Supporting Documentation · Jan 22, 2019
26-19 Exhibit-Authorizing Third Extension of Agreement with Reliable Wood for Operation of Recycling Center.pdf
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SECTION 3.0 PROPOSAL —.DOCUMENTS-- 31
ARTICLE 3.1 STOCKHOLDER DISCLOSURE CERTIFICATION [ certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. I certify that no one stockholder owas 10% or more of the issued and outstanding stock of the undersigned, PLEASE CHECK TYPE OF BUSINESS ORGANIZATION: Partnership Limited Partnership Limited Liability Co. x Corporation Sole Proprietorship Limited Liability Partnership __- Subchapter $ Corp PLEASE CHECK APPROPRIATE BOXES AND SIGN BELOW Stockholders Name. See Exhibit 3.1 attached hereto Home Address: Name: ~~ “Home Addtéssr 9 WT Name. Home Address: Name: Home Address: J ehh be Nicholas Vene, Senior Regional ‘Owner ‘or Representative Signature Print Name & Title Vice President OTORY PUBLIC Sworn before me this 27 day of August 20.13 ore are! weet 2
EXHIBIT 3.1 SHAREHOLDER DISCLOSURE
With regard to the disclosure requirements under NJ.S.A. 52:25-24.5, please review the following: Disclosure of Ownership: Reliable Wood Products, LLC., a New Jersey limited liability company and Nature’s Choice Corporation, a New Jersey corporation, each having a principal office at 1 Caven Point Avenue, Jersey City, NJ 07305, are both 100% owned by Harvest Garden State, L.L.C., a Delaware limited liability company with a principal address at 221 Crescent Street, Suite 402, Waltham, MA 02453 (“Harvest Garden State”}. Harvest Garden State is 100% owned by Harvest Power, Inc., a Delaware corporation with a principal address at 221 Crescent Street, Suite 402, Waltham, MA 02453 (“Harvest” or the “Company”). Harvest is owned by multiple stockholders. The following two stockholders own 10% or more of the outstanding stock: 3.1. KPCB Holdings, Inc. (“KPCB”) as nominee (c/o Kleiner Perkins Caulfield Byers, 2750 Sand Hill Road Menlo Park, CA 94025}. KPCB is a private equity investment fund with its principal office located in Mento Park, CA. The identities of individual fund investors having a ten percent (10%) or more ownership interest in the fund is not known by the owners, officers or employees of Harvest or its subsidiaries and is deemed confidential and the subject of separate non-disclosure agreements between individual investment partners and the fund and its officers, employees, managers and advisors. Neither Harvest nor any of its subsidiaries is a party to these non-disclosure agreements. 3.2. TNVP Harvest Power Fund |, LP. (“TNVP”} (205 N. Michigan Ave. Suite 2930 Chicago, Ii. 60601). TNVP is a private equity investment fund with its principal office located in Chicago, IL. The identities of individual fund investors having a ten percent (10%) or of Harvest or its subsidiaries and is deemed confidential and the subject of separate non-disclosure agreements between individual investment partners and the fund and its officers, employees, managers and advisors. Neither Harvest nor any of its subsidiaries is a party to these non-disclosure agreements. None of the stockholders of Harvest identified above have the ability to controi or manage the activity of the Company. 09-22-2013 “more ownership interest in the fund is not-known by the owners; officers or employees - ~
STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF REVENUE AND ENTERPRISE SERVICES SHORT FORM STANDING HARVEST GARDEN STATE, LLC 9600390586 I, the Treasurer of the State of New Jersey, do hereby certify that the | above-named Delaware Foreign Limited Liability Company was registered by this office on September 5, 2012. As of the date of this certificate, said business continues as an active business in good standing in the State of New Jersey, and its Annual Reports are current. 1 further certify that the registered agent and registered office are: The Corporation Trust Company 820 Bear Tavern Road West Trenton, NJ 08628 IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at Trenton, this vemos aa 25+ 16 th-day-of August 2013 - nn. == a am . Andrew P Sidamon-Eristoff Certification## 129294335 State Treasurer Verify this certificate at hitps:/Avww 1 state.nj.us/TYTR_StandingCert/ISP/Verify_Cert,jap Page 1 of 1
Article 3.2 Stale of New Jersey Township of West Orange Affidavit of Authorization for Contract State of New Jersey SS. County of. Hudson Nicholas Vene being duly sworn, deposes and says that he resides at 49_McCambell Rd., Holmdel,.Nd. Senior Regional thatheisthe Vice President (Title) who signed the Proposal for this Contract; that he was duly authorized to sign; that the seal attached is the seal of the Respondent; and that all declarations and statements contained in the Proposal are true, to the best of his knowledge and belief. (Type of print name! of affiant under signature) Nicholas Vene Subscribed and sworn to before me this 27th day of August 2013. _ fons Public) My commission expires Ma, Y¥, JOl¥ AIDA N. VEGA NOTARY PUBLIC OF NEW nly Commision 33
Artical 3.03 State of New Jersey Township of West Orange Moral Integrity Affidavit for Contract State of New Jerse SS. County of _Hudson Senior Regional J, Nicholas Vene , the Vice President of Reliable Wood Products, 1 1bereinafter called the Respondent, being duly sworn, deposes and says: 1. That the Respondent herewith submits a proposal regarding this Contract to the Township of West Orange. 2. That the Respondent wishes to demonstrate moral integrity to the satisfaction of the Township of West Orange. 3. That, as of the date of signing this Affidavit, neither the Respondent, nor “>> -—-any of his owners; officers; or directors are involved in any-Federal;State— -—-~ — ~~ or other Governmental investigations concerning criminal or quasi- criminal violations, except as follows: (if none, so state). NONE 4, That neither the Respondent not any of his owners, officers or directors have ever committed any violations of a Federal or State of quasi-criminal statute, except as follows (if none, so state). NONE 5. That the Respondent does not appear on the State of New Jersey’s Treasurer’s Department List. 6. That the State in which the Respondent is formed is: New gersey 34
7. That if the answer to question # 6 is a State other than New Jersey, the t Respondent has received from the Secretary of the State of New Jersey a certificate authorizing the corporation to conduct business in New Jersey. 8. That the names and addresses of the principals, officers, and shareholders of the Respondent are as follows: See Schedule 3.03 attached hereto (Use additional sheets if required) 9. That he is personally acquainted with the operation of the Respondent; has full knowledge of the factual basis comprising the contents of this Affidavit; and that the contents are true. 10. That this Affidavit is made to the Township of West Orange to accept the Proposal for.this Contract, knowing that the Township of West Orange relies upon the truth of the statements contained herein. fe? (Type or print name of affiant under signature) Nicholas Vene and sworn to before me this 27th day of August 2013. _-Wotary Public) My commission expires Af Chey y Poly AIDA N. VEGA YrARY PUBLIC OF NEW JERSEY Ay oniesn Epes SATAN 35 ee
| l ; SCHEDULE 3.03 RELIABLE WOOD PRODUCTS, LLC Officers: Nicholas Vene Senior Regional Vice President 1 Caven Point Avenue, Jersey City, NJ 07305 Eugene J, Ciarkowski Vice President & Secretary 1 Caven Point Avenue, Jersey City, NJ 07305 Matthew Vastano Vice President & Sales Manager 1 Caven Point Avenue, Jersey City, NJ 07305 Principals: Reliable Wood Preducts, LLC is a subsidiary of Harvest Garden State, LLC, having a principal office at 221 Crescent Street, Suite 402, _ ....__ Waltham, MA 02453. The managing member of this entityisPaw) Sellew. Harvest Garden State, LLC is a subsidiary of Harvest Power, lne., having a principal office at 221 Crescent Street, Suite 402, Waltham, MA 02453. The shareholders of Harvest Power, Inc. are disclosed on Exhibit 3.1 hereto which is made a part of this response and is incorporated herein by this reference as if set forth in its entirety.
Article 3.04 i Non-Collusion Affidavit Stateof New Jersey | [ | | SS. County of_Hudson LNicholas Vene _ of the Township of Holmdel , in the County of Monmouth and the State of _New Jerse of full age being duly sworn according to law, on my oath.devose and say that: I am PERSP Regi gia af of the firm of Seeaeers Wibod , the bidder making the proposal for the above named project, and that I executed the said proposal for the above named project, and that I executed the said proposal with full authority to do so; that said : bidder has not, directly or indirectly, entered into any agreement, participation in any : collusion or otherwise taken any action in restraint of free, competitive bidding in connection i with the above named project; and that all statements contained in said proposal and in this Affidavit are true and correct, and made with full knowledge that the Township of West Orange, New Jersey relies upon the truth of the statements contained in said proposal and in the statements contained in the affidavit in awarding the contract for the said project. I farther warrant that no person or selling agency has been employed or retained to solicit or ! - secure such a contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fid employees or bona fide established commercial or selling agencies maintained by Broducts, “Ere “(N.J.S.A.52:34-[5), Name of Contractor ReliabTb ooh Cabankd,, LLC a4 (Sign Name. Here) Subscribed and sworn before me on this__ 27th day of August ‘etary Public) My commission expires: Mag ¥ 2o1y Note to Notary: When completing this form, ali notaries must: 1- Indicate date. 2. Indicate State. 3. Sign Name. 4. Affix name by Printing it, typing it, using a rubber stamp, using aa impression seal or using a mechanical stamp. NOTE: The person who signed the proposal form from the respondent should sign this form also. 36
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