Township Council Meeting — Packet

STATEMENT OF OWNERSHIP DISCLOSURE Nul.8.A, 52:25-24.2 (P.L. 1977, ¢.33, as amended by P.L. 2016, c.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 proposal. Name of Oraanization. C £7CB0's l peck PEAY Gegenkuuses ene tdi 170 LitHelas Rd. Vaesizeany, UT ovosy Part | Check the box that represents the type of business organization: soe Proprietorship (skip Parts II and ill, execute certification in Part IV) Dnon-Proft Corporation (skip Parts I] and III, execute certification in Part IV) Palror-Proft Corporation (any type) DAhimitea Liability Company (LLC) lotrer (be specific): . Part Il 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 the limited liability company who own a 10 pereent-or-greater-interest therein,-as-the-case-may-be.(GOMPLETE-THE LIST BELOW IN-THIS————-—-—: SECTION) OR 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) (Please attach additional sheets if more space is needed): Name of Individual or Business Entity Address Aavdony CERO) IL 27) Brann Al?-Cameen ed Newrmerns, NIO78G 0 Toseph R.Cacba v7 BJT h woe TF ear\ Newren, NT o7 $e 0 Cyarty. A Cooper 2¢ Brie\\ayg Ro DarsiPeann WI o7dsy 7B

Part_ lll DISCLOSURE oF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART il i If a 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 i (SEC) or foreign equivalent filing, ownership disclosure can be met by providing i 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 i 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 Page #’s equivalent) filing f\ t ne rN Please list the names and addresses of each stockholder, partner or member owning i a 10 percent or greater interest in any corresponding corporation, partnership and/or limitectiability company (LLC) listed in Part Hl other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every non-corporate ‘stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed. Stockholder/Partner/Member and Address Corresponding Entity Listed in Part 11 al \ 79 :

Part IV Certification |, 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 | 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 | am under a continuing 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 wriling 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, permitting the Township of West Orange to declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print): bya TH: 9 C copa Title: V. p. Signature: Q fe , () Date:| J/- 3 -PS C/ v 80

SUBCONTRACTOR LIST The Contractor shail 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 H to the receipt of Bids, however, a Business Registration Certificate is not required in the submission i of the Proposal forms for this Contract. Name of Subcontractor Address/Telephone # Work to be performed | NA i DATE: -3: AS 8

ACKNOWLEDGMENT OF RECEIPT OF CHANGES TO BID DOCUMENTS FORM 2026 TREE PLANTING AT VARIOUS LOCATIONS TOWNSHIP OF WEST ORANGE Pursuant to N.J.S.A. 40A: 11-23. 1a, the undersigned Bidder hereby acknowledges receipt of the following notices, revisions, or addenda to the Bid Advertisement, Specifications or Bid Documents. By indicating date of receipt, Bidder acknowledges the submitted Bid takes into account the provisions of the Notice, Revision or Addendum. Note that the local unit's record of notice to Bidders shall take precedence and that failure to include provisions of changes in a Bid Proposal may be subject for rejection of the Bid. Local Unit Reference Number or Title of How Recelved (Mall Fax, Date Received Addendum/Revision ‘eked Up) NO ADDENDUM RECEIVED (check off if nothing received) Acknowledgment by Bidder: oo - } Gy 74), s . Name of Bidder: CéRea's Paes Pl fan Once ns houses Ent. By Authorized Representative: Cyatr#t LA (ila Signature: Cyt Chega Printed Name and Title: & eres Cao Pere. Vv. ?. Date: Mr 3-aAs 82.

CONSENT OF SURETY \ \y In consideration of the premises and of one Dollar ($1.00), lawful money of the United States, it is in hand paid by the CONTRACTOR, the receipt whereof is hereby acknowledged, the undersigned surety consents and agrees that if the Contract, for which the proceeding estimate and Proposal is made, be awarded to the person or persons submitting the same as contracted, it will become bound as surety and guarantor for its faithful performance, in an amount equal to one hundred (100%) percent of the contract price, and will execute it as party of the third part thereto when required to do so by the OWNER, and if the said CONTRACTOR shail omit or refuse to execute such Contract, if so awarded, it will pay without proof of notice and on demand fo the OWNER any increase between the sum fo which the said CONTRACTOR would have been entitled upon the completion of the said contract and the sum which the said OWNER may 4e-obligated to pay to another contractor to whom the contract may be afterwards awarded, the WoUnt in such case to be determined by the bids plus the cost, if any, of re-advertising for bids it this work, less the amount of any certified check or bid bond payable and received. iff witness whereof, said surety has caused these presents to be signed and attested by a duly | __________ authorized officer and its corporate seal t be -hereto-affixed thi: 7 | | day of , 20. (A corporate acknowledgement and statement of authority to be here attached by the surety company.) {Surety Company) BY. (Surety Company Attorney-in-Fact) Attest: (Surety may substitute a similar statement subject to the OWNER’S approval.) CETIE VE Cheuk epiosal, —= §3

