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