141-25 Exhibit.pdf

AFFIDAVIT OF NON-COLLUSION \ The undersigned. bidder of full age, being duly sworn according to law depose and hereby specifically certifies i that: AP the best of the bidder's] Jarowledge en betief the-annexcet bit propos for tis project has not tse ————> 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. . - - - os All references to the bidder are understood to include the undersigned and all principals, partners and officers of the bidder. Date: | (Gignature) {Name and Fite) (Conapany) ! (Kideessy (Corporate Seal) Subsoribed and sworn to before me this day of 20, Notary Seal

Icertify, pursuant to law, that neither the person or entity listed above, nor any parent | eniily, 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, e. 3 or in investment activities in Iran pursuant to PL. 2012, e. 25 ("Chapter 25 List"). I further certify that I am the person listed above, or I am an officer or representative 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.)

i | I certify, pursuant to law, that neither the person or entity listed above, nor any parent entily, 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 PL. 2022, c. 3. I further certify that I am the person listed above, or I am an officer or representative of the entily listed above and am authorized te make this certification on its.behalf(Skip Part 2_and_sign and complete-the Certification-|__ below.) Jam unable to certify ay above because ihe person or entity and/or a parent entity, subsidiary, or affiliate is listed on the Department's Russia-Belarus list and/or Chapter 25 Ivan list. I will provide a detailed, accurate, and precise description of the activities as directed in Part 2 below, and sign and complete the Certification below. Failure to provide 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.

Date Title Full Name (Print) Signature

EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.5.A, 10:5-31 at seq. (P.L. 1975, C. 127) NAC. 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 respect to affectional or sexual orientation and gender Identity or expression, the contractor will ensure that ~~ ~~ ——and-court decisions of the State of New Jersey and-as established -by applicable Federat law and-applicable—— -——— —— - equal employment opportunity is afforded to such applicants In recrultment and emplayment, and that employees are treated during employment, without regard to thelr age, race, creed, color, national orlgin, ancestry, marital status, affectional or sexual orientation, gender identity or expresstan, disability, nationality or sex, Such equal employment opportunity shall include, but not be !Imited to the following: ernployment, 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 pravislons 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 aff qualified applicants will recelve consideration for employment without regerd to age, race, creed, color, national erigin, 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 coples of the notice in conspicuous places available to

ce, to be provided by the agency contracting officer, advising the labor union of the contractor's commitments under this chapter and shall post coples 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 Amertcans with Disabilities Act, The contractor or subsentractor agrees to make good faith efforts to meet targeted county employment goals established in accordance with NJ.A.C, 17:27-5.2. The contractor or subcontractor agrees to inform In writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor 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, nationatity or sex, and that It will discontinue the use of any recruitment agency which engages In direct or indirect discriminatory 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. i Federal court decisions. In conforming with the targeted employment goals, the contractor or subcontractor agreds to review 4 i I i all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are { Page | 1s

taken without regard to age, race, creed, color, natlonal origin, ancestry, marital status, affectional or sexual orientation, gender Identity or expression, dlsabllity, nationality or sex, consistent with the statutes end court decisions of the State of New Jersey, and applicable Fecleral 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 Federat Affirmative Action Plan Approval Cartificate 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,n].us/treasury/contract_compliance) The contractor and Its subcontractors shall furnish such reports or other documents to the Division of Public Contracts Equal 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 @ compliance investigation pursuant to. Subchapter 10 of the Administrative Code 17:27, Page [19

STATEMENT OF OWNERSHIP DISCLOSURE NLS.A, 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43) ‘This statement shall be completed, certified to, and included with all bid and proposal submissions. Failare to'submit the required information is cause for automatic rejection of the bid or proposal, Name of Organization: Organization Address: Part I Check the box that represents the type of business organization: Dsote Proprietorship {skip Parts tl and III, execute certification in Part IV) Oo Non-Profit Corporation (skip Parts Il and Ill, execute certification in Part IV) oO For-Profit Corporation {any type) DDhimites Liability Company {LLC) oO Partnership ol Limited Partnership GAhinites Liability Partnership (LLP) | Other (be specific): Part oO The list below contains the names and addresses of all stockholders in the corporation who own 16 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own @ 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION) OR Oo No one stockholder in the corporation owns 10 percent or more of its stack, of any class, of no individual partner in the. partnershig owns a 10 percent or greater interest therein, or no member in the limited liability company owns 2 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) (Please attach additional sheets if more space is needed): Name of Individual or Business Entity Address Page | 20 Le ine |

Part IM DISCLOSURE OF 40% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II Ia hidder has.a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annuai federal Security and Exchange Commission {SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s} containing the last annual filing{s) with the federal Securities and Exchange Commission {or foreign equivalent) that contain the name and address of each person holding a 10% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filings) that contain the Information on each such person, Attach additional sheets if more space is needed, Website (URL) containing the last annual SEC (or foreign equivalent) filing Page #’s Please list the names and addresses of each stockholder, partner of member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part Il other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to NJS.A, 52:25-24.2 has been listed. Attach additional sheets if more space |s needed, Steckholder/Partner/Member and Address Corresponding Entity Listed in Part UI Part IV certification 1, being duly sworn upon my oath, hereby represent that the foregoing information and any ettachments thereto to the best of my knowledge are true and complete. | acknowledge: that | am authorized to execute this certification on behalf of the bidder/proposer; that the Township of West Orange is relying on the information. Page [2 oo —

‘ I i i I | ' i I | contalned heretn and thet }am under a continulng odligation from the date of this certification through the completion of any contracts with Township of West Orange to notify the Township of West Orange in writing of any changes to the information contained hereln; that | am aware that tt Is a criminal offense to make a false statement or misrepresentation in this certification, and if | do so, | am subject to criminal prosecution under the law 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 vold and unenforceable. Full Name (Print): . Title: Signature: Date: i i ‘ ! 1 | if Page [22