224-22 RFQ-ED Arborists.pdf

it I ~ Central Forms Repository & Payment Collection System - Payment Receipt 2 messages <CentralFormsRepositorySystem@treas.nj.gov> Fri, May 20, 2022 at 9:40 PM To: dilluvioevan@gmail.com Dear Business Representative, Thank you for your recent filing with the State of New Jersey. Following is a confirmation of your payment. Please print a copy for your records. Payment Type: Credit card transaction charge on 5/20/2022 9:39:30 PM Submission |D: 127139 Payment Transaction ID: 232866 Effective Date: 8/20/2022 Paid Amount: $150.00 Convenience Fee: $3.50 Confirmation Number: e13faSe7-aded-442b-83f7-35e985ac5427 Form Name: Initial AA302 Form Description: Employee Information Report (AA302 Initial) Please allow at least two (2) business days for your payment to post to your account. After your submission is reviewed and approved, you will receive an ernail with instructions on how to print your certificate. Please do not reply to this email, the email account is not monitored. CONFIDENTIAL: This electronic transmission, including any documents, files or previous e-mail messages attached to it, is covered by the Electronic Communisations Privacy Act, 18 U.S.C. §§ 2510-2521 and contains information, which may be privileged, proprietary, confidential and/or otherwise exempt from disclosure under applicable law, and may also be an attomey-client communication and as such Is privileged and confidential. Unintended disclosure does not in any mariner whatsoever waive the attorney-client privilege. This information is intended to be for the sole use of the individual or entity named above. If you are not the intended recipient, or a person responsible for delivering it to the Intended recipient, you are hereby notified that you must not read this transmission and that any unauthorized disclosure, copying, printing, distribution, dissemination or use of any of the information contained in or attached to this transmission is STRICTLY If you have recelved this transmission In error, PLEASE immediately notify the sender at https://Avww.state.nj.us/treas/treasmail.shtml and delete the original transmission and its attachments without reading or saving them in any manner. WARNING: This email and/or its attachments should be subjected to your own anti-virus procedures. Sender is not responsible for any loss or damage caused by opening this email or its

m in any manner. WARNING: This email and/or its attachments should be subjected to your own anti-virus procedures. Sender is not responsible for any loss or damage caused by opening this email or its attachments. NOTE: This is an automated response, Please do not reply to this email. evan dilluvio <dilluvicevan@gmail.com> Wed, Jun 1, 2022 at 8:38 AM Ta: llona.Ingenite@co.monmouth.nj.us Hi Ilona Receipt for report below. Evan Dilluvio Evan Dilluvio Tree Consultant/Arborist NJLTE #504 908-619-2087 [Quoted text hidden}

a p Twiclate this race) Eee ‘Tianslalion Digolaimer View Employee Information Report (AA302 Initial Form) Section A - Company Identification. a 1. FID Number or SSW: '146784792 4. Company Name: ‘ED Arborists Foresters ;3. Total NO. Employees in the Entire Company: (1 5. Street: '976 Old School House Road _[oounty: ‘SUSSEX H : jr __ lp Code: {07825 i } 6. Name of Parent or Affiliated Company (if none, so indicate}: — . ee a H foci _ ‘state: _|Zip Code: | 4 7.Company Type: /Single-Establishment én! 8. State the Number of Establishements In Nd location: {0 i | 9. Total Number of employees at establishment which has been awarded the contract: {7 i | 10. Public Agency Awarding Contract: [Mon : feity: Lincroft 7 i | County: {MONMOUTH ‘state: ‘NJ i ~- Section B - Employment Data. ca be . vote ca . “11. Report all permanent, temporary and partie enpioyees ON YOUR OWN PAYROLL. Enter the appropriate figures on ali ines and n all cokimns. Where there are no employees In a particular category, enter @ zero. Include ALL employees, not just those in minarity/non-minarity catagories. + |Officials/ Managers 0 0 0 0 4 0 1 : | [Professionals 0 6 ° 9 ) o ) i 1 frechnicians 0 oe 0 o 9 0 ° Sales Workers: oO 0 oO oO a oO oO 1 [Office & Clerical 0 oO) oO 0 a oO ) A » :Croflworkers (Skilled) 0 o o oO o o ) i | Operatives (Semt-skiled) o ° ° 0 a 0 0 i | |Laborers (Unskilled} o 6 o o a o oO) : "| etvice Workers 0 a ° oO i ° o : | [Temporary § Part-Time i Employees oO o o 0 0 oO o : ) froran. o ° 0 0 1 ° 1 ! "TOTAL MALE COUNT: 7 : / Officials / Managers a) o | 0 + © o | o 0 : | [Professionals H o 0 Hy 0 i 0 o o i 0 + Technicians : 9 6 i 6 i 0 0 : o 0 : i | Sales Workers i Oo) : 0 i o i 0 0 H a 9 LOffice & Clerical i cy 0 i 0 0 0 o 0 b |‘ Ghaftworkers (Skilled) ) oF 0 a 0 0 ne } ‘Operatives (Semi-skilled) o : 0 | 0 : ° ; 0 i 0 H 0 : * ‘Laborers (Unskilled) i a oO U : o iu o o 0 F 'service Workera, a o i o ! 0. 0 a : 0 Temporary & Peretima Sg o | 6 re . a | Employees i t i : i j ‘TOTAL 0 t) 0 1 0 ° a o H . TOTAL FEMALE COUNT: 0 : | 12, How Was Information as to Race or Ethnie Group In Sectlon B Obtained: {Other : : | 18, Date of Payroll Pertod Used From: '5/2/2022 Tor!5/9/2022 H ‘Section C - Personal Identification . neon ~ ~ . - - } 44. Contact Name: [Evan Dilluvio 18, Tite: Towner 7 “116. Contact Emali:(dilluvioevan@gmai.cam i : 2 17. Address: /97600ld School Hiouse Raed =

‘Section C - Personal Identification . neon ~ ~ . - - } 44. Contact Name: [Evan Dilluvio 18, Tite: Towner 7 “116. Contact Emali:(dilluvioevan@gmai.cam i : 2 17. Address: /97600ld School Hiouse Raed = ily: /Blalrstown IND” jzip Code: [07825 | i 18, Phone Number. 19086192087" " " ’ “iPhone Extenioni: | i Return Search Suomis Aevaue Merne| Rect ong |Cerfeatens|Tox ng [86S Rela Foy [Cemtact us Ponty Note Lega Slane | Assy Statens

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TOWNSHIP OF WEST ORANGE AFFIDAVIT OF NON-COLLUSION The undersigned bidder of full age, being duly sworn according to law depose and hereby specifically certifies that: To the best of the bidder's knowledge and belief, the annexed bid proposal for this project has not been prepared in collusion with any other bidder of like item or services and the prices, discounts, terms and conditions thereof have not been directly or indirectly communicated by or on behalf of the bidder to any person other than the recipient of the bid and will not be communicated to any person prior ta the official opening of the bid. The bidder fully understands that no premiums, rebates, or gratuities are permitted either with, prior to, or after signing of contract. Any violation will result in cancellation and removal from the bid list. The bidder further certifies that the undersigned has the necessary authority, to sign this stipulation stating that the bidder has not entered into any agreement, or otherwise taken any action in restraint of free competitive bidding in connection with this bid. All references to the bidder are understood to include the undersigned and all principals, partners and officers of the ia) i (Signature) yds Subscribed and sworn to Before me this day fu ust g of 20 Oa AFFIANT Lan yi} uvld C4 notary pusuicor VJ (ore? Cowan € MY COMMISSION EXPIRES: 207-25 67 & NATHAN PENN COMMISSION # 0050167130 NOTARY PUBLIC:NEW JERSEY MORRIS COUNTY Comm Expires Aug. 02, 2026 NAAAB ASS Page | 16

