Township Council Meeting — Packet

DEPARTMENT OF ECONOMIC DEVELOPMENT, TRAINING AND EMPLOYMENT DIVISION OF HOUSING & COMMUNITY DEVELOPMENT 20 Crestmont Road Verona, New Jersey 07044 Tel. (973) 655-0200 Joseph N. DiVincenzo, Jr. Anibal Ramos, Jr Essex County Executive Department Director John M. Soares Division Director SUB CONTRACTOR CERTIFICATION OF ELIGIBILITY , of (Name of Sub Contractor) (Name of Firm) by entering into this contract certify that neither |, nor my firm, nor any person or firm who has an interest in my firm, is a person or firm ineligible to be awarded government contracts by virtue of section 3 (a) of the Davis-Bacon Act or 29 CFR 5.12(a)(1). The penalty for making a false statement is prescribed in the US Criminal Code, 18USC 1001. PROJECT NAME: CONTRACT AMOUNT $ NATURE OF WORK TO BE PERFORMED: WORKMEN WILL REPORT FOR WORK ON OR ABOUT GENERAL CONTRATORS NAME: SIGNATURE: DATE: