HomeMy WebLinkAboutCONTRACT FOR CONSTRUCTION OF AIRPORT_ OBSTRUCTION REMOVAL AND INSTALL AIRFIELD SIGNAGE AND WINDCONE AT THE DANIEL FIELD AIRPORT DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
Of
� .
t ».»..,,**;10
Russell R.McMurry,P.E.,Commissioner ~r *mom.a
TS GEORGIA DEPARTMENT OF TRANSPORTATION
os s
i r r• One Georgia Center,600 West Peachtree Street,NW
*o ? _ = f * Atlanta,Georgie 30308
t*` 4. Telephone;(404)631-1000
O%e'
November 1,2016
The Honorable Hardie Davis,Jr,Mayor
The Unified Government of Augusta-Richmond County
4260 Frontage Road
Augusta,GA 30909
In Re:AP017-9026-53(245)Richmond
PID-T005959
Contract Amount-$210,627.00
The Department is electronically sending the Unified Government of Augusta-Richmond County a contract for obstruction
removal and install airfield signage and windcone at the Daniel Field Airport. This project contains 5203,224.00 of federal
funds and$7,403.00 of state funds with a local share of the cost being$15,177.41.
We are transitioning to electronic contract execution and appreciate the County's assistance. This is a new process,so please
call us immediately if you have any questions. All pages needing signatures have been flagged with the individual's name to
sign.
• The Department will send via email the electronic contract to the Hon.Hardie Davis,Jr.,Mayor,for review and to sign the
signature page on page 5. Signatures are also needed on the Exhibit B(Certification of Compliance with State Audit
Requirement)and Exhibit C(Georgia Security and Immigration Compliance Act Affidavit). Once the Mayor's signature has been
loaded onto the signature page,the system will prompt to select"adopt and sign"then'finish".The system will automatically
send the contract to the Clerk,Ms.Lena J.Bonner.
• Ms.Bonner will upload her signature and the County's seal.The signature and seal will have to be on a single line.To save the
signature and seal,one needs to take a white sheet of paper,sign and affix the seal adjacent to the signature. Then scan
signature and seal to desktop or take a picture of the signature and seal using a cell phone camera and send to email to save on
desktop. The County"Seal"is required on this document The system will give an option to"upload"the signature and the
county"Seal." The signature and county seal have to be uploaded together,as one document,and will need to be in a jpeg or
.bmp format A.pdf is not acceptable.Once the signature and seal have been uploaded successfully,the system will prompt to
select'adopt and sign"then'finish.'The system will automatically send the contract to the Notary,Ms.Natasha McFarley.
• Ms.McFarley will notarize Exhibit C(Georgia Security and Immigration Compliance Act Affidavit).Please follow the same
process as the mentioned above to upload the Notary's signature and seal(see highlighted information). Once the signature
and seal have been successfully uploaded,the contract will be electronically returned to the Department to complete the
execution process.
• if there are any questions or clarification needed,please call our office before selecting'Adopt and Sign. There is a
"Cancel"button to select that will allow the contract to be saved for later. Selecting"Adopt and Sign"before the
signature and seal Is attached will result in the contract being"rejected."
Once the contract has been fully executed,you will receive notification electronically stating the contract process is complete
along with a copy of the contract However,work cannot begin on the project until a written"Notice to Proceed"is received
from our office. If you have further questions,please do not hesitate to contact Corzetta Motley,Contracts/Grants Manager,at
(404)631-1073.
Stncerely,
6_, Ct/ 14--
Nan Cobb,Administrator
Divi 4 of lntermodal
NCC:Itf
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
Revised July 1, 2016
CONTRACT FOR CONSTRUCTION OF AIRPORT
AIRPORT PROJECT NO. AP017-9026-53(245)
PID - T005959
RICHMOND COUNTY
**LIMITED PARTICIPATION**
STATE OF GEORGIA ** DO NOT UNSTAPLE THIS BOOKLET.. .
ENTER ALL REQUIRED INFORMATION
FULTON COUNTY EITHER BY HAND OR STAMP.
12/12/2016
THIS AGREEMENT made and entered into on , by and
between the DEPARTMENT OF TRANSPORTATION OF GEORGIA, party of the
first part (hereinafter called "DEPARTMENT") , and the UNIFIED
GOVERNMENT OF AUGUSTA-RICHMOND COUNTY(hereinafter called "SPONSOR") ,
who have been duly authorized to execute this Agreement.
WITNESSETH:
WHEREAS, the DEPARTMENT and the SPONSOR desire the
construction of certain work at a certain airport, and the SPONSOR
agrees to contract for all the materials and to perform all work and
labor for said purpose, the Project being more particularly
described as follows:
OBSTRUCTION REMOVAL AND INSTALL AIRFIELD SIGNAGE AND WINDCONE
AT THE DANIEL FIELD AIRPORT IN AUGUSTA, GA
Now, therefore, in consideration of the premises and the mutual
covenants herein contained, the parties hereto agree as follows:
(1) The work and materials shall be in strict and entire
conformity with the provisions of this contract and the plans on
Airport Project No. T005959/AP017-9026-53(245) RICHMOND, prepared
(or approved) by the Georgia Department of Transportation and in
accordance with the Standard Specifications, 2013 Edition, and the
Supplemental Specifications and Special Provisions contained in
Attachment A, which are hereby made a part of this Agreement as
fully and to be the same effect as if the same had been set forth at
length in the body of this Agreement, and the Federal Aviation
Administration's Standards for Specifying Construction of Airports,
dated July 21, 2014.
The original plans and specifications are on file at the Office of
the Georgia Department of Transportation in Atlanta, Georgia and
said plans and specifications are hereby made a part of this
Agreement as fully and to be same effect as if the same had been set
forth at length in the body of this Agreement.
(2) At the time of execution of this Agreement, the SPONSOR agrees
to furnish to the DEPARTMENT, at the expense of the SPONSOR, a
complete set of plans and specifications for said project, and to
furnish to said DEPARTMENT from time to time on demand by the
DEPARTMENT to the SPONSOR all revisions of said plans and
specifications.
1
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
(3) This contract is accepted with the express understanding that
no person, firm, corporation or governmental agency can increase the
liability of the DEPARTMENT in connection herewith, except under
written agreement with the DEPARTMENT.
(4) The DEPARTMENT and the SPONSOR agree that the cost of this
Project shall be as follows:
The total estimated cost of the Project is TWO HUNDRED TWENTY-
FIVE THOUSAND EIGHT HUNDRED FOUR and 41/100 Dollars ($225,804.41) .
The total estimated cost of the Project as described herein is shown
on the Summary of Construction Items in Exhibit A, which is hereby
made a part of this Agreement as fully and to be the same effect as
if the same had been set forth at length in the body of this
Agreement.
It is further agreed that the DEPARTMENT'S obligation will
include state funds in the amount of SEVEN THOUSAND FOUR HUNDRED
THREE and 00/100 Dollars ($7,403.00) and federal funds in the amount
of TWO HUNDRED THREE THOUSAND TWO HUNDRED TWENTY-FOUR and 00/100
Dollars ($203,224.00.) for the Project as summarized in Exhibit A.
It is further agreed that the maximum amount the DEPARTMENT shall be
obligated to pay is the total amount of the state and federal share
of the project which is TWO HUNDRED TEN THOUSAND SIX HUNDRED TWENTY-
SEVEN and 00/100 Dollars ($210,627.00) . However, if the sum total of
the actual cost of the Project is less than the amounts indicated in
Exhibit A, the DEPARTMENT shall be obligated to pay its pro rata
share of the actual project cost as verified from the records of the
SPONSOR or actual measured quantities of the items listed in the
Summary of Construction Items (Exhibit A) , whichever is less. It is
further understood the sponsor's local share of the project is in
the amount of FIFTEEN THOUSAND ONE HUNDRED SEVENTY-SEVEN and 41/100
Dollars ($15,177.41) .
