product delivery on time and on schedule.) 9

12 V. We will not impose retail/wholesale credit card related discount/rebate programs that require the County s participation or funding. VI. We have and will keep in place during the term of the Agreement the following Product Quality Control Program: (Here describe, in detail, your quality control and assurance program. Include complete description of any documented breakdowns in quality of your product and itemize any instances of aircraft damage or personal injury that have been established as proximately caused by the failure of your product to meet specifications.) VII. Credit Card Program: (Here describe your credit card program. Include as much detail as necessary for the County to fully understand the operations of same and how it compares with other credit card programs operated by other aviation fuel suppliers.) VIII. Advertising and Promotions: (Here explain method or plan for the Habersham County Airport advertising in relation to national and international programs. Explain aviation directory support available from the Proposer including support of web-based fuel price directions. Set forth sales aids items provided and cost. Explain co-op program, if applicable, and funds available to the County.) 10

13 IX. Industry Involvement and Commitment: (Here set forth trade show participation by Proposer and how the County will benefit from these activities. Describe all memberships in industry organizations like NBAA and NATA, including active participation on committees, if any. Set forth a list demonstrating involvement with fuel resellers nationwide and examples of customers similar to the Airport.) X. Training: (Here describe the training program you propose to conduct at the Airport including the curriculum, the number of employees to be trained, the periodic retraining and the cost, if any. The training should include the following areas at the minimum: ground servicing, safety, refueling piston aircraft, refueling turbo prop aircraft, refueling jet aircraft, towing, fuel farm operation, quality control, customer service, and fire safety. Quality control and basic fuel farm operation should be provided on a regular basis to accommodate new employees.) XI. Liability Insurance: (Here describe Proposer s commercial general liability and pollution liability, environmental impairment liability, or hazard waste liability insurance policies that will provide coverage to the County. Include as much detail as necessary for the County to fully understand the adequacy of such policies.) 11

14 XII. Crisis Management Plan: (Here describe Proposers program or plan to support the County in the event Proposer s product is called into question or implicated in an aircraft incident or accident.) XIII. Specimen Contract: A draft contract Proposer would be willing to execute with the County if the Proposer is selected as the Fuel Supplier will be provided by the County by. XIV. Qualifications; References: (Here describe your company or organization; your qualifications to be selected as Fuel Supplier; and include at least five reference airports/contracts at which you are the exclusive provider of aviation fuel. Please include contract information for reference.) 12

15 ACKNOWLEDGEMENT OF PROPOSAL The undersigned, being the (position) of (complete business name), with full authority to bind the Proposer, do hereby make this proposal to the Habersham County Board of Commissioners this the day of, Proposer Signature Print Name Title Witness Print Name 13

16 The bidder understands, agrees and warrants: BIDDERS DECLARATION That the bidder has carefully read and fully understands the full scope of the requirements. That the bidder has the capability to successfully undertake and complete the responsibilities and obligations in said specifications. That the bidder has liability insurance and a declaration of insurance form will be provided before the commencement of any work. That this bid may be withdrawn by requesting such withdrawal in writing at any time prior to November 7, 2018 at 10:00 a.m. but may not be withdrawn after such date and time. That Habersham County reserves the right to reject any or all bids and to accept that bid which will, in its opinion, best serve the public interest. Habersham County reserves the right to waive any technicalities and formalities in the bidding. That by submission of this bid the bidder acknowledges that Habersham County has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information supplied by the bidder. If a partnership, a general partner must sign. If a corporation, the authorized corporate officer(s) must sign and the corporate seal must be affixed to this bid. BIDDER: Name Title Name Title AFFIX CORPORATE SEAL (If Applicable) 14

17 NON-COLLUSION AFFIDAVIT The following affidavit is to accompany the bid: STATE OF COUNTY OF Owner, Partner or Officer of Firm, Company Name, Address, City and State Being of lawful age, being first duly sworn, on oath says that he/she is the agent authorized by the bidder to submit the attached bid. Affidavit further states as bidder, that they have not been a party to any collusion among bidders in restraint of competition by agreement to bid at a fixed price or to refrain from bidding; or with any office of Habersham County or any of their employees as to quantity, quality or price in the prospective contract; or any discussion between bidders and any official of Habersham County or any of their employees concerning exchange of money or other things of value for special consideration in submitting a sealed bid for: FIRM NAME SIGNATURE TITLE Subscribed and sworn to before me this day of 20 NOTARY PUBLIC 15

18 CERTIFICATE OF NON-DISCRIMINATION In connection with the performance of work under this contract, the bidder agrees as follows: The bidder agrees not to discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, ancestry or disability. The vendor shall take affirmative action to insure that employees are treated without regard to their race, creed, color, sex, national origin, ancestry or disability. Such action shall include, but not be limited to the following: employment, upgrading, demotion, transfer, recruiting or recruitment, advertising, lay-off or termination, rates of pay or other compensation and selection for training, including apprenticeship. In the event of the bidder s non-compliance with this non-discrimination clause, the contract may be canceled or terminated by Habersham County. The bidders may be declared, by Habersham County, ineligible for further contracts with Habersham County until satisfactory proof of intent to comply shall be made by the vendor. The bidder agrees to include this non-discrimination clause in any sub-contracts connected with the performance of this agreement. BIDDER SIGNATURE TITLE 16

19 Form W-9 (Rev. August 2013) Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Other (see instructions) Address (number, street, and apt. or suite no.) City, state, and ZIP code Exemptions (see instructions): Exempt payee code (if any) Exemption from FATCA reporting code (if any) Requester s name and address (optional) List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the Name line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part II Certification Under penalties of perjury, I certify that: Social security number Employer identification number 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below), and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. The IRS has created a page on IRS.gov for information about Form W-9, at Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the Date withholding tax on foreign partners share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section ). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. Cat. No X Form W-9 (Rev ) 17

20 Office of County Commissioners 555 Monroe Street, Unit 20, Clarkesville, GA Fax: STATE OF GEORGIA AFFIDAVIT AND AGREEMENT PROGRAM VENDOR/CONTRACTOR COMES NOW before me, the undersigned officer duly authorized to administer oaths, the undersigned contractor, who, after being duly sworn, states as follows: By executing this affidavit, the undersigned contractor verifies it s compliance with O.C.G.A , stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Habersham County 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 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 (b). Contractor hereby attests that its federal work authorization user identification number and date are as follows: EEV / Basic Pilot Program User ID Number (E-Verify) FURTHER AFFIANT SAYETH NOT. BY: Authorized Officer or Agent Signature Contractor Address Title of Authorized Officer or Agent of Contractor Above Company / Contractor Name Contractor City, State, Zip Code Date of Contract between Contractor and Habersham County Sworn to and subscribed before me This day of, 20 Notary Public My commission expires: * 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 of 1986 (!RCA), P.L As of the effective date of O.C.G.A , the applicable federal work authorization program is the "EEV I Basic Pilot Program" 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). 18