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Lead Closed
This opportunity is no longer accepting submissions.
Finance And Water And Sewer Utility Consultant
BID #: 29
ISSUED: 1/10/2024
DUE: 1/11/2024
VALUE: TBD
100
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Green Risk
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Executive Summary
The City of Orange Township is seeking proposals from qualified respondents for Finance and Water and Sewer Utility Consultant Services. The contract will be awarded through a fair and open process. Proposals must be submitted to the Finance Department via mail or hand delivery by 11:00 a.m. on January 11, 2024. Facsimile or email submissions will not be accepted.
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Bid Postings • FINANCE AND WATER AND SEWER UTILITY CONSULTAN Skip to Main Content EMERGENCY ALERT SNAP Recipients - Find Food Sources Near You Read On... Create a Website Account - Manage notification subscriptions, save form progress and more. Website Sign In Search Residents Business UEZ Program How Do I... City Government Departments Home Bid Postings Print Sign up to receive a text message or email when new bids are added! Print Bid Title: FINANCE AND WATER AND SEWER UTILITY CONSULTANT Category: Bids and Request for Proposals (RFPs) Status: Closed Description: Introduction and Purpose The City is seeking proposals from qualified Respondents to provide Finance and Water and Sewer Utility Consultant Services. Fair and Open Process It is the intention of the City of Orange Township to award a contract through a fair and open process as set forth in N.J.S.A. 19:44A-20.5 et seq. and intends to award the contracts pursuant to N.J.S.A. 40A:11-5 (l)(a)(i). Evaluation Proposals will be reviewed and evaluated by the City's Finance Department. The proposals will be reviewed to determine if the Respondent has met the professional, administrative, and subject areas described in this RFP. All communications concerning this RFP or the RFP process shall be directed to the City contact person, in writing, via fax, or via e-mail. Responses to all questions will be forwarded as addenda to all prospective Respondents who have provided contact information. It is the prospective Respondents responsibility to provide accurate contact information. Publication Date/Time: 1/10/2024 12:00 AM Closing Date/Time: 1/11/2024 11:59 PM Contact Person: Christopher Hartwyk, Business Administrator 29 North Day Street Orange, New Jersey 07050 (973) 952-6089 chartwyk@orangenj.gov Related Documents: RFP -Finance and Water and Sewer Utility Consultant - FINAL Return To Main Bid Postings Page Live Edit Bill Pay Public Notice Agendas & Minutes Job Openings Documents & Forms Notify Me® Contact Us Orange City Hall 29 North Day Street Phone: 973-952-6100 Staff Directory Quick Links Finance Forms, Permits, and License Applications Mayor's Office Public Works Vital Statistics Staff Directory /QuickLinks.aspx Helpful Links Home Site Map Contact Us Accessibility Copyright Notices Privacy Policy /QuickLinks.aspx Government Websites by CivicPlus® Loading Loading Do Not Show Again Close Arrow Left Arrow Right [] Slideshow Left Arrow Slideshow Right Arrow
Document Text
--- Document: RFP -Finance and Water and Sewer Utility Consultant - FINAL ---
REQUEST FOR
PROPOSALS
Finance and Water and Sewer Utility Consultant
SUBMISSION DEADLINE:
11:00 AM
January 11, 2024
ADDRESS ALL PROPOSALS TO:
Christopher Hartwyk
Business Administrator
29 North Day Street
Orange, New Jersey 07050
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 1
SUBMISSION DEADLINE
11:00 AM - January 11, 2024
SECTION 1: GENERAL INFORMATION & SUMMARY
1.1 Organization Requesting Proposal
City of Orange Township - Finance Department
29 North Day Street
Orange, New Jersey 07050
1.2 Contact Person
Christopher Hartwyk, Business Administrator
29 North Day Street
Orange, New Jersey 07050
(973) 952-6089
chartwyk@orangenj.gov
1.3 Procurement Process
This contract will be awarded as a professional services agreement using a fair and open process under the "New
Jersey Local Unit Pay-to-Play Law,"N.J.S.A. 19:44A-20.5 et seq.
The City Council will vote to approve a resolution awarding a contract to the Contractor for a sum not to exceed
a specified amount and for a term of one (1) year.
1.4 Contract Form
If selected to provide services, it is agreed and understood that the successful Respondent shall be bound by the
requirements and terms contained in this RFP with regard to services performed, payments, indemnification,
insurance, termination, and applicable licensing provisions.
It is also agreed and understood that the acceptance of the final payment by Contractor shall be considered a
release in full of all claims against the City of Orange Township (City) arising out of, or by reason of, the work
done and materials furnished under this Contract.
1.5 Submission Deadline
Proposals must be submitted to, and be received by the Finance Department, via mail or hand delivery, by
11:00 a.m. prevailing time on January 11, 2024. Proposals will not be accepted by facsimile transmission or
e-mail.
1.6 Opening of Proposals
Proposals shall be opened in public at 11:00 a.m. prevailing time on J a n u a r y 1 1 , 2024 in the Business
Administrator’s Office, located at 29 North Day Street, City of Orange Township, N.J.
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 2
1.7 Definitions
The following definitions shall apply to and are used in this Request for Proposal (RFP):
"City" refers to the City of Orange Township.
"RFP" - refers to this Request for Proposals, including any amendments thereof or supplements thereto.
“Respondent" or "Respondents" - refers to the interested persons and/or firm(s) that submit a Proposal.
"Consultant" or "Consultants" - refers to the interested persons and/or firm(s) that submit a Proposal.
1.8 Submission address
All proposals should be sent to:
Christopher Hartwyk, Business Administrator
29 North Day Street
Orange, New Jersey 07050
SECTION 2: INTRODUCTION AND GENERAL INFORMATION
2.1 Introduction and Purpose
The City is seeking proposals from qualified Respondents to provide Finance and Water and Sewer Utility
Consultant Services.
2.2 Fair and Open Process
It is the intention of the City of Orange Township to award a contract through a fair and open process as set
forth in N.J.S.A. 19:44A-20.5 et seq. and intends to award the contracts pursuant to N.J.S.A. 40A:11-5
(l)(a)(i).
