Township Council Meeting — Packet

taken without regard to age, race, creed, color, natlonal origin, ancestry, marital status, affectional or sexual orientation, gender Identity or expression, dlsabllity, nationality or sex, consistent with the statutes end court decisions of the State of New Jersey, and applicable Fecleral law and applicable Federal court decisions. The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federat Affirmative Action Plan Approval Cartificate of Employee Information Report Employee Information Report Form AA302 (electronically provided by the Division and distributed to the public agency through the Division’s website at www.state,n].us/treasury/contract_compliance) The contractor and Its subcontractors shall furnish such reports or other documents to the Division of Public Contracts Equal Employment Opportunity Compliance as may be requested by the office from time to time In order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of Public Contracts Equal Employment Opportunity Compliance for conducting @ compliance investigation pursuant to. Subchapter 10 of the Administrative Code 17:27, Page [19

STATEMENT OF OWNERSHIP DISCLOSURE NLS.A, 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43) ‘This statement shall be completed, certified to, and included with all bid and proposal submissions. Failare to'submit the required information is cause for automatic rejection of the bid or proposal, Name of Organization: Organization Address: Part I Check the box that represents the type of business organization: Dsote Proprietorship {skip Parts tl and III, execute certification in Part IV) Oo Non-Profit Corporation (skip Parts Il and Ill, execute certification in Part IV) oO For-Profit Corporation {any type) DDhimites Liability Company {LLC) oO Partnership ol Limited Partnership GAhinites Liability Partnership (LLP) | Other (be specific): Part oO The list below contains the names and addresses of all stockholders in the corporation who own 16 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own @ 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION) OR Oo No one stockholder in the corporation owns 10 percent or more of its stack, of any class, of no individual partner in the. partnershig owns a 10 percent or greater interest therein, or no member in the limited liability company owns 2 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) (Please attach additional sheets if more space is needed): Name of Individual or Business Entity Address Page | 20 Le ine |

Part IM DISCLOSURE OF 40% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II Ia hidder has.a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annuai 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 beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filings) 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) filing Page #’s Please list the names and addresses of each stockholder, partner of member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part Il other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to NJS.A, 52:25-24.2 has been listed. Attach additional sheets if more space |s needed, Steckholder/Partner/Member and Address Corresponding Entity Listed in Part UI Part IV certification 1, being duly sworn upon my oath, hereby represent that the foregoing information and any ettachments thereto to the best of my knowledge are true and complete. | acknowledge: that | am authorized to execute this certification on behalf of the bidder/proposer; that the Township of West Orange is relying on the information. Page [2 oo —

‘ I i i I | ' i I | contalned heretn and thet }am under a continulng odligation 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 hereln; that | am aware that tt 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, permitting the Township of West Orange to declare any contract(s) resulting from this certification vold and unenforceable. Full Name (Print): . Title: Signature: Date: i i ‘ ! 1 | if Page [22

REQUIRED EVIDENCE APFIRMATIVE ACTION REGULATIONS NJ. S.A. 10:5-31, et seq. (NLA. C. 17:27) If awarded a contract, the Bidder will be sequited to comply with the requitements of NLS.\, 10:531, et seq., and NJAS,.. 17.27. Within five (6) days after tecelpt of the notification of intent to awatd the conteact, the Bidder shall present one of the following: 1. Approptiate evidence that the Conitactot 1s opetating under an existing federally approved of sanctioned affirmative action program; ot 2. A Cestificate of Employee Information Report Approval iseued in accotdance with NLAC, 17:27-4; ox 3 —Aeninltint— Hap loyer—infotmntion—Report—vemsinting ffm —previciedby—tine Affirmative Action Office and coinpleted by Contractor in accordance with NLA.C, 17:27-4, ‘The Bidder must submit no later than theee (3) days after the signing of the Contract an Initiel Project Manning Table consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with NLA.G, 17:27-7. Biddess are teferted to the Bidder's Information Section of the Bid Packet for a further desctiption of the above requitements, NO BIDDER MAY BE ISSUED A CONTRACT UNLESS THEY COMPLY WITH THE AFFIRMATIVE ACTION REGULATIONS OF NJS.A, 10:5-31, et seq. ‘The following questions must be answered by all Bidders: . L Do you have a federally-approved or sanctioned Affirmative Action Program? Yes______. (If yes, submit 4 copy of such approval) No 2 Do you have a State Cettificate of Employee Information Report approval? Yes {If yes, submit 2 copy of such appsoval.) Ne ‘The undersigned Bidder ceitifies that he is aware of the commitment to comply with the requirements of NJS.A, 10:5-31, et seq., and agrees to furnish the tequited documentation pursuant 10 the law. COMPANY: NAME: SIGNATURE: PETE: NOTE: A bid must be rejected as non-ccsponsive if a Bidder fails to comply with requirements of NJS.A. 10:5-31, et seq. within the time frame stipulated. Page | 23

