18-10 Contract

Essex County Division of Senior Services CHECK-OFF LIST OF REQUIRED DOCUMENTS Your agency is required to submit with your contract materials copies of a documents listed below with original signature and seals. x x |< [x 1X bad >< [KK [KK 1K LK LK LX Disclosure Statement Non-Collision Affidavit ° Affirmative Action Requirements Statement of Individual(s) Owning 10% or more of Stock or Interest in the Bidders Business Entity Consent of Insurance Coverage Insurance Certificates (current) The County of Essex must be listed as the additional insured. Hold Harmless Agreement Statement of Certain Political Contributions made after July 11, 1986 Certificate of Paid or Outstanding Municipal/County Real Estate Taxes, Water and/or Sewer Obligations . Equal Opportunity for Individuals with Disabilities Vendor Information Proposer’s Affidavit Authorization and Release Copy of the Business Registration Certificate issued by the NJ Department of Treasury Copy of SOIC status or equivalent ( non-profit agencies) Documentation of Current Registration with the New Jersey Division of Consumer Affairs’ Charities Registration Section Most recent audit report or annual financial statement Statement of Adequacy of Accounting System Financial Assurances Assurance of Compliance/Title VI, Civil Rights Act of 1964 Certification Regarding Debarment and Suspension Listing of the Agency’s current Board of Directors, including names, addresses and terms of all members M/A 3 Signature pages with original signatures Governmental Agency — Copy of Resolution by the governing body indicating acceptance of the Obligation under the grant

DISCLOSURE STATEMENT The attention of prospective vendors is drawn to the provisions of the Local Government Ethics Law (N.J.S.A. 40A:9-22- 1, et seq.) which prohibits a County Officer or employee or member of his/her immediate family from having an interest in a business organization or engaging in any business transaction, or professional activity which is in substantial conflict with the proper discharge of his/her duties in the public interest. In furtherance thereof, every vendor must disclose below, being an Essex County officer or employee or whether an immediate family member is an Essex County officer of employee. If the vendor is a business organization, then disclosure shal! be made with respect to anyone having an interest in the business and their immediate family members. Please answer the following: Is the vendor, or a member of the vendor's immediate family, or anyone having an interest in the vendor’s business organization including their immediate family members, an officer or employee of Essex County? NO X YES AnthOrized Representative Joseph A. Fonzino Print Name Director/Health Officer Title If yes, provide the name of the individual and identify the position held, below, and notify in writing the Office of County Counsel, Hall of Records, 465 Dr. Martin Luther King, Jr. Blvd., Room 535, Newark, NJ 07102. (Attach a copy of the correspondence to this form). N/A NOTE: All terms used herein are to be construed in accordance with their meaning under the Local Government Ethics Law, cited above. *FAILURE TO SIGN THIS AFFIDAVIT BY A DULY AUTHORIZED COMPANY OFFICIAL WILL RESULT IN REJECTION OF THIS PROPOSAL.

NON-COLLUSION AFFIDAVIT I,__ Joseph A. Fonzino of the City of West Orange , in the County of Essex , and the State of ___New Jersey , of full age, being duly sworn according to law on my oath depose and say that: West Orange Iam Director , of the firm of Health Dept. the vendor making this Proposal for the above named project, and that J executed the said Proposal with full authority to do so; that said vendor has not, directly or indirectly, entered into an agreement, participated in any collusion, or otherwise taken any action in restraint of free competition in connection with the above named project and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the State of New Jersey, County of Essex, relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said project. 1 fully warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by_ Township of West Orange (Company Name) Za Piresigent ice reece or em Tathote Representative Joseph A. Fonzino Print Name Director/Health Officer Tile * FAILURE TO SIGN THIS AFFIDAVIT BY A DULY AUTHORIZED COMPANY OFFICIAL WILL RESULT IN REJECTION OF THIS PROPOSAL.