2.3 Evaluation
Proposals will be reviewed and evaluated by the City's Finance Department. The proposals will be reviewed
to determine if the Respondent has met the professional, administrative, and subject areas described in this
RFP.
All communications concerning this RFP or the RFP process shall be directed to the City contact person, in
writing, via fax, or via e-mail. Responses to all questions will be forwarded as addenda to all prospective
Respondents who have provided contact information. It is the prospective Respondents responsibility to
provide accurate contact information.
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 3
2.4 Procurement Schedule
The steps involved in the process and the anticipated completion dates are set forth in the Procurement
Schedule below. The City reserves the right to, among other things, amend, modify or alter the Procurement
Schedule upon notice to all potential Respondents.
Activity
1. Receipt of Proposals
January 11, 2024
2. Completion of evaluation of Proposals
January 15, 2024
3. Award of Contract
January 16, 2024
2.5 Rights of the City
The City reserves, holds and may exercise, at its sole discretion, the following rights and options with regard to this
RFP and the procurement process in accordance with the provisions of applicable law:
•
To conduct investigations of any or all of the Respondents, as the City deems necessary or convenient, to
clarify the information provided as part of the Proposal and to request additional information to support
the information included in any Proposal.
•
To suspend or terminate the procurement process described in this RFP at any time (in its sole discretion.)
If terminated, the City may determine to commence a new procurement process or exercise any other rights
provided under applicable law without any obligation to the Respondents.
2.6 Cost of Proposal Preparation
Each Proposal and all information required to be submitted pursuant to the RFP shall be prepared at the sole cost and
expense of the Respondent. There shall be no claims whatsoever against the City, its officers, officials or
employees for reimbursement for the payment of costs or expenses incurred in the preparation of the Proposal
or other information required by the RFP.
2.7
Proposal Evaluation
Proposals will be evaluated by the Finance Department based on the specific criteria detailed in Section 6.
2.8
Written Proposal
Prospective Respondents must submit a written proposal in a format specified by the City. The required format
is detailed in Section 3.
2.9
Additional Requirements
Consultant is required to comply with requirements of P.L. 1975, c. 127, the Law Against Discrimination and
with N.J.A.C. 17:27-1.1 et seq., the Affirmative Action Rules.
A party responding to this RFP must indicate what type of business organization it is e.g., corporation,
partnership, sole proprietorship, or non-profit organization. If a party is a subsidiary or direct or indirect
affiliate of any other organization, it must indicate in its proposal the name of the related organization and the
relationship. If a party responding to this RFP is a corporation, it shall list the names of those stockholders
holding 10% or more of the outstanding stock.
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 4
Section 7 of this document describes general terms and conditions. Section 8 of this document contains
required administrative forms, which must accompany all proposals. Exclusion of any required form is
grounds for rejection of proposals.
2.10
Disposition of RFP
Upon submission of a Proposal in response to this RFP, the Respondent acknowledges and consents to the
following conditions relative to the submission and review and consideration of its Proposal:
•
All Proposals shall become the property of the City and will not be returned.
•
All Proposals will become public information at the appropriate time, as determined by the City (in the
exercise of its sole discretion) in accordance with law.
SECTION 3: WRITTEN PROPOSAL FORMAT
Proposals must address all information requested in this RFP. Proposals which in the judgment of the City fail
to meet the requirements of the RFP or which are in any way conditional, incomplete, obscure, contain
additions or deletions from requested information, or contain errors may be rejected.
3.1 Mandatory content
Each proposal submitted must contain the following
•
Title Page
•
Table of Contents
•
Executive Summary
•
Firm Background
•
Scope of Service
•
Timing & Fees
•
Business Registration Certificate
•
Non-Collusion Affidavit
•
Insurance Requirements and Acknowledgement Form
•
The information requested by the sectional format described above is further defined.
3.2 Title Page
The proposal should include a title page, which identifies the project; the Respondent’s firm, name of the
Respondent’s primary contact, address, telephone number, fax number and email address.
3.3 Table of Contents
The Respondent's proposal should include a Table of Contents, which lists the titles and page numbers for
each major topic and sub-topic contained in the proposal.
3.4 Executive Summary
This section should include a summary of the key points and highlights of the Respondent's response and
should discuss the pricing contained in the proposal.
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 5
3.5 Firm Background
In this section of the proposal, the Respondent should review its understanding of the business drivers behind
the City's strategy.
3.6 Scope of Service
In this section of the proposal, the Respondent should state what it believes to be the scope of the intended
strategy within the City. If there are any gaps between what the Respondent believes should be the proper
scope of the solution given all information known at the time of this RFP, the Respondent should clearly
state these gaps in this section and clearly mark these concerns as such.
3.7 Timing and Fees
In this section, please describe the timing and associated fees the Respondent is proposing for the
implementation. Respondents should be sure to include all expenses associated with delivery, in addition to
professional fees. Respondents should identify hourly participation and hourly fees by specific personnel.
It is important to note that pursuant to N.J.S.A. 40A:5-16, the City is prohibited from paying for goods or
services before they have been provided. Therefore, any proposals which specify payment upon
contract signing will be deemed unresponsive and rejected.
SECTION 4: SCOPE OF SERVICES
4.1 Scope of Work to be Performed
Assistance in the Finance Department and Administration as it relates to the best practice process and procedure,
supplemental debt statements, annual debt statements, audits and capital and operating expenses, CFO assistance,
budget guidance, CAP waiver training, levy CAP and RUT calculations training and review, emergency
appropriations calculations, bank reconciliations, pension compliance issues, Local Finance Board
applications and presentations, consulting services related to the City’s Water Utility, Finance and
Operations.
SECTION 5: PROPOSAL SUBMISSION REQUIREMENTS
To be responsive, Proposals must provide all requested information, and must be in strict conformance with
the instructions set forth herein. Proposals and all related information must be bound, and signed and
acknowledged by the Respondent.
5.1 Number of Copies
Respondents must submit one signed original and five (5) copies of their proposals.
5.2 Proposal Media
Proposals forwarded by facsimile or e-mail will not be accepted.
5.3 Proposal Format
To facilitate a timely and comprehensive evaluation of all submitted proposals, it is essential that all Respondents
adhere to the required response format. The City requires a standard format for all proposals submitted to
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 6
ensure that clear, concise and complete statements are available from each Respondent in response to
requirements. The required format is detailed in Section 3.
