Township Council Meeting — Packet

NT OF OWNERS. DISCLOS NLLS.A. $2:25-24.2 (P.L. 1977, ¢.33, as amended by P.L. 2016, ¢.43) This statement shall be completed, certified to, and included with all bid and proposal submissions, Failure to submit the required information is cause for automatic rejection of the bid or propasal. Name of Organization: _ Shauger Property Services, Inc. Organization Address: 420 Dodd Street, East Orange, NJ 07017 Part I Check the box that represents the type of business organization: O Sole Proprietorship (skip Parts Ii and Ill, execute certification in Part IV) non-profit Corporation (skip Parts If and III, execute certification in Part TV) Blror-protit Corporation (any type) Diimitea Liability Company (LLC) Cl raitnersiip Da initea Partnership Chrimitea Liability Partnership (LLP) a Other (be specific): Part 0 Bs ‘The list below contains the names and addresses of all stockholders in the corporation who own 10 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 thé limited liability company who own a 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 stock, of. any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) lease attach additio ts if space is needed): Name of Individual or Business Entity Address Lisa Shauger (1 00%) 10 Meadow Lane, Roseland, NJ 07068 13

Part I] DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART 11 Ifa bidder 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 annual 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 filing(s) 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 i's Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part II other than for any publicly traded parent entities referenced above. The disclosure shal! be continued until _____names_and, addresses of ery non-corporate: stockholder, and i individual _partne: and momber excesding the 10. ta ait 7 Ie Ss | ifsmere space 8 needed, — . Stockholder/Partner/Member and Address Corresponding Entity Listed in Part I Part IV Certification I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. [ acknowledge: that I am authorized to execute this certification on behalf of the bidder/proposer; that the Township of West Orange is relying on the information contained herein and that I am under a contiauing obligation 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 herein; that 1 am aware that it is a criminal offense to make a false statement or mistepresentation in this certification, and if I do so, I am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the, permitting the

or mistepresentation in this certification, and if I do so, I 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 contraci(s) resulting from this certification void and unenforceable. Full Name (Print): Linda M. Spahle Title: | Acting Secretary . Signature: : Mule 4 spall Date: | 40/8/2025 : J fe / 32

BUSINESS REGISTRATION CERTIFICATION AND PUBLIC WORKS CONTRACTOR REGISTRATION CERTIFICATION Effective September 1, 2004, the State has expanded its Contractor Registration Program to local Government contracts, P.L. 2004, o57. All business organizations that do business with a focal government agency are required to be registered with the State. The business must provide proof of that registration to the local government agency before that local government agency can enter into a contract with the business. A copy of the Business Registration Certificate must also be on file before any purchase order/voucker or other contracting document can be issued. Contractors are responsible for notifying subcontractors. Further information and registration can be obtained online from the NJ Treasury, Division of Revenue or by calling (609) 292-1730, FOI IT RII Id I P.L, 1999 Chapter 238. The Public Works Contractor Registration Act specifies that no contractor or subcontractor shall bid on or engage in any contract (or part thereof) for public work which is subject to the provisions of the "New Jersey Prevailing Wage Act", P.L. 1963 C. 150 (c. 34:11-56.25 et seq.) for the construction, reconstruction, demolition, alteration, repair, or maintenance of a public building regularly open to and used by the general public or public institution, and includes any subcontractor or lower tier subcontractor of a contractor unless they ate registered with the Commissioner of Labor. 33

CERTIFICATION OF NON-INVOLVEMENT IN PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS Pursuant to N.Jw-S.A, 52:32-80,1, st seq. (1. 2022, ¢, 3) any person or entity (hereinafter “Vendor”) that seeks to enter Into of renew a contrect with a State agency for the provision of goods or services, or the purchase of bonds or other obligations, Must complete the certification below Indicating whether or not the Vendor Is identified on the Office of Foreign Assets Conval {OFAG) Specially Designatdd Nationals _ and = Blocked = Persons list, | available here: z ofa. . If the Department of the ‘Treasury finds that a Vendor has made a certification in violation of the law, it shaif 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 parly in default and seeking debarment or suspension of the party, 1, the undersigned, certify ihat | have read the definition of "Vendor" below, and have reviewed the Olfice of Foreign Assets Control (OFAC) Spesiaily Designated Nationals and Blocked Persons list. and having done so certify: (Check the Appropriate Box) B45 use the Vendor is identified on the OFAG Specially i pled to Russia andor Belarus. OR That | am unable to certify as to "A" above, because the Vendor is identified on the OFAC Spaciatty c. Be ignated Natonals and Blocke gons list. However, the Vendor is engaged in activity related to Russia oO “ ardéor Belarus consistent with federal law, regulation, fcense of exernption. A datailed description of how the Vendor's activily related to Russia and/or Belarus Is consistent with federal law is set forth below, (Altech Ackdittonat Sheats ¥ Necaxsary.) 10/8/2025 Hf ed Representative Date > Linda M. Spahlé, Acting Secretary 22-3564559 Print Name end Tille of Vandor's Authorizad Representative Vendor's FEN : rly. Services, Inc. 973.876.2100 Vendors’ io * ® Vendor's Phone Number’ 429 Dodd Street 973-676-8200 / 973-676-5641 Vandar's Address (Strast Address) Vendor's Fax Number East Orange, NJ 07017 Ispahle@shauger.com / mmulligan@shauger.com Vandar's Address (City/State/Zip Code) Vendors Email Address ‘ Vandor means: (1) A natural porsan, corporation, company, limited partnership, iIrited liability partnership, tevied Habilly company, dusiriess association, sole proprietorship, joint venture,

