160-25 Exhibit.pdf

PHIL MURPHY DEPARTMENT OF THE TREASURY Governor DIVISION OF REVENUE & ENTERPRISE SERVICES P.O. BOX 026 SHEILA OLIVER TRENTON, NJ 08625-034 ELIZABETH MAHER MUOIO Lt, Governor PHONE: 609-292-2146 FAX: 609-984-6679 State Treasurer APPROVED under the Small Business Set-Aside Act This certificate acknowledges MILLENNIUM STRATEGIES LLC as a Category 2 approved Small Business (SBE) that has met the criteria established by N.J.A.C. 17:13 and/or 17:14.. This registration will remain in effect for three years. Annually the business must submit, not more than 60 days prior to the anniversary of the registration notice, an annual verification statement in which it shall attest that there is no change in the ownership, revenue eligibility or control of that business. If the business fails to submit the annual verification statement by the anniversary date, the SBE registration will lapse and the business SBE status will be revoked in the New Jersey Selective Assistance Vendor information (NJSAVI) database that lists registered Small businesses. If the business seeks to be registered again, it will have to reapply and complete a new application Peter Lowicki Deputy Director Issued: 10/10/2020 Expiration: 10/10/2023 Certification Number: A0125-62

APPENDIX A AMERICANS WITH DISABILITIES ACT OF 1990 Equal Opportunity for Individuals with Disability The contractor and the Township of _West Orange (hereafter “owner’) do hereby agree that the provisions of Title 11 of the Americans With Disabilities Act of 1990 (the "Act") (42 U.S.C, $121 01 et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs, and activities provided or made available by public entities, and the rules and regulations promulgated pursuant there unto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the owner pursuant to this contract, the contractor agrees that the performance shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall defend the owner in any action or administrative proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the owner, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages, of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the owner’s grievance procedure, the contractor agrees to abide by any decision of the owner which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the owner, or if the owner incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense, The owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim, If any action or administrative proceeding is brought against the owner or any of its agents, servants, and employees, the owner shall expeditiously forward or have forwarded to the

lars of the claim, If any action or administrative proceeding is brought against the owner or any of its agents, servants, and employees, the owner shall expeditiously forward or have forwarded to the contractor every demand, complaint, notice, summons, pleading, or other process received by the owner or its representatives. It is expressly agreed and understood that any approval by the owner of the services provided by the contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the owner pursuant to this paragraph, It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the contractor’s obligations assumed in this Agreement, nor shall they be construed to relieve the contractor from any liability, nor preclude the owner from taking any other actions available to it under any other provisions of the Agreement or otherwise at law. 23

Proposal RFP for Grant Writing Services Submission Deadline: Tuesday, July 11, 2023 at 11:00AM Recipient: Panayiota Reynolds Township of West Orange 66 Main Street, Room 111 West Orange, New Jersey 07052 In accordance with and subject to all stipulations, conditions, requirements, and instructions so far as they relate to this proposal are made part of it, submit my quote for services described: | submit the following annual cost of services: $3,900.00 per month retainer fee not $ to exceed $46,800.00 per annum Three thousand nine hundred dollars per month retainer fee, not to exceed fourty six thousand eight hundred dollars per annum DOLLAR AMOUNT IN WRITING ***In addition to the base proposal, the Township requests proposers respond to this Add- Alternate to provide State and County Grant Administration Services on an as needed basis. This service includes assistance with the execution of grant agreements and the preparation/submission of programmatic and financial reports. This service does not include project management, tracking or record retention services. This service will only be provided when requested in writing and mutually agreed to by the proposer. The propose reserves the right to reject any grant administration task at any time for any reason, as long as it notifies the Township in sufficient time to transfer responsibility back to the Township to complete the responsibilities in a timely manner.*** Hourly Rate _$150.00 NAME : Edward Farmer Date: 09/06/2023 ADDRESS: 60 Columbia Road, Building B, Suite 230 Morristown, NJ, 07960 EMAIL; _efarmer@m-strat.com PHONE: (973) 226-3329 (Signature authorized to execute a contract) 24

Request for Taxpayer Identification Number and Certification Dopartment of the Treasury Internal Revenue Service > Go to www.irs.gov/FormW9 for instructions and the latest Information. 1 Name (as shown on your Income tax return). Name Is required on this ling; do not leave this line blank. Millennium Strategies LLC 2 Business namo/disregarded entity name, I diferent from above ron W=9 (Rev, October 2018) Give Form to the requester. Do not send to the IRS. 4 Exemptions (codes apply only to certain entities, not individuals; see Instructions on page 3): ‘9 Check appropriate box for fadaral tax classification of the person whose name ls enterad on lina 1, Check only one of tha following seven boxes. O)scorporation [1] Partnership (1 trustvestate {1 indivicuat/sote proprietor or +] © Corporation singlo-momber LLC Exempt payee code (if any) Limited llabllily company, Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) >_P. ‘Note: Check the appropriate box In the line above for the tax classification of the single-member owner. Do not cheok LLG If the LLG Is classified as a single-member LLC that Is disregarded from the owner unless the owner of the LLG Is another LLG that Is not disregarded fram the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that} Exemption from FATCA reporting cod (if any) J) Other (see Instructions) > {s disragardad from the owner should check the appropriate box for the tax classification of Its owner, (Mpples to accounts mantened outs toe US) & Address (number, street, and apt. or sulle no) See Instructions. 60 Columbia Road, Building B, Suite 230 Print or type. See Specific Instructions on page 3. Requester’s name and address (optional) 6 Clty, state, and ZIP code Morristown, NJ, 07960 7 List account number(s) here (optional) Part | Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avald backup withholding, For individuals, this Is generally your social security number (SSN), However, for a resident alien, sole proprietor, or disregarded entity, see the Instructions for Part |, later. For other - - entities, it is your employer identification number (EIN), If you do not have a number, see How to gat a TIN, later. Note: If the account Is In more than one name, see the Instructions for

other - - entities, it is your employer identification number (EIN), If you do not have a number, see How to gat a TIN, later. Note: If the account Is In more than one name, see the Instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. ‘Social security number or Employer identification number 2)0/ -|3/7/4/9/8/6/4 Certification Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer Identification number (or | am walting for a number to be issued to me); and 2. am not subject to backup withholding bacause: (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue Service (IRS) that | am subject to backup withholding as a result of a fallure to report all Interest or dividends, or (c) the IRS has notified me that | am no longer subject to backup withholding; and 3.1m aU.S. cltizen or other U.S. person (defined below); and 4, The FATCA code(s) entared on this form (if any) Indicating that | am exempt from FATCA reporting Is correct, Certification instructions. You must cross out item 2 above if you have heen notified by the IRS that you are currently subject to backup withholding because you have fallad to report all Interest and dividends on your tax return, For real estate transactions, item 2 does not apply. For mor\gage Interest pald, acquisition or abandonment of sacured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not requlrad to sign the certification, but you must provide your correct TIN. See the Instructions for Part Il, later. Sign Signature of Here US. person fe ima OTSA GA AP General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments, For the latest Information about developments related to Form W-9 and Its Instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form ‘An Individual or entity (Form W-9 requester) who Is requlred to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer Identification number (TIN), adoption taxpayer Identification number

S must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer Identification number (TIN), adoption taxpayer Identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return, Examples of Information returns Include, but are not limited to, the following, * Form 1099-INT (interest earned or paid) * Form 1099-DIV (dividends, Including those from stoc<s or mutual funds) * Form 1099-MISC (various typas of income, prizes, awards, or gross proceeds) * Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) * Form 1099-8 (proceeds from real estate transactions) * Form 1099-K (merchant card and third party network transactions) * Form 1098 (home mortgage Interest), 1098-E (student loan interest), 1098-T (tuition) * Form 1099-C (canceled dabt) * Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person (inoluding a resident alien), to provide your correct TIN. Ifyou do not return Form W-9 to the requester with e TIN, you might be subject to backup withholding. See What Is backup withholding, later. Cal. No, 10231X Form W-9 (Rev. 10-2018)

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 Making Contribution |__ Milennium strategies LLC 1,500.00 usan MeCariney far Mayor 40127120: Pariners: Edward Farmer/Susan Seavone Allcontrfoutions spt between parties 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. =i | 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 Millennium Strategies LLC Company Name = oo. Authorized Signature Edward Farmer, President and CEO Printed Name 07/06/2023 Date

Prohibited Russia-Belarus Activities & Iran Investment Activities ] I Person or Entity Millennium Strategies LLC Part 1: Certification COMPLETE PART | BY CHECKING ONE OF THE THREE BOXES BELOW Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter into or renew a contract, for goods or services must complete the certification below prior to contract award to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or| affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as a person or| entity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods or services can| be amended or extended, a person or entity must certify that neither the person or entity, nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list, Both lists are found lon Treasury’s website at the following web addresses: https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf lwww.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the below certification. A person or entity unable to make the certification must provide a detailed, accurate, and precise description lof 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. The person or entity must cease engaging in any prohibited activities and provide an updated certification before the contract can be entered into. If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may be| provided by law, rule, or contract, including but not limited to imposing sanctions, seeking compliance, recovering damages, declaring the party in default, and seeking debarment or suspension of the party. ICONTRACT AWARDS AND RENEWALS 7 certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, 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

bsidiary, 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 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.)