18-10 Contract

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