Township Council Meeting — Packet

S must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer Identification number (TIN), adoption taxpayer Identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return, Examples of Information returns Include, but are not limited to, the following, * Form 1099-INT (interest earned or paid) * Form 1099-DIV (dividends, Including those from stoc<s or mutual funds) * Form 1099-MISC (various typas of income, prizes, awards, or gross proceeds) * Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) * Form 1099-8 (proceeds from real estate transactions) * Form 1099-K (merchant card and third party network transactions) * Form 1098 (home mortgage Interest), 1098-E (student loan interest), 1098-T (tuition) * Form 1099-C (canceled dabt) * Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person (inoluding a resident alien), to provide your correct TIN. Ifyou do not return Form W-9 to the requester with e TIN, you might be subject to backup withholding. See What Is backup withholding, later. Cal. No, 10231X Form W-9 (Rev. 10-2018)

Political Contribution Disclosure Statement Pursuant to Chapter 2, Section 68 of the Revised General Ordinances of the Township of West Orange Pursuant to Section 2-68.1 of the Revised General Ordinances of the Township of West Orange, please set forth below all political contributions in cash or in kind of two hundred ($200.00) dollars or more made within five (5) 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, either directly or indirectly, by the individuals or any of the principals of the business entity completing this form or by the business entity itself, to any elected official of the Township of West Orange currently in office or any political organization affiliated with an elected official of the Township currently in office. Amount of Recipient of Date of Contribution Contribution Contribution Making Contribution |__ Milennium strategies LLC 1,500.00 usan MeCariney far Mayor 40127120: Pariners: Edward Farmer/Susan Seavone Allcontrfoutions spt between parties NONE If you have NOT made any contributions within the scope of Section 2-68.1, as set forth above, please X the line to the right. =i | hereby certify under penalty of perjury that the information provided herein is true and accurate to the best of my knowledge, information and belief. The current elected officials of the Township include the following: Mayor Susan McCartney, Councilman Bill Rutherford, Councilwoman Michelle Casalino, Councilwoman Tammy Williams, Councilwoman Asmeret Ghebremicael and Councilwoman Susan Scarpa Millennium Strategies LLC Company Name = oo. Authorized Signature Edward Farmer, President and CEO Printed Name 07/06/2023 Date

Prohibited Russia-Belarus Activities & Iran Investment Activities ] I Person or Entity Millennium Strategies LLC Part 1: Certification COMPLETE PART | BY CHECKING ONE OF THE THREE BOXES BELOW Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter into or renew a contract, for goods or services must complete the certification below prior to contract award to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or| affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as a person or| entity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods or services can| be amended or extended, a person or entity must certify that neither the person or entity, nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list, Both lists are found lon Treasury’s website at the following web addresses: https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf lwww.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the below certification. A person or entity unable to make the certification must provide a detailed, accurate, and precise description lof the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or investment activities in Iran. The person or entity must cease engaging in any prohibited activities and provide an updated certification before the contract can be entered into. If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may be| 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. ICONTRACT AWARDS AND RENEWALS 7 certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of entities engaged in prohibited activities in Russia or Belarus pursuant to P.L, 2022, c. | 3 or in investment activities in

bsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of entities engaged in prohibited activities in Russia or Belarus pursuant to P.L, 2022, c. | 3 or in investment activities in Iran pursuant to P.L. 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. (Skip Part 2 and sign and complete the Certification below.)

CONTRACT AMENDMENTS AND EXTENSIONS / certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate is listed on the N.J. Department of the Treasury's lists of entities determined to be engaged in prohibited activities in Russia or Belarus oO ursuant to P.L. 2022, c. 3. I further certify that I am the person listed above, or 1am jan officer or representative of the entity listed above and am authorized to make this certification on its behalf. (Skip Part 2 and sign and complete the Certification below.) IF UNABLE TO CERTIFY 7 am unable to certify as above because the person or entity and/or a parent entity, subsidiary, or affiliate is listed on the Department's Russia-Belarus list and/or Chapter 125 Iran list. Iwill provide a detailed, accurate, and precise description of the activities O las directed in Part 2 below, and sign and complete the Certification below, Failure to provide such will prevent the award of the contract to the person or entity, and appropriate penalties, fines, and/or sanctions will be assessed as provided by law. Part 2: Additional Information PLEASE PROVIDE FURTHER INFORMATION RELATED TO PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS AND/OR INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate, and precise description of the activities of the person or entity, or of al parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or investment| activities in Iran in the space below and, if needed, on additional sheets provided by you.

