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