It is further understood and agreed that any costs of the
total Project that exceed the above estimated Project costs will be
the sole responsibility of the SPONSOR.
It is further understood and agreed that any line item in the
Summary of Construction Items as shown in EXHIBIT A may be increased
or decreased without the execution of a Supplemental Agreement,
provided that the DEPARTMENT'S total maximum obligation under this
agreement is not changed.
Payments by the DEPARTMENT shall be made upon the submission
of monthly work progress statements. The payments by the DEPARTMENT
for the work completed, as evidenced by the monthly statements,
shall be on a prorated basis. These monthly payments will be made
in the amount of sums earned less all previous partial payments. Any
amounts held by the SPONSOR as retainage will not be paid by the
DEPARTMENT until such retainage is paid by the SPONSOR.
Upon completion of the project, the DEPARTMENT will pay the
SPONSOR a sum equal to one hundred percent (100%) of the
DEPARTMENT'S share of the compensation set forth herein less the
total of all previous partial payments made, or in the process of
payment.
2
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
The SPONSOR shall maintain all books, documents, papers,
accounting records, and other evidence pertaining to costs incurred
on the Project and used in support of their proposal and shall make
such material available at all reasonable times during the period of
the Contract, and for three years from the date of final payment
under the Contract, for inspection by the Department and copies
thereof shall be furnished if requested.
5) The work shall be done in accordance with the Laws of the State
of Georgia and to the satisfaction of the DEPARTMENT. It is further
agreed that the SPONSOR shall comply with all applicable Federal
laws, regulations, executive orders, policies, guidelines, and
requirements as they relate to the application, acceptance and use
of Federal funds for this project. All construction on this project
shall be in accordance and compliance with the 2013 Edition of the
Standard Specifications, of the DEPARTMENT, the Supplemental
Specifications and Special Provisions included in Attachment A and
made a part of this contract and the Standards for Specifying
Construction of Airports, dated July 21, 2014, Federal Aviation
Administration, hereinafter jointly referred to as the "STANDARDS."
The DEPARTMENT reserves the right to refuse payment on any monthly
statement presented for work which does not comply with the
STANDARDS. The DEPARTMENT reserves the right to withhold the final
payment until the project is completed to the DEPARTMENT'S
satisfaction and complies with the STANDARDS. The decision of the
Chief Engineer upon any question connected with the execution or
fulfillment of this Agreement shall be final and conclusive.
(6) The SPONSOR further covenants that it is the owner of fee
simple title to the land whereon the actual construction of said
project is performed, as evidenced by Certificate of Title
heretofore furnished to DEPARTMENT.
(7) It is further understood and agreed that no money derived from
motor fuel taxes shall be expended for this project and that for the
purposes of this contract a specific allotment of funds has been
made, from sources other than motor fuel taxes.
(8) To the extent allowed by law, the SPONSOR hereby agrees to
defend any and all suits, if any should arise as a result of said
project, at the entire expense of said SPONSOR, and to pay from the
funds of said SPONSOR any and all settlements or judgments that may
be made or had under or as a result of such suits.
(9) To the extent allowed by law, the SPONSOR further agrees to
save harmless the DEPARTMENT from any and all claims for any damages
whatsoever that may arise prior to or during construction of the
work to be done under said project and this contract, or as a result
of said construction work whether said damages arise as a result of
the actual construction work or from change of grade, change of
location, drainage, loss of access, loss of ingress and egress,
torts, or any other cause whatsoever; it being the intention of this
Agreement to save harmless the DEPARTMENT from any claim that could
or may arise as a result of construction of said project.
(10) The SPONSOR further agrees that, at its own cost and expense,
it will maintain said project in a manner satisfactory to the
DEPARTMENT and said SPONSOR will make provisions each year for such
maintenance.
3
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
(11) It is agreed by the SPONSOR that time is of the essence in
the completion of this project and that the obligation of the
DEPARTMENT is made in the interest and for the public welfare.
Therefore, the SPONSOR shall perform its responsibilities for the
project until the maximum allowable cost to the Department is
reached or until OCTOBER 31, 2018, whichever comes first.
(12) SERVICE DELIVERY STRATEGY CERTIFICATION: By execution of this
contract, the SPONSOR certifies, under penalty of law, that the
UNIFIED GOVERNMENT OF AUGUSTA-RICHMOND COUNTY is in compliance with
the Service Delivery Strategy Law (House Bill 489) and is not
debarred from receiving financial assistance from the State of
Georgia. Also, the SPONSOR certifies that the funds to be use on
the project are consistent with applicable Service Delivery
Strategy.
(13) For land purchased for airport development purposes, the
SPONSOR will, when the land is no longer needed for airport
purposes, dispose of such land and make available to the DEPARTMENT
an amount equal to the DEPARTMENT'S original monetary participation
in the land purchase. Land shall be considered to be needed for
airport purposes under this provision if (a) it may be needed for
aeronautical purposes (including runway protection zones) and (b)
the revenue from interim uses of such land contributes to the
financial self-sufficiency of the airport.
(14) In accordance with the provisions of Section 36-81-7 of the
Official Code of Georgia Annotated, the SPONSOR will provide
certification of compliance with state audit requirements as
described in Exhibit B which is hereby made a part of this Agreement
as if fully set out herein.
(15) Pursuant to O.C.G.A. Sec. 50-5-58, CONTRACTOR hereby certifies
that it is not currently engaged in, and agrees that for the
duration of this contract, it will not engage in a boycott of
Israel.
(16) In accordance with the provisions of Section 13-10-91 of the
Official Code of Georgia Annotated, the SPONSOR will provide
certification of compliance with the Georgia Security and
Immigration Compliance Act as described in Exhibit C which is hereby
made a part of this Agreement as if fully set out herein.
(17) It is FURTHER AGREED that the SPONSOR shall comply and require
its contractors, subcontractors and consultants to comply with the
requirements of Executive Order No. 13153, Federal Leadership on
Reducing Text Messaging while driving, October 1, 2009, and DOT Order
3902.10, Text Messaging While Driving, December 30, 2009.
4
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C 1
IN WITNESS WHEREOF, the DEPARTMENT has caused these presents to be
executed by the COMMISSIONER of said DEPARTMENT, who has been duly
authorized, and by the CHAIRMAN of the UNIFIED GOVERNMENT OF AUGUSTA-
RICHMOND COUNTY, who has been duly authorized by the UNIFIED GOVERNMENT OF
AUGUSTA-RICHMOND COUNTY, who have hereto set their hands this day and year
hereafter written.
DEPARTMENT OF TRANSPORTATION BY: Executed on behalf of
0.--DocuSigned by:
rwstif, r A A, _ UNIFIEDEGOVERNMENT OF AUGUSTA-RICHMOND
COUNT
`MtM4fbr (SEAL) 11/15/2016
DATE:
ft
-DoeuSigned by:
fteir it, Davis, Jr,
Tergfatf
04E5_
Hardie Davis Jr.
PRINTED NAME
DocuSigned by:
ATTEST: 71086DSDOrAC426...
Treasurer
This contract approved by
UNIFIED GOVERNMENT OF AUGUSTA-RICHMOND
COUNTY
at a meeting held at:
535 Telfair St Board Meeting 09/06/2016
11/28/2016
DATE:
DocuSigned by:
r
ClerK2ew"D4rA... (SEAL)
582204274
Federal ID/IRS #
5
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
4
L
Tm
�p y� y�
g 000b gggggg egggbgjSgggggS3o
0000 0uiuiUuiui uiluiuiui1eiui1ui000W60o
8888 883888 000oo000u7u7o ? Q8$
pOp O Q OQ pap O O O U) N N pQ 0
4Z• W H OW N f0+ ' 2. �2.� O ti y g M g g fls,7,.g'V' y N
��jj =
W W�y W W W WWW W t. °g r.
Wu. NW 0 11).-s-
10;
1).-s
•
y� y� C N O
g MI 00• W O W O
U-
0)0
C o W 01 COi W OOi SD 001 W Of
a m v 888888
88OOo 8888888 8 0 0 0 m o pp
w
(A oNaci
046 .666 C CC oO w d 1fi 6 M b
0 0O ga giMN pNpPPpavazzwi
LL
W Z dNOO dr!oiw o rNWOaD1[ W <0O vNM WtW ' NNW" ..ft.-
v. wRW
ppppoopp pppppppppp 2 tQt
NJ
L- oo o '888088 888888888880t° 8; 883
ow O 0 N N N O O y M
1C%1 ,-
0 8 sssos8 88s8g8I gs g
r tIO e- r.o w o o N o r
w pt O N 10
Q 4"N I� r m N N r A A!. r r 01 s 2 Ip tr N O
Z f. a-NW. ;W Wag.W .....NW .. N NMN
'�
G M N W
Z p p p p p p p p p p p
Q � 0000 888888 88 ° 888001(750000
_
w) V W WWW 8Sop gO 8 Cp c pp p
N '- N4NW
uu gl- 8ONN 42 ii iz
W
a I T.d -r N A v ai X31
~
0 0 44494,444449
4,49444444444444444444
.....LZ Z
0Q V us 44ON ° O to
p gwp — vr — — ,2C — rRopp0 — ggOiR . 00
)o 44
Z4( R a TM re 4 .7,1.6EZCL
ufof
1
I-
0 0. _ ocnz mS t
J = = QWW WQWdydUaQdd LLWW m= AQ
to
W m 2
WQ O o
re 0D
p Z g I• a
a M o c N.
U) C W
a
S iu
Z a
4 h
V Q w g 0
gvizi C Q
E Z S U ~ E $ 0
m t0i• nih ZZQ 0 � a iai c a.3 m CO
35 m cD � 5 0
NIA
sm m g22 !� - 2 L sE0NE2
c `m � `m t 4 H / V Ac 5 E E E E
_� c cw
mam83d612- g8R3 .78 & Ogn,, A880%;
W
(�tQ 4qg ('7P1� NOm0W gg
W ¢ Q Q G . . . . . 2
00 N O O N O O O O g CJ` 0
.g LLLLLLLL is 0. aad iia. JJJ IJJ ,L LLLLul
uj t' O .- N M V N m I\ O W O r N l7 V f
tw rNp1V OmAW Ar NN NNNQ
I.
g0 r
OZ
7
00
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
EXHIBIT B
CERTIFICATION OF
COMPLIANCE WITH STATE AUDIT REQUIREMENT
I hereby certify that I am a principle and duly authorized representative of
Augusta, Geo rgiawhoseaddress iS 535 Telfair St Sui d200
it is also certified that:
The provisions of Section 36-81-7 of the Official Code of Georgia Annotated,relating to
the"Requirement of Audits"have been complied with in full such that:
(a) Each unit of local government having a population in excess of 1,500
persons or expenditures of$175,000.00 or more shall provide for and cause
to be made an annual audit of the financial affairs and transactions of all
funds and activities of the local government for each fiscal year of the local
government.
(b) The governing authority of each local unit of government not included above
shall provide for and cause to be made the audit required not less often than
once every two fiscal years.
(c) The governing authority of each local unit of government having
expenditures less than$175,000.00 in that government's most recently ended
fiscal year may elect to provide for and cause to be made, in lieu of the
biennial audit, an animal report of agreed upon procedures for that fiscal
year.
(d) A copy of the report and any comments made by the state auditor shall be
maintained as a public record for public inspection during the regular
working hours at the principal office of the local government.Those units of
local government not having a principal office shall provide a notification to
the public as to the location of and times during which the public may inspect
the report.
DocuSigned{b�y:
11/15/2016 1 *n1 1/ S) Jr.
Date nacoicSignature
EXHIBIT B
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
'
i ,J.
