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 1, 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: