203-25 Exhibit A.pdf

STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.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. Failure to submit the required information is cause for automatic rejection of the bid or proposal. Matrix New World Engineering, Land Surveying and Landscape Architecture P.C. Name of Organization:_________________________________________________________________ 26 Columbia Turnpike, 2nd Floor, Florham Park, NJ 07932 Organization Address:_________________________________________________________________ Part I Check the box that represents the type of business organization: Sole Proprietorship (skip Parts II and III, execute certification in Part IV) Non-Profit Corporation (skip Parts II and III, execute certification in Part IV) x For-Profit Corporation (any type) Limited Liability Company (LLC)  Partnership Limited PartnershipLimited Liability Partnership (LLP) Other (be specific): ______________________________________________ Part II x  The list below contains the names and addresses of all stockholders in the corporation who own 10 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 a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION) OR  No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 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 Jayne Warne, PE 21 Bloomfield Way, West Orange, NJ 0752 Demetrios Stamatis 218 Ludlow Avenue, Spring Lake, NJ 07762 Neal Weitman, PE 7633 Thornlee Drive, Lake Worth, FL 33467 41