Township Council Meeting — Packet

INITIAL PROJECT WORKFORCE REPORT - CONSTRUCTION FORMAL 20 Ranet i693 READ INSTI 1. FID HUMBER STATE OF NEW JERSEY DIVISION OF CONTRACT COMPLIANCE EQUAL EMPLOYMENT OPPORIUNITY IN PUBLIC CONTRACTS 3. NAME AND ADDRESS OF PRIME CONTRACTOR INITIAL PROJECT WORKFORCE REPORT CONSTRUCTION TONS ON THE BACK CAREFULLY BI PLEASE TYPE OR PRINT IN BLACK OR BLUE INK. 2 CONTRACTOR ID NUNEER Official Use Only Assignment $$ $s Code Ra ame) CONTRACT NUMBER = ATE OF AWARD DOLLAR AMOUNT OF AWARD (Street Address) © NAME AND ADDRESS OF PROJECT 5 PROTECT SUMBER SUE (city) Gat) iy Code) county 2 18 THIS PROJECT COVERED BY A PROJE( 4.18 THIS COMPANY MINORITY OWNED { ] OR WOMAN OWNED { } % TRADE OR CRAFT LABOR AGREEMENT (PLAJ? OYES’ ONC —— — I PROJECTED MINORITY EMPLOVEES ey — 1, ASBESTOS WORKER PROJECTED PROJECTED PHASE -IN COMPLETION DATE DATE en 2. BRICKLAYER OR MASON 3. CARPENTER 4, ELECTRICIAN §. GLAZIER 6. HVAC MECHANIC 7, IRONWORKER §. OPERATING ENGINEER 9. PAINTER 10, PLUMBER 11. ROOFER 12. SHEET METAL WORKER 13, SPRINKLER FITTER 14. STEAMFITTER. 1§. SURVEYOR _} 16. TILER 17, TRUCK DRIVER 18. LABORER { } 19. OTHER | 20. OTHER 1 Thereby cerdfy that the foregoing stateme false, I ara subject to punishment. smade by me are true. Tate aware thatit any of tie foregoing watemente are wilfalle (Signature) Tw (Please Print Your Nasa) Tn ‘Area Code) ‘(Telephone Number) Ex) P-54 Dare}

we INSTRUCTIONS FOR COMPLETING THE INITIAL PROJECT WORKFORCE REPORT - CONSTRUCTION (44201) DO NOT COMPLETE THIS FORM FOR GOODS AND/OR SERVICE CONTRACTS Enter the Federal Idencification Number assigned to the contractor by the Internal Revenue Service, or if a Federal Employer Identification Number has been applied for but not vet issued, or if your business is such that you have not or will not receive a Federal Identificati umber, enter the social security number assigned to the single owner or one partner, in the case of a partnership. Note: The Division of CC/EEO will assign a contractor ID number to your company. This number will be vour permanently assigned contractor ID number that must be on all correspondence and reports submitted to this office Enter the prime contractor's name, address and zip code number. Check box if Company is Minority Owned or Woman Owned Enter the complete name and address of the Public Agency awarding the contract. Include the contract number, date of award and dollar amount of the contract. 6. Enter the name and address of the project, including the county in which the project is located. Note: A project contract ID number will be assigned to your firm upon receipt of the completed Initial Project Workforce Report (AA201) for this contract. This number must be indicated on all correspondence and reports submitted to this office relating to this contract. , Cheek: “Yes” or “No” to indicate whether a Project Labor Agreement (PLA) was established withthe labor organization(s) for this project. Under the Projected Total Number of Employees in each trade or craft and at each level of classification, enter the total composite workforce of the prime contractor and all subcontractors projected to work on the project. Under Projected Employees enter total iinority and female employees of the prime contractor and all subcontractors projected to work on the project. Minority employees include Black, Hispanic, American Indian and Asian, (J=Journerworker, AP=Apprentice). Include projected phase-in and completion dates. 10. Print or type the name of the company official or authorized Equal Employment Opportunity EEO) official include signature and ticle, phone number and date the report is submitted, This report must be submitted to the Public Agency that awards the contract and the Division of Contract Comphauce and

