Township Council Meeting — Packet

ESSEX COUNTY DIVISION OF HOUSING AND COMMUNITY DEVELOPMENT CONTRACTOR CLEARANCE REQUIREMENTS To be completed by all Bidders on Community Development Block Grant Projects Name of Company: Address: IRS TAX ID: SAM UEI #: SAM CAGE CODE # PRINCIPALS TITLE NAME ADDRESS SOC SEC # ai Are any of the company principals on the Federal or State List of Debarred or Suspended Contractors? YES NO. If Yes, please attach a detailed explanation for debarment or suspension Form completed by: Print Name and Title Signature The above information is true to the best of my knowledge and belief. | understand any falsification of facts will result in a determination that the Company is ineligible to work on this project. DATE: PROJECT: