238-25 Exhibit B.pdf

i Part IT DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART I If'a bidder has 2 direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greafor beneficial interest in the publicly traded parent entity as of the last annual federal Security and Exchange Commission (SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s) containing the last annual filing(s) with the federal Securities and Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater betieficial interest in the publicly traded parent entity, along with the relevant page 1umbets of the filing(s) that contain the information on each such person, Attach additional sheets if more space is needed, Website (URL) containing the last annual SEC (or foreign equivalent) fling Page #’s Please list the names and addresses of each stockholder, pariner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part I other than for any publicly traded parent entities referenced above. ‘The disclosure shall be continued until names and, addresses of every.non-corporate, stackhalder, and individual pattner,.and.member-sxceeding.the.10 ..- . percent-ownership-criterta-established-pursuant-to-Na:Sat92125-24;2 lias been-listed Attach additional gheets————— if more space is needed, | _ Stockholder/Partner/Member ane Address Corresponding Entity Listed in Part II : Part IV Certification I, being duly swern upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. | acknowledge: that I am authorized to execute this certification on behalf of the bidder/proposer; that the Township of West Orange is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the completion of any contracts with Township of West Orange to notify the Township of West Orange in writing of any changes to the information contained herein; that Iam aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if! do so, 1am subject to criminal prosecution

the information contained herein; that Iam aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if! do so, 1am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the, permitting the Towaship of West Orange to declare any contract(s) resulting from this certification vold and unenforceable, FullName (prey: |PAgL lL Gekbowees Tite: | PES Hiay Signature: 4A ri Kaahourt bate: | Ocr DBE. 8 Zo25° 32