224-22 Exhibit B-RFQ Licensed Tree Expert for Township Tree Inventory.pdf

Page | 25 Certification: I, 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. I attest that I am authorized to execute this certification on behalf of the above referenced person or entity. I acknowledge that the Township of West Orange, State of New Jersey is relying on the information contained herein and thereby acknowledge that I 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. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I recognize that I am subject to criminal prosecution under the law 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): __________________________ Signature: __________________________________ Title: ____________________________________ Date: ______________________

Page | 26 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. ************************ 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 | 27 TOWNSHIP OF WEST ORANGE CHECKLIST PROFESSIONAL SERVICE TITLE:____________________________________________ SUBMISSION DATE: Wednesday, August 17, 2022 at 10:00am. The following items are required to be included with the sealed submission:  Qualification Statement  Non-Collusion Affidavit  Disclosure of Ownership Form  Insurance Requirement Acknowledgement Form  Mandatory Equal Employment Opportunity Notice Acknowledgement  Copy of your Business Registration Certificate as issued by the  State of New Jersey, Department of Treasury, Division of Revenue  Acknowledgement of Corrections, Additions or Deletions Form  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.