Start your 7-day free trial — unlock full access instantly.

Lead Closed

This opportunity is no longer accepting submissions.

City of OrangeGreen Risk

ClosedGeneral

Request for Qualifications-Legislative Research Officer-2024 - Revised

BID #: 21

ISSUED: 11/22/2023

DUE: 12/7/2023

VALUE: TBD

100

Rating

Risk Rank

Green Risk

AI-Powered Lead Insights

Executive Summary

The City of Orange Township is seeking Qualification Statements from interested parties to provide Legislative Research Officer Services to the Orange Municipal Council. The selected candidate or firm will work under compensation terms determined by the City and the contract term will not exceed one year from the award date. Qualification Statements must demonstrate the professional, financial, and administrative capabilities to provide the services. Respondents must have at least 10 years of experience in municipal law and knowledge of Title 40 and 40A of New Jersey. An original and five copies of the Qualification Statement must be submitted by mail or hand-delivered to the City Attorney by December 7, 2023, at 11:00 a.m. Facsimile or email submissions will not be accepted. The City Attorney will review Qualification Statements to determine if the Respondent has met the minimum professional, administrative, and financial requirements.

Web Content

Bid Postings • Request for Qualifications-Legislative Resear
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:
Request for Qualifications-Legislative Research Officer-2024 - Revised
Category:
Bids and Request for Qualification (RFQs)
Status:
Closed
Description:
INTRODUCTION AND GENERAL INFORMATION
1.1.
Introduction and Purpose.
The City is soliciting Qualification Statements from interested persons and/or firms for the provision of services, as more particularly described herein.  Through a Request for Qualification process described herein, persons and/or firms interested in assisting the City with the provision of such services must prepare and submit a Qualification Statement in accordance with the procedure and schedule in this RFQ.  The City will review Qualification Statements only from those persons and/or firms that submit a Qualification Statement which includes all the information required to be included as described herein (in the sole judgment of the City).
The City intends to qualify person(s) and/or firm(s) that (a) possesses the professional, financial and administrative capabilities to provide the proposed services, and (b) will agree to work under the compensation terms and conditions determined by the City to provide the greatest benefit to the taxpayers of the City.
Publication Date/Time:
11/22/2023 12:00 AM
Closing Date/Time:
12/7/2023 11:59 PM
Contact Person:
Gracia Robert Montilus
City Attorney
The City of Orange Township
29 North Day Street
Orange, New Jersey 07050
(973) 952-6095
Qualifications:
SUBMISSION REQUIREMENTS
3.0.	Minimum Qualifications:
Minimum Qualifications and Response Requirements
In order for an individual’s or firm’s proposal to be considered by the City, interested parties submitting proposals in response to this solicitation must meet the following:
Must have at least 10 years of experience in all phases of municipal law and extensive knowledge experience in the application of Title 40 and 40A of New Jersey;
3.1.	General Requirements.
The Qualification Statement submitted by the Respondent must meet or exceed the professional, administrative and financial qualifications set forth in this Section 3 and shall incorporate the information requested below.
In addition to the information required as described below, a Respondent may submit supplemental information that it feels may be useful in evaluating its Qualification Statement. Respondents are encouraged to be clear, factual, and concise in their presentation of information.
3.2.	Administrative Information Requirements.
All statements of qualifications and proposals for this RFQ shall include at a minimum the following information:
Names of the individuals who will perform the required tasks;
Identify the person who will be primarily responsible for these services required by the City of Orange Township;
Identify persons who will serve as backup to the primary person.  Attach a resume of both the primary and backup contact persons.
List of references;
Provide the names and addresses and telephone numbers of persons who can verify your experience and record of success.
Ability to provide services in a timely manner;
Describe staffing;
Describe familiarity with the services required in the City of Orange Township;
Identify the business address of the key staff that will be responsible for providing services under the contract.
Whether or not the respondent has any disciplinary matters pending or has had a suspension of license. If so, provide an explanation concerning the disciplinary matter and/or suspension.
Certification that the respondent is not currently suspended from the practice of law.
Respondent shall provide a brief description of any conflicts of interests.
SECTION 4
INSTRUCTIONS TO RESPONDENTS
Submission of Qualification Statements.
Respondents must submit an original and five (5) copies of their Qualification Statement to the Designated Contact Person:
Qualification Statements must be received by the City no later than November 16, 2023 December 7, 2023 at 11:00 a.m., and must be mailed or hand-delivered. Qualification Statements forwarded by facsimile or e-mail will not be accepted.
To be responsive, Qualification Statements must provide all requested information, and must be in strict conformance with the instructions set forth herein. Qualification Statements and all related information must be bound, and signed and acknowledged by the Respondent.
Related Documents:
Request for Qualifications-Legislative Research Officer-2024-revised
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: Request for Qualifications-Legislative Research Officer-2024-revised ---
1
REQUEST FOR QUALIFICATIONS
LEGISLATIVE RESEARCH OFFICER 
FOR THE CITY OF ORANGE TOWNSHIP
ORANGE MUNICIPAL COUNCIL
CITY OF ORANGE TOWNSHIP
SUBMISSION DEADLINE
11:00 A.M.
November 16, 2023
December 7, 2023
ADDRESS ALL QUALIFICATIONS STATEMENTS TO:
Gracia Robert Montilus
City Attorney
The City of Orange Township
29 North Day Street
Orange, New Jersey 07050
(973) 952-6095