Georgia Department of'irtation
GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT
Contractor's Name: Unified Government of Augusta-Richmond County
Solidtadon/Cont ract NoJ Call No.
T005959/AP417-9026-53(245)Richmond Obstr.Removal and Install Airfield Signage
or Project Description:
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 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:
46923 7/9/07
Federal Work Authorization User Identification Number Date of Authorization
(EEV/E-Verify Company Identification Number)
Augusta Georgia
Name of Contractor
I hereby declare under penalty of perjury that the
foregoing is true aid correct
Hardie Davis Jr Mayor
Prigted 8Tneaay(of Authorized Officer or Agent of Contractor) Title(of Authorized Officer or Agent of Contractor)
�— uS
�Air1.i t1 s) jr. 11/15/2016
'—a3EE4E8 E ...
Signature(f prized Officer or Agent) Date Signed
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE
DATE: 11/30/2016
e--DocuSianed by:
s ¢34]
Notary7l'ubli5A244t... [NOTARY SEAL]
My Commission Expires: May 25, 2019
EXHIBIT C
Rev.11/01/15
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
Department of Transportation
State of Georgia
October 28, 2016
SPECIAL PROVISIONS
AIRPORT PROJECT NO. T005959/AP017-9026-53(245) RICHMOND
OBSTRUCTION REMOVAL AND INSTALL AIRFIELD SIGNAGE AND WINDCONE AT THE DANIEL FIELD
AIRPORT IN AUGUSTA, GA
S.P. CODE SPECIAL PROVISIONS DESCRIPTION
108-1-01-SP Prosecution and Progress
109-1-01-SP Measurement and Payment
Attachment A, 1 of 3
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
Date:July 1,2015
Date: May 29,2001
First Use Date 2001 Specifications:November 1,2002
DEPARTMENT OF TRANSPORTATION
STATE OF GEORGIA
SPECIAL PROVISION
Section 108—Prosecution and Progress
Retain Subsection 108.03 except as modified below:
For this Project,the Progress Schedule required by Subsection 108.03 need not be submitted.
Attachment A,2 of 3
DocuSign Envelope ID:5EA8077A-570E-48AE-A7A5-7AA7D2604D3C
Date:July 1,2015
Date: July 3,2001
First Use Date 2001 Specifications: November 1,2002
DEPARTMENT OF TRANSPORTATION
STATE OF GEORGIA
SPECIAL PROVISION
Section 109—Measurement & Payment
Delete the first sentence of Subsection 109.07.A,paragraph one,and substitute the following:
A. General: On the tenth day of each calendar month,the total value of Items complete in place will be estimated by the
Engineer and certified for payment.
Attachment A,3 of 3
Docui
■slcuIro
Certificate Of Completion
Envelope Id:5EA8077A570F48AEA7A57AA7D2604D3C Status:Completed
Subject:48400-140-IGOIP1700642/RICHMOND COUNTY
Source Envelope:
Document Pages: 12 Signatures:7 Envelope Originator:
Certificate Pages:6 Initials:0 GDOT Contracts Admin
AutoNav:Enabled 600 W Peachtree St,NW
Envelopeld Stamping:Enabled Atlanta,GA 30308
Time Zone:(UTC-05:00)Eastern Time(US&Canada) gdot_contracts@dot.ga.gov
IP Address: 143.100.53.12
Record Tracking
Status:Original Holder:GDOT Contracts Admin Location:DocuSign
11/3/2016 gdot_contracts@dot.ga.gov
Signer Events Signature Timestamp
Hardie Davis,Jr. x
EkartitAG
Dustoedby: Sent:11/3/2016
mayordavis@augustaga.gov OSS)Jr. Viewed:11/9/2016
Security Level:Email,Account Authentication ae,Es,ercwEs... Signed:11/15/2016
(None)
Using IP Address: 184.95.149.120