cial include signature and ticle, phone number and date the report is submitted, This report must be submitted to the Public Agency that awards the contract and the Division of Contract Comphauce and Equal Employment Opportunity in Public Contracts no later than three (3) days after the contractor signs the contract. THE CONTRACTOR Is TO RETAIN THE FOURTH AND FINAL COPY MARKED "CONTRACTOR", SUBMIT THE THIRD COPY MARKED “PUBLIC AGENCY” TO THE PUBLIC AGENCY AWARDING THE CONTRACT AND FORWARD THE REMAINING TWO (2) COPIES TO: NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF CONTRACT COMPLIANCE & EQUAL EMPLOYMENT OPPORTUNITY IN PUBLIC CONTRACTS

FORM W-9 Request for Taxpayer Identification Number and Certification on W-9 Give Form to the (Rev. Oolobar 2012) requester. Dont ert lhe Toasiry z ioral Revenue Sancn > Go to wwnwairs.gov/FormWS for instructions and the latest information. "T Néme (a5 shown on your income tax ratury, Name is required on this ine; do not eave ths line Blane. 2 Business name/oisreqardes encty name, l Otarent Wom above ‘3 Check appropriate box tor federal tax classif cain of the person whose name Is envered on tne 1 Check only one of the 4 to ing seven boxes. beside Exemolions (codes ccertan entites, not individuals: 268 Instuctions on page 3) Cscepoavon 0) Partrrshio CL) tusvestate 7 individuavsoie prooriotor cr ~C) CCorperation single-member LLC D1 Unites satitity compary. Enter the tax classiticalion (C=C corporation, S=8 corporation, P=Partnwshio) > ‘Nate: Check the anpropriate box in tne line above for te tax olassficaton of the singie-member owner. D> not check LLG the LLG i classified as a singla member LLG thal is dsragared fcr te owner uniess Ihe ower of the LLC a ‘nother LLC that Is not deregarced from tns owner for U.S. feceral tax purposes. Othenvdso, a singla-member LLG that Iselaregarced from the owner should check the aopropriate box lr the ax cassitation ot ts ne, Oiher (see instructions) > 'S Adatess (number, street, and apt. or sute no) See insiructions. Exempl payea code if any) Exemption rom FATCA reporting code (i any) Print or type. ‘See Specific Instructions on page 3. Hectnoncoaats manana ito.) equester's name and address foptionaly © Gity, sala, and ZIP cod 7 Ustaccount ruribarta) here (optional) Taxpayer Identification Number (TIN) _ Enter your TIN in the appropriate box. The TIN provided must match the name civen on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part |, later. For other entities, it is your employer identification number (EIN). It you do not have a number, see How to get @ TWN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requesier for guidelines on whose number to enter. Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my

line 1. Also see What Name and Number To Give the Requesier for guidelines on whose number to enter. Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and 2. Lam not subject to backup withholding because: (a) | am exempt Irom backup withholding, or (0) | have not beer notified by the Internal Revenue ‘Service (IRS) that | am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that | am ‘no longer subject to backup withholding; and 3.1amaU.S citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct. Certification Instructions. You must cross out Item 2 above it you have been not fied by the IRS that you are ‘currently Sub.ect to oackup withholding because ‘you have failed to report al interest end clidends on your tax return. For real estate transactions, iter 2 does not appy. For mor-gage interest paid, ‘acquisition or abandonment of secured , cancellation of debt, contributions to an individual retirement arrangement (i ‘and generally, payments property, IRA). ‘otter thar ‘nlerost and dividends, you are nat required to sign the certification, but you must provide your corteot TIN. See tha instructions for Par kale. Sign Signature of Here US, parson > Date > General Instructions Section references are to the Interial Revenue Code unless otherwise noted, Future developments. For the latast information about developments ‘elated to Form W-9 and its instructions, such as legislation enacted after they were published. go to wvnvirs. gou/Formi/9. Purpose of Form ‘An individual or entity (Form W-9 requester) who is required fo file an Information relum with the IRS must obtaln your correct t Identification number (TIN) which may be your social security number (BSN. individual taxpayer ‘dentification number (TIN), adoption ‘taxpayer identilication numiver (ATIN), or employer identification number (EIN), to raport on an information retum the amount paid to you, orather amount reportable on an information ratum. Examples of information returns include, but are not limited to, the followng. '* Form 1099-INT (interest eared o* paid) ‘+ Form

mount paid to you, orather amount reportable on an information ratum. Examples of information returns include, but are not limited to, the followng. '* Form 1099-INT (interest eared o* paid) ‘+ Form 1099-DIV (dividends, including those from stocks or mutual funds) ‘+ Form 1098-MISC (various types of income, prizes, awards, or gross proceeds) + Form 1098-6 (stock or mutual {und sales and certan other transactions by brokers) '* Form 1099-5 (proceeds from real estate transactions) ‘+ Form 1099-K (merchant card and third party natwork transactions) ‘= Form 1096 (home mortgage interest), 1088-E (student loan interest), 1098-T (tition) ‘+ Form 1099-C (canceled debt) + Form 1039-A (acquisition or abandonment of secures property} Use Form W-9 only If you are a U.S. parson (including a resident alien}, to provide your correct TIN. 4H you do not return Form W-9 ta the requester with a TIN, you might be subject to backup withholding. See Wrat is backup withholding, Iter. Cat. No, 10231% P-56 Foo W-9 Fev. 10-2018)

STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE 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, c57. All business organizations that do business with a local 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/voucher 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. SOR RGR A OR a aR kk ae a ak fea oe ak ae 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 are registered with the Commissioner of Labor. P-57

SAMPLE CERTIFICATE SUSINESS REGISTHAT OV CERT FICATE A i FOR STATE AGENCY AND CASINO SERVICE CONTRACTOR E & ee anita cain TAXPAYER NAME TRAL AWE ; i, TAX REGISTRATION Test ACCOUNT cui -AS TRAY hi TAXPAYER IBENTIFIC 8 74ONi SEQL NUMBER 970-097-282/200 107: ye anneess ISSUANCE DATE ‘ JUNG AY TRE\ss un HJ 030 Sree VE DA a DW bs ” Gu. Fou Cerner ite rane @ P tiat! Se cee: ie Sones Sea STATE OF NEW JERSEY . BUSINESS REGISTRATION CERTIFICATE Taapayer Name: TAN KEG TEST ACCOUNT Trade Name: Address: $47 ROEBLING AVE TRENTON, NE S611 Certificate Numbers 1093907 Date of Issuance: Oviaher 14. 2005 For Office tise Onty: 200-4101-4112823533 P-58

PUBLIC WORKS CONTRACTOR REGISTRATION “yreurdoreneg earn yoy pus s0qe7 Jo 319VU34SNVAL NON iuewdojanag aqapyi9g, JBUOISSIUOD BL) Aq aSNED 405 Payxonas aq ABW pue pue Joge7 Jo JUaUNIedeQ HaAUOFSSIUWIOD paubisse Jo pesojsuey aq Jou Kew ayeoynied si) STU SYN aneUasesday 91q:SUOdsoy ©S0S 20) Yom O11GNd Aue Jo eqUEULOPEd ay) UI BuiBeSuE 404 40 410% 0)" IO} jOWNIUCD AUL UC BuIypia JO WesowI"d 0 Panss| §| LONEAIS|B91 Jo SFEDL|NEO S1YI “y LOEAS|HSY sOI2eAUDD BHIO/\\ IK ON }O LES IE RP OS-LL.re “VSN OL UeNsINg yy uoNessiBay JO}eNUOD SHJOAA DIIGNg SBOUBI|GWOD INO} pue ebepy jo uorsinig JUaUIdOJENEq So10}4J0AA PUB JOGeq Jo JUBWeEdeq Aasiaf MAN Jo aye1s aati Szovsitt ——:9¥eq uenBUIGK saquinN aeDyRNED EzOZ/9LH © -eieC VoRensIBey P-59

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