ress ‘ Vandor means: (1) A natural porsan, corporation, company, limited partnership, iIrited liability partnership, tevied Habilly company, dusiriess association, sole proprietorship, joint venture, partnership, soclely, trust, or any other nongovernmental snfity, organizetion, or group: (2) Ary govern} ely o instrumentally of 2 gavammen Including a rutleerat development inion, ax defined in Gaction 1704(a}(3) af the Intemational Financial institutions Act, 22 U.S.C. 262163), or (3) Any parent, successor, subunk, dlireot or indirect subsidiary, of any entity under common ownership or control with, any entity deseribed In paragraph (1) or (2). NG Ry, 122.2024 34

SITE INSPECTION AFFIDAVIT ], Linda M, Spahie _, on behalf of the bidder, Shauger Property Services, Jnc. do hereby declare that, I or my duly authorized representative, did satisfactorily inspect the project limits for the purpose of being fully informed as to the locations and conditions of the various Sidewalks, Paths, Crosswalk and Bus Shelters and Stops within the Township of West Orange for snow removal to be cleared under this contract. t L inspected the various sites on the_26th_dayof_September , 2025 and I hereby acknowledge that I have satisfied myself regarding the conditions of the various sites and the nature and extent of the work to be performed under this contract. g i By. 4 { a : fa, Agting secre t int Sriype ni of "y . Shauger Property Services, Inc. (Bidding Firm/Contractor) Subscribed and swort t i Sworn before me this_8th day of _ October, 2025 ¢ _ (Notary Public) My commission expires on PLoS, RO 2 | TEEGRAH K, LAMORTICELLA | “NOTARY PUBLIC STATE OF NEW JERSEY SA SSION EXPER SPT. 24, 21 35

Disclosure of Investment Activities in Tran N.J.S.A. 52:32-55 et seq. N.S.A. 40A:11-2.1 NULS.A. 18A:184-49,4 YIN Mandatory Optional NIA Goods and LPCL Y Services x PSCL. Y | Construction x P.L. 2012, ¢.25 prohibits the awarding of State and local public contracts for activities in energy or finance sectors of Iran. Prior to contract award, vendors and _| affiliate is listed on the New Jersey Department of the Treasury's list of éntities | determined to be engaged In prohibited activities in Iran pursuant to P.L. 2012, ¢. 25 (“Chapter 25 List"). contractors must certify that neither they nor any parent entity, subsidiary, or 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. 36

ener Person or Entity Shauger Property Services, Inc. COMPLETE PART | BY CHECKING EITHER BOX, found on ‘Treasury’s ~ websile af I certify, pursuant to Public Law 2012, ¢. 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 P.L. 2012, c. 25 (“Chapter 25 List"). 1 Jurther certify that I am the person listed above, or I am an officer or representative of the entity listed _above_and_am—authorized_—io—make—this_| certification on its behalf. I will skip Part 2 and sign and complete the Certification below. Jam tunable 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. 37

PLEASE PROVIDE FURTHER INFORMATION RELATED TO. INVESTMENT ACTIVITIES ‘IN IRAN. ; You must provide a detaited, accurate and precise description of the activities of the person-or entity, ora 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. ae ff being dilly sworn upon my oath, hereby represent ond state that the foregoing information and _| any attachments there to the best of my knowledge are irue and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person or enlity. T acknowledge that the Township of West Orange is'relying on the information contained herein. and thereby acknowledge that Iam under a contioning obligation from the date of this certification through the campletion of any coniracts with the Reference to Township af West Orange to notify ihe. ___|_Reference to Township of West Orange in writing of any changes.to: the answers-of -ixformation—|——_——— tontained herein. J acknowledge thet I'am aware that it is a criminal offense to maké a false statement or misrepresentation in this certification, and tf Ido so, I recognize that I am subject to criminel prosecution under the law ane that it will alse constitute a material breach of my agreemeni(s) with the Towaship of West Orange and that the Reference to Township of West Orange al ls option may declare any vontract(s) resulting from this certification void and unenforceable. Full Name (Print) Linda M. Spahle ; Title | Acting Secretary Signature on Yy yy. fealle- Date | 10/8/2025 vi a 38