295-24 Exhibit.pdf

h Township of West Orange to notify the Township of West Orange in writing of any changes to the information contained herein; that |am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if | do so, lam subject to criminal prosecution under the Jaw and that it will constitute a material breach of my agreement(s) with the, permitting the Township of West Orange to declare any contract(s) resulting from this certification void and unenforceable. 23|Page

Full Name (Print): Bary PBortse Title: | 0 y -awAy ee Signature: Ee b45_— Date: Y~1G- 2 a 24| Page ~~ 7

(REVISED 4/10) EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (PL. 1975, C. 127) NJ.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with tespect to affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a notice, to be provided by the agency contracting officer, advising the labor union of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with

r this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A, 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals established in accordance with N.J.A.C. 17:27-5.2. (continued) The contractor or subcontractor agrees to infarm in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and iabor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or

REQUIRED EVIDENCE AFFIRMATIVE ACIION REGULATIONS NJ. $.A. 10:5-31, et seq, (NLA, C. 17:27) If awarded a contract, the Bidder will be required to comply with the requirements of NJ.S.A. 10:531, et seg., and N.A.C_ 17:27, Within five (5) days after receipt of the notification of intent to award the contract, the Bidder shall present one of the following: 1, Appropriate evidence that the Contractor is operating under an existing federally approved or sanctioned affirmative action program; or 2. A Certificate of Employee Information Report Approval issued in accordance with NJ.A.C, 17:27-4; or 3. An initial Employee Information Report consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with NLA.C. 17:27-4, ‘The Bidder must submit no later than three (3) days after the signing of the Contract an Initial Project Manning Table consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with NLA.C, 17:27-7. Bidders are referred to the Bidder's Information Section of the Bid Packet for a further description of the above requirements. NO BIDDER MAY BE ISSUED A CONTRACT UNLESS THEY COMPLY WITH THE AFFIRMATIVE ACTION REGULATIONS OF NJ.S.A. 10:5-31, et seq. ‘The following questions must be answered by all Bidders: 1. Do you have a federally-approved or sanctioned Affirmative Action Program? Yes (Lf yes, submit a copy of such approval.) (No) 2: Do you have a State Certificate of Employee Information Report approval? Yes {IE yes, submit a copy of such approval.) Ro? ‘The undersigned Bidder certifies that he is aware of the commitment to comply with the requirements of NJS.A, 10:5-31, et seq., and agrees to furnish the required documentation pursuant to the law. COMPANY: S7¢4uwG S&CUUT/ES NAME; GARY B6076S sIoNaTuRE: <2—&—P TLE: Co~ otu nwa NOTE:A bid must be tejected as non-responsive if a Bidder fails to comply with requitements of NJ.S.A. 10:5-31, et seq, within stipulated time.

TOWNSHIP OF WEST ORANGE DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN Proposer: STEMS SECURITIES Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certification below to attest, under penalty of perjury, that the person or entity, or one of the person or entity’s parents, subsidiaries, or affiliates, is not identified on a list created and maintained by the New Jersey Department of the Treasury as 2 person or entity engaging in investment activities In Iran. If the Director finds a person or entity to be in violation of the principles which are the subject of this law, s/he shall take action as may be appropriate and provided by law, rule or contract, Including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring, declaring the party in default and seeking debarment or suspension of the person or entity. I certify, pursuant to Public Law 2012, c, 25, that the person or entity listed above for which | am authorized to submit a proposal: Must check appropriate boxes ls not providing goods or services of $20,000,000 or more in the energy sector of Iran, including a person or entity that provides oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas, for the energy sector of Iran, and a Is not a financial institution that extends $20,000,000 or more In credit to another person or entity, for 45 days, or more, if that person or entity will use the credit to provide goods or services in the energy sector in Iran. In the event that a person or entity is unable to make the above certification because it or one of its parents, subsidiaries, or affiliates has engaged in the above referenced activities, a detailed, accurate and precise description of the activities must be provided in part 2 below to the New Jersey Turnpike Authority under penalty of perjury. Failure to provide such will result in the proposal being rendered as non-responsive and appropriate penalties, flnes and/or sanctions will be assessed as provided by law. Part 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN [RAN You must provide a detailed, accurate and precise description of the activities of the proposer, or one of its parents,

t 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN [RAN You must provide a detailed, accurate and precise description of the activities of the proposer, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below, Meas & 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. | attest that | am authorized to execute this certification on behalf of the above referenced person or entity. | acknowledge that the Township of West Orange, State of New Jersey Is relying on the Information contained herein and thereby acknowledge that | 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. | acknowledge that | am aware that it is a criminal offense to make a false statement or misrepresentation in this 25|Page

‘ i | | | sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatary practices. The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The 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: Letter of Federal Affirmative Action Plan Approval Certificate of Employee Information Report Employee Information Report Form AA302 (electronically provided by the Division and distributed to the public agency through the Division’s website at www.state.nj.us/treasury/contract_compliance) The contractor and its subcontractors shall furnish such reports or other documents to the Division of Public Contracts Equa! Employment Opportunity Compliance as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies Shall furnish such information as may be requested by the Division of Public Contracts Equal Employment Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.

| i | | | I certification, and if | do so, | recognize that | am subject to criminal prosecution under the law and that it will also constitute 2 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. ef Full Name (Print); GA47 BOeTES — sipnature:_< Title: LE-B0N B Date: off 2 [zsb

t 1 | i i 1 i t AFFIDAVIT OF NON-COLLUSION The undersigned bidder of full age, being duly sworn according to law depose and hereby specifically certifies that: A. To the best of the bidder's knowledge and belief, the annexed bid proposal for this project has not been prepared in collusion with any other bidder of like item or services and the prices, discounts, terms and conditions thereof have not been directly or indirectly communicated by or on behalf of the bidder to any person other than the recipient of the bid and will not be communicated to any person prior to the official opening of the bid. B. The bidder fully understands that no premiums, rebates, or gratuities are permitted either with, prior to, or after signing of contract. Any violation will result in cancellation and removal from the bid list. C, The bidder further certifies that the undersigned has the necessary authority, to sign this stipulation stating that the bidder has not entered into any agreement, or otherwise taken any action in restraint of free competitive bidding in connection with this bid. All references to the bidder are understood to include the undersigned and all principals, partners and officers of the bidder.. Date: f= =e (Signature) GARY Boerées ZG ~ Oto SR (Name and Tile) e opettintG SECURMTIGS ‘Company Name) a Ce Domerens AE UEROLA KT OPOYY (Address) (Corporate Seal) Subscribed and sworn to before me 2A F this__ /Y day of Loe 20 274 F Notary Seal_ ra a Us vi ude AS pean) (ee RO oes Bu din, C ee c 3 %,