2
GENERAL INFORMATION & SUMMARY
ORGANIZATION REQUESTING PROPOSAL
The City of Orange Township
29 North Day Street
Orange, New Jersey 07050
CONTACT PERSON
Gracia Robert Montilus
City Attorney
City of Orange Township
29 North Day Street
Orange, New Jersey 07050
(973) 952-6115
PURPOSE OF REQUEST
The City of Orange Township (hereafter the “City”) is requesting proposals from qualified
individuals and firms to provide Legislative Research Officer Services for the Orange
Municipal Council.  Proposals will be evaluated in accordance with the criteria set forth in
this Request for Qualifications (RFQ).  If selected, the governing body will approve a
resolution listing the individual and/or firms as Legislative Research Officer based on an
hourly rate of compensation established by the City of Orange.  The contract term will
not exceed one (1) year from the date of the award.
FORM AS TO SELECTION
If selected to provide services, the successful Respondent shall be forwarded a letter of
engagement that shall be binding on the Respondent and/or Respondent’s firm, which
includes indemnification, insurance, termination and licensing provisions.  It is also agreed
and understood that the acceptance of the representation shall be considered a release in full
of all claims against the City arising out of, or by reason of, the work done and materials
furnished under this award.


3
DETAILED REQUIREMENTS OF THE
REQUEST FOR QUALIFICATIONS FOR
LEGISLATIVE RESEARCH OFFICER
GLOSSARY
The following definitions shall apply to and are used in this Request for Qualifications
(RFQ): 
"City" - refers to the City of Orange Township Municipal government.
"Qualification Statement" - refers to the complete responses to this RFQ submitted by the
Respondents. 
"Qualified Respondent" - refers to those Respondents who (in the sole judgment of the City)
have satisfied the qualification criteria set forth in this RFQ. 
"RFQ" - refers to this Request for Qualifications, including any amendments thereof or
supplements thereto. 
"Respondent" or "Respondents" - refers to the interested persons and/or firm(s) that submit
a Qualification Statement. 
SECTION 1
INTRODUCTION AND GENERAL INFORMATION
1.1.
Introduction and Purpose.
The City is soliciting Qualification Statements from interested persons and/or firms for the
provision of services, as more particularly described herein.  Through a Request for
Qualification process described herein, persons and/or firms interested in assisting the City
with the provision of such services must prepare and submit a Qualification Statement in
accordance with the procedure and schedule in this RFQ.  The City will review Qualification
Statements only from those persons and/or firms that submit a Qualification Statement
which includes all the information required to be included as described herein (in the sole
judgment of the City).
The City intends to qualify person(s) and/or firm(s) that (a) possesses the professional,
financial and administrative capabilities to provide the proposed services, and (b) will agree
to work under the compensation terms and conditions determined by the City to provide the
greatest benefit to the taxpayers of the City. 
1.2.
Procurement Process and Schedule.


