Township Council Meeting — Packet

CERTIFICATION OF NON-INVOLVEMENT IN PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS Pursuant to NJ.S,A, 62:32-60.1, et seq (L, 2022, c, 3) arly person or eiity {hereitiafler "Vendor") thal seeks to shite into or ranev-a contract with a State agenay forthe provision of goods or services, or the purchase of bonds or othst obligations, must complete the certification below indicating whether or ict. the Vendor ‘s ‘identified on the Office of Foreign Assets tro) FAC) Specially Designated Nationals and Blocked Persons. isl, vallable Here: e [the Department of the Treasury finds that a Vendor has made. a certification in ‘Woletion of tha law, it shall take ‘any action'as may be appropriate and provided by law, rulé or contract, including but not lifted to, linposing sanétions, Seeking compliance, recovering damages, declaring the party if default aid seeking dabarmant orsuspeasion of the party. |, fie undersigned, ceitify Hist | have reed the definition of “Varitor" bélow, and have raviewed the Offica of Foreign Assets Cortrol (OFAG): Specially Designated Nationals and Blocked Persons list, and having dangesa certify: (Ghetk the Appropriate Box) 4, thatthe Vendor is not ideniified on the FAG. Spa oO gosddunt of adlivity related to Russta and/or Belarus, OR p, ‘That lam unable to certify as-to “AY above, bocause the Vendor is identified on the OFAC Spésially OQ * Desianated Nationals shd Blocked Persons list onl acount of nctivity related to Russia andor Belarus, ‘OR ‘That |-em uneble to certify as to “A shove, becausé the Vendor is Idefttified on ihe ofa Sbecially ) <. ‘Desiqnated Nationals:and Blocked Persons list. Hewever, the: Vendor is engaged Inactivily related to Russia " and/or Belanis nonsistent with federal law, regulation, license er-exemption. A detailed description of how the Vendor's activity related fo Russia and/or Belarus is: consistent with federal jaw is set forth below. (Aitanti Adtilianal Shoots if Necossay) ‘Signature oF Vendor's Authorized Representative Bate PriitNarne and Tike of Veridrs Authorized Reprocuntabve, Vendors FEIN ‘Vendor's Name Vendors Prone Number Vendors Address (Sirset Address} Vendor's Bax Number Vendor's Address (GiiiStatelZip Gade) ‘Vendors Emall Address | Wendor means: (1) A-netural person, corporation, company, lined partnership, limited ilablily partnership, limited Nablity company; bushesy-nssoclation, sole

iStatelZip Gade) ‘Vendors Emall Address | Wendor means: (1) A-netural person, corporation, company, lined partnership, limited ilablily partnership, limited Nablity company; bushesy-nssoclation, sole proprictorship, foint ventore, partnership, soclety, trust, or any ther nongovernmental ently, organizalion, or gous (@j Any governmental entity-or insttumertality of a goverment, frelaling a thullilateral develonment Institution, 8s defined in Section 470140\(3) of the international Financial Institutions Act, 22 U.8.G, 262/(0)(3)° or (8) Any ‘parent, stiocessot, susunit, direct or indirect Subsidiry,-ot-any sntily under commdn ownership or control with, any enfity described in paragraph (4) or (2). Noy, {h004 Page | 31