181-26 Exhibit A- Final Specifications_compressed.pdf

STATEMENT OF BIDDER'S RESPONSIBILITY (This Statement must accompany the Bid) 1. Name under which Bidder conducts business: _______________________ _____________________________________________________________ 2. Business address: ______________________________________________ _____________________________________________________________ 3. Form of Bidder's business: Individual Corporation Partnership If Bidder is a joint venture, all questions must be answered by each venturer. If a corporation, state Date of incorporation___________________________________________ State of incorporation___________________________________________ Address of principal office in New Jersey ___________________________ _____________________________________________________________ If a partnership, state Date of organization____________________________________________ Is partnership general or limited? ________________________________ Names and addresses of general partners: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ 4. State the number of years during which the Bidder has engaged in business under the name set forth above: _____________________________________________________________ P-37

5. If within the last five (5) years the Bidder conducted business under another name, or if the Bidder was the successor to another business within the last five (5) years, state the former name and address and the period during which such business was operated: Prior name: _________________________________________________ Prior address: ________________________________________________ ________________________________________________ Period of operation: ___________________________________________ 6. Has the Bidder or any officer, director or partner thereof been adjudicated bankrupt in the past ten (10) years? __________ If so, give full details, including the name and address of such person and present position with the Bidder: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ 7. List each piece of equipment which is available to the Bidder and intended to be used by the Bidder in the performance of the Contract. State whether the equipment is owned by the Bidder or will be leased, and if to be leased, the name of the lessor. Equipment of Owned or Vehicle Body Type Leased Lessor ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ P-38

8. Has the Bidder or any predecessor thereof ever failed to complete any work under any contract or subcontract? ___________ If so, give full details: __________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ 9. Has the Bidder or any predecessor thereof every failed to execute a contract awarded to the Bidder or any predecessor? _______ If so, give full details:__________________________________________ ____________________________________________________________ 10. List all companies which have written performance bonds for the Bidder or any predecessor thereof within the last five (5) years. ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Date: ________________ _________________________________________ (Name of Bidder) By: ________________________________________ ________________________________________ (Printed name and title of person signing above) P-39

EQUIPMENT CERTIFICATION The undersigned Bidder hereby certifies as follows: The bidder owns, controls, or has proof of lease of all the necessary equipment required to accomplish the work described in the specifications. To the extent that said equipment is not currently owned or under lease by the bidder, attached hereto is documentation from that owner or leasing organization that states the equipment will be available as required by the bidder upon award of a contract.  Check here if documentation is attached. Name of Bidder: By: (Signature of Authorized Representative) Name: Title: Date: P-40

CERTIFICATE OF BIDDER SHOWING ABILITY TO PERFORM CONTRACT PURSUANT TO N.J.S.A. 40A: 11-20 The undersigned Bidder hereby certifies as follows: The undersigned bidder hereby certifies to the Township of West Orange that he owns, leases or controls all the necessary equipment required by the plans, specifications, and advertisements under which bids are asked for. To the extent that the undersigned is not the actual owner or lessee of any such equipment, I have completed and attached hereto the Equipment Source List showing the source from which the equipment will be obtained together with a certificate from the owner or person in control of the equipment granting to the undersigned the control of the equipment required during such time as may be necessary for the completion of that portion of the contract for which the equipment is required and necessary. Signed Date P-41

STATUS OF PRESENT CONTRACTS Give full information about all of your contracts; whether private or government contracts; whether prime or sub-contracts; whether in progress or awarded but not yet begun; or where you are low bidder pending formal award of contract. OWNER PHONE # LOCATION DESCRIPTION ADJUSTED DATE OF CONTRACT COMPLETION AMOUNT ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ P-42

LOWEST BIDDER PREVAILING WAGE CERTIFICATION In the matter of an award of a TOWNSHIP OF WEST ORANGE contract for public work Certification of Lowest Bidder ______________________________________, of full age and under oath, duly provides the following sworn statement: (1). I am the owner and/or highest-ranking official or officer of a company or firm named ______________________________________, which holds a currently valid public works contractor registration pursuant to the New Jersey Public Works Contractor Registration Act, N.J.S.A. 34:11-56.48 et seq., certificate number ____________________. (2). I submitted a bid for a contract award in the above identified project and the public body has informed me that I am the lowest bidder by 10 percent or more as compared to the next lowest bid submitted. (3). The amount of my bid does include paying the prevailing wage rate to all workers who perform work on the project at rates of pay, including both base wage and fringe benefits, set forth in applicable Wage Determinations, (1) for the appropriate locality, (2) for the appropriate work classification (e.g., carpenter, electrician, mason, plumber), and (3) for the appropriate job title (e.g., Apprentice, Journeyman, Foreman), published by the New Jersey Department of Labor and Workforce Development (NJDOL) pursuant to the New Jersey Prevailing Wage Act (NJPWA), N.J.S.A. 34:11-56.25 et seq., and corresponding NJDOL rules, N.J.A.C. 12:60. I certify under penalty of perjury that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are false, I am subject to punishment. See N.J.S.A. 2C:28-1 et seq., specifically, N.J.S.A. 2C:28-3, within the New Jersey Code of Criminal Justice. Dated:_________________ Signature:_________________ Title: ____________________________ P-43

HOLD HARMLESS AGREEMENT BETWEEN THE TOWNSHIP OF WEST ORANGE AND Company Name Address (Not Post Office Box) Telephone Number Organization Type (Individual, Partnership, Non-Profit Corporation, Corporation, Public Entity) The bidder awarded the contract under the bid specifications shall indemnify and hold harmless the Township of West Orange, its officers, employees, agents and servants from and against any and all claims, demands, suits, actions, recoveries, judgments, costs and expenses including attorney's fees incurred or suffered on account of property damage or loss and/or personal injury, including loss of life, of any person, agency, corporation or governmental entity which shall arise out of the course of or in consequence to any acts or omissions of the bidder, its employees, agents, servants or subcontractors in the performance of the work to be reimbursed pursuant to these specifications or the failure of the bidder, its employees, agents, servants or subcontractors to comply with any term or condition of these specifications. The bidder further agrees that this indemnification by the bidder shall continue after completion of the contract for all claims, demands, suits, actions, recoveries, judgments, costs and expenses, including attorney's fees resulting from acts or omissions of the bidder, its employees, agents, servants or subcontractors which occur prior to the completion of the contract. Signed this _______ day of _______ 20___ as The binding act in deed of __________________ Business Name Authorized Signature Type or Print Name Witness P-44

SUBCONTRACTOR LIST The Contractor shall list below all Subcontractors that will be working on this Project. Business Registration, New Jersey Public Works Contractor Certification and proof of insurance must be submitted prior to award of Contract. A Valid Business Registration issued by the State of New Jersey is to be provided prior to the Award of Contract. The Business Registration Certificate must be obtained by the Subcontractor prior to the receipt of Bids, however, a Business Registration Certificate is not required in the submission of the Proposal forms for this Contract. Name of Subcontractor Address/Telephone # Work to be performed ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ DATE: P-45

DISCLOSURE OF POLITICAL CONTRIBUTIONS C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Contractor Instructions Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a “fair and open” process (defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of N.J.S.A. 19:44A-20.26. This law provides that 10 days prior to the award of such a contract, the contractor shall disclose contributions to: • any continuing political committee (a.k.a., political action committee) • any candidate committee of a candidate for, or holder of, an elective office: o of the public entity awarding the contract o of that county in which that public entity is located o of another public entity within that county o or of a legislative district in which that public entity is located or, when the public entity is a county, of any legislative district which includes all or part of the county The disclosure must list reportable contributions to any of the committees that exceed $200 per election cycle that were made during the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8 and 19:44A-16 for more details on reportable contributions. N.J.S.A. 19:44A-20.26 itemizes the parties from whom contributions must be disclosed when a business entity is not a natural person. This includes the following: • individuals with an “interest” ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit • all principals, partners, officers, or directors of the business entity or their spouses • any subsidiaries directly or indirectly controlled by the business entity • IRS Code Section 527 New Jersey based organizations, directly or indirectly controlled by the business entity and filing as continuing political committees, (PACs). When the business entity is a natural person, “a contribution by that person’s spouse or child, residing therewith, shall be deemed to be a contribution by the business entity.” [N.J.S.A. 19:44A-20.26(b)] The contributor must be