Common use of PROJECT NUMBER AND DESCRIPTION Clause in Contracts

PROJECT NUMBER AND DESCRIPTION.  Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 Institution Name, 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

PROJECT NUMBER AND DESCRIPTION.  Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(391(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 Institution Name, 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 an any affidavit from a sub-subcontractor to the contractor within five business days (name of receipt. If the undersigned subcontractor receives notice that a or sub-subcontractor with whom such sub-subcontractor has received an affidavit from any other contracted subprivity of contract). 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 SubcontractorSub-subcontractor Project Number and Description Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 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 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 ______________________________

PROJECT NUMBER AND DESCRIPTION.  Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(391(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 Institution Name, 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 an any affidavit from a sub-subcontractor to the contractor within five business days (name of receipt. If the undersigned subcontractor receives notice that a or sub-subcontractor with whom such sub-subcontractor has received an affidavit from any other contracted subprivity of contract). 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 SubcontractorSub-subcontractor Project Number and Description Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 COUNTY OF ________________________________ STATE OF ________________________________ I do solemnly swear on my oath that as to the Contract dated_________________________, 20_____________, between _______________________________________________________________________________ (NAME OF XXXXXXXXXX) 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 XXXXXXXXXX) 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 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 ______________________________

PROJECT NUMBER AND DESCRIPTION.  Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(391(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 Institution Name, 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 an any affidavit from a sub-subcontractor to the contractor within five business days (name of receipt. If the undersigned subcontractor receives notice that a or sub-subcontractor with whom such sub-subcontractor has received an affidavit from any other contracted subprivity of contract). 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 SubcontractorSub-subcontractor Project Number and Description Name of Project Board of Regents of the University System of Georgia For the use and benefit of Institution Name Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on ­­­______, ___, 20__ 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 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 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: