87-25 Exhibit A.pdf

Orange, State of New Jersey Is relying on the Information contained herein and thereby acknowledge that |am under acontinuing 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 certification, and if | do so, | recognize that | am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the Township of West Orange, State of New Jersey and that the Township at at Its - ~ —option may declare any contract(s)-resulting from this bole and unenforceable, —- Full Name (Print); Robert W. Bohny Signature: ono Fiile fesident becerber 1,.2022.\ Fh =a == ===pater a = a al = Please check appropriate boxes on this form. Page | 18