4
The selection is in accordance with the "New Jersey Local Unit Pay-to-Play" Law and
municipal ordinances establishing the “pay-to-play” criteria.  The City has structured a
procurement process that seeks to obtain the desired results described above, while
establishing a competitive fair and open process to assure that each person and/or firm is
provided an equal opportunity to submit a Qualification Statement in response to the RFQ.
Qualification Statements will be evaluated in accordance with the criteria set forth in
Section 2 of this RFQ, which will be applied in the same manner to each Qualification
Statement received. 
Qualification Statements will be reviewed and evaluated by the City Attorney.  The
Qualification Statements will be reviewed to determine if the Respondent has met the
minimum professional, administrative and financial areas described in this RFQ.  Based
upon the totality of the information contained in the Qualification Statement, including
information about the reputation and experience of each Respondent, the members of the
City Council in consultation with the City Attorney will determine which Respondents are
qualified (professionally, administratively and financially).
The RFQ process commences with the issuance of this RFQ.  The steps involved in the
process and the anticipated completion dates are set forth in Table 1, Procurement Schedule.
The City reserves the right to, among other things, amend, modify or alter the Procurement
Schedule upon notice to potential Respondents. 
All communications concerning this RFQ or the RFQ process shall be directed to the City's
Designated Contact Person, in writing. 
Qualification Statements must be submitted to, and be received by, the Office of the City
Attorney via mail or hand delivery, by 11:00 a.m. on November 16, 2023 December 7, 2023
at 11:00 a.m. Qualification Statements will not be accepted by facsimile or e-mail
transmissions.
Subsequent to issuance of this RFQ, the City (through the issuance of addenda to all persons and/or
firms that have received a copy of the RFQ) may modify, supplement or amend the provisions of
this RFQ in order to respond to inquiries received from prospective Respondents or as otherwise
deemed necessary or appropriate by (and in the sole judgment of) the City. 


5
TABLE 1
ANTICIPATED PROCUREMENT SCHEDULE
ACTIVITY DATE
1.1. 
Issuance of Request for Qualifications: November 22, 2023.
1.2. 
Receipt of Qualification Statements: November 16, 2023 December 7, 2023.
1.3.
Conditions Applicable to RFQ.
Upon submission of a Qualification Statement in response to this RFQ, the Respondent
acknowledges and consents to the following conditions relative to the submission and
review and consideration of its Qualification Statement: 
*
This document is a RFQ and does not constitute a Request for Proposals (RFP).
*   
This RFQ does not commit the City to issue an RFP.
*  
All costs incurred by the Respondent in connection with responding to this RFQ
shall be borne solely by the Respondent. 
*
The City reserves the right (in its sole judgment) to reject for any reason any and
all responses and components thereof and to eliminate any and all Respondents
responding to this RFQ from further consideration for this procurement. 
*
The City reserves the right (in its sole judgment) to reject any Respondent that
submits incomplete responses to this RFQ, or a Qualification Statement that is not
responsive to the requirements of this RFQ. 
*
The City reserves the right, without prior notice, to supplement, amend, or
otherwise modify this RFQ, or otherwise request additional information.
*  
All Qualification Statements shall become the property of the City and will not be
returned. 
* 
All Qualification Statements will be made available to the public at the appropriate
time, as determined by the City (in the exercise of its sole discretion) in accordance
with law. 
*
The City may request Respondents to send representatives to the City for
interviews.
*
Any and all Qualification Statements not received by the City Attorney by 11:00
a.m. on November 16, 2023 December 7, 2023, will be rejected.
*
Neither the City, nor its officers, officials or employees shall be liable for any
claims or damages resulting from the solicitation or preparation of the Qualification
Statement, nor will there be any reimbursement to Respondents for the cost of


6
preparing and submitting a Qualification Statement or for participating in this
procurement process. 
1.4.
Rights of City.
The City reserves, holds and may exercise, at its sole discretion, the following rights and
options with regard to this RFQ and the procurement process in accordance with the
provisions of applicable law: 
*
To determine that any Qualification Statement received complies or fails to comply
with the terms of this RFQ.
*
To supplement, amend or otherwise modify the RFQ through issuance of addenda
to all prospective Respondents who have received a copy of this RFQ. 
*
To waive any technical non-conformance with the terms of this RFQ.
*  
To change or alter the schedule for any events called for in this RFQ upon the
issuance of notice to all prospective Respondents who have received a copy of this
RFQ.
*
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
Qualification Statement and to request additional information to support the
information included in any Qualification Statement. 
*  
To suspend or terminate the procurement process described in this RFQ 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.
*
The City shall be under no obligation to complete all or any portion of the
procurement process described in this RFQ.
1.5.
Addenda or Amendments to RFQ.
During the period provided for the preparation of responses to the RFQ, the City
may issue addenda, amendments or answers to written inquiries. Those addenda will be
noticed by the City and will constitute a part of the RFQ. All responses to the RFQ shall be
prepared with full consideration of the addenda issued prior to the Qualification Statement
submission date. 
1.6.
Cost of Qualification Statement Preparation.
Each Qualification Statement and all information required to be submitted pursuant
to the RFQ 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 Qualification
Statement or other information required by the RFQ. 


7
1.7.
Qualification Statement Format.
Qualification Statements must cover all information requested in this RFQ.
Qualification Statements which in the judgment of the City fail to meet the requirements of
the RFQ or which are in any way conditional, incomplete, obscure, contain additions or
deletions from requested information, or contain errors may be rejected. 
SECTION 2
SCOPE OF SERVICES
It is the intent of the City to solicit Qualification Statements from Respondents that have
expertise in the provision of Legislative Research Services to the Orange Municipal Council
as described below and as set forth in the attached Notice of Solicitation for Responses.
Respondents must demonstrate that they will have the continuing capabilities to perform
these services. 
The City is seeking an individual or firm that will provide Legislative Research Services to
the Orange Municipal Council as directed by the City Council in accordance with municipal
ordinance.
The Legislative Research Officer shall perform the duties set forth in the Orange Municipal
Code governing the Legislative Research Officer position.  
SECTION 3
SUBMISSION REQUIREMENTS
3.0.
Minimum Qualifications:
Minimum Qualifications and Response Requirements
In order for an individual’s or firm’s proposal to be considered by the City, interested parties
submitting proposals in response to this solicitation must meet the following:
A.
Must have at least 10 years of experience in all phases of municipal law and
extensive knowledge experience in the application of Title 40 and 40A of New
Jersey;
3.1.
General Requirements.
The Qualification Statement submitted by the Respondent must meet or exceed the
professional, administrative and financial qualifications set forth in this Section 3 and shall
incorporate the information requested below. 
In addition to the information required as described below, a Respondent may submit
supplemental information that it feels may be useful in evaluating its Qualification


8
Statement. Respondents are encouraged to be clear, factual, and concise in their presentation
of information. 
3.2.
Administrative Information Requirements.
All statements of qualifications and proposals for this RFQ shall include at a minimum the
following information:
1.
Names of the individuals who will perform the required tasks;
a.
Identify the person who will be primarily responsible for these services required by
the City of Orange Township;
b. Identify persons who will serve as backup to the primary person.  Attach a resume
of both the primary and backup contact persons.
2.
List of references;
a.
Provide the names and addresses and telephone numbers of persons who can verify
your experience and record of success.
3.
Ability to provide services in a timely manner;
a.
Describe staffing;
b. Describe familiarity with the services required in the City of Orange Township;
c.
Identify the business address of the key staff that will be responsible for providing
services under the contract.
4.
Whether or not the respondent has any disciplinary matters pending or has had a
suspension of license. If so, provide an explanation concerning the disciplinary matter
and/or suspension.
5.
Certification that the respondent is not currently suspended from the practice of law.
6.
Respondent shall provide a brief description of any conflicts of interests.
SECTION 4
INSTRUCTIONS TO RESPONDENTS
Submission of Qualification Statements.
Respondents must submit an original and five (5) copies of their Qualification Statement
to the Designated Contact Person: 


9
Qualification Statements must be received by the City no later than November 16, 2023
December 7, 2023 at 11:00 a.m., and must be mailed or hand-delivered. Qualification
Statements forwarded by facsimile or e-mail will not be accepted.
To be responsive, Qualification Statements must provide all requested information, and
must be in strict conformance with the instructions set forth herein. Qualification Statements
and all related information must be bound, and signed and acknowledged by the
Respondent. 
SECTION 5
EVALUATION
The City's objective in soliciting Qualification Statements is to enable it to select a
Respondent that will provide high quality and cost effective services to the citizens of
Orange. The City will consider Qualification Statements 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 RFQ. 
Qualification statements will be evaluated by the City on the basis of which is most
advantageous, experience and other factors considered. The evaluation will consider: 
1. 
Experience and reputation in the field; and
2. 
Knowledge of the municipal corporations; and
3. 
Availability to accommodate the required meetings of the City; and
4. 
Pertinent government experience; and
5. 
Other factors demonstrated to be in the best interest of the City.
The City will select the most advantageous Qualification Statements based on all of the
evaluation factors set forth in this RFQ. The City will make the award(s) that is in the best
interest of the City.
Each Qualification Statement must satisfy the objectives and requirements detailed in this
RFQ except as otherwise stated. Successful Respondents shall be determined by an
evaluation of the total content of the Qualification Statement submitted. The City reserves
the right to not select any of the Qualification Statements.
The City shall not be obligated to explain the results of the evaluation process to any
Respondent
SECTION 6
GENERAL TERMS AND CONDITIONS
1. 
The City reserves the right to reject any or all Qualification Statements, if
necessary, or to waive any informalities in the Qualification Statements, and, unless
otherwise  specified by the Respondent, to accept any item, items or services in the
Qualification statement should it be deemed in the best interest of the City to do so.


10
2. 
Each Qualification Statement must be signed by the person authorized to do so.
3. 
Qualification Statements may be hand delivered or mailed consistent with the
provisions of the legal notice to Respondents. In the case of mailed Qualification
Statements, the City assumes no responsibility for Qualification Statements
received after the designated date and time and will return late Qualification
Statements unopened. Qualification Statements will not be accepted by facsimile
or e-mail. 
4.
In accordance with Affirmative Action Law, P.L. 1975/ c.127 (N.J.A.C. 17:27) with
implementation of July 10, 1978, successful Respondents must agree to submit
individual employer certifications and numbers or complete Affirmative Action
employee information report (form AA-302). Also, during the period of
engagement, the contractor agrees as follows: (a) The contractor or subcontractor
where applicable, will not discriminate against any employee because of age, race,
creed, color, national origin, ancestry, marital status or affectional or sexual
orientation. The contractor will take affirmative action to ensure that such
applicants are recruited and employed and that employees are treated during
employment, without regard to their age, race, creed, color, national origin,
ancestry, marital status, sex or handicap. Such action 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 section for training, including apprenticeship. The contractor
agrees to post in conspicuous places, available to employees and applicants for
employment, notice to be provided by the Public Agency Compliance Officer
setting forth provisions of this nondiscrimination clause: (b) 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, sex or handicap; (c)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 worker's representative of the contractor's commitments under
this act and shall post copies of the notice; (d) the contractor or subcontractor, where
applicable, agrees to comply with any regulations promulgated by the treasurer
pursuant to the P.L. 1975, c.127, as amended and supplemented from time to time.
 5. 
No Respondent shall influence, or attempt to influence, or cause to be influenced,
any City officer or employee to use his/her official capacity in any manner which
might tend to impair the objectivity or independence of judgment of said officer or
employee. 
6. 
No Respondent shall cause or influence, or attempt to cause or influence, any City
officer or employee to use his/her official capacity to secure unwarranted privileges
or advantages for the proposer or any other person. 


11
7. 
Should any difference arise between the contracting parties as to the meaning or
intent of these instructions or specifications, the City Attorney’s decision shall be
final and conclusive. 
8. 
The City shall not be responsible for any expenditure of monies or other expenses
incurred by the Respondent in making its proposal. 
END OF GENERAL INSTRUCTIONS


12
ALL OF THE
FOLLOWING
DOCUMENTS
MUST BE
INCLUDED
WITH
PROPOSAL


13
CITY OF ORANGE TOWNSHIP
CHECKLIST
PROFESSIONAL SERVICE: Legislative Research Officer
SUBMISSION DATE: November 16, 2023 December 7, 2023  at 11:00 A.M.
The following items, as indicated below (x), shall be provided with the receipt of sealed submissions:
Bidder’s Affidavit  ……..…………………………………………
______________
Non-Collusion Affidavit  ……………………………….…………
______________
Disclosure of Ownership Form ………………………………….…
______________
Insurance Requirement Acknowledgement Form  ...………………
______________
Mandatory Equal Employment Opportunity Notice Acknowledgement … ______________
Copy of your Certificate of Employee Information Report …………….
______________
Copy of your Business Registration Certificate as issued by the State of New
Jersey, Department of Treasury, Division of Revenue  ……………
______________
Professional Service Entity Information Form  ……………………
______________
Qualification Submission Form ……………………………………
______________
Acknowledgement of Corrections, Additions or Deletions Form  …….… ______________
Statement of Indebtedness Form ………………………………………..
______________
Agreement for Payment of Commodity/Service Form …………..….……. ______________
Disclosure of Investment Activities in Iran…………..….….……………………. _______________
Letter of Intent ………………………………….…………………….…… ______________
Letter of Qualification ……………………………………..……..
______________
Business Entity Disclosure Certification ………………………………… ______________
Reminder:  Please submit one (1) original and five (5) copies of the sealed submission.


