180-26 - Exhibit A. CDBG 2025 SPECS_compressed.pdf

List of Agencies with Elected Officials Required for Political Contribution Disclosure N.J.S.A. 19:44A-20.26 County Name: Essex State: Governor Legislative District #s: 26, 27, 28, 29, 34, & 40 State Senator and two members of the General Assembly per district. County: County Commissioners County Clerk Sheriff County Executive Surrogate Registrar of Deeds Municipalities (Mayor and members of governing body, regardless of title): Belleville Township Irvington Township Orange City Bloomfield Township Livingston Township Roseland Borough Caldwell Borough Maplewood Township South Orange Village Cedar Grove Township Millburn Township Verona Township East Orange City Montclair Township West Caldwell Township Essex Fells Township Newark City West Orange Township Fairfield Township North Caldwell Borough Glen Ridge Borough Nutley Township Boards of Education (Members of the Board): Belleville Town Bloomfield Township Caldwell-West Caldwell Cedar Grove Township Essex Fells Borough Fairfield Township Glen Ridge Borough Irvington Township Livingston Township Millburn Township Newark City North Caldwell Borough Nutley Town Roseland Borough South Orange-Maplewood Verona Borough West Essex Regional West Orange Town Fire Districts (Board of Fire Commissioners): NONE P-43

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN STANDARD BID DOCUMENT REFERENCE Name of Form DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN N.J.S.A. 52:32-55 et seq. Statutory | NALS.A. 40A:11-2.1 Reference N.J.S.A. 18A;:18A-49.4 Y/N Mandatory Optional N/A Goods and x Applicability ES x Services ESCL Y Construction x Instructions Reference Description P.L. 2012, c.25 prohibits the awarding of State and local public contracts for goods and services with persons or entities engaging in certain investment activities in energy or finance sectors of Iran. Prior to contract award, vendors and contractors must certify that neither they nor any parent entity, subsidiary, or affiliate is listed on the New Jersey Department of the Treasury’s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c, 25 ("Chapter 25 List"). The Certification form requires the insertion of contracting unit identification information which should be filled in (in italics on the form) prior to its use. P-44

Disclosure of Investment Activities in Iran Person or Entity Part 1: Certification COMPLETE PART | BY CHECKING EITHER BOX. Pursuant to Public Law 2012, c. 25, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter into or renew a contract, must complete the certification below to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or affiliate is identified on the State Department of Treasury's Chapter 25 list as a person or entity engaging in investment activities in Iran. The list is found on Treasury’s website at www.state.nj.us/treasury/purchase/pdf/Chapter25SList.pdf. The Chapter 25 list must be reviewed prior to completing the below certification. If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may provided by law, rule or contract, including but not limited to imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party. I certify, pursuant to Public Law 2012, c. 25, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate thereof is listed on the N.J. Department of the Treasury's list of entities determined to be engaged in prohibited activities in Iran pursuant to PL. 2012, c. 25 ("Chapter 25 List"). I further certify that I am the person listed above, or I am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. I will skip oO Part 2 and sign and complete the Certification below. OR Zam unable to certify as above because the person or entity and/or a parent entity, subsidiary, or affiliate thereof is listed on the N.J. Department of the Treasury's Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below sign and complete the Certification below. P-45

Part 2: Additional Information PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the person or entity, or a parent entity, subsidiary, or affiliate thereof engaging in investment activates in Iran below and, if more space is needed, on additional sheets provided by you. Part 3: Certification of True and Complete Information I, being duly sworn upon my oath, hereby represent and state that the Joregoing information and any attachments there to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person or entity. 1 acknowledge that the TOWNSHIP OF WEST ORANGE is relying on the information contained herein and thereby acknowledge that | am under a continuing obligation from the date of this certification through the completion of any contracts with the TOWNSHIP OF WEST ORANGE to notify the TOWNSHIP in writing of any changes to the answers of information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, Irecognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the TOWNSHIP OF WEST ORANGE and that the TOWNSHIP at its option may declare any contract(s) resulting from this certification void and unenforceable. Full Name . (Print) tds Signature Date P-46