The City is not under any obligation to search for clarification through additional or unformatted information
submitted as a supplement to the formatted response. Where a proposal contains conflicting information,
the City at its option may either request clarification or may consider the information unresponsive.
5.4 Proposal Length
The exact presentation and layout format of proposals is up to the discretion of the Respondent. However, a
maximum length of 30 pages is strongly suggested.
5.5 Submission Deadline
Proposals must be received by the City no later than 11:00 AM prevailing time on January 11, 2024 and must be
mailed or hand-delivered in a sealed envelope marked “Response to RFP – Finance and Water and Sewer
Utility Consultant”.
SECTION 6: PROPOSAL EVALUATION
The City's objective in soliciting Proposals is to enable it to select a Respondent that will provide high quality
and cost effective services to the citizens of Orange Township. The City Finance Department will consider
Proposals only from Respondents that, in the City's sole judgment have demonstrated the capability and
willingness to provide high quality services to the citizens of the City in the manner described in this RFP.
6.1 Evaluation of Methodology
Proposals will be evaluated by the Finance Department on the basis of which is the most advantageous, and
this evaluation will consider the following:
Required Format
The extent to which the proposal includes the required sections (Title page, Table of contents, etc.).
a.
Appropriateness of proposed methodology
The extent to which the proposed methodology meets the City's goals as described in Section 4 of this RFP.
The degree to which specific activities and milestones are described will also be evaluated.
Respondents should describe their methodology and explain how it will meet the City's needs.
b.
Prior experience with similar cities
The City does not wish to overly educate its Consultants as to the workings (both operational and statutory)
of municipal government. As a result, proposals should reference of similar type experience.
c.
Cost
The winning proposal will not necessarily be that with the lowest cost, but that which provides the greatest
value to the City. Proposals should provide detailed breakdowns on the cost components. Proposals will be
evaluated on the detailed breakdown provided and whether pricing is appropriate to the project scope.
6.2 Final Evaluation
The City will select the most advantageous Proposal Statement based on the all of the evaluation factors set
forth in this RFP, and make the award in the best interest of the City. Each Proposal must satisfy the
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 7
objectives and requirements detailed in this RFP. The successful Respondent shall be determined by an
evaluation of the total content of the Proposal Statement submitted. The City shall not be obligated to explain
the results of the evaluation process to any Respondent.
6.3
Contract Award
A contract will be awarded a professional service agreement pursuant to the "fair and open" provisions of
the "New Jersey Local Unit Pay-to-Play Law", N.J.S.A. 19:44A-20.4 et seq.
The Municipal Council will vote to accept the proposal of a Respondent within sixty (60) days of the receipt
of proposals, except that the proposals of any Respondents who consent thereto, may, at the request of the City,
be held for consideration for such longer period as may be agreed.
SECTION 7: GENERAL TERMS AND CONDITIONS
The following are general terms and conditions which may or may not be explained elsewhere in this RFP.
7.1 City’s Right to Reject
The City reserves the right to reject any or all proposals, if necessary, or to waive any informalities in the
proposals, and, unless otherwise specified by the Respondent, to accept any item, items or services in the
Proposal should it be deemed in the best interest of the City.
7.2 Original/Authorized Signatures
Each proposal and all required forms must be signed in ink by a person authorized to do so.
7.3 Delivery of Proposals
Proposals may be hand delivered or mailed consistent with the provisions of the legal notice to Respondents.
In the case of mailed proposals, the City assumes no responsibility for proposals received after the designated
date and time and will return late proposals unopened. Proposals will not be accepted by facsimile or e-mail.
7.4 Affirmative Action Requirements
Respondents are required to comply with the provisions of N.J.S.A. 10:5-31 and N.J.A.C. 17:27 et seq. No
Contractor may be issued a contract unless it complies with these affirmative action provisions. The
Mandatory Equal Employment Opportunity/Affirmative Action Language for Goods, Professional Services
and General Service Contracts, Exhibit A summarizes the full required regulatory text.
Goods and Services (including professional services) consultants/contractors shall submit to the public agency,
after notification of award but prior to execution of a goods and services contract, one of the following three
documents:
a.
A photo copy of a valid letter that the contractor is operating under an existing Federally approved or
sanctioned affirmative action program (good for one year from the date of the letter); or
b.
A photocopy of a Certificate of Employee Information Report approval, issued in accordance
with N.J.A.C. 17:27-4; or
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 8
c.
A photocopy of an Employee Information Report (FormAA302) provided by the Division and distributed
to the public agency to be completed by the contractor, in accordance with N.J.A.C. 17:27-4.
The Respondents attention is also called to Exhibit A and Exhibit B of this document, which contains the required
information and forms.
7.5 Business Registration Certificate
P.L. 2004, c. 57 (Chapter 57) amends and supplements the business registration provisions of N.J.S.A.
52:32-44 which impose certain requirements upon a business competing for or entering into a contract with a
local contracting agency whose contracting activities are subject to the requirements of the Local Public
Contracts Law (N.J.S.A. 40A:11-1 et seq.).
Consultants are required to comply with the requirements of P.L. 2004, c. 57 (Chapter 57) which include
submitting a copy of their Business Registration Certificate (BRC), issued by the NJ Department of the
Treasury.
7.6 Indemnification
The Vendor, if awarded the contract, agrees to protect, defend, indemnify and save harmless the City against
damage for payment for the use of any patented material, process, article or device that may enter into the
manufacture, construction or form a part of the work covered by either order or contract, and further agrees to
indemnify and save harmless the City from suits or actions of every nature and description brought against it
for, or on account of, any injuries or damages received or sustained by any party or parties by, or from, any
of the acts of the contractor, its servants or agents.
7.7 Termination
Should a dispute arise, and if, after a good faith effort at resolution, the dispute is not resolved, either party
may terminate the contract by providing 30 days written notice to the other party. Notwithstanding the
foregoing, the City reserves the right to cancel the contract at its convenience by providing 30 days written notice
to the Consultant.
RFP: Finance and Water and Sewer Utility Consultant
Due Date: January 11, 2024
Page 9
SECTION 8: REQUIRED ADMINISTRATIVE FORMS
Please place the checklist and the required forms which follow at the front of your proposal to facilitate review
CITY OF ORANGE TOWNSHIP
PROJECT:
Finance and Water and Sewer Utility Consultant
RESPONDENT:
____________________________________
RESPONDENTS CHECKLIST
Item
Respondent Initials
Purchasing Review
A. Qualification Statement
B. Non-Conclusion Affidavit properly notarized
C. Public Disclosure Statement
D. Mandatory Affirmative Action Language
E. Americans with Disability Act
F. Affirmative Action Compliance Notice
G. Employee Information Report
H. Business Registration Certificate
I.
Original signature(s) on all required forms
J.
Certification of Compliance with State Pay-to Play
K. Political Contribution Disclosure
L. Mandatory Equal Employment Opportunity Statement
M. One signed original and five (5) copies of their proposal
N. Authorized signatures on all documents (and notarized,
as applicable)
`NON-COLLUSION AFFIDAVIT
STATE OF NEW JERSEY
:
COUNTY OF : ss.
I, , on behalf of the firm of , upon my
oath or affirmation, hereby depose and say:
1.
That I executed the documents submitted herein with full authority so to do;
2.
That neither I nor the firm has directly or indirectly entered into any Agreement, participated in any collusion, or
otherwise taken any action in restraint of fair and open competition in connection with this contract;
3.
That all statements contained in the documents submitted herewith, and in this Affidavit are true and correct, and made
with full knowledge that the City of Orange Township will rely upon the truth of the statements contained therein in
making determinations regarding award of this contract; and,
4.
That no person or selling agency has been employed to solicit or secure this engagement agreement or understanding for
a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial
selling agencies of the proposer. See N.J.S.A. 52:34-25.
The undersigned hereby acknowledges the above listed requirements.
For
(Individual or Firm Name)
By:
(Signature)
(Date)
(Printed Name)
(Title)
Sworn before me on this day of , 202__.
Notary Public
(NOTE: THIS FORM MUST BE COMPLETED, NOTARIZED AND RETURNED WITH THIS PROPOSAL)
.
PUBLIC DISCLOSURE INFORMATION
Chapter 33 of the Public Laws of 1977 provides that no Corporation or Partnership shall be awarded any State, City,
Municipal or Schools District contracts for the performance of any work or the furnishing of any materials or
supplies, unless prior to the receipt of the bid or accompanying the bid of said corporation or partnership there
is submitted a public disclosure information statement. The statement shall set forth the names and addresses of all
stockholders in the corporation or partnership who own ten percent (10%) or more of its stock of any class, or of
all individual partners in the partnership who own a ten percent (I 0%) or greater interest therein.
STOCKHOLDERS:
Name
Address
% owned
SIGNATURE: _______________________________________________________________________
TITLE: ______________________________________________________________________________
SUBSCRIBED AND SWORN TO
BEFORE ME THIS DAY ____________________ of 202____
(TYPE OR PRINT NAME OF AFFIANT UNDER SIGNATURE)
NOTARY PUBLIC OF
MY COMMISSION EXPIRES: 202___
(NOTE: THIS FORM MUST BE COMPLETED, NOTARIZED AND RETURNED WITH THIS PROPOSAL).
EXHIBIT A
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L.1975, c.127); N.J.A.C. 17:27
Goods, Professional Service and General Service Contracts
During the performance of this contract, ,
(“contractor”
or
“subcontractor”,
as
appropriate), agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment
because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or
expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or
expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and
employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin,
ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal
employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer;
recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination
clause.
The contractor or subcontractor, where applicable, will, in all solicitations or advertisements for employees placed by or on behalf
of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed,
color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality
or sex.
The contractor or subcontractor, where applicable, will send to each labor union or representative or workers with which it has a
collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer
advising the labor union or workers' representative of the contractor's commitments under this act and shall post copies of the
notice in conspicuous places available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to
N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to employ minority and women workers consistent with the
applicable county employment goals established in accordance with N.J.A.C. l7:27-5.2.
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to,
employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age,
creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability,
nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory
practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing
conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey
and as established by applicable Federal law and applicable Federal court decisions.
In conforming with the applicable employment goals, the contractor or subcontractor agrees to review all procedures relating to
transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, creed, color, national
origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex,
consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal
court decisions.
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE (cont’d)
N.J.S.A. 10:5-31 et seq. (P.L.1975, c.127); N.J.A.C. 17:27
The contractor or subcontractor shall submit to the public agency, after notification of award but prior to execution of a goods and
services contract, 1 of the following 3 documents:
1. Federal Letter of Approval of Equal Employment Opportunity Policies;
2. Certificate of Employee Information Report; or,
3. Completed Employee Information Report Form AA302.
Goods, Professional Service and General Service Contracts
The contractor or subcontractor shall furnish such reports or other documents to the City as may be requested from time to
time in order to carry out the purposes of these regulations, and the City may furnish such information as may be requested by
the New Jersey Division of Purchase & Property, Contract Compliance Administration Unit, EEO Monitoring Program for
purposes of conducting a compliance investigation pursuant to N.J.A.C. 17:27-10 et seq.
The undersigned hereby acknowledges the above listed requirements.
For
(Individual or Firm Name)
By:
(Signature)
(Date)
(Printed Name)
(Title)
Tel No.:_______________________________________________
REQUIRED EVIDENCE
AFFIRMATIVE ACTION REGULATIONS
P.L. 1975, C. 127 (N.J.A.C. 17:27-3.2)
Before being awarded a contract, bidders are required to comply with the requirements of P.L. 1975, C.127,
(N.J.A.C. 17:27-3.2). Within seven (7) days after receipt of the notification of intent to award the contract or receipt
of the contract, whichever is sooner, the contractor should present one of the following to the Contact Person:
1.
A photocopy of a valid letter from the U.S. Department of Labor that the contractor has an existing federally-
approved or sanctioned Affirmative Action Plan (good for one year from the date of the letter);
OR
2.
A photocopy of approved Certificate of Employee Information Report issued in accordance w ith N.J.A.C.
17:24-4;
OR
3.
An initial Employee Information Report (Form AA302) provided by the Affirmative Action Office and
completed by the bidder in accordance with N.J.A.C.17:27-4;
OR
4.
All successful construction contractors must submit within three days of the signing of the contract
an Initial Project Workforce Report (AA201) for any contract award that meets or exceeds the Public Agency
bidding threshold (available upon request) in accordance with N.J.A.C.17:27-7.
NO FIRM MAY BE ISSUED A CONTRACT UNLESS IT COMPLIES WITH THE AFFIRMATIVE ACTION
REGULATIONS OF P.L. 1975, C.127.
The following questions must be answered by all bidders:
1.
Do you have a federally-approved or sanctioned Affirmative Action Program?
Yes
No
If yes, please submit a copy of such approval
2.
Do you have a Certificate of Employee Information Report Approval?
Yes
No
If yes, please submit a copy of such certificate
The undersigned contractor certifies that he is aware of the commitment to comply with the requirements
of P.L. 1975, C.127 and agrees to furnish the required documentation pursuant to the law.
Company:
Signature: _______________________
Title:
AMERICANS WITH DISABILITIES ACT OF
Equal Opportunity for Individuals with Disability
The contractor and the
of (hereafter "owner") do hereby agree that the provisions of Tile11
of the Americans With Disabilities Act of 1990 (the "Act") (42 U.S.C. S121 01 et seq.), which prohibits
discrimination on the basis of disability by public entities in all services, programs, and activities provided or made
available by public entities, and the rules and regulations promulgated pursuant there unto, are made part of this
contract. In providing any aid, benefit, or service on behalf of the owner pursuant to this contract, thec6ntractor agrees
that the performances shall be in strict compliance with the Act. In the event that the contractor, its agents, servants,
employees, or subcontractors violates or are alleged to have violated the Act during the performance of this contract, the
contractor shall defend the owner in any action or administrative proceeding commenced pursuant to this Act. The
contractor shall indemnify, protect, and save harmless the owner, its agents, servants, and employees from and against
any and all suits, claims, losses, demands, or damages, of whatever kind or nature arising out of or claimed to arise
out of the alleged violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for
legal services and any and all costs and other expenses arising from such action or admlnistrati.ve proceeding or
incurred in connection therewith. In any and all complaints brought pursuant to the owner's grievance procedure, the
contractor agrees to abide by any decision of the owner which is rendered pursuant to said grievance procedure. If
any action or administrative proceeding results in an award of damages against the owner, or if the owner incurs any
expenses to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor
shall satisfy and discharge the same at its own expense.
The owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the
contractor along with full and complete particulars of the claim. If any action or administrative proceeding is brought
against the owner or any of its agents, servants and employees, the owner shall expeditiously forward or have
forwarded to the contractor every demand, complaint, notice summons, pleading, or other process received by the
owner or its representatives.
It is expressly agreed and understood that any approval by the owner of the services provided by the contractor
pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend,
indemnify, protect,1and save harmless the owner pursuant to this paragraph:
It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless the contractor, its
agents, servants, employees and subcontractors for any claim which may arise out of their performance of this
Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification shall
in no-way limit the contractor's obligations assumed in this Agreement, nor shall they .be construed to relieve the contractor
from any liability nor preclude the owner from taking any other actions available to it under any other provisions of
the Agreement or otherwise at law.
Representative Name/Title Print ______________________________________
Representative’s Signature: __________________________________________
Name of Company: ________________________________________________
Telephone No.: ___________________________________________________
EXHIBIT B
BUSINESS REGISTRATION CERTIFICATE (BRC)
CERTIFICATE OF REGISTRATION
(P.L. 1999, C.238)
To:
PROSPECTIVE BIDDERS
Re:
NEW JERSEY BUSINESS REGISTRATION CERTIFICATE
I.
Pursuant to P.L. 1999, c.238, et al., specifically, P.L. 2003, c.91, N.J.S.A. 34:11-56.51,
all Bidders are required to be registered by the New Jersey Department of Labor at the time bids
are received by the Project Owner pursuant to the Public Works Contractor Registration Act. *
II.
No bidder shall list a subcontractor in a Bid Proposal for the contract unless the
subcontractor is registered pursuant to P.L. 1999, c. 238 at the time of bid is made.
III.
No contractor or subcontractor shall engage in the performance of any public work subject
to the contract, unless the contractor or subcontractor is registered pursuant to the Act.
IV.
Each contractor shall, after the bid is made and prior to the award of the contract, submit
to the Project Owner the certificates of registration for the bidder and all subcontractors listed in
the Bid Proposal.
*Any bidder who is not registered pursuant to the Act at the time bids are received
shall be automatically disqualified and the bid shall be rejected.
Renewal Package
for
Certificate
of
Employee
Information Report
State of New Jersey
DEPARTMENT OF THE TREASURY DIVISION
CHRIS OF PURCHASE & PROPERTY CONTRACT ANDREW P.SIDAMON-ERISTOFF
CHRISTIE COMPLIANCE AUDIT UNIT EEO MONITORING State Treasurer
Governor PROGRAM
KIM GUADAGNO P.O. BOX 206
Lt. Governor TRENTON, NJ 08620-0206
ISSUANCE OF CERTIFICATE OF
EMPLOYEE INFORMATION REPORT
Enclosed is your Certificate of Employee Information Report (hereinafter referred to as
the ''Certificate" and issued based on the Employee Information Report {AA-302) form
completed by a representative of your company or firm. Immediately upon receipt, this certificate
should be forwarded to the" person in your company or firm responsible for ensuring equal
employment opportunity and/or overseeing the company or firm's contracts with public agencies.
Typically, this person may be your company or firm's Human Resources Manager, Equal
Employment Opportunity Officer or Contract Administrator. If you do not know to whom the
certificate should be forward, kindly forward it to the head of your company or firm. Copies
of the certificate should also be distributed to all facilities of your company or firm who engage
in bidding on public contracts in New Jersey and who use the same federal identification number
and company name. The certificate should be retained in your records until the date it expires. This
is very important since a request for a duplicate/replacement certificate will result in a $75.00
fee.
On future successful bids on public contracts, your company or firm must present a
photocopy of the certificate to the public agency awarding the contract after notification of the
award but prior to execution of a goods and services or professional services contract. Failure to
present the certificate within the time limits prescribed may result in the awarded contract being
rescinded in accordance with N.J.A.C. 1727-4.Jb.
Please be advised that this certificate has been approved only for the time periods stated on
the certificate. As early as ninety (90) days prior to its expiration, the Division will forward
a renewal notification. Upon the Division's receipt of a properly completed renewal
application and $150.00 application fee, it will issue a renewal certificate. In addition,
representatives from the Division may conduct periodic visits
and/or request additional
information to monitor and evaluate the· continued equal employment opportunity compliance
of your company or firm. Moreover, the Division may provide your company or firm with
technical assistance, as required. Please be sure to notify the Division immediately if your
company's federal identification number, name or address changes.
If you have any questions, please call (609) 292-5473 and a representative will be
available to assist you.
Enclosure(s) (AA-01 Rev. 11/11)
INSTRUCTIONS FOR COMPLETING THE
EMPLOYEE INFORMATION REPORT (FORM AA302)
IMPORTANT: READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE
COMPLETING THE FORM. PRINT OR TYPE ALL INFORMATION. FAILURE TO
PROPERLY COMPLETE THE ENTIRE FORM AND TO SUBMIT THE REQUIRED $150.00
NON-REFUNDABLE FEE MAY DELAY ISSUANCE OF YOUR CERTIFICATE. IF YOU
HAVE A CURRENT CERTIFICATE OF EMPLOYEE INFORMATION REPORT, DO NOT
COMPLETE THIS FORM UNLESS YOUR ARE RENEWING A CERTIFICATE THAT IS
DUE FOR EXPIRATION. DO NOT COMPLETE THIS FORM FOR CONSTRUCTION
CONTRACT AWARDS.
ITEM 1 - Enter the Federal Identification Number assigned by the Internal Revenue Service,
or if a Federal Employer Identification Number has been applied for, or if your business is
such that you have not or will not receive a Federal Employer Identification Number, enter the
Social Security Number of the owner or of one partner, in the case of a partnership.
ITEM 2 - Check the box appropriate to your TYPE OF BUSINESS. If you are engaged in more
than one type of business check the predominate one. If you are a manufacturer deriving more
than 50% of your receipts from your own retail outlets, check "Retail".
ITEM 3 - Enter the total "number" of employees in the entire company, including part-time
employees. This number shall include all facilities in the entire firm or corporation.
ITEM 4 - Enter the name by which the company is identified. If there is more than one company
name, enter the predominate one.
ITEM 5 - Enter the physical location of the company. Include City, County, State and Zip
Code.
ITEM 6 - Enter the name of any parent or affiliated company including the City, County, State
and Zip Code. If there is none, so indicate by entering "None" or NIA.
ITEM 7 - Check the box appropriate to your type of company establishment. "Single-
establishment Employer" shall include an employer whose business is conducted at only one
physical location. "Multi-establishment Employer" shall include an employer whose business
is conducted at more than one location.
ITEM 8 - If "Multi-establishment" was entered in item 8, enter the number of establishments
within the State of New Jersey.
ITEM 9 - Enter the total number of employees at the establishment being awarded the contract.
ITEM 10 - Enter the name of the Public Agency awarding the contract. Include City, County,
State and Zip Code. This is not applicable if you are renewing a current Certificate.
ITEM 11 - Enter the appropriate figures on all lines and in all columns. THIS SHALL ONLY
INCLUDE EMPLOYMENT DATA FROM THE FACILITY THAT IS BEING AWARDED
THE CONTRACT. DO NOT list the same employee in more than one job category. DO NOT
attach an EEO-1 Report.
Racial/Ethnic Groups will be defined:
Black: Not of Hispanic origin. Persons having origin in any of the Black racial groups of Africa.
Hispanic: Persons of Mexican, Puerto Rican, Cuban, or Central or South American or other
Spanish culture or origin, regardless of race.
American Indian or Alaskan Native: Persons having origins in any of the original peoples
of North America, and who maintain cultural identification through tribal affiliation or
community recognition.
Asian or Pacific Islander: Persons having origin in any of the original peoples of the Far
East, Southeast Asia, the Indian Sub-continent or the Pacific Islands. This area includes for
example, China, Japan, Korea, the Philippine Islands and Samoa.
Non-Minority: Any Persons not identified in any of the aforementioned Racial/Ethnic Groups.
ITEM 12 - Check the appropriate box. If the race or ethnic group information was not obtained
by 1 or 2, specify by what other means this was done in 3.
ITEM 13 - Enter the dates of the payroll period used to prepare the employment data presented
in Item 12.
ITEM 14 - If this is the first time an Employee Information Report has been
submitted for this company, check block "Yes".
ITEM 15 - If the answer to Item 14 is "No", enter the date when the last Employee Information
Report was submitted by this company.
ITEM 16 - Print or type the name of the person completing the form. Include the signature,
title and date.
ITEM 17 - Enter the physical location where the form is being completed. Include City, State,
Zip Code and Phone Number.
TYPE OR PRINT IN SHARP BALL POINT PEN
THE VENDOR IS TO COMPLETE THE EMPLOYEE INFORMATION REPORT FORM
(AA302) AND RETAIN A COPY FOR THE VENDOR'S OWN FILES. THE VENDOR
SHOULD ALSO SUBMIT A COPY TO THE PUBLIC AGENCY AWARDING THE
CONTRACT IF THIS IS YOUR FIRST REPORT; AND FORWARD ONE COPY WITH
A CHECK IN THE AMOUNT OF $150.00 PAYABLE TO THE TREASURER,
STATE OF NEW JERSEY(FEE IS NON-REFUNDABLE) TO:
NJ Department of the Treasury
Division of Purchase & Property Contract Compliance
Audit Unit EEO Monitoring Program
P.O. Box206
Trenton, New Jersey 08625-0206
Telephone No. (609) 292-5473
BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To N.J.S.A. 19:44A-20.8
CITY OF ORANGE TOWNSHIP
Part I – Vendor Affirmation
The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that
______________________________________________________________________________________________
(Contractor)
has not made and will not make any reportable contributions pursuant to N.J.S.A. 19:44A-1 et seq. that, pursuant to P.L.