14
BIDDER’S AFFIDAVIT
STATE OF __________________________
COUNTY OF ________________________
__________________________________________ being duly sworn, deposes and says that he
resides at _____________________________________________________________________
_____________________________________________________________________________
and that he is the _____________________________________________________________________
(Title)
of __________________________________________________________________________________
(Name of Organization)
who signed the above Proposal of Bid, that he was duly authorized to sign and that the Bid is the true offer of the
Bidder, that the seal attached is the seal of the Bidder and that all declarations and statements contained in the Bid are
true to the best of his knowledge and belief.
He further deposes that he has submitted herewith a list of names and addresses of all stockholders and/or partners
owning a 10% or greater interest in compliance with P.L. 1977, Chapter 33, effective as of March 8, 1977.
                                                                                                _________________________________________
                                                                     
Affiant
Subscribed and Sworn before me
This             day of               , 2023
__________________________ (Seal)
(Notary Public)
____________________________
    (Commission expiration date)


15
NON-COLLUSION AFFIDAVIT
STATE OF NEW JERSEY    )
) SS:
COUNTY OF
)
I, _____________________________ of the City/Township of _____________________
in the County of _______________________________and the State of _____________________
of full age, being duly sworn according to the law on my oath depose and say that:
I am, ________________________________________________________ (Title)
 
(a partner, or officer of the firm of, etc.)
of the firm of __________________________________________________________________
the bidder making the Proposal for the above named project, and that I executed the said Proposal
with full authority so to do; that said bidder has not, directly or indirectly, entered into any
agreement, participated in any collusion, or otherwise taken any action in restraint of free,
competitive bidding in connection with the above-named project; and that all statements contained
in said Proposal and in this affidavit are true and correct, and made with full knowledge that the
CITY OF ORANGE, NJ relies upon the truth of the statements contained in said Proposal and in
the statements contained in this affidavit in awarding the contract for the said project.
I further warrant that no person or selling agency has been employed or retained to solicit
or secure such contract upon an agreement or understanding for a commission, percentage,
brokerage or contingent fee, except bona fide employees or bona fide established commercial or
selling agencies maintained by ___________________________________.
               (Name of Contractor)
    _______________________________________
    (Also type or print name of affiant under 
signature)
Subscribed and sworn to
before me this ________ day
of ______________ 2023
________________________________________
Notary Public of:  _________________________
My commission expires:  ____________________


16
OWNER DISCLOSURE CERTIFICATION
This Statement Shall Be Included with RFQ Submission
Name of Business______________________________________________________
 
I certify that the list below contains the names and home addresses of all stockholders 
holding 10% or more of the issued and outstanding stock of the undersigned.
OR
 
I certify that no one stockholder owns 10% or more of the issued and outstanding stock of
the undersigned.
 
OR
 
I certify that there are no stockholders
Check the box that represents the type of business organization:
 Partnership
 Corporation
 Sole Proprietorship
 Limited Partnership
 Limited Liability Corporation
 Limited Liability 
Partnership
 Subchapter S Corporation
  Other (describe)___________________
Sign and notarize the form below, and, if necessary, complete the stockholder list below.
Stockholders:
Name: ______________________________
Name: ______________________________
Home Address: _______________________
____________________________________
Home Address: _______________________
____________________________________
Name: ______________________________
Name: ______________________________
Home Address: _______________________
____________________________________
Home Address: _______________________
____________________________________
Name: ______________________________
Name: ______________________________
Home Address: _______________________
____________________________________
Home Address: _______________________
____________________________________


