99-24 Exhibit to Temporary Extension Agreement.pdf

______ _____________________________________________________________________ (Use additional (Use additional sheets sheets if if required) required) 9. That 9. That he he is is personally personally acquainted acquainted with the operation with the operation of of the the Respondent; Respondent; has has full full knowledge of knowledge of the the factual factual basis basis comprising comprising the the contents contents of of this this Affidavit; Affidavit; and and that that the the contents are contents are true. true. 10. That 10. That this this Affidavit Affidavit is is made made toto the the Township Township of

made toto the the Township Township of of West West Orange Orange to to accept accept the the Proposal Proposal for this Contract, knowing that the Township of West Orange relies upon the truth for this Contract, knowing that the Township of West Orange relies upon the truth of of the statements the statements contained contained herein. herein. _________________________________________ (Respondent) (Respondent) _________________________________________ (Type or (Type or print print name name of of affiant affiant under under signature) signature) Subscribed and Subscribed and sworn sworn to to before before me me this this _________ day

to before before me me this this _________ day day of of _______________ 2018. 2018. ___________________________ (Notary Public) (Notary Public) My commission My commission expires expires ____________________________. 39 39

Article 3.05 Article 3.05 Non-Collusion Affidavit Non-Collusion Affidavit State of_____________________ State of SS. SS. County of___________________ County of I,I, __________________ of of the the Township Township of of ________________________,, in in the the County County of of __________________ and and the the State State ofof __________________________,, of of full full age age being being duly duly sworn according sworn according to to law, law, on on mymy oathoath depose depose andand say say that: that: I| amam _____________________ of of the the firm of firm of _____________________,, the the bidder bidder making

of _____________________,, the the bidder bidder making making thethe proposal proposal for for the the above above namednamed project, project, and that and that I| executed executed the the said said proposal proposal for for the the above above named named project, project, andand that that I| executed executed the the said said proposal with proposal with full full authority authority to to dodo so; so; that that said said bidder bidder has has not, not, directly directly or

not, directly directly or or indirectly, indirectly, entered entered into into any agreement, any agreement, participation participation in in any any collusion collusion or or otherwise otherwise taken taken any any action action in in restraint restraint of of free, free, competitive bidding competitive bidding in in connection connection with the above with the above named named project; project; and and that that all all statements statements contained in contained in said said proposal proposal andand in in this this Affidavit Affidavit

proposal proposal andand in in this this Affidavit Affidavit areare true true and and correct, correct, and and made made with full with full knowledge that knowledge that the the Township Township of of West West Orange, Orange, New New Jersey Jersey relies relies upon upon the the truth truth ofof the the statements statements contained in contained in said said proposal proposal andand in in the the statements statements contained contained in in the

tatements contained contained in in the the affidavit affidavit in in awarding awarding the the contract for contract for thethe said said project. project. I| further further warrant warrant that that no no person person or or selling selling agency agency has has been been employed employed or or retained retained to to solicit solicit or or secure such secure such aa contract contract upon upon anan agreement agreement or or understanding understanding for for aa commission, commission, percentage, percentage, brokerage or brokerage or contingent contingent fee, fee, except except bona bona fide

ent fee, fee, except except bona bona fide fide employees employees oror bona bona fide fide established established commercial commercial oror selling agencies maintained by selling agencies maintained by _________________________ (N.J.S.A. 52:34-15). (N.J.S.A. 52:34-15). Name of Name of Contractor Contractor __________________________ __________________________ (Sign Name (Sign Name Here) Here) Subscribed and Subscribed and sworn sworn before before me me on on this this ______________ day day of of _________________________ 2018. 2018. _________________________ (Notary Public) (Notary Public) My commission My commission expires: expires: ___________________________ Note to Note to Notary: Notary: When When completing completing this this form,

to Note to Notary: Notary: When When completing completing this this form, form, all all notaries notaries must: must: 1-1- Indicate Indicate date. date. 2. 2. Indicate Indicate State. State. 3. 3. Sign Sign Name. 4. Name. 4. Affix Affix name name by by Printing Printing it, it, typing typing it, it, using using aa rubber rubber stamp, stamp, using using an an impression impression seal seal or or using using aa mechanical stamp. mechanical stamp. NOTE: