FORM 483-S
REVISED 11/2007
STATE OF GEORGIA
DEPARTMENT OF TRANSPORTATION
CERTIFICATION OF SUBCONTRACTOR’S CURRENT CAPACITY
Submitted by the Undersigned with and as a part of
REQUEST FOR APPROVAL OF SUBCONTRACT
Date:
Project Number:
Location:
Prime Contractor:
CERTIFICATION OF SUBCONTRACTOR
We,
(Name of Individual, partnership, or Corporation)
hereby certify that the amount of the proposed subcontract for which approval is requested in connection with the above noted Project does not exceed the amount of our CURRENT CAPACITY. The following is a true and correct computation of such CURRENT CAPACITY.
MY CURRENT CAPACITY RATING IS $
Deduct the Total Uncompleted Work
as shown on the attached “Status
of Contracts on Hand” report. $
MY CURRENT CAPACITY IS $
The attached report of “Status of Contracts on Hand” includes all contracts which have been awarded to us up to and including the date of this Certificate.
Sworn to and subscribed before me this
day of ,
NAME OF FIRM
(year). BY:
TITLE:
NOTARY PUBLIC
My Commission Expires:
DATE
SUBCONTRACTOR’S WORK AUTHORIZATION CERTIFICATION
Pursuant to O.C.G.A. § 13-10-91, all qualifying contractors and sub-contractors performing work within the State of Georgia on a contract with a public employer must register and participate in a federal work authorization program. Sub-contractors may participate in 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 (“IRCA”).
The date by which your company must register and participate in a federal work authorization program depends on the number of employees in your company. If your company has 500 or more employees, you are required to register and participate in a federal work authorization program by July 1, 2007. If your company has 100 or more employees, you are required to register and participate in a federal work authorization program by July 1, 2008. If your company has 99 employees or fewer, you are required to register and participate in a federal work authorization program by July 1, 2009.
Certify compliance with O.C.G.A. § 13-10-91 by checking the appropriate line below:
_____ The undersigned has registered for and is participating in
a qualifying federal work authorization program; or,
_____ The undersigned is not required to register for or participate in a
qualifying federal work authorization program at this time. But, if
the undersigned becomes a qualifying sub-contractor in the future,
the undersigned agrees to immediately:
(1) Notify the covered prime contractor; and,
(2) Register for and participate in a qualifying federal work authorization program.
_____________________________ ___________________________
BY: Authorized Officer or Agent Date
_____________________________
Title of Authorized Officer or Agent SUBSCRIBED AND SWORN
_____________________________ BEFORE ME ON THIS THE
Printed Name ______ DAY OF ________, 20____.
_____________________________ _____________________________
Basic Pilot User Identification Number Notary Public
(if applicable) My Commission Expires: _________