18-10 Contract

DATE (MMODNYYY) OPID C2. 12/31/08 WESTO-3 PRODUCER, 900 Route 9 North Woodbridge NJ 07095 Phone: 732-634-8400 Fax:7 iNsuRED ack Sayers 66 Main’ stree BGIA-GSMJIF Underwriting Unit 32-634-5379 Township of Weat Ozange + West Orange Nd 07052 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW| INSURERS AFFORDING COVERAGE NAIC # insuReRA Garden State Municipal JIF INSURER &: INSURER C INSURER 0 INSURER E: COVERAGES ANY REQUIREMENT, TERM OR CONDITION THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU! MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBI POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ‘OF ANY CONTRACT ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH FECTIVE |POLICY EXPIRATION a yo0' Ne Ina TYPE OF NSURANCE POLICY NUMBER TSAI ray [BRIE damrooN SD LMT | GENERAL LIABILITY EACH OCCURRENCE: $15,250,000 A |X [x ] commercia ceneraluiasuiy | GSMITF2009 01/01/09 | 01/01/10 |Prenises(esccurenc) |$ None CLAIMS MADE |X | OCCLR MED EXP {Anyone person) |¢ Included |_| PERSONAL &AOVINURY | $ Included GENERAL AGGREGATE $None GENL AGGREGATE LIMIT APPLIES PER" PRODUCTS xCOMPICP AGG | $ Included. poucy[ [BS [roc AUTOMOBILE LIABILITY =z COMBINED SINGLE LIMT . : $15,250,000 A] [x |awasto GSMITE2009 01/01/09} o1/o1/io | Eeastn) ' |__| Av owen autos BODILY INJURY 3 SCHEDULED AUTOS: {Per person) |__| HIRED suros BODILY INJURY $ NON-OWNED ALTOS: (Per accident} PROPERTY DAMAGE : Per accor) GARAGE LIABILITY PUTO ONLY -EAACCIDENT | $ ANY AUTO OTHER THAN EAACC|$ AUTO ONLY: acc |$ EXCESSAMORELLALIABILITY EACH OCCURRENCE: + [~] occur CLAMS MADE AGGREGATE $ . _ _ es ie _ + DEDUCTIBLE $ RETENTION ¢ $ WORKERS COMPENSATION AND X frowvumirs | [en EMPLOYERS" LIABILITY A | aary PROPRETORI ARTNEREXECUTIVE GSMIIF2009 01/01/09 | 01/01/10 | et EACH ACCIDENT $15,250,000 OFFICERIME MBER EXCLUDED? EL. DISEASE - EAEMPLOYES $ 15,250,000 yee ee VISIOIS below EL DSEASE -poucyumm|s 15,250,000 OTHER DESCRIPTION OF OPERATIONS /LOGATIONS / VEHICLES /EXGLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is included as additional insured on the ommercial General Liability policy per terms, conditions and

ONS /LOGATIONS / VEHICLES /EXGLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is included as additional insured on the ommercial General Liability policy per terms, conditions and exclusions of the policy as respects nursing services, visits to home bound seniors. * CERTIFICATE HOLDER CANCELLATION Suite 3200 ESSCTYD Essex County Division of Aging 50 S. Clinton Street East Orange NJ 07018 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI DATE THEREOF, THE ISSUINGINSURER WILL ENDEAVOR TOMA, 10_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ILI ACORD 25 (2001/08) © ACORD CORPORATION 1

