180-26 - Exhibit B. AJ Contractors_compressed.pdf

Municipality of Princeton 400 Witherspoon Street Princeton, NJ 08540 eton, NJ 08540 ~lan Engineer: Municipatity of Princeton Engineering — 40¢ Baker 609-921-7077 Class of work: Curbs, Sidew Excavation, Aprons, Storm Sewer, Milling and Paving Project: Hearthstone Improvements Was work completed on time? ~ Yes Work was completed — 03/2021 Contract amount: $767,288.34 Township of Springfield 100 Mountain Avenue Springfield, NJ,07081 Gibraltar Dr Suite 24, ? Keller & Kirckoatrick (GP! Class of work: Excavation, curbs, sidewalis, aprons, storm sewer, Bicycle safe grates, ADA, Milling and aving Project: Improvements to Benjamin Drive and New Brook Lane Contract # sp-2020-04 Was work completed on time? —Yes Work was completed ~ 01/2021 Contract Amount: $365,868.70

FEDERAL NON-DEBARMENT CERTIFICATION CERTIFICATION OF NON-DEBARMENT FOR FEDERAL GOVERNMENT CONTRACTS N.J.S.A. 52:32-44.1 (P.L. 2019, c.406) This certification shall be completed, certified to, and submitted to the contracting unit prior to contract award, except for emergency contracts where submission is required prior to payment. PART I: VENDOR INFORMATION Individual or Organization Name larwa Oy he AZ Physical Address of Individual . - A ‘ omniaion | OC federal RA. mange) Unique Entity ID (if ° ¥ | applicable) CAGE/NCAGE Code . . ) f Ca waptens | HY F229 / CDR AD Check the box that represents the tyge of business organization: Dole Proprietorship (skip Parts III and 1V) CINon-Profit Corporation (skip Parts Il and IV) OFor-Profit Corporation (any type) OLimited Liability Company (LLC) ElPartnership OLimited Partnership Limited Liability Partnership (LLP) Oother (be specific): PART Il — CERTIFICATION OF NON-DEBARMENT: Individual or Organization | hereby certify that the individual or organization listed above in Part | is not debarred by the federal government from contracting with a federal agency. | further acknowledge: that | am authorized to execute this certification on behalf of the above-named organization; that the Township of West Orange is relying on the information contained herein and that | am under a continuing obligation from the date of this certification through the date of contract award by the Township of West Orange to notify the Township of West Orange in writing of any changes to the information contained herein; that | am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if | do so, | am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the Township of West Orange permitting the Township of West Orange to declare any contract(s) resulting from this certification void and unenforceable. Sores ret” | TOG PD Mage | Signature: ad fp Dates CEPAABS P-49

Percent of Organization Section A (Check the Box that applies) PART Ill — CERTIFICATION OF NON-DEBARMENT: Individual or Entity Owning Greater than 50 ra Below is the name and address of the stockholder in the corporation who owns more than 50 percent of its voting stock, or of the partner in the partnership who owns more than 50 percent interest therein, or of the member of the limited liability company owning more than 50 percent interest therein, as the case may be. Name of Individual or Organization AIST (anita. Physical Address lot fr3clovael BP, Nuame , ul No one stockholder in the corporation owns more than 50 percent of its voting stock, or no partner in the partnership owns more than 50 percent interest therein, or no member in the limited liability company owns more than 50 percent interest therein, as the case may be. Section B (Skip if no Business entity is listed in Section A above) Oo Below is the name and address of the stockholder in the corporation who owns more than 50 percent of the voting stock of the organization’s parent entity, or of the partner in the partnership who owns more than 50 percent interest in the organization’s parent entity, or of the member of the limited liability company owning more than 50 percent interest in organization’s parent entity, as the case may be. Stockholder/Partner/Member Owning Greater Than 50 Percent of Parent Entity Physical Address OR No one stockholder in the parent entity corporation owns more than 50 percent of its voting stock, no partner in the parent entity partnership owns more than 50 percent interest therein, or no member in the parent entity limited liability company owns more than 50 percent interest therein, as the case may be, P-50

