99-24 Exhibit to Temporary Extension Agreement.pdf

shall be be required within required within seven seven (7) (7) days days of of receipt receipt ofof the the notice notice of of award award of of the the contract, contract, to to file file with with the the Division of Division of Purchase Purchase and and thethe Township Township Clerk Clerk in in accordance accordance with with Ordinance Ordinance 1180-93, 1180-93, aa written written statement setting statement setting forth forth allall political political contributions contributions in in cash cash oror inin kind, kind, of of

cash oror inin kind, kind, of of $200.00 $200.00 or or more more mademade within five (5) within five (5) years years ofof the the date date ofof the the notice notice of of the the award, award, either either directly directly or or indirectly, indirectly, by by said said bidder, and/or bidder, and/or anyany of of it it principal principal officers, officers, to to any any elected elected official official of of the the Township Township currently currently in in the

currently in in the the office or office or any any political political organization organization affiliated affiliated withwith an an elected elected official official of of the the Township Township currently currently in in office. All office. All bid bid proposals proposals shallshall contain contain aa written written statement statement by by the the bidder bidder that that the the bidder bidder is is aware aware of this of this disclosure disclosure requirement requirement and and agrees agrees to to bebe bound bound by by its

agrees to to bebe bound bound by by its its terms. terms. II have have read read the the above above statement statement and and agree agree to to be be bound bound by by its its terms terms BIDDER: BIDDER: ______________________________ SIGNATURE SIGNATURE TITLE: TITLE: ______________________________ FOR: FOR: ______________________________ CONTRACTOR CONTRACTOR Sworn to Sworn to and and subscribed subscribed before before me me on on this this _______________ day day of of _______________,, 2018. 2018. __________________________________ (Notary Public) (Notary Public) My commission My commission expires expires on on _________________________. 54 54

Article 3.17 Article 3.17 DISCLOSURE OF DISCLOSURE OF INVESTMENT INVESTMENT ACTIVITIES ACTIVITIES IN IN IRAN IRAN Proposer: Proposer: Pursuant to Pursuant to Public Public Law Law 2012,2012, c.c. 25, 25, any any person person or or entity entity that that submits submits aa bidbid or or proposal proposal or or otherwise proposes otherwise proposes to to enter enter into into oror renew renew aa contract contract mustmust complete complete the the certification certification below below to to attest, under attest, under penalty penalty of of perjury, perjury, that that the the person person or or entity, entity, or or one

entity, or or one one of of the the person person or or entity's entity's parents, parents, subsidiaries, or subsidiaries, or affiliates, affiliates, is is not not identified identified on on aa list list created created and and maintained maintained by by the the New New Jersey Jersey Department of Department of the the Treasury Treasury as as aa person person or or entity entity engaging engaging in in investment investment activities activities in in Iran.

investment activities activities in in Iran. Iran. IfIf the the Director finds Director finds aa person person or or entity entity toto be be in in violation violation of of the the principles principles which which areare the the subject subject of of this this law, s/he law, s/he shall shall take take action action as as may may be be appropriate appropriate and and provided provided by by law, law, rule rule or or contract, contract, including

contract, including including but not but not limited limited to, to, imposing imposing sanctions, sanctions, seeking seeking compliance, compliance, recovering recovering damages, damages, declaring, declaring, declaring the declaring the party party inin default default and and seeking seeking debarment debarment or or suspension suspension of of the the person person or or entity. entity. II certify, certify, pursuant pursuant to to Public Public Law Law 2012, 2012, c. c. 25, 25, that that the the person person or or entity entity listed

or entity entity listed listed above above for for which which II amam authorized authorized to to submit submit aa proposal: proposal: €€ Is Is not not providing providing goods goods or or services services ofof $20,000,000 $20,000,000 or or more more inin the the energy energy sector sector of of Iran, Iran, including aa person including person or or entity entity that that provides provides oil oil or or liquefied liquefied natural natural gas gas tankers, tankers, or

gas tankers, tankers, or or products products used to used to construct construct or or maintain maintain pipelines pipelines used used toto transport transport oil oil or or liquefied liquefied natural natural gas, gas, for for the energy the energy sector sector of of Iran, Iran, and and €€ Is Is not not aa financial financial institution institution that that extends extends $20,000,000 $20,000,000 oror more more in in credit credit to to another