224-22 RFQ-ED Arborists.pdf

TOWNSHIP OF WEST ORANGE ACKNOWLEDGMENT OF RECEIPT OF ADDENDA The undersigned Bidder hereby acknowledges receipt of the following addenda: Please assign the number, date anc initial. Addendum Number Dated Acknowledge Receipt _(|nitial) /No addenda was received. Acknowledged for: ED Arborists and Fores ters | {Company Name) By: Brous al Hind (Signature of Authorized Representative) Name: Evan Dilluvie (Print) Title: Owner me B JUBA Page | 23

TOWNSHIP OF WEST ORANGE DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN Proposer: Euan ) idly vio Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certification below to attest, under penalty of perjury, that the person or entity, or one of the person or entity’s parents, subsidiaries, or affiliates, is not identified on a list created and maintained by the New Jersey Department of the Treasury as a person or entity engaging in investment activities in Iran. If the Director finds a person or entity to be in violation of the principles which are the subject of this law, s/he shall take action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring, declaring the party in default and seeking debarment or suspension of the person or entity. I certify, pursuant to Public Law 2012, c. 25, that the person or entity listed above for which | am authorized to submit a proposal: Must check appropriate boxes Is not providing goods or services of $20,000,000 or more in the energy sector of tran, including a person or entity that provides oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas, for the energy sector of Iran, and Is not a financial institution that extends $20,000,000 or more in credit to another person or entity, for 45 days, or more, if that person or entity will use the credit to provide goods or services in the energy sector in Iran, In the event that a person or entity is unable to make the above certification because it or one of its parents, subsidiaries, or affiliates has engaged in the above referenced activities, a detailed, accurate and precise description of the activities must be provided in part 2 below to the New Jersey Turnpike Authority under penalty of perjury. Failure to provide such will result in the proposal being rendered as non- responsive and appropriate penalties, fines and/or sanctions will be assessed as provided by law. Part 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN You must provide a detailed, accurate and precise description of the activities of the proposer, or one of its parents,

2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN You must provide a detailed, accurate and precise description of the activities of the proposer, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. Name: Relationship to Proposer: Description of Activities: Duration of Engagement: Anticipated Cessation Date: Proposer Contact Name: Contact Phone Number: Page | 24

Certification: 1, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. | attest that } am authorized to execute this certification on behalf of the above referenced person or entity. | acknowledge that the Township of West Orange, State of New Jersey is relying on the information contained herein and thereby acknowledge that | am under a continuing obligation from the date of this certification through the completion of any contracts with the Township to notify the Township in writing of any changes to the answers of information contained herein. | acknowledge that | am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if 1 do so, | recognize that | am subject to criminal prosecution under the taw and that it will also constitute a material breach of my agreement(s) with the Township of West Orange, State of New Jersey and that the Township at its option may declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print): Lvon D. | lute Signature: Guth VHD Title: Qumer- Date: 3) ofan Page | 25

Business Registration Certification and Public Works Contractor Registration Certification Effective September 1, 2004, the State has expanded its Contractor Registration Program to local Government contracts, P.L. 2004, c57. All business organizations that do business with a local government agency are required to be registered with the State. The business must provide proof of that registration to the local government agency before that local government agency can enter into a contract with the business. A copy of the Business Registration Certificate must also be on file before any purchase order/voucher or other contracting document can be issued, Contractors are responsible for notifying subcontractors. Further information and registration can be obtained online from the NJ Treasury, Division of Revenue or by calling (609) 292-1730. TEI OSS OCI IORI CE AIO ICE IO P.L. 1999 Chapter 238. The Public Works Contractor Registration Act specifies that no contractor or subcontractor shall bid on or engage in any contract (or part thereof) for public work which is subject to the provisions of the “New Jersey Prevailing Wage Act”, P.L. 1963 C. 150 (c. 34:11-56.25 et seq.) for the construction, reconstruction, demolition, alteration, repair, or maintenance of a public building regularly open to and used by the general public or public institution, and includes any subcontractor or lower tier subcontractor of a contractor unless they are registered with the Commissioner of Labor. Page | 26

L TOWNSHIP OF WEST ORANGE CHECKLIST PROFESSIONAL SERVICE TITLE: _L-( CONS" ob Tree Exper tC N J) SUBMISSION DATE: Wednesday, August 17, 2022 at 10:00am. The following items are required to be included with the sealed submission: © Qualification Statement vO * Non-Collusion Affidavic va © Disclosure of Ownership Form * Insurance Requirement Acknowledgement Form W~ e Mandatory Equal Employment Opportunity Notice Acknowledgement va e Copy of your Business Registration Certificate as issued by the Vv e State of New Jersey, Department of Treasury, Division of Revenue ¢ Acknowledgement of Corrections, Additions or Deletions Form “ e Non- Conflict of Interest Declaration ~ © Political Disclosure Certification ~~ ¢ Iranian Disclosure statement Reminder: Please submit one (1) original and one (1) additional set of the sealed submission. Copy can be on a USB stick. Multiple fields can be submitted in one envelope. Page | 27

