318-22 Exhibit A-Coronis Health for Emergency Transport Third Party Billing - 2022.pdf

TOWNSHIP OF WEST ORANGE insured coverage and shall name the TOWNSHIP as an additional insured. 3. Indemnification. Successful vendor shall indemnify and hold harmless the TOWNSHIP from all claims, suits or actions and damages or costs of every name and description to which the TOWNSHIP may be subjected or put by reason of injury to the person or property of another, or the property of the TOWNSHIP, resulting from negligent acts or omissions on the part of the vendor, the vendor's agents, servants or subcontractors in the delivery of goods and services, or in the performance of the work under the contract. V. STATUTORY AND OTHER REQUIREMENTS. The following are mandatory requirements of this proposal and contract. 1. Mandatory Affirmative Action Certification. No firm may be issued a contract unless it complies with the affirmative action provisions of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-1 et seq. The following information summarizes the full, required regulatory text, which is included as Exhibit A of this proposal specification. Goods and Services (including professional services) Contracts: Each contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: a. A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned Affirmative Action program (good for one year from the date of the letter), or b. A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4; or c. A photocopy of an Employee Information Report (Form AA302) provided by the State of New Jersey, Division of Contract Compliance & Equal Employment Opportunity and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4. 3. Stockholder Disclosure. Vendors shall submit a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners

a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners in the partnership who own a ten percent or greater interest therein. The included Statement of Stockholder Disclosure shall be completed and attached to the bid. This requirement applies to all forms of corporations and partnerships, including, but not limited to, limited partnerships, limited liability partnerships and Subchapter S corporations. Failure to submit a stockholder disclosure document shall result in rejection of the proposal. 7