115-25 Proposal - CPS.pdf

subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c. 3 or in investment activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 List"). I further certify that I am the person listed above, or I am an officer or ‘epresentative of the entity listed above and am authorized to make this certification on its behalf. (Skip Part 2 and sign and complete the Certification below.) 21|Page

|CONTRACT AMENDMENTS AND EXTENSIONS ¢ certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate is listed on the N.J. Department of the Treasury’s lists of entities determined to be engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c. 3. I further certify that I am the person listed above, or Iam n officer or representative of the entity listed above and am authorized to make this lcertification on its behalf. (Skip Part 2 and sign and complete the Certification below.) IF UNABLE TO CERTIFY oO part : Additional Information am unable to certify as above because the person or entity and/or a parent entity, subsidiary, or affiliate is listed on the Department's Russia-Belarus list and/or Chapter 25 Iran list. will provide a detailed, accurate, and precise description of the activities las directed in Part 2 below, and sign and complete the Certification below. Failure to wovide such will prevent the award of the contract to the person or entity, and appropriate penalties, fines, and/or sanctions will be assessed as provided by law. PLEASE PROVIDE FURTHER INFORMATION RELATED TO PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS AND/OR INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate, and precise description of the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or investment activities in Iran in the space below and, if needed, on additional sheets provided by you. 22|Page

Township of West Orange Court Security Specifications Part 3: Certification of True and Complete Information /, being duly sworn upon my oath, hereby represent and state that the foregoing information and any ttachments there, to the best of my knowledge, are true and complete. I attest that I am authorized to execute his certification on behalf of the above-referenced person or entity. {/ acknowledge that the Township of West Orange is relying on the information contained herein and hereby knowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with the Township of West Orange to notify the Township of West Orange in writing of any changes to the answers of information contained herein. |! acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification. If I do so, I recognize that I 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 and that the Township of West Orange at its option may declare any contract(s) resulting from this certification void fand unenforceable. Prine Robent fe Wist Title Tice PrRegepenT Signature (Cal) Wine Date 2] ‘ | a> 23|Page

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: Daf Wik Signature} Robot lsc VCE Pyesipe wt (Name and Title) Custom PaerécrwE Services (Com fame) c ee Pauwewn hve Sule sot (Address) New Yo (NY (0007 (Corporate Seal) Subscribed and sworn to before me This | day of Felor aa 20 ROY Abel. J—~_, Notary Seal 17| Page

BID PROPOSAL FORM Armen | umbameo Seceerty obkieas (Description of item/service being bid) We the undersigned propose to furnish and deliver the above item/service pursuant to the bid specification and made part hereof: s 40.00 Foak, DOellans Cost per hour per Armed security officer Written Figure ¢ 27.00 Tweak Seyew 7 Cost per hour per Unarmed security officer Written Figure Below to come to the cost please use 9 hours per week, 52 weeks per year ¢ FG/L0.00 Foley Six Thea sav, OnE HersbatOr Sixty Dollaustod | Annual Cost 3 Armed security officers Written Figure s $ 5006, 00 Fifty THousaud Seventy SX Dolla s-t oo Cen Annual Cost 2 Armed security officer and Written Figure 1 Unarmed security officer 5 S297A.00 Fenty: -Thvee THo4 SAMO, Nine Ho OLED AND Annual Cost 1 Armed security officer and Written Figure Seve wy -TWo De) ASA 2 Unarmed security officer ov GEAKS The undersigned is a (Corporation), (Partnership), or (Individual) under the laws of the state of Nw oUC _ having its principal office at 395" Lexinaton Ave Near Yoo, Ny. Custom Protective Séauices $2-3206¢ 33 Company Name Fed |.D. # or S.S. Number (Cut wie Robert NIsc- \signatu re of Authorized Agent Type or Print Name 2147 6F-F1S 1 a [i [3025 Telephone Number Date PLEASE SUBMIT PROPOSAL IN DUPLICATE WHICH CAN BE ON A USB/FLASH DRIVE. THE AMOUNT SHALL BE SHOWN IN BOTH WORDS AND FIGURES. IN CASE OF A DISCREPANCY, THE AMOUNT SHOWN IN WORDS WILL GOVERN. 8| Page

Township of West Orange Court Security Specifications TOWNSHIP OF WEST ORANGE ACKNOWLEDGMENT OF RECEIPT OF ADDENDA The undersigned Bidder hereby acknowledges receipt of the following addenda: Please assign the number, date and initial. Addendum Number Dated Acknowledge Receipt (Initial) of ws addenda was/were received. Custom Peotecdv€ Séeuees Acknowledged for: (Company Name) wv (abt Wie \ (Signature.of Authorized Representative) Name: iobent W Se (Print) title: Vick PreseOen T pate: 2 [. [> Lae | 2 | Page

Township of West Orange Court Security Specifications Political Contribution Disclosure Statement Pursuant to Chapter 2, Section 68 of the Revised General Ordinances of the Township of West Orange Pursuant to Section 2-68.1 of the Revised General Ordinances of the Township of West Orange, please set forth below all political contributions in cash or in kind of two hundred ($200.00) dollars or more made within five (5) years of the date of acceptance of a proposal for a negotiated contract with the Township of West Orange, or within five (5) years of the notice of award for a bid contract with the Township of West Orange, either directly or indirectly, by the individuals or any of the principals of the business entity completing this form or by the business entity itself, to any elected official of the Township of West Orange currently in office or any political organization affiliated with an elected official of the Township currently in office. Amount of Recipient of Date of Contribution Contribution Contribution NONE If you have NOT made any contributions within the scope of Section 2-68.1, as set forth above, please X the line to the right. | hereby certify under penalty of perjury that the information provided herein is true and accurate to the best of my knowledge, information and belief. The current elected officials of the Township include the following: Mayor Susan McCartney, Councilman Bill Rutherford, Councilwoman Michelle Casalino, Councilwoman Tammy Williams, Councilwoman Asmeret Ghebremicael and Councilwoman Susan Scarpa . Custom Prokechve Seayices “Pol Wise Authorized Signature Robert Wise Printed Name 311) 5 24|Page

The State of New Jersey DEPARTMENT OF LAW AND PUBLIC SAFI DIVISION OF STATE POLICE License Number: 1532 Date of Expiration: 07/24/2023 Date of License: 07/24/2013 Security Company License This Is to Certify, pursuant to the provisions of Title 45, Chapter 19A of the Revised Statutes, and supplements and amendments thereto, Corp Name: Custom Protective Services Trading As: on July 24, 2021 has been duly renewed as a Security Company located at: 355 Lexington Ave, 402, New York, NY 10017 For the term of two years from the issued date of this license. In Witness Whereof, the New Jersey Division of State Police has caused this certificate to be signed and the official seal affixed ' fs) C0. T Colonel New Jersey State Police

intact BID BOND BOND No, 800025861 KNOW ALL MEN BY THESE PRESENTS, That we, Custom Protective Services, LLC 355 Lexington Ave, Suite 501, New York, NY 10017 as Principal, and Atlantic Specialty Insurance Company, a corporation duly organized under the laws of the State of New York, as Surety, are held and firmly bound unto The Township of West Orange, 66 Main Street, West Orange, NJ 107052 as Obligee, in the sum of Six Thousand --- aad son nnnnnnnnnnnenn ncn ($. 6,000.00 -- ) Dollars for the payment of which Principal and Surety bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, Principal has submitted a bid for Armed/Unarmed Security Services at The Township of West Orange Municipal Court. 60 Main Street, West Orange, NJ 107052 the Project. NOW, THEREFORE, if the Obligee accepts the bid of the Principal and the Principal enters into a Contract with the Obligee for the Project; or, if the Principal pays the Obligee the amount of this Bond or the difference between Principal's bid and the next lowest bid for the Project, whichever is less: this obligation is null and void, otherwise to remain in full force and effect. Signed and sealed this 274 day of February 2028 Custom Protective Services/(| jc YU » olf WA SL ness ,, Pri igipal rs: ive hes eK Atlantic Specialty Insurance Company GHOST ocr BY: Witness Svetlana Novikova Attorney-In-Fact sean Abrams Poe 605 Highway 169 North, Suite 800 Plymouth, Minnesota, USA 55441 Web: intactspecialty.com/surety E-mail: surety@intactinsurance.com B-01-001

Bond No. 800025861 ACKNOWLEDGMENT OF PRINCIPAL IF A CORPORATION STATE OF )\ is url ) ; ) ss.t COUNTY OF Nevo Yor) if On the 2 _ day of te in the year’ C23 before me, the undersigned, personally appeared Nhe personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) sefpA executed the instrument. huh, JPr— Noten, publ pane and office of individtal taking acknowledgment) * jusTIN CUOMO Notary Public, State of New York No. orcues| bles aty falified in New York Cour Eemaisiion Expires November 24, 2026