203-25 Exhibit A.pdf

TOWNSHIP OF WEST ORANGE CHECKLIST Municipal Engineering PROFESSIONAL SERVICE TITLE:____________________________________________ SUBMISSION DATE: December 03, 2024 at 1:00PM. The following items are required to be included with the sealed submission:  Qualification Statement  Non-Collusion Affidavit  Statement of Ownership Disclosure  Insurance Requirement Acknowledgement Form  Mandatory Equal Employment Opportunity Notice Acknowledgement  Copy of your Business Registration Certificate as issued by the State of New Jersey, Department of Treasury, Division of Revenue  Acknowledgement of Corrections, Additions or Deletions Form  Non- Conflict of Interest Declaration  Political Disclosure Certification  Iranian Disclosure Statement  Russia-Belarus Certification  Americans with Disabilities Act of 1990 Reminder: Please submit one (1) original and one (1) additional copy must be on a USB stick/flash drive/external hard drive. If a company has multiple services, a separate Qualification packet for each service should be submitted. Page | 48