AFFIRMATIVE ACTION REQUIREMENTS Township of West Orange COMPANY NAME: SIGNATURE: PRINT NAME: fose| - Fonzino TITLE: Director/Health Officer VENDORS ARE REQUIRED TO COMPLY WITH THE REQUIREMENTS OF PLL. 1975, c. 127 (NJ.S.A. 10:5-31, et seq.). See also N.J.A.C. 17:27 et seq. REQUIRED AFFIRMATIVE ACTION EVIDENCE A. PROCUREMENT & SERVICE CONTRACT (which are not subject to a Federally approved or sanctioned affirmative action program). Alll successful vendors must submit within ten calendar (10) days of the notice of intent to award (Memorandum of Agreement) or the signing of the contract, whichever is sooner, one of the following: A PHOTO COPY OF THEIR FEDERAL LETTER OF AFFIRMATIVE ACTION PLAN APPROVAL. OR A PHOTO COPY OF THEIR CERTIFICATE OF EMPLOYEE INFORMATION REPORT. w OR A COMPLETED AFFIRMATIVE ACTION EMPLOYEE INFORMATION REPORT (AA302), B. CONSTRUCTION CONTRACTS ALL SUCCESSFUL CONTRACTORS MUST SUBMIT WITHIN TEN (10) DAYS OF THE NOTICE OF INTENT TO AWARD A CONTRACT (MEMORANDUM OF AGREEMENT), AN INITIAL PROJECT MANNING REPORT (AA201) FOR ANY CONTRACT AWARD THAT MEETS OR EXCEEDS THE PUBLIC AGENCY BIDDING THRESHOLD.

EXHIBIT A NJ.S.A, 10:5-31 et seq, NJAC. 17:27 MANDATORY EQUAL EMPLOYENT OPPORTUNITY LANGUAGE GOODS, PROFESSIONAL SERVICES AND GENERAL SERVICE CONTRACTS (Mandatory Affirmative Action Language) During the performance of this contract, the contractor agrees as follows: ‘The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation or sex. Except with respect to affectional or sexual orientation, the contractor will take affirmative action fo ensure that such applicants are recruited and employed, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation or sex. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for available to employees and applicants for training, including apprenticeship, The contractor agrees to post in conspicuous places, employment, notices to be provided by the Public Agency Compliance Officer setting for the provisions of this nondiscrimination clause, will, in all solicitations or advertisements for employees placed by or on behalf of the The contractor or subcontractor, where applicable, ployment without regard to age, race, creed, color, national contractor, state that all qualified applicants will receive consideration for em origin, ancestry, marital status, affectional or sexual orientation or sex. The contractor or subcontractor, where applicable, will send to each labor union or representative or workers with which if has a collective bargaining agreement or other contract or understanding, 2 notice, to be Provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under this act and shall post copies of this notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with the regulations promulgated by the Treasurer pursuant to N.J.S.A.10:5-31 et seq., as amended and supplemented from time fo time

The contractor or subcontractor, where applicable, agrees to comply with the regulations promulgated by the Treasurer pursuant to N.J.S.A.10:5-31 et seq., as amended and supplemented from time fo time and the Americans With Disabilities Act. The contractor or subcontractor agrees to attempt in good faith efforts to employ minority and women workers consistent with the applicable county employment goals established in accordance with N.J.A.C. 17:27-5.2 ora binding determination of the applicable county employment goals determined by the Division, pursuant fo N.J.A.C. 17:27-5.2, The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited fo, employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age, creed, color, national origin, ancestry, marital status, sex, affectional or serual orientation or sex, and that it will discontinue-the use of any recruitment agency which engages in direct or indirect discriminatory practices, The contractor or subcontractor agrees to revise any of is testing procedure, if necessary, to assure that all personnel testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions, In conforming with the applicable employment Boals, the contractor or subcontractor agrees (0 review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law atid applicable Federal court decisions. The contractor shall submit to the public agency, affer notification of award but prior to execution of a goods and services contract, one of the following three documents: Lettter of Federal Affirmative Action Plan Approval Certificate of Employee Information Report Employee Information Report Form AA302 The contractor and its subcontractors shall furnish such reports or other documents to the Division of Contract Compliance & EEO as may be requested by the division from time to time in

rt Form AA302 The contractor and its subcontractors shall furnish such reports or other documents to the Division of Contract Compliance & EEO as may be requested by the division from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of Contract Compliance & EEO for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code (NJAC 17:27), 10/27/05 revised