Section C — Part Ill Certification | hereby certify that no individual or organization that is debarred by the federal government from contracting with a federal agency owns greater than 50 percent of the Organization listed above in Part | or, if applicable, owns greater than 50 percent of a parent entity of . | further acknowledge: that | am authorized to execute this certification on behalf of the abovenamed organization; that the Township of West Orange is relying on the information contained herein and that | am under a continuing obligation from the date of this certification through the date of contract award by the Township to notify the Township in writing of any changes to the information contained herein; that | am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if | do so, lam subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the Township permitting the Township to declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print): Toe (p ANA Title: WYER. | 4 Part IV— CERTIFICATION OF NON-DEBARMENT: Contractor — Controlled Entities Section A Below is the name and address of the corporation(s) in which the Organization listed in Part ! owns more than 50 percent of voting stock, or of ps the partnership(s) in which the Organization listed in Part | owns more than 50 percent interest therein, or of the limited liability company or companies in which the Organization listed above in Part | owns more than 50 percent interest therein, as the case may be. Name of Business Entity Physical Address ASF Lata.| loc feceyal bel Mnnrae, aT 1k Tt wane ta Af dom | “Pb a8 ad **Add additional sheets if necessary** OR The Organization listed above in Part | does not own greater than 50 percent Oo of the voting stock in any corporation and does not own greater than 50 percent interest in any partnership or any limited liability company. P-51

Section B (skip if no business entities are listed in Section A of Part Iv) Below are the names and addresses of any entities in which an entity listed in oO Part Ill A owns greater than 50 percent of the voting stock (corporation) or owns greater than 50 percent interest (partnership or limited liability company). Name of Business Entity Controlled by Entity Physical Address Listed in Section A of Part IV **Add additional Sheets if necessary** OR No entity listed in Part Ill A owns greater than 50 percent of the voting stock Oo in any corporation or owns greater than 5O percent interest in any partnership or limited liability company. Section C — Part IV Certification ' hereby certify that the Organization listed above in Part | does not own greater than 50 percent of any entity that that is debarred by the federal government from contracting with a federal agency and, if applicable, does not own greater than 50 percent of any entity that in turns owns greater than 50 percent of any entity debarred by the federal government from contracting with a federal agency. | further acknowledge: that | am authorized to execute this certification on behalf of the above-named organization; that the Township of West Orange is relying on the information contained herein and that | am under a continuing obligation from the date of this certification through the date of contract award by Township to notify the Township in writing of any changes to the information contained herein; that | am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if | do so, lam subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the Township permitting the Township to declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print): WAN D SPA. Title: WZ Ca ee viii owe |” NEB DZ KU P-52

DUNS / FEDERAL ID NUMBER The undersigned Bidder hereby affirms the following to be their DUNS / Federal ID number as issued by the United States Federal Government. DUNS No. GUY KBAR 2 Federal ID No. _EPRAPO se bhp. bh fe f_oahatporr e TN. (Authorifett SieHathre)L Tae. Dp - Mase [yes (Namdand Title) 7 aa P-53

INITIAL PROJECT WORKFORCE REPORT - CONSTRUCTION FORMAL 20 Ranet i693 READ INSTI 1. FID HUMBER STATE OF NEW JERSEY DIVISION OF CONTRACT COMPLIANCE EQUAL EMPLOYMENT OPPORIUNITY IN PUBLIC CONTRACTS 3. NAME AND ADDRESS OF PRIME CONTRACTOR INITIAL PROJECT WORKFORCE REPORT CONSTRUCTION TONS ON THE BACK CAREFULLY BI PLEASE TYPE OR PRINT IN BLACK OR BLUE INK. 2 CONTRACTOR ID NUNEER Official Use Only Assignment $$ $s Code Ra ame) CONTRACT NUMBER = ATE OF AWARD DOLLAR AMOUNT OF AWARD (Street Address) © NAME AND ADDRESS OF PROJECT 5 PROTECT SUMBER SUE (city) Gat) iy Code) county 2 18 THIS PROJECT COVERED BY A PROJE( 4.18 THIS COMPANY MINORITY OWNED { ] OR WOMAN OWNED { } % TRADE OR CRAFT LABOR AGREEMENT (PLAJ? OYES’ ONC —— — I PROJECTED MINORITY EMPLOVEES ey — 1, ASBESTOS WORKER PROJECTED PROJECTED PHASE -IN COMPLETION DATE DATE en 2. BRICKLAYER OR MASON 3. CARPENTER 4, ELECTRICIAN §. GLAZIER 6. HVAC MECHANIC 7, IRONWORKER §. OPERATING ENGINEER 9. PAINTER 10, PLUMBER 11. ROOFER 12. SHEET METAL WORKER 13, SPRINKLER FITTER 14. STEAMFITTER. 1§. SURVEYOR _} 16. TILER 17, TRUCK DRIVER 18. LABORER { } 19. OTHER | 20. OTHER 1 Thereby cerdfy that the foregoing stateme false, I ara subject to punishment. smade by me are true. Tate aware thatit any of tie foregoing watemente are wilfalle (Signature) Tw (Please Print Your Nasa) Tn ‘Area Code) ‘(Telephone Number) Ex) P-54 Dare}

we INSTRUCTIONS FOR COMPLETING THE INITIAL PROJECT WORKFORCE REPORT - CONSTRUCTION (44201) DO NOT COMPLETE THIS FORM FOR GOODS AND/OR SERVICE CONTRACTS Enter the Federal Idencification Number assigned to the contractor by the Internal Revenue Service, or if a Federal Employer Identification Number has been applied for but not vet issued, or if your business is such that you have not or will not receive a Federal Identificati umber, enter the social security number assigned to the single owner or one partner, in the case of a partnership. Note: The Division of CC/EEO will assign a contractor ID number to your company. This number will be vour permanently assigned contractor ID number that must be on all correspondence and reports submitted to this office Enter the prime contractor's name, address and zip code number. Check box if Company is Minority Owned or Woman Owned Enter the complete name and address of the Public Agency awarding the contract. Include the contract number, date of award and dollar amount of the contract. 6. Enter the name and address of the project, including the county in which the project is located. Note: A project contract ID number will be assigned to your firm upon receipt of the completed Initial Project Workforce Report (AA201) for this contract. This number must be indicated on all correspondence and reports submitted to this office relating to this contract. , Cheek: “Yes” or “No” to indicate whether a Project Labor Agreement (PLA) was established withthe labor organization(s) for this project. Under the Projected Total Number of Employees in each trade or craft and at each level of classification, enter the total composite workforce of the prime contractor and all subcontractors projected to work on the project. Under Projected Employees enter total iinority and female employees of the prime contractor and all subcontractors projected to work on the project. Minority employees include Black, Hispanic, American Indian and Asian, (J=Journerworker, AP=Apprentice). Include projected phase-in and completion dates. 10. Print or type the name of the company official or authorized Equal Employment Opportunity EEO) official include signature and ticle, phone number and date the report is submitted, This report must be submitted to the Public Agency that awards the contract and the Division of Contract Comphauce and

cial include signature and ticle, phone number and date the report is submitted, This report must be submitted to the Public Agency that awards the contract and the Division of Contract Comphauce and Equal Employment Opportunity in Public Contracts no later than three (3) days after the contractor signs the contract. THE CONTRACTOR Is TO RETAIN THE FOURTH AND FINAL COPY MARKED "CONTRACTOR", SUBMIT THE THIRD COPY MARKED “PUBLIC AGENCY” TO THE PUBLIC AGENCY AWARDING THE CONTRACT AND FORWARD THE REMAINING TWO (2) COPIES TO: NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF CONTRACT COMPLIANCE & EQUAL EMPLOYMENT OPPORTUNITY IN PUBLIC CONTRACTS

FORM W-9 Request for Taxpayer Identification Number and Certification on W-9 Give Form to the (Rev. Oolobar 2012) requester. Dont ert lhe Toasiry z ioral Revenue Sancn > Go to wwnwairs.gov/FormWS for instructions and the latest information. "T Néme (a5 shown on your income tax ratury, Name is required on this ine; do not eave ths line Blane. 2 Business name/oisreqardes encty name, l Otarent Wom above ‘3 Check appropriate box tor federal tax classif cain of the person whose name Is envered on tne 1 Check only one of the 4 to ing seven boxes. beside Exemolions (codes ccertan entites, not individuals: 268 Instuctions on page 3) Cscepoavon 0) Partrrshio CL) tusvestate 7 individuavsoie prooriotor cr ~C) CCorperation single-member LLC D1 Unites satitity compary. Enter the tax classiticalion (C=C corporation, S=8 corporation, P=Partnwshio) > ‘Nate: Check the anpropriate box in tne line above for te tax olassficaton of the singie-member owner. D> not check LLG the LLG i classified as a singla member LLG thal is dsragared fcr te owner uniess Ihe ower of the LLC a ‘nother LLC that Is not deregarced from tns owner for U.S. feceral tax purposes. Othenvdso, a singla-member LLG that Iselaregarced from the owner should check the aopropriate box lr the ax cassitation ot ts ne, Oiher (see instructions) > 'S Adatess (number, street, and apt. or sute no) See insiructions. Exempl payea code if any) Exemption rom FATCA reporting code (i any) Print or type. ‘See Specific Instructions on page 3. Hectnoncoaats manana ito.) equester's name and address foptionaly © Gity, sala, and ZIP cod 7 Ustaccount ruribarta) here (optional) Taxpayer Identification Number (TIN) _ Enter your TIN in the appropriate box. The TIN provided must match the name civen on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part |, later. For other entities, it is your employer identification number (EIN). It you do not have a number, see How to get @ TWN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requesier for guidelines on whose number to enter. Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my