2004, c. 19 would bar the award of this contract in the one year period preceding _____________________________
(date of award scheduled for approval of the contract by the governing body) to any of the following named candidate
committee, joint candidates committee; or political party committee representing the elected officials of the City of
Orange Township as defined pursuant to N.J.S.A. 19:44A-3(p), (q) and (r).
Mayor Dwayne D. Warren
Jamie Summers-Johnson
Kerry J. Coley
Adrienne Wooten
Tency A. Eason
Quantavia L. Hilbert
Weldon M. Montague, III
Clifford R. Ross
Part II – Ownership Disclosure Certification
oI certify that the list below contains the names and home addresses of all owners holding 10% or more of the
issued and outstanding stock of the undersigned.
Check the box that represents the type of business entity:
oPartnership
oCorporationoSole Proprietorship
oSubchapter S Corporation
oLimited PartnershipoLimited Liability Corporation
oLimited Liability Partnership
Name of Stock or Shareholder
Home Address
Part 3 – Signature and Attestation:
The undersigned is fully aware that if I have misrepresented in whole or part this affirmation and
certification, I and/or the business entity, will be liable for any penalty permitted under law.
Name of Business Entity:
___________________________________________________________________
Signature of Affiant: __________________________________ Title: ________________________________
Printed Name of Affiant: ______________________________ Date: _______________________________
BUSINESS ENTITY DISCLOSURE CERTIFICATION (cont’d)
Subscribed and sworn before me this ___________
day of _________________, 202____.
My Commission expires:
_________________________________
(Witnessed or attested by)
________________________________
(Seal)
BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To N.J.S.A. 19:44A-20.8
CITY OF ORANGE TOWNSHIP
The following is statutory text related to the terms and citations used in the Business Entity Disclosure
Certification form.
“Local Unit Pay-To-Play Law” (P.L. 2004, c.19, as amended by P.L. 2005, c.51)
19:44A-20.6 Certain contributions deemed as contributions by business entity.
5. When a business entity is a natural person, a contribution by that person's spouse or child, residing therewith,
shall be deemed to be a contribution by the business entity. When a business entity is other than a natural person,
a contribution by any person or other business entity having an interest therein shall be deemed to be a
contribution by the business entity.
19:44A-20.7 Definitions relative to certain campaign contributions.
6. As used in sections 2 through 12 of this act:
“business entity" means any natural or legal person, business corporation, professional services corporation,
limited liability company, partnership, limited partnership, business trust, association or any other legal
commercial entity organized under the laws of this State or of any other state or foreign jurisdiction;
“interest" means the ownership or control of more than 10% of the profits or assets of a business entity or 10% of
the stock in the case of a business entity that is a corporation for profit, as appropriate;
Temporary and Executing
12. Nothing contained in this act shall be construed as affecting the eligibility of any business entity to perform a public
contract because that entity made a contribution to any committee during the one-year period immediately preceding
the effective date of this act.
~~~~~~~~~~~~~~~~~~~~~
The New Jersey Campaign Contributions and Expenditures Reporting Act (N.J.S.A. 19:44A-1 et seq.)
19:44A-3 Definitions. In pertinent part…
p. The term "political party committee" means the State committee of a political party, as organized pursuant to
R.S.19:5-4, any county committee of a political party, as organized pursuant to R.S.19:5-3, or any municipal
committee of a political party, as organized pursuant to R.S.19:5-2.
q. The term "candidate committee" means a committee established pursuant to subsection a. of section 9 of
P.L.1973, c.83 (C.19:44A-9) for the purpose of receiving contributions and making expenditures.
r. the term "joint candidates committee" means a committee established pursuant to subsection a. of section 9 of
P.L.1973, c.83 (C.19:44A-9) by at least two candidates for the same elective public offices in the same election in
a legislative district, county, municipality or school district, but not more candidates than the total number of the
same elective public offices to be filled in that election, for the purpose of receiving contributions and making
expenditures. For the purpose of this subsection: …; the offices of member of the board of chosen freeholders
and county executive shall be deemed to be the same elective public offices in a county; and the offices of mayor
and member of the municipal governing body shall be deemed to be the same elective public offices in a
municipality.
19:44A-8 and 16 Contributions, expenditures, reports, requirements.
While the provisions of this section are too extensive to reprint here, the following is deemed to be the pertinent
part affecting amounts of contributions:
“The $300 limit established in this subsection shall remain as stated in this subsection without further adjustment
by the commission in the manner prescribed by section 22 of P.L.1993, c.65 (C.19:44A-7.2)
BUSINESS OWNERSHIP DISCLOSURE
Pursuant to N.J.S.A. 52:25-24.2, the City of Orange Township (“City”) is prohibited from awarding a contract to any business
entity unless, the business entity provides the City with a statement setting forth the names and addresses of all individuals
with 10.00% or more ownership interest therein at the time of proposal.
A. Business Entity Name & Organization
Legal Name of Business Entity:
Type of Entity:
“C” Corporation
“S” Corporation
Limited Liability Company
General Partnership
Limited Partnership
Limited Liability Partnership
B. Ownership Information
No person or entity has 10.00% or greater ownership interest in the business entity.
Names and addresses for all persons or entities with at least 10.00% ownership interest in the business entity, along with
corresponding ownership interest percentages, are as follows (attach additional sheets as necessary):
Name
Address
Ownership %
If any owner identified above is a business entity list the names and addresses of all persons and/or entities owning at least
10.00% of each such entity, repeating this process until the names and addresses of all non-businesses owning at least
10.00% of the business and all related entities are disclosed (attach additional sheets as necessary):
Name
Address
Ownership %
If the business entity has a direct or indirect parent entity which is publicly traded, and any person holds a 10.00% or
greater beneficial interest in the publicly traded parent entity as of the last annual federal Security and Exchange
Commission (“SEC”) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s)
containing the last annual filing(s) with the SEC (or foreign equivalent) that contain the name and address of each person
holding a 10.00% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers
of the filing(s) that contain the information on each such person (attach additional sheets if necessary):
URL of Last Annual SEC (or foreign equivalent) Filing
Page #
BUSINESS OWNERSHIP DISCLOSURE CERTIFICATION (cont’d)
C. General Disclosures
The following questions must be answered as to the business entity and all parties identified in Part B above (“owner”). To the
extent the answer to any question is “yes”, a separate explanation identifying the relevant party(ies) and the circumstances
involved must be appended to this Disclosure.
