18-10 Contract

PROPOSER’S AFFIDAVIT THIS AFFIDAVIT IS PART OF THE PROPOSAL State of New Jersey County of _ Essex I, Joseph A. Fonzino , . (Print Name) certify that Iam the _ Director/Health Officer (State Title) of the business entity submitting this proposal; thal I have completed and signed all of the required documents; that I am duly authorized to sign the proposal on behalf of the business entity; and that all of the declarations and statements contained in the proposal document are true and accurate to the best of my knowledge and belief. 01/07/10 yposer) (Date) NOTARY: Subscribed and sworn to before me a_(Wesk © Range this BN dayof An. 20ho 4 lotary Public) * Notary DENISE M. URSO NOTARY PUBLIC OF NEW JERSEY Commission Expires: ————Gemmission Expires 07/14/2014

AUTHORIZATION AND RELEASE The undersigned hereby: Releases Essex County, New Jersey, and its affiliates, their respective officers, employees and agents from any liability for any damage whatsoever as a result of any investigation, inquiry, consumer report or investigative consumer report made or received by the County, its representatives and designees, Authorizes any person, association, firm, company, law enforcement agency or personnel office to furnish any information including but not limited to business reputation, credit history, references, performance, criminal conviction record, civil record, and any other record, as well as any records or reports relating to me or the Company. N/A Print Name Signature Home Address City State Zip Phone (Daytime) Phone (Evening) Township of West Orange Company Name 66 Main Street, West Orange, NJ 07052 Company Address City State Zip 01/07/10 Date

Appendix Revised Contract Language for BRC Compliance Goods and Services Contracts, Professional Service Contracts N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly provide goods or perform services for a contractor fulfilling this contract: 1) the contractor shall provide written notice to its subcontractors to submit proof of business registration to the contractor: 2) prior to receipt of final payment from a contracting agency, a contractor must submit to the contracting agency an accurate list of all subcontractors or attest that none was used; 3) during the term of this contract, the contractor and its affiliates shall collect and remit to the Director, New Jersey Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A. $4:2B-I et seq.) on all sales of tangible personal property delivered into this State. Construction Contracts (including public works related purchase orders) N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly provide goods or perform services for a contractor fulfilling this contract: 1. the contractor shall provide written notice to its subcontractors and suppliers to submit proof of business registration to the contractor. 2. subcontractors through all tiers of a project must provide written notice to their subcontractors and suppliers to submit proof of business registration and maintain them on file; 3. prior to receipt of final payment from a contracting agency, a contractor must submit to the contracting agency an accurate list of all subcontractors and suppliers or attest that none was used; and 4. during the term of this contract, the contractor and its affiliates shall collect and remit, and shall notify all subcontractors and their affiliate that they collect and remit, to the Director, New Jersey Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act. (N.J.S.A.54:2B-1 et seq) on all sales of tangible personal property delivered into this State. A contractor, subcontractor or supplier who fails to provided proof of business registration information shall be liable to a penalty of $25.00 for each day of violation, not to exceed $50,000.00 for each business registration copy not properly provided of maintained under a contract with a contracting agency.

e liable to a penalty of $25.00 for each day of violation, not to exceed $50,000.00 for each business registration copy not properly provided of maintained under a contract with a contracting agency. Information on the law ant its requirements are available by calling 609- 292-9292. PLEASE NOTE: NON-PROFIT ORGANIZATIONS ARE EXEMPT-HOWE VER NON- PROFIT ORGANIZATIONS MUST PROVIDE A COPY OF THEIR 501C STATUS OR EQUIVALENT.

ASSEMBLY BILL NO. 3130 STATE OF NEW JERSEY 211™ LEGISLATURE INTRODUCED JUNE 21, 2004 SECTION 1 OF P. L. 2001.C.134 (c.52:32-44) EFFECTIVE SEPTEMBER 1, 2004, A COPY OF THE BUSINESS REGISTRATION CERTIFICATE ISSUED BY THE NJ DEPARTMENT OF TREASURY MUST BE PROVIDED AT THE TIME THE PROPOSAL IS SUBMITTED; FAILURE TO DO SO IS A FATAL DEFECT THAT CANNOT BE CURED. TO OBTAIN A BUSINESS REGISTRATION CERTIFICATE, CONTACT THE NEW JERSEY DIVISION OF REVENUE AT 1-609-292-1730 OR REGISTRARION ONLINE. Www. State.nj.us/treasury/revenue/busregcert Not Applicable for Government Agencies