Electronic Record and Signature Disclosure:
Accepted: 11/9/2016
ID:c852626a-26ae-4f87-8ac6-e2c510850ab2
Lena J.Bonner e—Do`uftned"" Sent:11/15/2016
lbonner@augustaga.gov Viewed:11/16/2016
SecurityLevel:Email,Account Authentication �'an'x°57°O`�"
Signed: 11/28/2016
(None)
Using IP Address:184.95.149.120
Electronic Record and Signature Disclosure:
Accepted:11/16/2016
ID:8027d7e4-b0a6-4dc6-93d4-e93b5c5df8ee
Natasha L.McFarley °r ElkeuSlynod
Sent:11/28/2016
nmcfarley@augustaga.gov Resent: 11/30/2016
Security Level:Email,Account Authentication D5
741
5A244
1" Viewed:11/28/2016
(None) Signed: 11/30/2016
Using IP Address:184.95.149.120
Electronic Record and Signature Disclosure:
Accepted:11/30/2016
ID:0752f90f-e950-4a 37-b5d b-fae3e6195708
Keisha Franks Completed Sent:11/30/2016
kefranks@dot.ga.gov Viewed: 11/30/2016
Security Level: Signed: 11/30/2016
.Email Using IP Address:143.100.53.12
ID:b5e02dbe-61ff-4576-9a67-3dcf5451fe3f
11/30/2016
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Signer Events Signature Timestamp
Nancy Clayton Cobb Completed Sent:11/30/2016
ncobb@dot.ga.gov Resent:11/30/2016
Security Level: Viewed: 12/5/2016
.Email Using IP Address:143.100.53.12 Signed: 12/5/2016
ID:eff24445-b1e5-4762-ab43-06638dc14d31
12/5/2016
Electronic Record and Signature Disclosure:
Accepted:6/6/2016
ID:367185d7-0052-481c-bfbd-927bae9fe0ad
Margaret Bryson Pirkle Completed Sent:12/5/2016
mpirkle@dot.ga.gov Resent: 12/5/2016
Security Level: Viewed: 12/5/2016
.Email Using IP Address:143.100.53.12 Signed:12/5/2016
ID:269cbf09-e4c8-4949-b4fc-a9542255b194
12/5/2016
Electronic Record and Signature Disclosure:
Accepted:2/25/2016
ID:e21c5282-8106-45b2-9ad2-92a17511f9a3
Annette F.Simelaro Completed Sent:12/5/2016
asimelaro@dot.ga.gov Resent: 12/7/2016
Security Level: Viewed: 12/7/2016
.Email Using IP Address: 143.100.53.12 Signed:12/7/2016
ID:483a29e2-4afb-40e1-9834-bbf092354321
12/7/2016
Electronic Record and Signature Disclosure:
Accepted:12/7/2016
ID:f573d6a0-1b54-472f-a785-4e48882174a7
Angela 0.Whitworth Completed Sent:12/7/2016
awhitworth@dot.ga.gov Resent: 12/7/2016
Security Level: Viewed:12/9/2016
.Email Using IP Address: 143.100.53.12 Signed:12/9/2016
ID:0303a44d-9189-4505-8486-d419d0e03325
12/9/2016
Electronic Record and Signature Disclosure:
Accepted:2/26/2016
ID:9a5effa8-cd4c-40bb-b3c9-d32c1f9c7bf3
Russell R McMurry Deeu6Wnedby: Sent:11/30/2016
rmcmurry@dot.ga.gov C.'4.Su'�' K "1 Resent: 12/9/2016
Security Level: 7°O�7D00�`F� Viewed: 12/9/2016
.Email Signed: 12/9/2016
12/9/2016 Using IP Address:174.218.9.208
Signed using mobile
Electronic Record and Signature Disclosure:
Accepted:-2/26/2016
ID:cd5459ce-99ae-409c-b25c-b6922ca5a283
Angela 0.Whitworth DaeuBbne""'':, Sent:12/9/2016
awhitworth@dot.ga.gov Resent: 12/9/2016
Security Level: lll���„oefieseoF�c.zs. Viewed: 12/12/2016
.Email Signed: 12/12/2016
ID:5365e314-e56c-484e-ab8e-8d32e5278c37 Using IP Address:143.100.53.12
12/12/2016
Electronic Record and Signature Disclosure:
Accepted:2/26/2016
ID:2a61aae5-fe62-454e-9e47-e070cdbd9d0a
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status
intermediary Delivery Events = Status Timestamp
Certified Delivery Events Status Timeatamp
Carbon Copy Events ; Status r { j . : ime mp ..# �
Notary Events
nvelopemmary�nsm." fus .,.
