111-26 Agreement.pdf

ATTEST TOWNSHIP OF WEST ORANGE By:_____________________ _______ By:____________________________ KAREN J. CARNEVALE, R.M.C. SUSAN McCARTNEY, MAYOR Date: Date: ONE TOTAL CLEANING, LLC By: ___________________________ By: ___________________________ Date: Date:

EXHIBIT A

EXHIBIT B

EXHIBIT C CRIMINAL BACKGROUND CHECK WAIVER AND RELEASE OF ALL CLAIMS FORM Please read this form carefully and be aware that by agreeing to allow the Township to investigate your criminal background. you will be waiving and releasing all claims for damages you might sustain out of the criminal background check and review I hereby authorize The Township of (the “Township") to conduct a criminal background investigation of the undersigned and authorize it to receive reports from law enforcement agencies and/or Clerks of Courts, including without limitation, a criminal history check from the New Jersey State Police, Police Information Management Systems and/or the FBI (collectively, "Law Enforcement Agencies"). I further authorize the Township to disclose any such criminal background information to ____________________ for whom I am providing or have offered to provide services relative to the Township's Janitorial Services Agreement with ________________ (`Cleaning Services") and to use said information to deny the undersigned permission to perform said Cleaning Services, pursuant to said Agreement. I agree to waive and relinquish all claims I may have against the Township and its officials, officers, agents, volunteers, and employees, as a result of participating in the criminal background check. I do hereby fully release and discharge the Township, its officials, officers, agents, volunteers, and employees from any and all claims from damages which I may have or which may accrue to me on account of the results of any aspect of the criminal background check and/or from relying on, utilizing and/or releasing any reports and/or other information provided by any Law Enforcement Agencies. I have read and fully understand this Waiver and Release of All Claims. Dated: ____________________________ Signature ____________________________ Printed Name ____________________________

Date of Birth Signed and Sworn to before me this day of , 20 _________________________ Notary Public