AFFIRATIVE ACTION EEOP SHORT FORM Grant Title: Visiting Nurses Grant Number: 45502214 Dental 20102327 Grantee Name: Township of West Orange Award Amount: $37,871.00 Address: 66 Main Street West Orange, NJ 07052 Contact Person: John K. Sayers Telephone # 973-325-4050 Date and effective duration of EEOP: 01/01/10 - 12/31/10 Policy Statement: It_is the policy of the Township of West Orange to assure equitable and fair treatment_of applicants _and_employees in all employment _realted matters without regard to race, color, gender, creed, national origin, ethnicity, ancestry, religious beliefs, age, marital status, sexual orientation, political_affiliation, military status, or _physicial_or mental disability that with reasonable accommodation does not significantly interfere with the ability to perform the essential functions of the job. This policy shall_apply_to_all_phases of employment, such as, recruitment, selection, intment, placement, promotion, demotion, transfer, training, wages, benefits, workin: conditions, and such human resource actions as layoff, recall, discharge, disciplinary action, and performance evaluation. Business Administrator 01/04/10 A / Signatufe a Title Date

EQUAL EMPLOYMENT OPPORTUNITY PLAN TOWNSHIP OF WEST ORANGE UTILIZATION ANALYSIS The United States Department of Labor does not publish community labor statistics indigenous solely to the Township of West Orange. The closest this analysis can come is to the statistics compiled for the County of Essex. For analysis purposes, we can extrapolate West Orange statistics by comparing similar averages within Essex County to achieve a working ratio. There is a need for better representation of the minority community in the township’s workforce. Unfortunately, there has been a hiring freeze for the past few years due to budgetary constraints. Further, the Township of West Orange traditionally grants employment preference to residents of the Township. For applicants with similar job qualifications, residency is a tie breaker. In 2003, the Township Council repealed a municipal ordinance requiring municipal workers to live within the Township. This was a significant first step in equaling the playing field for potential municipal workers. For the category labeled Protective Services, there is a need for a better representation of non- white employees both in the Officials category and the Patrol Officers category. The Township of West Orange is considered a Merit System jurisdiction and falls under the rules of the New Jersey Department of Personnel and is subject to the provisions of NJAC 4A:1-1 et seq. in all employment related actions. As a result, applicants for law enforcement positions must take a written test promulgated and conducted by the New Jersey Department of Personnel. Applicants are hired based upon their relative position of the list published by the New Jersey Department of Personnel. This list is compiled without any reference to any protected class. The better your score, the higher ranking you will achieve on the hiring list. An extensive background check is conducted to select the best candidates solely on merit. The West Orange Police Department first became integrated in 1993. In the twelve years since, the number of minority law enforcement employees has varied from a high of 10 % in 1995 to the current levels illustrated in the attached Utilization Chart. Promotional opportunities within the police department are based solely on merit through the New Jersey Department of Personnel. Based on the statistical data provided by the United

ilization Chart. Promotional opportunities within the police department are based solely on merit through the New Jersey Department of Personnel. Based on the statistical data provided by the United States Census Bureau for 2000, the Race/Ethnicity groups comprising West Orange are: White, Non Hispanic 62.1% Black, Non-Hispanic 17.1% Other Races, Non-Hispanic 10.8% Total Hispanic (All Races) 10.0% This is a much different depiction of the Township of West Orange from the 1990 Census. In 1990, the Race/Ethnicity groups comprising West Orange were: White, Non Hispanic 84.3% Black, Non-Hispanic 5.6% Other Races, Non-Hispanic 5.8% Total Hispanic (All Races) 4.2% EEOC Utilization Analysis 01/01/08 Page 1 of 3