17
Subscribed and sworn before me this ___ day of 
___________ ,  
20 __.
(Notary Public)
My Commission expires:
___________________________________
(Affiant)
________________________________
(Print name & title of affiant)
(Corporate Seal)


18
CITY OF ORANGE
INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT
FORM
Certificate(s) of Insurance shall be filed with the City’s Clerk’s Office upon award of contract by
the Municipal Council.
The minimum amount of insurance to be carried by the selected Professional Service Entity shall
be as follows:
Professional Liability Insurance
Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each
policy period.
*Vendor / Firm shall not commence operations until Township has been furnished original
certificate(s) of Insurance and certified original copies of endorsements or policies of insurance in
the amounts and/or minimum coverage(s) required in this proposal.
Acknowledgement of Insurance Requirement:
_________________________________________       ______________________________
(Signature)
(Date)
_______________________________________________________
(Printed Name and Title)


19
AFFIRMATIVE ACTION AFFIDAVIT
(Items No. 2 through Item No. 6 to be completed
by firms with less than 50 employees)
STATE OF NEW JERSEY
)
COUNTY
)
I, _____________________________ of the (City, Town, Borough of ________________
in the County of _______________________, State of ______________ of full age, being duly
sworn according to law on my oath depose and say that:
1.
I am (President, partner, owner) of the firm _______________________________
a bidder making a proposal upon the above named project.  We have fifty (50) or more employees
and have forwarded an Affirmative Action Plan to the State.  _____Yes _____No
2.
___________________________ does not have 50 employees or more inclusive
of 
all officers and employees of every type.
3.
I am familiar with the affirmative action requirements of P.L. 1975, c 127 and rules
and regulations issued by the Treasurer, State of New Jersey pursuant thereto.
4.
__________________________ has complied with all the affirmative action
requirements of the State of New Jersey including those required by P.L.  1975, c 127 and the
rules and regulations issued by the Treasurer, State of New Jersey pursuant thereto.
5.
I am aware that if ___________________________ does not comply with P.L. 175,
c 127 and rules and regulations issued pursuant thereto, that no monies will be paid by the State of
New Jersey, County of __________________, (City, Town, Borough) of ____________________
until an affirmative action plan is approved.  I am also aware that the contract may be terminated
and the ___________________________ may be debarred from all public contracts, for a period
of up to five (5) years.
6.
In the event my workforce increases to 50 employees, I must contact the State
Affirmative Action Office and complete and Employees Information Report.
Subscribed and sworn to
Before me this _____ day
        ________________________________
____________ 2023____ 
                   Signature of Authorized Representative
______________________________
_____________________________
(Seal) Notary Public of New Jersey
     Name and Title


20
AFFIRMATIVE ACTION REGULATIONS:
A. Procurement of Service Contract:  The parties to this contract agree to incorporate into this
contract the mandatory language of subsection 3.4(a) of the Regulations promulgated by
the Treasurer pursuant to P.L. 1975, C. 127, as amended and supplemented from time to
time and the contractor or subcontractor agrees to comply fully with the terms, provisions,
and obligations of said subsection 3.4 (a) provided that said subsection shall be applied
subject to the terms of subsection 3.4 (d) of said Regulations.
The parties to this contract agree to incorporate into this contract the mandatory language
of section 5.3 of the Regulations promulgated by the Treasurer pursuant to P.L. 1975, C.
127, as amended and supplemented from time to time and the contractor or subcontractor
agrees to comply fully with the terms, provisions, and obligations of said section 5.3.
B. Construction Contract:  The parties to this contract agree to incorporate into this contract
the mandatory language of subsection 3.4 (a) of the Regulations promulgated by the
Treasurer pursuant to P.L. 1975, C. 127, as amended and supplemented from time to time
and the contractor or subcontractor agrees to comply fully with the terms, provisions, and
obligations of said subsection 3.4 (a) provided that said subsection shall be applied subject
to the terms of subsection 3.4 (d) of said regulations.
The parties to this contract agree to incorporate into this contract the mandatory language
of subsections 7.4 (a) and (b) of the Regulations promulgated by the Treasurer pursuant to
P.L. 1975, C. 127, as amended and supplemented from time to time and the contractor or
subcontractor agrees to comply fully with the terms, provisions, and obligations of
subsections 7.4 (a) and (b).
Signature ___________________________
                                                         Title         ___________________________
Company ___________________________
Address    ___________________________
      ___________________________
      ZIP CODE
NOTE:  FORM MUST BE RETURNED WITH THE BID PROPOSAL.