TOWNSHIP OF WEST ORANGE cl UIREMENTS AND ACKNOWLE. IT FORM Certificate(s) of Insurance shall be filed with the Municipal Clerk's Office upon award of contract by the Mayor and Township Council. The minimum amount of insurance to be carried by the Professional Service Entity shall he as i follows: OFESSIONAL LIABILITY IN: Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000,.00 aggregate each i policy period. f | Acknowledgement of Insurance Requirement: | ED behest ad Foresters : Sau Liu) Bele (Signature) id (Date) | Exon Qillwie , Orunec (Printed Name and Title) This form must be completed, signed and returned with RFQ. Daca | 17

TOWNSHIP OF WEST GRANGE KI DISCLO: CERTIFIC, I certify that the list below contains the names and home addresses of ail stockholders holding 10% or more of the issued and outstanding stock of the undersigned, \ certify that no one stockholder owns 10% or more of the Issued and outstanding stock of the undersigned. “a PLEASE CHECK TYPE OF BUSINESS ORGANIZATION: Partnership Limited Partnershi Limited Liability Corp Corporation Sole Proprietorship _| / Limited Liability Partnership ___ Subchapter $ Corp PLEASE CHECK APPROPRIATE BOXES AND SIGN BELOW Name: LVm Dillu vlo Home Address: WIE Old <hual Hees fed Bluivsboun, AAT O78AS Name: Home Address: Name. Home Address: Aullae Oumey Owner or Represenitative Signature Print Name & Title NOTORY PUBLIC I Sworn before me thisday of / 20% “aa radbradli NATHAN PENN COMMISSION 0050167130 NOTARY PUBLICNEW JERSEY MORRIS COUNTY < Comm Expires Aug, 02, 2028 PITTI Pace | 12

TOWNSHIP OF WEST ORANGE E FICATI REQUEST FOR QUALIFICATIONS FOR Lictused Tree expert professiznal Serutces ¥ (Title of RFQ) The undersigned certifies to the Township of West Orange, County of Essex, State of New Jersey that in performing services to the Township he/she is aware of no circumstance that would constitute a conflict of interest, financial or otherwise, between him/her (or his/her firm) and the interests of the Township. The undersigned certifies that he/she has made a search of his/her firm’s client base and has executed this certification subsequent to such search, The undersigned acknowledges this a continuing certification, and shall remain in effect for the term of the services contained in the solicited request for qualifications. I certify that the foregoing statements made by me are true and accurate to my personal knowledge; I am making this certification in good faith. I am aware that if any of the foregoing statements made by me are false, the Board is free to terminate any professional service agreement entered into with the undersigned and/or his or her firm. Certifying Official: PRINT NAME: Evan dilluvio SIGNED BY: Dew dkhuiz) | TITLE: (AOU AONa | DATE: @ [12 [9 Pasa 119

Pursuant to Section 2-68.1 of the Revised General Ordinances of the Township of West Orange, ' please set forth below all political contributions in cash or in kind of two hundred ($200.00) dollars or more made within five (5) years of the date of acceptance of a proposal for a negotiated contract with the Township of West Orange, or within five (5) years of the notice of award for a bid contract with the Township of West Orange, either directly or indirectly, by the individuals or any of the principals of the business entity completing this form or by the business entity itself, to any elected official of the Township of West Orange currently in office or any political organization affiliated with an elected official of the Township currently in office. The current elected officials of the Township include the following: Mayor Robert D. Parisi; Councilwoman Susan McCartney; Councilwoman Cindy Matute Brown; Councilman Bill Rutherford; Councilwoman Tammy Williams; and Councilwoman Michelle Casalino. Name of Contributor Amount Recipient of Contribution Contribution Date If you have NOT made any contributions within the scope of Section 2-68.1, as set forth above, please indicate here Wi | hereby certify under penalty of perjury that the information provided herein is true and accurate to the best of my knowledge, information and belief. Signature a A Ea PrintName:___ Even oilluvis coma: ED Arborists and Foresters Page | 22