18-10 Contract

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.