TOWNSHIP OF WEST ORANGE ACKNOWLEDGMENT OF RECEIPT OF ADDENDA The undersigned Bidder hereby acknowledges receipt of the following addenda: Please assign the number, date and initial. Addendum Number Dated Acknowledge Receipt 7 . (nittal) [1 No addenda was/were received, Acknowledged for: (Company Name} By: (Signature of Authorized Representative) Name: (Print) Title: Date; Page P24

i i { t Ic: ion Disclosure Statement Pursuant to Ch lon 68. 1 Revise General Ordinances of the Township of West Orango Pursuant to Section 2-68.1 of the Revised General Ordinances of the Township of West Orange, please set farth below ail political contributions in cash or in kind of two hundred ($209.00), dollars or more made within five (6) years of the date of acceptance of a proposal for a negotiated contract with the Township of .. West Orange, or within five (5) years of the notice of award for a bid contract with the Township of West Orange, elther directly or indirectly, by the individuals or any of the principals of the business antily completing this form or hy the business entity itself, to any elected official of the Township of West Orange currently in office or any political organization affiflated with an elected official of the Township currently in office,’ Ifyou have NOT made any contributions within the scope of Section 2-58.1, as set forth above, please X the line to the right. — {hereby certify under penalty of perjury that the information provided herein is true and accurate to the best of my knowledga, Information and belief. ‘The current elected officials of the Township include the following: Mayor Susan McCartney, Councilman Bill Rutherford, Counciwoman Michelle Casalino, Councilwoman Tammy Williams, Councilwoman Asmeret Ghebremicae! and Councilwoman Susan Scarpa . Company Name Authorized Signature Printed Name Date rage [25 —. en ee

BIDDER’S CHECK LIST Business Registration Certification Statement of Ownership Affirmative Action Compliance Notice Prohibited Russla-Belarus Activities & Iran Investment Activities Non-Collusion Affidavit Proposal Form Acknowledgement of Addenda Political Contribution Form Bidders must provide documented proof of qualifications (Certffications). Three (3) references Please initial lines. Please provide one additional copy of entire bid package, which can be a USB/Flash Stick END OF BID Page | 26

142-25 May 20, 2025 RESOLUTION APPROVING THE TITLE VI PROGRAM FOR THE TOWNSHIP OF WEST ORANGE DEPARTMENT OF HEALTH & WELFARE, TRANSPORTATION DIVISION WHEREAS, the Township of West Orange, Department of Health & Welfare operates a Transportation Division for the benefit of qualifying West Orange residents; and WHEREAS, the Township of West Orange, through a grant received from the New Jersey Department of Transportation, is a sub-recipient of grant money from the Federal Transit Administration utilized for the operation of the Transportation Program; and WHEREAS, to receive grant money from the Federal Transit Administration as a recipient or sub-recipient, the Township of West Orange is required to implement a program to ensure compliance with Title VI of the Civil Rights Act of 1964; and WHEREAS, the Township of West Orange operates its Transportation Program and Services without regard to race, color, or national origin in accordance with Title VI of the Civil Rights Act of 1964; and WHEREAS, the Township of West Orange Department of Health & Welfare drafted a Title VI Program to ensure continued compliance with Title VI of the Civil Rights Act of 1964, which was subsequently reviewed by the New Jersey Department of Transportation and found to be fully compliant with federal requirements. NOW, BE IT HEREBY RESOLVED, by the Township Council of the Township of West Orange, in the County of Essex, State of New Jersey, that the attached Title VI Program is hereby approved and adopted. RESOLVED, by the Township Council of the Township of West Orange, in the County of Essex, State of New Jersey, that the Mayor or her designee is authorized to execute such

documents consistent with this Resolution and to take such other action on behalf of the Township of West Orange in furtherance of this Resolution. ________________________________ Karen J. Carnevale, R.M.C. Municipal Clerk Dated: May 20, 2025 Adopted: May 20, 2025 Joe Krakoviak Council President