i | i PROGRESSIVE Progressive Po Box 94739 COMMERCIAL Cleveland, OH 44401 1-800-895-2886 Policy number: 958488296 Underwritten by: Drive New Jersey Insurance Company NAIC Number: 11410 August 7, 2022 Page | of 1 Certificate of Insurance Evan Dilluvio 976 Old School House Road Blairstown, NJ 07825 Evan Dilluvio PROG COMMERCIAL Kara Venella PO BOX 94739 976 OLD SCHOOL HOUSE ROAD CLEVELAND, OH 44101 BLAIRSTOWN, NJ 07825 Description Kp Form 5241 (05/16) This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confets no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policles listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these polices. Liability coverage may not apply to all scheduled vehicles. Policy Fffective Date: Jun 6, 2022 i! Policy Expiration Date: lun6,2023.°~C*<“‘<S*~<CS~S~S~S~S~*S Uninsured/Underinsured PD (indudec in combined single limit w/$500 Ded) of Location/Vehicles/Special Items Medical Expense $15,000 Extended Medical Payments $1,000 Comprehensive $1,000 Ded Collision $1,000 Ded

EVANDIL-01 MCRUZ1 —~ AELRP CERTIFICATE OF LIABILITY INSURANCE one aamnonen THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SOuEScT House - RPM RPM Insurance Agency RPM Insurance Agence! INE 201 Edward uryave. eee, Exip - [ERE wo Suite 202 RMilss, None@acrisure.com Sisten Island, NY 10314 INSURER(S) AFFORDING COVERAGE NAIC # insurer 4: Hartford Underwriters Insurance Company [30104 INSURED insurer a: Sentinel Insurance Company, Ltd 11000 Evan Dilluvio Tree Consulting insurer c: Lloyd's 524210 976 Old School House Rd. INSURER D. Blairstown, NJ 07825 INSURER Es INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD. INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ‘TYPE OF INSURANCE Peon POLICY NUMBER HOE | dane yy Limms. ‘A | X | COMMERCIAL GENERAL LiABILITY EACH OCCURRENCE $ 1,000,000 ] ctamssaane [X] occur HOSBMASTAVC 6/1/2022 | 6/1/2023 | BAMIR ES REN ED cy |e 1,000,000 Ld MED EXP (Anyene person) | $ 5,000 ft - PERSONAL & ADVINJURY | § 1,000,000} | CEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000) |X| Poucy SR; Loc PRODUCTS - COMP/OP AGG | $ 7,000,000) OTHER: $ | AUTOMOBILE LIABILITY FQNBIER SINGLE Livi g |__| any Auto: BODILY INJURY (Per person) | $ OWNED SCHEDULED |__| AUTOS ONLY AUTOS BODILY

X| Poucy SR; Loc PRODUCTS - COMP/OP AGG | $ 7,000,000) OTHER: $ | AUTOMOBILE LIABILITY FQNBIER SINGLE Livi g |__| any Auto: BODILY INJURY (Per person) | $ OWNED SCHEDULED |__| AUTOS ONLY AUTOS BODILY INJURY (Per agoident)| & |, RHE onuy AGRON area ep MASE 4 $ UMBRELLA LIA3 occur EACH OCCURRENCE $ | |excessuas |_| cLAMS-MADE AGGREGATE $ _ veo |__| RevENTION® 4 8 TROTRBES URN, wn , XT Sffure [Tf Ba ANY PROPRIETOWARTNER/EXECUTIVE iy] NA OWECASTAWH 6/1/2022 | 6/1/2023 |e cach ACCIDENT 4 1,000,000 isadc ARR EL. DISEASE - EA EMPLOYEE! 1,000,000) BeSEMPSION OF Operations below E.4, DISEASE - POLICY LIMIT | 1,000,000 ¢ [Professional Liabili JANE 5131222 6/1/2022 | 6/1/2023 [Aggregate 1,000,000] DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AGORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Township of West Orange ACCORDANCE WITH THE POLICY PROVISIONS. ain Stree! West Orange, NJ 07052 AUTHORIZED REPRESENTATIVE i‘ 1 si ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

7 State of New Jersey Board of Tree Experts Tree Expert and Tree Care Operator Licensing Act Tits Certifies Thai EVAN W DILLUVIO i LTE #504 In decordance With The Provisions Of Chapter 237, PL, 2009, Has Been Duly Examined Or Accepted In Reciprocity And Licensed To Practice As A Licensed Tree Expert in Witness Whereof, I have hereunto caused the Seal of the State of New Jersey to be Licensed No. #291296 affixed. Steve M. Chishoim, i December 31, 2023 President Board of Tree i Expiration Date Experts A This certificate may not be transferred or assigned and may be revoked or Suspended for cause by the Board of Tree Experts