AcoRD, CERTIFICATE OF LIABILITY INSURANCE gee 25 | Tay ai yon PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOI ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BGIA-GSMJIF Underwriting Unit HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 900 Route 9 North ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW| Woodbridge NJ 07095 Phone: 732-634-8400 Fax:732-634-5379 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA Garden State Municipal JIF INSURER seepsbipeet * West Ozange NSURERG West Orange WN. 5 07052 INSURER O INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IwsR ADDY 7 Crm INGA TYPE OF INSURANCE POLICY NUMBER Tae mars [BRE kilroRy Lats GENERAL LIABILITY EACH OCCURRENCE $15,250,000 rx] DEMME TO RENTED A(X [X ] commercia ceneravisauity | GSMIIF2009 01/01/09 | 01/01/10 | PREMISES (Ea ocarence) | $ None CLAIMS MADE | X | OCCLR MED EXP (Anyone person) | $ Included |_| PERSONAL & ADV iNURY |$ Included GENERAL AGGREGATE | $ None GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS .comPice acc | $ Included [_Jroucy[ 18%: [toc AUTOMOBILE LIABILITY ‘COMBINED SINGLE LIMIT 5 $15,250,000 A [x | avy auto GSMITF2009 01/01/09 | 01/01/10 | Eesecen ‘ |_) ALL OWNED ALTOS BODILY INLRY $ SCHEDULED AUTOS Per person) |_| HiRED autos BODILY INURY $ NONLOWNED AUTOS Per accigert) PROPERTY DAMAGE $ (Per accident) [ GARAGE LIABILITY ALTO ONLY-EAACCIDENT | $ ANY ALTO omHertHN EA ACE | $ AUTO ONLY: ca |s EXCESS(UMBRELLALIABILITY ACHOCCURRENCE $ ocr — [_] ctams maoe ‘AGGREGATE $ _ $ DEDUCTIBLE $ RETENTION $ $ ‘WORKERS COMPENSATION AND x [rowers | [ER EMPLOYERS’ LIABILITY A AY PROPRETORPARTNERIEXECUINVE GSMITEF2009 01/01/09} 01/01/20 |e. Each AcciDENT $15,250,000 Orr ICERMENEER EX E.L DISEASE -EA EMPLOYER $ 15, 250,000 SAE EROVEISNS below EL DSEASE -PoLICY UM |$ 15,250,000 ‘OTHER, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADOED BY ENDORSEMENT? SPECIAL PROVISIONS The Certificate Holder is included as addtional insured on the

PoLICY UM |$ 15,250,000 ‘OTHER, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADOED BY ENDORSEMENT? SPECIAL PROVISIONS The Certificate Holder is included as addtional insured on the Commercial General Liability Policy per terms, conditions and exclusions of the policy as respects dental services. * CERTIFICATE HOLDER CANCELLATION ESCTYDI | SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMA, 10__ DAYS WRITTEN NOTIGE To THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 $0 SHALL Essex County Division of Aging IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 50 South Clinton St Suite 3200 REPRESENTATIVES. East Orange NJ 0701 CRE gegen ACORD 25 (2001/08) © ACORD CORPORATION 1

COUNTY OF ESSEX NEWARK, NEW JERSEY HOLD HARMLESS AGREEMENT BETWEEN: . The County of Essex Hall of Records 465 Dr. Martin Luther King, Jr. Blvd. Newark, NJ 07102 AND TOWNSHIP OF WEST ORANGE Contractor's Name Health Department, 66 Main Street, West Orange, NJ 07052 . Address ~ nol a post office box 973-325-4124 973-325-4005 healthdept@westorange.org Telephone Number; Fax Number; & e-mail address It is understood and agreed the Contractor is: 1, An independent Contractor and not an employee of the County of Essex. The Contractor agrees to indemnify and hold harmless the County of Essex, the Essex County Board of Chosen Freeholders, and all of its officers, agents and employees of and from any and all liability for damages for injury to person and, Property, including death, and against and from all suits and actions and all costs, damages and charges of whatsoever kind and nature, including attorneys’ fees to which the County of Essex may be put for, or on account of, any injury or alleged injury to person, including death, or property, resulting from the performance of the Contractor's operations under this contract, or by or in consequence of any neglect or omission of the part of the Contractor in the performance of operations under this contract, whether such operations, or the absence thereof, be by the Contractor or anyone directly or indirectly employed by the Contractor. The Contractor shall hold the County of Essex harmless for damages to the Contractor’s equipment utilized during the term of this contract. ae5? or Signature of Authorized Representative Director/Health Officer 01/07/10 Joseph A. Fonzino Title Date Print Name