Part 3: Certification of True and Complete Information , being duly sworn upon my oath, hereby represent and state that the foregoing 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 entily. acknowledge that the Township of West Orange is relying on the information contained herein and hereby acknowledge that I 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 of West Orange in writing of any changes to the answers of information contained herein. ! acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification. If Ido so, I recognize 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 of West Orange at its option may declare any contract(s) resulting from this certification void land unenforceable. Full Name Title (Print) ; Edward Farmer President and CEO Signature Ya ae Date 07/06/2023 17

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 (Initial) (Kh addenda was/were received. Millennium Strategies LLC (Company Name) Acknowledged for: (Signature of Authorized Representative) Name: Edward Farmer (Print) tite, President and CEO pate;__07/06/2023

AFFIDAVIT OF NON-COLLUSION The undersigned bidder of full age, being duly sworn according to law depose and hereby specifically certifies that: A. To the best of the bidder's knowledge and belief, the annexed bid proposal for this project has not been prepared in collusion with any other bidder of like item or services and the prices, discounts, terms and conditions thereof have not been directly or indirectly communicated by or on behalf of the bidder to any person other than the recipient of the bid and will not be communicated to any person prior to the official opening of the bid. B. The bidder fully understands that no premiums, rebates, or gratuities are permitted either with, prior to, or after signing of contract. Any violation will result in cancellation and removal from the bid list. C. The bidder further certifies that the undersigned has the necessary authority, to sign this stipulation stating that the bidder has not entered into any agreement, or otherwise taken any action in restraint of free competitive bidding in connection with this bid. All references to the bidder are understood to include the undersigned and all principals, partners and officers of the bidder. Date: 07/06/2023 wh —— (Gignature) Edward Farmer, President and CEO (Name and Title) Millennium Strategies LLC (Company) 60 Columbia Road, Building B, Suite 230 (Address) Morristown, Nd, 07960 (Corporate Seal) ee Subscribed and sworn to before me Semnnuscions r} oh ee My Commission Expires 06/03/2026 this_6th day of __July , 20.23 Notary Seal fuse Ch pe Jessica Carvajal ig Human Resources Generalist

INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM Certificate(s) of Insurance shall be filed with the Municipal Clerk's Office upon award of contract by the Mayor and Township Council, The minimum amount of insurance to be carried by the Professional Service Entity shall he as follows: PROFESSIONAL LIABILITY INSURANCE Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy period. Acknowledgement of Insurance Requirement: Millennium Strategies LLC wW pp 07/06/2023 (Signature) (Date) Edward Farmer, President and CEO (Printed Name and Title)

MILLSTR-O41 MLESZCZYNSKI —, ACCORD CERTIFICATE OF LIABILITY INSURANCE on eereoes THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{ies) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an ondorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER §QNTACT Dianne DeMott Levi 60 Pascale Ave, Suite 120 {H-No,cxp (973) 797-0841 1168 TER no: Fairfield, NJ 07004-3508 oles: DLevi@acrisure.com INSURER(S) AFFORDING COVERAGE NAIC # insurer A: Hartford Insurance Company of Midwest 37478 INSURED isurer Sentinel Insurance Company Ltd 11000 to Golunitis Rost Bite, B isuzer c: Twin City Fire Insurance Company 29459 Ste 230 insurero: RL Insurance Company 13056 Morristown, NJ 07960 INSURER E.:, INSURER F ! COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSI hal TYPE OF INSURANCE Neo wa POLICY NUMBER (GRIDDAY | daMoD YD LIMIT A |X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000) [| J cxams-tape [X] occur H3SBAILe856 2izei2023 | 2izerzoz4 | PAMGETOREMTES | | 500,000 |_| MED Exp (Any one person) | $s 10,000 poof PERSONAL & ADVINJURY |S 4,000,000) | GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE. 2,000,000 LX roucy| | 8% | Ytoc pnoouers -counerace |& 7,000,000 OIHeR: 8 A | auromopite LIABILITY GOMBINES SINGLE LIMIT 7,000,000) |__| ANY AUTO M3SBAIL6856 2/28/2023 | 2/28/2024 | soniy INJURY (Per