Has the business or any owner been a party in litigation brought within the last 5 years involving laws
governing hours of labor, minimum wage standards, discrimination in wages or child labor?
Yes
No
Has the business or any owner ever been charged with, convicted of, under indictment, on parole, on
probation or a plaintiff in, any criminal or civil offense other than a minor motor vehicle violation?
Yes
No
Has the business or any owner ever been subject to, or have pending, any disciplinary action by any
administration, governmental or regulatory body?
Yes
No
Has the business or any owner ever been subject to any order resulting from any criminal, civil or
administrative proceeding brought by any administrative governmental, or regulatory agency?
Yes
No
Has the business or any owner ever been denied any license on the grounds of moral turpitude by any
administrative, governmental or regulatory agency?
Yes
No
Has the business or any owner been informed that it/he/she is the target of any current investigation with
respect to possible violations of state or federal securities, antitrust or criminal laws?
Yes
No
Has the business or any owner ever been denied a business-related license or had any such license
suspended or revoked by any administrative, governmental or regulatory agency?
Yes
No
Has the business or any owner ever been debarred, suspended or disqualified from contracting with any
federal, state or municipal agency?
Yes
No
Has the business or any owner ever been in receivership or adjudicated bankrupt?
Yes
No
Has the business or any owner ever been in default on a personal or business loan?
Yes
No
D. Certification
I hereby certify that the foregoing information and any attachments hereto are true and complete. I acknowledge that: (a) I am
authorized to execute this certification on behalf of the business entity and all parties listed in Parts A and B above; (b) the City
will rely on the information contained herein and the business and all owners are under a continuing obligation to notify the
City in writing of any changes to the information contained herein; and, (c) I am aware that it is a criminal offense to make a
false statement or misrepresentation in this certification, and if I do, the City will reject this submission and I may be subject
to prosecution.
For
(Individual or Firm Name)
By:
(Signature)
(Date)
(Printed Name)
(Title)
POLITICAL CONTRIBUTION DISCLOSURE
Pursuant to N.J.S.A. 19:44A-20.26, this form must be submitted not later than 10 days prior to the award of any contract with
the City of Orange Township (“City”) that may have an anticipated value exceeding $17,500.00.
A. Instructions
All persons and business entities contracting with the City must disclose contributions to:
1.
any continuing political committee (i.e., political action committee); and/or,
2.
any candidate committee of a candidate for, or holder of, an elective office of the City,
the County of Essex, another public entity within the County of Essex, and/or the
legislative district where the City is located, (see Part B below).
The disclosure must list reportable contributions to any of the committees that exceed $200.00 per election cycle, made during
the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8; N.J.S.A. 19:44A-16. For business entities, this
requirement applies to:
•
individuals with an ownership interest or control of more than 10.00% of the profits
or assets of the business entity;
•
all principals, partners, officers, or directors of the business entity and their respective
spouses;
•
any subsidiaries directly or indirectly controlled by the business entity;
•
any New Jersey-based IRS Code § 527 organization, directly or indirectly controlled
by the business entity and filing as a continuing political committee (i.e., PAC).
When the contractor is a natural person, “a contribution by that person’s spouse or child, residing therewith, shall be deemed
to be a contribution [by the contractor].” N.J.S.A. 19:44A-20.26(b).
Any contractor that fails to comply with these disclosure provisions shall be subject to a fine imposed by the New Jersey
Election Law Enforcement Commission in an amount based upon the amount that the contractor failed to report.
The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official
and/or candidate campaign committees are affected by the disclosure requirement. It is the contractor’s responsibility to
identify the specific committees to which contributions may have been made and need to be disclosed. The disclosed
information may exceed the minimum requirement.
The enclosed form, a content-consistent facsimile, or an electronic data file containing the required details (along with a signed
cover sheet) may be used as the contractor’s submission and is disclosable to the public under the Open Public Records Act,
N.J.S.A. 47:1A-1 et seq.
B. List of Agencies & Elected Officials Required for Disclosure
State:
Governor, and Legislative Leadership Committees
Legislative Districts:
21, 27, 28, 29, 34, 36, and 40
1 State Senator and 2 members of the General Assembly per district
County:
County Executive; Commissioners; County Clerk; Sheriff; Surrogate; Registrar of Deeds
Municipalities (mayor and members of governing body, regardless of title):
Belleville Township
Irvington Township
City of Orange Township
Bloomfield Township
Livingston Township
Roseland Borough
Caldwell Borough
Maplewood Township
South Orange Village
Cedar Grove Township
Millburn Township
Verona Township
City of East Orange
Montclair Township
West Caldwell Township
Essex Fells Borough
City of Newark
West Orange Township
Fairfield Township
North Caldwell Borough
Glen Ridge Borough
Nutley Township
[CONTINUED ON NEXT PAGE]
POLITICAL CONTRIBUTION DISCLOSURE (cont’d)
B. List of Agencies & Elected Officials Required for Disclosure (cont’d)
Boards of Education (members of the board):
Belleville Public School District
Irvington Public School District
Roseland Public School District
Bloomfield Public School District
Livingston Public School District
South Orange-Maplewood PSD
Caldwell-West Caldwell PSD
Millburn Public School District
Verona Public School District
Cedar Grove Public School District
Newark Public School District
West Essex Regional PSD
Essex Fells Public School District
North Caldwell Public School District
West Orange Public School District
Fairfield Public School District
Nutley Public School District
Glen Ridge Public School District
Orange Public School District
C. Contractor Information
Legal Name of Business Entity:
Address:
D. Reportable Contribution Disclosure
Pursuant to N.J.S.A. 19:44A-20.26, this disclosure must include all reportable political contributions (more than $200.00 per
election cycle) over the 12 months prior to submission (attach additional sheets as necessary).
No reportable contributions.
Contributor
Recipient
Date
Amount
E. Certification
The undersigned, being authorized, hereby certifies that the submission provided herein complies with the provisions of
N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form.
By:
(Signature)
(Date)
(Printed Name)
(Title)
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Business Administrator · Finance Department
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Mar 31, 2026
Last Info Update
Apr 30, 2026
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