293-22 Exhibit A.pdf

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 incorporated is: ______________________ 7. That if the answer to question #6 is a State other than New Jersey, the 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 address of the principals, officers, and shareholders of the Respondent are as follows: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ (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. _________________________________________ (Respondent) _________________________________________ (Type or print name of affiant under signature) Subscribed and sworn to before me this _________ day of _______________ 2018. ___________________________ (Notary Public) My commission expires ____________________________. 39

Article 3.05 Non-Collusion Affidavit State of_____________________ SS. County of___________________ I, __________________ of the Township of ________________________, in the County of __________________ and the State of __________________________, of full age being duly sworn according to law, on my oath depose and say that: I am _____________________ of the firm of _____________________, 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 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 further 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 fide employees or bona fide established commercial or selling agencies maintained by _________________________ (N.J.S.A. 52:34-15). Name of Contractor __________________________ __________________________ (Sign Name Here) Subscribed and sworn before me on this ______________ day of _________________________ 2018. _________________________ (Notary Public) My commission expires: ___________________________ Note to Notary: When completing this form, all notaries must: 1- Indicate date. 2. Indicate State. 3. Sign Name. 4. Affix name by Printing it, typing it, using a rubber stamp, using an impression seal or using a mechanical stamp. NOTE: The person who signed the proposal form from the respondent should sign this form also.

ng an impression seal or using a mechanical stamp. NOTE: The person who signed the proposal form from the respondent should sign this form also. 40

Article 3.06 State of New Jersey Township of New Jersey Sub-Contractor Use Form Furnish below the company name, address, telephone number, and name of contact person for each sub-subcontractor, if any, to be used in the performance of the Work for the Contract. Experience statements shall be attached hereto for each sub-contractor. NOTE: If no work will be sub-contracted, indicate NONE. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The contractor is advised that any change of sub-contractor(s) from the ones listed herein is subjected to the Township of West Orange’s approval. Change of sub-contractor(s) will be approved only if made for good cause and not as a result of an arbitrary purpose. Witness: ________________________________ (Name of Company) ________________________________ (Address) ___________________________ BY: ________________________________ (Date) (Sign Name (Original Signature Only) ________________________________ (Print Name & Title) 41

Article 3.07 Experience Statement Township of West Orange, West Orange, New Jersey Gentlemen: I hereby certify that my company has performed the following private or public work which is relevant to this proposal. I further certify that my company has never defaulted under any contract. (Give name of project, owner’s name and address, contact person, and phone number, type of work, when started and completed, and dollar amount of work.) ___________________________________ ________________________________ (Witness) (Name of Company) ________________________________ (Address) ___________________________________ BY: _____________________________ (Date) Sign Name (Original Signature Only) ________________________________ (Print Name and Title) (You may attach your own forms to this sheet if you prefer, but sign and witness this sheet) 42

Article 3.08 Qualifications of Personnel Below provide the names of the personnel – both management, supervisory and non supervisory who will be assigned to the West Orange Recycling Center. In addition to their names please provide their experience in operating a facility for Class B, Vegetative Waste Processing, Class C, Leaf Composting and Recycling Convenience Center. Experience shall include the amount of time served in the various positions held. I hereby certify that these employees will be assigned to the West Orange Recycling Center and that their individual experience is as described. ___________________________________ ________________________________ (Witness) (Name of Company) ________________________________ (Address) ___________________________________ BY: _____________________________ (Date) Sign Name (Original Signature Only) ________________________________ (Print Name and Title) (You may attach your own forms to this sheet if you prefer, but sign and witness this sheet) 43

Article 3.09 Equipment List Type/Purpose Description Age Owned Lease or Term, if Leased applicable 44

Article 3.10 Consent of Surety To Accompany Proposal _____________________ (hereinafter called Surety), organized and existing under the laws of The State of _____________ and duly authorized and qualified to transact business in the State of New Jersey, in consideration of the sum of One Dollar ($1.00), lawful money of the United States of America, to it in hand paid, receipt whereof is hereby acknowledged, and in consideration, hereby certified and agrees that if the contract for which that attached bid is made be awarded to ____________________ (hereafter called Contractor) for the performance of certain work or supplying of certain materials, or both, as more particularly set forth in said bid and described for purposes of this instrument as a bid for ______________________________ to the TOWNSHIP OF WEST ORANGE and if Contractor shall enter into the contract with a bond in the full amount of the contract price. __________________________________________________________ (Name of Insurance Company) ___________________________________________________________ (Address) ______________________________________________ ______________________________________________ (Signature Attorney-In-Fact for Insurance Company) Note: Proof of authority of officers of Surety Company to execute this document must be submitted. 45

Article 3.11 MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will take affirmative action to ensure that such applicants are recruited and employed, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor, where applicable, will send to each labor union or representative or workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer advising the labor union or workers' representative of the contractor's commitments under this act and shall post copies of the notice in conspicuous

, to be provided by the agency contracting officer advising the labor union or workers' representative of the contractor's commitments under this act and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to employ minority and women workers consistent with the applicable county employment goals established in accordance with N.J.A.C. l7:27-5.2, or a binding determination of the applicable county employment goals determined by the Division, pursuant to N.J.A.C. 17:27-5.2. 46