Under the Local Public Contracts Law (NJ.S.A. 40A: 11-23.2) failure to submit proof of registration with a bid warrants a mandatory rejection of bids as a non-waivable defect. This applies to construction work, as well as non-construction bids, and Competitive Contracting requests for proposals. Under case law, this requirement falls into the category of documents where failure to submit proof is deemed a fatal defect that renders the bid proposal unresponsive and one that cannot be cured by the governing body. To obtain a Business Registration Certificate, contact the New Jersey Division of Revenue at 1-609-292- 1730 or register online @http://www.state.ni.us/treasury/revenue/busregcert.htm THESE ARE SAMPLES OF THE ONLY ACCEPTABLE BUSINESS REGISTRATION CERTIFICATES. FAILURE TO SUBMIT ONE OF THESE DOCUMENTS WITH THE BID WILL CAUSE YOUR BD TO BE REJECTED, REGARDLESS OF THE FACT THAT A COPY MAY ALREADY BE ON FILE WITH THE COUNTY OF ESSEX. STATE OF HEE JERSEY BUSINESS REGISTHATION CERTIFICATE FOR STATE AGENCY AND CASINO SERVICE ©: ci iterate TAMPAYER Rugtte: TAX REGISTRATION TEST ACCOUNT —_ Taig Gexanewte oe scoseacmunness HI enien se 24 a st atewt acoarton, EA ETE Soa SSeS = STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Faxpayer Name: TAX REG TES Trade Name: Address: 847 ROEBLING AVE TRENTON, NE 08611 Certifiente Nenvher: 15907 Date of issuances Ccvtober b4, 2005 For Office Use Ont: 200460 14112823533 NOT APPLICABLE FOR GOVERMENT AGENCIES

Instructions For Certification . By signing and submitting this proposal, the prospective recipient of federal assistance funds is providing the certification as set out below. . The Certification in this clause is a material representation of fact upon which reliance was placed when this transaction was enter into. If it is later determined that the prospective recipient of the Federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies including suspension and/or debarment. . The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of charged circumstances. . The terms “covered transaction,” “debarred,” “suspended,” “ineligible,” “lower tier covered transaction,” “participant,” “person,” “primary covered transaction,” “principal,” “proposal,” and “voluntarily excluded,” as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. . The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. . The prospective recipient of Federal assistance funds further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — Lower Tier Covered Transactions,” without modification, in all lower tier covered transactions and in all proposals for the lower tier covered transaction. . A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or

ransaction. . A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may but is not required to check the List of Parties Excluded from Procurement or Non-procurement Programs. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally processed by a prudent person in the ordinary course of business dealings. . Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly entered into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntary excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOL may pursue available remedies, including suspension and/or debarment.

STATEMENT OF ADEFOUACY OF ACCOUNTING SYSTEM Essex County Division on Aging 50 So. Clinton Street East Orange, NJ 07018 Gentlemen: of the Township of West Orange Edward J. Coleman, CFO Name of Grantee Tide of Chief Financial Officer I am the And, in the capacity, I will be responsible for establishing and maintaining the financial accounts for_South West Essex Dental Services/West Orange Regional Name of Project The accounting system that will be established and maintained for the purpose of this grant will be adequate to: Provide for accurate identification of the receipts and expenditures of Essex County Division 1. on Aging funds by approved budget cost categories. rovide documentation supporting book entry filed in such a way that it can be readily located. 12 Provide accurate and current financial repdrting information. is) 4. Be integrated with a strong system of intemal control. 5. Will conform to any and all requirements or guideline; Aging may issue. Edward J. Coleman Sighatare of Financial Officer CFO Title Township of West Orange Name of Grantee

McENERNEY, BRADY & COMPANY, LLC Certified Public Accountants * A Limited Liability Company John L. Ezyske, CPA, RMA Francis M. McEnerney, CPA, RMA John F. Lauria, RMA Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed In Accordance with Government Auditing Standards The Honorable Mayor and Members of the Township Committee Township of West Orange West Orange, New Jersey We have audited the financial statements of the Township of West Orange, New Jersey as of and for the year ended December 31, 2008, and have issued our report thereon dated May 22, 2009. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States and the audit requirements prescribed by the Division of Local Government Services, Department of Community Affairs, State of New Jersey. As described in Note A, the financial statements were prepared in conformity with the accounting practices prescribed by the Division of Local Government Services, Department of Community Affairs, State of New Jersey, that demonstrates compliance with the modified accrual basis, with certain exceptions, and the budget laws of New Jersey, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America. Internal Control Over Financial Reporting In planning and performing our audit, we considered the Township of West Orange’s internal control over financial reporting as a basis for designing our auditing procedures for the purpose of expressing our opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of the Entity’s internal control over financial reporting. Accordingly, we do not express an opinion on the effectiveness of the Entity’s internal control over financial reporting. ‘A control deficiency exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect misstatements on a timely basis. A significant deficiency is a control deficiency, or combination of control deficiencies, that adversely affects