164-22 Exhibits to Agreement for Workers Compensation Third Party Administration - 2022.pdf

REQUIRED EVIDENCE AFFIRMATIVE ACTION REGULATIONS N.J, S.A. 10:5-31, et seq. (NLA. C. 17:27) If awarded a contract, the Bidder will be required to comply with the requirements of N.LLS.A. 10:5- 31, et seq, and N.LA.C_ 17:27. Within five (5) days after receipt of the notification of intent to award the contract, the Bidder shail present one of the following: 1. Appropriate evidence that the Contractor is operating under an existing federally approved or sanctioned affirmative action program; or 2. A Certificate of Employee Information Report Approval issued in accordance with N.LLA.C. 17:27-4; or 3. An initial Employee Information Report consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with NJAC, 17:27-4. The Bidder must submit no later than three (3) days after the signing of the Contract an Initial Project Manning Table consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with N.J.A.C. 17:27-7. Bidders are referred to the Bidder's Information Section of the Bid Packet for a further description of the above requirements. NO BIDDER MAY BE ISSUED A CONTRACT UNLESS THEY COMPLY WITH THE AFFIRMATIVE ACTION REGULATIONS OF N.J.S.A, 10:5-31, et seq. The following questions must be answered by all Bidders: . Do you have a federally-approved or sanctioned Affirmative Action Program? Yes (If yes, submit a copy of such approval.) No 2. Do you have a State Certificate of Employee Information Report approval? Yes X {If yes, submit a copy of such approval.) No The undersigned Bidder certifies that he is aware of the commitment to comply with the requirements of NJ.S.A. 10:5-31, ef seg., and agrees to furnish the requited documentation pursuant to the law. COMPANY: Claims ResobttGon 26fpbration, Inc, NAME: David Harris SIGNATURE: TITLE: _President NOTE: A bid must befefected as non-responsive if a Bidder fails to comply with requirements of N.J.S.A. 10:5-31, et seq., within the time frame stipulated. 13