238-25 Exhibit B.pdf

C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.LS.A. 19:44A-20.26 This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. Parti — Vendor Information : Vendor Name: [WC ENTERPRISES INC, | Address: PO BOX 1293 City: [MAPLEWOOD | State:NT | Zip:07040 | The undersigned being authorized to certify, hereby certifies that the submission provided herein represents ! compliance with the provisions of N.J.S.A, 19:44A-20,26 and as represented by the Instructions accompanying this form. CoN ee Signature Printed NameDANIEL CHRISTOFFERSON TitlePRESIDENT Part H - Contribution Disclosure Disclosure requirement: Pursuant to NLLS.A, 19:44A-20,26 this disclosure must include all reportable political contributions (more than $200 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local Unit, a Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Dollar Amount $ 15