141-25 Exhibit.pdf

REQUIRED EVIDENCE APFIRMATIVE ACTION REGULATIONS NJ. S.A. 10:5-31, et seq. (NLA. C. 17:27) If awarded a contract, the Bidder will be sequited to comply with the requitements of NLS.\, 10:531, et seq., and NJAS,.. 17.27. Within five (6) days after tecelpt of the notification of intent to awatd the conteact, the Bidder shall present one of the following: 1. Approptiate evidence that the Conitactot 1s opetating under an existing federally approved of sanctioned affirmative action program; ot 2. A Cestificate of Employee Information Report Approval iseued in accotdance with NLAC, 17:27-4; ox 3 —Aeninltint— Hap loyer—infotmntion—Report—vemsinting ffm —previciedby—tine Affirmative Action Office and coinpleted by Contractor in accordance with NLA.C, 17:27-4, ‘The Bidder must submit no later than theee (3) days after the signing of the Contract an Initiel Project Manning Table consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with NLA.G, 17:27-7. Biddess are teferted to the Bidder's Information Section of the Bid Packet for a further desctiption of the above requitements, NO BIDDER MAY BE ISSUED A CONTRACT UNLESS THEY COMPLY WITH THE AFFIRMATIVE ACTION REGULATIONS OF NJS.A, 10:5-31, et seq. ‘The following questions must be answered by all Bidders: . L Do you have a federally-approved or sanctioned Affirmative Action Program? Yes______. (If yes, submit 4 copy of such approval) No 2 Do you have a State Cettificate of Employee Information Report approval? Yes {If yes, submit 2 copy of such appsoval.) Ne ‘The undersigned Bidder ceitifies 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 tequited documentation pursuant 10 the law. COMPANY: NAME: SIGNATURE: PETE: NOTE: A bid must be rejected as non-ccsponsive if a Bidder fails to comply with requirements of NJS.A. 10:5-31, et seq. within the time frame stipulated. Page | 23

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 7 . (nittal) [1 No addenda was/were received, Acknowledged for: (Company Name} By: (Signature of Authorized Representative) Name: (Print) Title: Date; Page P24

i i { t Ic: ion Disclosure Statement Pursuant to Ch lon 68. 1 Revise General Ordinances of the Township of West Orango Pursuant to Section 2-68.1 of the Revised General Ordinances of the Township of West Orange, please set farth below ail political contributions in cash or in kind of two hundred ($209.00), dollars or more made within five (6) 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, elther directly or indirectly, by the individuals or any of the principals of the business antily completing this form or hy the business entity itself, to any elected official of the Township of West Orange currently in office or any political organization affiflated with an elected official of the Township currently in office,’ Ifyou have NOT made any contributions within the scope of Section 2-58.1, 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 knowledga, Information and belief. ‘The current elected officials of the Township include the following: Mayor Susan McCartney, Councilman Bill Rutherford, Counciwoman Michelle Casalino, Councilwoman Tammy Williams, Councilwoman Asmeret Ghebremicae! and Councilwoman Susan Scarpa . Company Name Authorized Signature Printed Name Date rage [25 —. en ee

BIDDER’S CHECK LIST Business Registration Certification Statement of Ownership Affirmative Action Compliance Notice Prohibited Russla-Belarus Activities & Iran Investment Activities Non-Collusion Affidavit Proposal Form Acknowledgement of Addenda Political Contribution Form Bidders must provide documented proof of qualifications (Certffications). Three (3) references Please initial lines. Please provide one additional copy of entire bid package, which can be a USB/Flash Stick END OF BID Page | 26