293-22 Exhibit A.pdf

Name: _________________________ Relationship to Proposer: _______________________ Description of Activities: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Duration of Engagement: ____________________ Anticipated Cessation: __________________ Date: _____________________ Proposer Contact Name: _____________________ Contact Phone: _______________________ Number: ________________________ 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 crin1inal 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: _____________________________ 56

Article 3.18 List All Certified Compost Facility Operators and Include Copies of Certificates, Including Compost Facility Operator Certificate (to be supplied by responding party) 57

INTENTIONALLY

Article 3.18 EQUIPMENT DEDICATION AFFIDAVIT STATE OF NEW JERSEY } COUNTY OF ESSEX } SS: Township of West Orange Recycling I, , am the (Name of Affiant) (Identify Relationship to Bidder) of the and being duly (Name of Bidder) sworn, I depose and say: All statements contained in this affidavit are true and correct and made with full knowledge that the State of New Jersey and the West Orange Township Council rely upon the truth of the statements contained in this affidavit and in said Bid Proposal in signing the contract for the said project. At all times during the performance of this contract, I agree to commit, for use as required in the Township of West Orange, the equipment reasonably calculated to ensure that the Class A, Class B, and Class C recycling operations are in full compliance with all site operating conditions as provided herein and under all applicable New Jersey Department of Environmental Protection regulations, and that such equipment is in compliance with this Request for Proposals and with New Jersey Law. I further warrant that should additional or replacement equipment be required during the terms of this agreement, the Township of West Orange will not be responsible for any costs incurred by the operator. I also understand and agree that during the terms of this agreement, the Township of West Orange has the right to inspect all equipment at any time and for any reason. I also understand and agree that failure to comply with the representations contained herein shall be cause for breach of contract and will entitle the Township of West Orange to damages arising therefrom. ________________________________ Name of Firm or Individual Title ________________________________ Signature Date 59

Subscribed and sworn to before me this day of 20___ Notary Public of ___________________________ My Commission expires ________________20___ 60

Article 3.19 Bid Bond Form 61

THIS PAGE LEFT INTENTIONALLY BLANK

APPENDICES FACILITY SITE PLAN AND SITE IMPROVEMENT PLAN 4849-1061-2834, v. 1 63

LEGEND GENERAL NOTES DUST CONTROL NOTES SOIL EROSION & SEDIMENT CONTROL NOTES LIMIT OF DISTURBANCE 1. TOPOGRAPHIC SURVEY INFORMATION BASED ON WEST ORANGE TOPOGRAPHIC SURVEY PREPARED BY WSP*SELLS, CHARLTON, MA. DATE OF PHOTOGRA[PHY SILT FENCE SPRING 2010.

SILT FENCE SPRING 2010. 1. ALL SOIL EROSION AND SEDIMENT CONTROL PRACTICES ON THIS PLAN WILL BE CONSTRUCTED IN 2. PROPERTY LINES ARE SHOWN BASED ON PLAN ENTITLED "INCINERATOR ACCORDANCE WITH THE JERSEY STANDARDS FOR SOIL EROSION AND SEDIMENT 7TH PROPOSED GRAVEL/ASPHALT MILLING STABILIZED TRAVEL WAY EDITION LAST REVISED JANUARY 2014. THESE MEASURES WILL BE INSTALLED PRIOR TO ANY MAJOR SOIL