18-10 Contract

APPLICATION FOR ESSEX COUNTY DIVISION ON AGING GRANT CERTIFICATION REGARDING DEBARMENT AND SUSPENSION In accordance to Federa] Executive Order 12549, “Debarment and Suspension,” the undersigned certifies, to the best of his or her knowledge that as an applicant, this agency or its key employees: a. are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal Department or agency, or by the State of New Jersey: have not within a 3-year period preceding this application been convicted of or had a civil judgement rendered against them for commission or fraud or a criminal offense, in Connection with obtaining, attempting to obtain, or performing a public (Federal, State, or Local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; are not presently indicted or for otherwise criminally or civilly charged by a gover- mental entity (Federal, State, or Local) with commission of any offenses enumerated in paragraph (b) of this certification; and d. have not within a 3-year period preceding this application had one or more public transactions (Federal, State, or Local) terminated for cause of default. The applicant agrees that by submitting this application, it will obtain from all its sub- grantees a certification that includes without modification paragraphs (a), (b), (c), (d), of this certification in accordance with Federal Executive Order 12549. NAME OF AGENCY Township of West Orange NAME AND TITLE OF OFFICIAL SIGNING FOR AGENCY Joseph A. Fonzino, Director/Health Officer SIGNATURE_OF ABO DATE SIGNED 01/07/10 ij NOTE: ‘oll Ed related to Debarment and Suspension as required by Federal regulations Will be used as the basis for completion of this certification: List of parties excluded from Federal Procurement of Non-Procurement Programs. This document is distributed by U.S. General Services Adminstration. U.S. Printing Office. Washington D.C. This document can be acquired from the Superintendent of Documents.

Western Surety Company CONTINUATION CERTIFICATE SSOASTSSIOIIT Western Surety Company hereby continues in force Bond No. 68590858 briefly described as COMPTROLLER - TOWN OF WEST ORANGE FaRdane for EDWARD J. COLEMAN : , as Principal, F in the sum of $ ELETY THOUSAND AND NO/100 Dollars, for the term beginning a April 01, 2009 _, and ending ______April 01 _, _2010 __, subject to all : the covenants and conditions of the original bond referred to above. This continuation is issued upon the express condition that the liability of Western Surety Company under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed the total sum above written. Dated this il day of __March , 2009 . WESTERN URETY COMPANY wy let Z | Paul T. Bruflat, Sefior Vice President THIS "Continuation Certificate" MUST BE FILED WITH THE ABOVE BOND. Form 90-A-4-2002 ESSSSSISISIS Se RTT TOT ST LR MERICAS OLDEST BONSINS EMPANIts SOQOERSSOOSO SEO {s]

Western Surety Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, lowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United States of America, does hereby make, constitute and appoint Paul T. Bruflat of Sioux Falls State of South Dakota , its regularly elected Senior Vice President as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on its behalf as Surety and as its act and deed, the following bond: One COMPTROLLER - TOWN OF WEST ORANGE bond with bond number __68590858 for _EDWARD J. COLEMAN as Principal in the penalty amount not to exceed: $50,000.00 Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company duly adopted and now in force, to-wit: Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attomeys-in-Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Senior Vice

The signature of any such officer and the corporate seal may be printed by facsimile. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Senior Vice President___with the corporate seal affixed this ___11 day of _ March ; 2009 . ATTEST WE N SURETY COMPANY of. Rela on’ By at 7 7 L. Nelson, Assistant Secretary Paul T. Bruat, Senior Vice President ES Heer STATE OF SOUTH DAKOTA Ad = COUNTY OF MINNEHAHA Da TENS Sse “rete On this 11 day of March , 2009 , before me, a Notary Public, personally appeared Paul T. Bruflat and L. Nelson who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as __Senior Vice President __ and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the voluntary act and deed of said Corporation. $9 SERENE EEE EE EEnEEEONnOEe + s s # = Novany PUBLIC NE Ad tires cy NOTARY PUBLIC ZN\S HEA) soutu pakota SA) . Notary Public tononnaaneannnnennananee + My Commission Expires November 30, 2012 Ky Form F1975-9-2006 ue

Wd9E*) 8 NWP AWEL INTYd WdSE*L 8 ‘NYP AWIL C3AT9939 ONTRACT SIGNA! S DA’ This contract has been signed and séaled by the parties on the dates set forth below. ATTEST: COUNTY OF ESSEX - BY: DATE: Deborah Davis Ford, Clerk Joseph N. DiVincenzo Jr. Essex County Board of Chosen Freeholders County Executive ATTEST: , GRANTEE: BY: DATE The aforementioned Agreement has been reviewed and approved as to form. BY: DATE County Counsel Office of County Counsel BY: DATE Anibal Ramos, Jr., Director Department of Citizen Services BY: DATE Jaklyn DeVore, Director Division of Senior Services 7B FOV dad HLTWS3H S9NVeO M G@GPSZEELE SE:ET 8182/88/18

Wa9E+L 8 NWP INTL LNTYd WdSE*L °8 NWP ANIL 03A19 9038 CONTRACT SIGNA: DATES: This contract has been signed and sealed by the parties on the dates set forth below. ATTEST: ; COUNTY OF ESSEX BY: DATE; Deborah Davis Ford, Clerk . Joseph N. DiVincenzo Jr. Essex County Board of Chosen Freeholders County Executive ATTEST: "| GRANTEE: BY: : : “DATE The aforementioned Agreement has been reviewed and approved as to form. BY: DATE County Counsel Office of County Counsel BY: DATE Anibal Ramos, Jr., Director Department of Citizen Services BY: DATE Jaklyn DeVore, Director Division of Senior Services €@ 3dvd dad HLTWSH SONVAO M S@Brgzee/e SE'ET G18Z/88/T8

Wd9E*) 8 NWP INTL LNIYd WdSE*L °8 NWP INTL 03AT3038 [Se) SI S ATES: This contract has been signed and séaled by the parties on the dates set forth below. ATTEST: COUNTY OF ESSEX ; : BY: DATE: Deborah Davis Ford, Clerk : Joseph N. DiVincenzo Jr. Essex County Board of Chosen Freeholders County Executive ATTEST: _ GRANTEE: BY: DATE The aforementioned Agreement has been reviewed and approved as to form. BY: DATE , County Counsel Office of County Counsel BY: ; DATE Anibal Ramos, Jr., Director Department of Citizen Services BY: DATE Jaklyn DeVore, Director Division of Senior Services PB ADV id3d HLW3H SSNvao M GOGPSZEELE SE:EL @1z/80/Ta

RESOLUTION WHEREAS, the Essex County Division of Senior Services has agreed to provide partial funding for a Senior Citizen Public Health Nurse and the Dental Program for the contract period January 1, 2010 through December 31, 2010 in the amount of $37,871 - January 1, 2011 through December 31, 2011 in the amount of $37,871 and January 1, 2012 through December 31, 2012 in the amount of $37,871; and WHEREAS, the Director of Health/Health Officer has reviewed the annexed agreement and recommends execution and approval; and WHEREAS, the Township has participated in this program in previous years; and WHEREAS, annexed hereto is a copy of the-agreement; NOW, BE IT HEREBY RESOLVED, by the Township Council of the Township of West Orange that the Mayor be and is hereby authorized to execute the annexed agreement with the Essex County Division of Senior Services and additional agreements for partial funding of a Senior Citizen Public Health Nurse and the Dental Program and the Municipal Clerk be and is hereby authorized to attest to the Mayor's signature; and it is further RESOLVED, that a permanent copy of this agreement shall be maintained by the Municipal Clerk and the Director of the Department of Health.