204-25 Exhibit A.pdf

TOWNSHIP OF WEST ORANGE CHECKLIST PROFESSIONAL SERVICE TITLE:__ Municipal Engineering Services SUBMISSION DATE: December 03, 2024 at 1:00PM. The following items are required to be included with the sealed submission: © Qualification Statement e Non-Collusion Affidavit e Statement of Ownership Disclosure e Insurance Requirement Acknowledgement Form * Mandatory Equal Employment Opportunity Notice Acknowledgement e Copy of your Business Registration Certificate as issued by the State of New Jersey, Department of Treasury, Division of Revenue e Acknowledgement of Corrections, Additions or Deletions Form e Non- Conflict of Interest Declaration e Political Disclosure Certification ¢ Iranian Disclosure Statement e 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