REQUIRED EVIDENCE AFFIRMATIVE ACTION REGULATIONS NJ.S.A, 10:5-31, et seq. (NILA. C. 17:27) Ifewarded 2 contract, the Bidder will be required to comply with the requitements of NJS.A. 10:531, et seq., and N,).A.C. 17:27. Within five (5) days after receipt of the notification of intent to award the conttact, the Bidder shall present one of the following: 1. Appropriate evidence that the Contractot is operating under an existing federally approved or sanctioned affirmative action program; or 2 A Ceitificate of Hmployee Information Report Approval issued in accordance with NJ.A.C. 17:27-4; ot 3, An initial Employee Information Repott consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with N.JLA.C 17:27-4, Manning Table consisting of forms provided by the Affirmative Action Office and completed by The Bidder must submit no later-than-thtee (3) days after the sipning of the Contract an Initial Projet if Contractor in accordance with NAC, 1727-7. Bidders are referred to the Biddes's Information Section of the Bid Packet for a further description of the above requirements. 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 Bieldess: 1, Do you have a federnlly-apptoved or sanctioned Affitmative Action Progeam? Yes (If yes, submit 4 copy of such approval.) Cro) 2. Do you have a State Certificate of Hmployee Information Repott approval? Yes {If yes, submit a copy of such approval) No The undersigned Bidder cettifies that he is aware of the commitment to comply with the requirements of NJSA, 10:5-31, ef 8eq,, and agrees to furnish the required documentation pursuant to the law. COMPANY: NAME: SIGNATURE; TITLE: NOTE: A bid must be sejected as non-tesponsive if a Bidder fails to comply with requiements of N,J.S.A. 10:5-31, et seq,, within stipulated time.

TOWNSHIP OF WEST ORANGE AFFIRMATIVE ACTION AFFIDAVI STATE OF NEW JERSEY COUNTY OF ESSEX I, Cyo Lf ol agPUe , of the (Township, City, Town, Township) of N Qens SJease V4 of full age, being duly sworn according to law on my oath depose and say that: . | Fats ipa wy aIn the County of Yow aus , State of | | ral nN 4. 1am (President, Partner, Owner) of the firm of Ceked s aa. Mame Cremmhorses, Lane. A Bidder making a Proposal upon the Project entitled 2096 “te of Lending af Vac fou Lerah'ord 2. lam familiar with the Affirmative Action requirement of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 and rules and regulations issued by the Treasurer, State of New Jersey, pursuant thereto. 3. The firm has complied with all the Affirmative Action requirements of the State of New Jersey, including those required by N.J.S.A. 10:5-31 et seq. and N.J.A.C, 17:27 and the rules and regulations issued by the Treasurer, State of New Jersey, pursuant thereto. 4, | am aware that if the firm does not comply with N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 and rules and regulations issued pursuant thereto, that no monies will be paid by the State of New Jersey, County of Hudson, Township of West Orange, until an Affirmative Action Plan is approved. | am also aware that the Contract may be terminated and the firm may be debarred from all public contracts for a period of up to five (5) years. | i i i 5. lam aware that this affidavit does not fulfil the Affirmative Action requirements of the State of New Jersey and that further action on my partis necessary as provided in section C-58 of the corresponding Specification. Sworn and i subscribed ' Signature of Authorized Representative before me this day of , 20 Name and Title Seal-Notary Public of NU Firm's Address 85

! I My commission expires EQUIPMENT LIST The Contractor shall list below all equipment, owned or leased by him, that is available for use in connection with the attached Bid Proposal. : CAPACITY MANUFACTURER i UNIT AND MODEL YEAR i i | | DATE: 86

Certificate Number 653045 State Department of L Division of Public Works Pursuant to N.J.S.A. 34:11-56.48, ef seq. of the Publi for purposes of bidding on any contract Cerbo's P Responsible Representative(s): Anthony Cerbo, President Cynthia Cooper, Vice-President [dugy— Robert Asaro-Angelo, Commissioner Department of Labor and Workforce Development pl Registration Date: 10/30/2025 Expiration Date: 10/29/2027 of New Jersey or and Workforce Development fage and Hour Compliance Contractor Registration Act ic Works Contractor Registration Act, this certificate of registration is issued ublic work or for engaging In the performance of any public work to: 2025~ Responsible Representatives): Joseph Cerbo, Vice-President This certificate may not be transferred or assigned and may be revoked for cause by the Commissioner NON TRANSFERABLE of Labor and Workforce Development.