CERTIFICATION OF NON-INVOLVEMENT IN PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS CERTIFICATION OF NON-INVOLVEMENT IN PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS Pursuant to N.J.S.A. 52:32-60 1, et seq. and NJ.S.A 40A:11-2.2 (L. 2022, c. 3) any person or entity (hereinafter “Vendor’) that seeks to enter into or renew a contract with a local contracting unit subject to the Local Public Contracts Law for the provision of goods or services, or the purchase of bonds or ather obligations, must complete the certification below indicating whether or not the Vendor is identified an the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, available here: htios://sanctionssearch ofac.treas.govi. If the Department of the Treasury finds that a Vendor has made a certification in violation of the law, it shall take any action as may be appropriate and provided by law. rule or contract. including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party |, the undersigned, certify that | have read the definition of “Vendor” below, and have reviewed the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, and having done so certify: (Check the Appropriate Box) ‘a, _ That the Vendor is not identified on the OFAC Specially Designated Nationals and Blocked Persons list on © * account of actviy elated to Russie andr Balas. OR p, That | am unable because the Vendor is identified on the OFAC Specially O ® besianated Nations ctivity related to Russia and/or Belarus. OR That | am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially O c, Designated Nationals and Blocked Persons list. However, the Vendor is engaged in activity related to Russia and/or Belarus consistent with federal law, regulation, license or exemption. A detailed description of how the Vendor's activity related to Russia and/or Belarus is consistent with federal law is set forth below. (Altach Additional Sheets If Necessary.) Signature of Vendor's Authorized Representative Date Print Name and Title of Vendor's Authorized Representative Vendor's FEIN Vendor's Name Vendor's Phone Number Vendors Address (Street Address) Vendor's Fax Number Vendor's Address (City/State/Zip Code) Vendor's

and Title of Vendor's Authorized Representative Vendor's FEIN Vendor's Name Vendor's Phone Number Vendors Address (Street Address) Vendor's Fax Number Vendor's Address (City/State/Zip Code) Vendor's Email Address ‘Vendor means: (1) A natural person, corporation, company, limited partnership, limited liability partnership, limited liability company, business association, sole proprietorship, joint venture, partnership, society, trust, or any other nongovernmental entity, organization, or ‘group; (2) Any governmental entity o” instrumentality of a govemment, including a mutilateral development institution, as defined in Section 1701(¢)(3) of the International Financial Institutions Act, 22 U.S.C. 262r(cX3); or (3) Any parent, successor, subunit, direct or indirect ‘subsidiary, or any entity under common ownership or control with, any entity described in paragraph (1) or (2). NIRev 1.222024 P-47

AMERICAN’S WITH DISABILITIES ACT OF 1990 Date: AMERICANS WITH DISABILITIES ACT OF 1990 Equal Opportunity for Individuals with Disability The contractor and the Township of West Orange, (hereafter "TOWNSHIP") do hereby agree that the provisions of Title 11 of the Americans With Disabilities Act of 1990 (the "Act") (42 U.S.C. S121 01 et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs, activities provided or made available by public entities, and the rules and regulations promulgated pursuant there unto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the TOWNSHIP pursuant to this contract, the contractor agrees that the performance shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall defend the TOWNSHIP in any action or administrative proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the TOWNSHIP, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages, of whatever kind of nature arising out of or claimed to arise out of the alleged violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the TOWNSHIP's grievance procedure, the contractor agrees to abide by any decision of the TOWNSHIP which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the TOWNSHIP, or if the TOWNSHIP incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense. The TOWNSHIP shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim, if any action or administrative proceeding is brought against the TOWNSHIP or any of its agents, servants, and employees, the

f to the contractor along with full and complete particulars of the claim, if any action or administrative proceeding is brought against the TOWNSHIP or any of its agents, servants, and employees, the TOWNSHIP shall expeditiously forward or have forwarded to the contractor every demand, complaint, notice, summons, pleading, or other process received by the TOWNSHIP or its representatives. It is expressly agreed and understood that any approval by the TOWNSHIP of the services provided by the contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the TOWNSHIP pursuant to this paragraph. It is further agreed and understood that the TOWNSHIP assumes no obligation to indemnify or save harmless the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the contractor's obligations assumed in this Agreement, nor shall they be construed to relieve the contractor from any liability, nor preclude the TOWNSHIP from taking any other actions available to it under any other provisions of the Agreement or otherwise at law. | acknowledge: Signature of Vendor P-48

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 Physical Address of Individual or Organization Unique Entity ID (if applicable) CAGE/NCAGE Code (if applicable) Check the box that represents the type of business organization: Oole Proprietorship (skip Parts Ill and lV) CINon-Profit Corporation (skip Parts III and IV) Ofor-Profit Corporation (any type) OLimited Liability Company (LLC) OPartnership OLimited Partnership Limited Liability Partnership (LLP) Other (be specific): PART II — CERTIFICATION OF NON-DEBARMENT: Individual or Organization | hereby certify that the individual or organization listed above in Part I 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. Full Name Title: (Print): Signature: Date: P-49

PART Ill — CERTIFICATION OF NON-DEBARMENT: Individual or Entity Owning Greater than 50 Percent of Organization Section A (Check the Box that applies) oO 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 Physical Address OR oO 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 (Ski ip 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