238-25 Exhibit B.pdf

STATE OF ERSUIP LOSURE NSA, 52:25-24.2 (P.L, 1977, 6.33, as amended by P.L, 2016, 6.43) 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. Name of Organization:DWC ENTERPRISES INC, Organization Address:PO BOX 1293 MAPLEWOOD NJ 07040 Part I Check the box that represents the type of business organization: sole Proprietorship (skip Parts I and IH, execute certification in Part IV) [Non-Profit Corporation (skip Parts II and II, execute certification in Part IV) Adfror-proti Corporation (any type) i Limited Liability Company (L1.C) [}Partnership [Limited Partnership [_luimited Liability Parmership (LLP) O Other (be specific): Parti — | 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 Ol No one stockholder ta 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 inthe 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 Z [DANIEL CHRISTOFFERSON B35 HAZELWOOD PLACE PISCATAWAY NJ 08854 18