STATEMENT OF CERTAIN POLITICAL CONTRIBUTIONS MADE AFTER JULY 11, 1986 -NEGOTIATED CONTRACTS- (This Statement is part of the proposal packet) Ordinance Number 0-86-0007, as amended by Ordinance Number 0-95-0003, adopted by the Board of Chosen Freeholders of the County of Essex, requires that all proposals for negotiated contracts submitted by individuals and/or business entitles seeking to provide goods to or to perform services for the County of Essex shall contain a statement setting forth each political contribution by them of $500.00 or more made within five years next preceding the date of said contract, either directly or indirectly, to any County elected political official, County political party and/or County official, political organization, or any State political party. Set forth name of County elected official, County political party and/or County official, political organization, or State political party to whom a political contribution of $500.00 or more was made by proposer within five (5)-years of the date hereof. If none, write “none”. NAME . AMOUNT None Proposer__ Je Z Py » OLE bag fit or Type Name of Signatory Joseph A. Fonzino

COUNTY OF ESSEX CERTIFICATION OF PAID OR OUTSTANDING REAL ESTATE TAX, WATER, AND/OR SEWER OBLIGATION N/A am the duly authorized representative of (Name of Individual) in connection with a proposed contract with the County of (Name of Firm) Essex to provide the goods/services described on paye 2 of this document for the contract period identified on page 3. and Thereby state that I have reviewed the records of. determine that there ( ) are, ( ) are not outstanding charges due and owing for real estate taxes, water and/or sewer costs. If there are outstanding obligations owed, state amount, and dates below: I certify that the aforestated representation is true and accurate. Name and Title:__Joseph A. Fonzino, Director/Health Officer Signature: LAC Date: __01/

AMERICANS WITH DISABILITIES ACT EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABILITIES The contractor and the County of Essex, (hereafter “Owner”) do hereby agree that the provisions of Title I of the Americans With Disabilities Act of 1990 (the “Act”) (42 U.S.C. $12.10! et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs and activities provided or made available by public entities, and the rules and regulations promulgated pursuant thereunto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the Owner pursuant to this contract, the contractor agrees that the performance shall be in strict compliance with the Act. In the event the contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall defend the Owner in any action or administrative Proceeding commenced pursuant to this Act. The contractor shall indemnity, protect, and save harmless the Owner, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The contractor shall, at it own expense, appear, defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant fo the Owner's grievance procedure, the contractor agrees to abide by any decision of the Owner which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the Owner, or if the Owner incurs any expense fo cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense. The Owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim. If any action or administrative proceeding is brought against the Owner or any of its agents, servants, and employees, the Owner shall expeditiously forward of have forwarded to the contractor every demand, complaint,

dministrative proceeding is brought against the Owner or any of its agents, servants, and employees, the Owner shall expeditiously forward of have forwarded to the contractor every demand, complaint, notice, summons, pleading, or other process received by the Owner or its representatives, It is expressly agreed and understood that any approval by the Owner of the services provided by the contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the Owner pursuant {o this paragraph. It is further agreed and understood that the Owner assumes no obligation to indemnify or save harmless the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of (his indemnification clause shall in no Way limit the contractor's obligations assumed in this Agreement, nor shall they be construed {o relieve the contractor from any liability, nor preclude the Owner from taking any other actions available to it under any other provisions of this Agreement or otherwise at law. SI ignature of Authorized Representative Joseph A. Fonzino Director/Health Officer 01/07/10 Title Date Print Name

VENDOR INFORMATION In order to assure that all future correspondence is directed to the correct address, assure proper ordering, expedite future payments, and in accord with LR.S. regulations, the following information must be provided with this proposal. Township of West Orange Name of Business: (Print) Joseph A. Fonzino Name of Contact Person: (Print) Correspondence Address (including zip code): Township of West Orange 66 Main Street West Orange, NJ 07052 Purchase Order Address (including zip code): same Payment Address (including zip code): same Telephone Number (including area code): (973 325-4124 Fax Number (including area code): 973 325-4005 healthdept@westorange. org E-Mail Address: Employer LD. # or S.S, #; 227-600-2396 FAILURE TO PROVIDE ALL OF THE ABOVE INFORMATION MAY RESULT IN REJECTION OF THIS PROPOSAL, -