Envelope Sent Hashed/Encrypted 12/9/2016
Certified Delivered Security Checked 12/12/2016
Signing Complete Security Checked 12/12/2016
Completed Security Checked 12/12/2016
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on:2/24/2016
Parties agreed to:Hardie Davis,Jr.,Lena J.Bonner,Natasha L.McFarley,Nancy Clayton Cobb,Margaret Bryson Pirkle,Annette F.Simelaro,Angela 0.Whitworth,R
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Georgia Department of Transportation(we, us or Company) may be required
by law to provide to you certain written notices or disclosures. Described below are the terms
and conditions for providing to you such notices and disclosures electronically through your
DocuSign, Inc. (DocuSign)Express user account. Please read the information below carefully
and thoroughly, and if you can access this information electronically to your satisfaction and
agree to these terms and conditions, please confirm your agreement by clicking the 'I agree'
button at the bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. For such copies, as long as you are an authorized user of the
DocuSign system you will have the ability to download and print any documents we send to you
through your DocuSign user account for a limited period of time (usually 30 days) after such
documents are first sent to you. After such time, if you wish for us to send you paper copies of
any such documents from our office to you, you will be charged a$0.00 per-page fee. You may
request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign'Withdraw Consent'form on the signing page of your
DocuSign account. This will indicate to us that you have withdrawn your consent to receive
required notices and disclosures electronically from us and you will no longer be able to use your
DocuSign Express user account to receive required notices and consents electronically from us
or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through your DocuSign user account all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process,please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Georgia Department of Transportation:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: gdot_contracts@dot.ga.gov
To advise Georgia Department of Transportation of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at gdot_contracts@dot.ga.gov and in
the body of such request you must state: your previous e-mail address, your new e-mail address.
We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in DocuSign.
To request paper copies from Georgia Department of Transportation
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to gdot_contracts@dot.ga.gov and in the
body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Georgia Department of Transportation
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign account, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to gdot_contracts@dot.ga.gov and in the body of such request you
must state your e-mail, full name, IS Postal Address, telephone number, and account
number. We do not need any other information from you to withdraw consent.. The
consequences of your withdrawing consent for online documents will be that transactions
may take a longer time to process..
Required hardware and software
Operating Systems: Windows2000? or WindowsXP?
Browsers (for SENDERS): Internet Explorer 6.0? or above
Browsers (for SIGNERS): Internet Explorer 6.0?, Mozilla FireFox 1.0,
NetScape 7.2 (or above)
Email: Access to a valid email account
Screen Resolution: 800 x 600 minimum
Enabled Security Settings:
•Allow per session cookies
•Users accessing the interne behind a Proxy
Server must enable HTTP 1.1 settings via
proxy connection
** These minimum requirements are subject to change. If these requirements change, we will
provide you with an email message at the email address we have on file for you at that time
providing you with the revised hardware and software requirements, at which time you will
have the right to withdraw your consent.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you,please verify that you
were able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to
e-mail this disclosure and consent to an address where you will be able to print on paper or
save it for your future reference and access. Further, if you consent to receiving notices and
disclosures exclusively in electronic format on the terms and conditions described above,
please let us know by clicking the 'I agree'button below.
By checking the'I Agree'box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify Georgia Department of Transportation as described above,I
consent to receive from exclusively through electronic means all notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be
provided or made available to me by Georgia Department of Transportation during the
course of my relationship with you.