21
CITY OF ORANGE
PROFESSIONAL SERVICE ENTITY INFORMATION FORM
If the professional service Entity is an INDIVIDUAL, sign name and give the following information:
Name:  ________________________________________________________________________
Address:  ______________________________________________________________________
Telephone No.:  _______________________Social Security No.:  _________________________
Fax No.:  _____________________________E-Mail Address:  ____________________________
If individual has a TRADE NAME, give such tradename:
Trading As:  _____________________________ Telephone:  ____________________________
If the professional service Entity is a PARTNERSHIP, sign name and give the following information:
Name of Partners:  ______________________________________________________________
Firm Name:  ____________________________________________________________________
Address:  ______________________________________________________________________
Telephone No.:  _______________________Federal I.D. No.:  ____________________________
Fax No.:  _____________________________E-Mail Address:  ____________________________
Social Security No.:  ______________________________________________________________
Signature of authorized Agent:  ____________________________________________________
If the professional service Entity is an INCORPORATED, sign name and give the following information:
State under whose laws incorporated:  ______________________________________________
Location of principal office:  _______________________________________________________
Telephone No.:  _______________________Federal I.D. No.: ___ _________________________
Fax No.:  _____________________________E-Mail Address:  ____________________________
Name of agent in charge of said office upon whom notice may be legally served.
Telephone No.:  ___________________________ Name of Corporation:  _________________________
Signature:  _______________________________ By:  _________________________________________


22
QUALIFICATION AFFIDAVIT
The CITY OF ORANGE reserves the right to reject the bid of any bidder who has
previously failed to perform properly or to complete on time, contracts of a similar nature; who is
not qualified to perform the contract; or who has repeatedly or without good cause failed to pay
bills or otherwise failed to perform its obligations to subcontractors, materialmen, employees of
this or any other government body or agency in similar contracts.  In determining the lowest
responsible bidder and its qualifications, the following elements, in addition to those above
mentioned, will be considered; Whether the bidder (1) maintains a permanent place of business;
(2) has adequate plant and equipment available to do the work properly and expeditiously; (3) has
suitable financial resources to meet the obligations incident to the work; (4) has appropriate
technical experience.
Each bidder must supply the following certified statement.  Failure to do so shall be deemed
a material defect in the bid, resulting in rejection of the bid:
State of New Jersey   )
County of ________) SS:
I am the (President, Partner, Owner) of_________________________________________
_____________________________________, the bidder herein.
I know that the bidder, _____________________________________, has not previously failed to
perform properly, or complete on time, contracts of a nature similar to that bid upon; is qualified
to perform the contract; has not repeatedly or without just cause failed to pay bills or otherwise
failed to perform its obligations to sub-contractors, materialmen, employees, of this or any other
government or agency in similar contracts.
I certify that the foregoing statements made by me are true.  I am aware that if any of the
foregoing statements made by me are willfully false, I am subject to punishment.
______________________________
Company Name
Subscribed and Sworn to
______________________________
Before me this _____ day
Sign Name
Of ________ 20___.
______________________________
Print Name
_________________________
Notary Public of:  _____________
______________________________
My commission expires:  __________
           Print/Type Title


23
CITY OF ORANGE
SUBMISSION FORM
1.
Names and roles of the individuals who will perform the services and description of their education
and experience with projects similar to the services contained herein including their education,
degrees and certifications:
2.
References and record success of same similar service:
3.
Description of ability to provide the services in a timely fashion (including staffing, familiarity and
location of key staff):


24
4.
Cost details, including the hourly rates of each of the individuals who will perform services, and all
expenses:
Note:  Attach additional sheets as necessary.
Firm  ___________________________________________   Date:  _______________________
Authorized Representative (Print):  _________________________________________________
Signature:  ________________________________________   Title:  _____________________
Telephone #:  _____________________________   Fax #:  _____________________________


25
CITY OF ORANGE
ACKNOWLEDGEMENT OF CORRECTIONS, ADDITIONS AND
DELETIONS FORM
I, ____________________________________________________________________________
of the firm 
_____________________________________________________________________
Hereby acknowledge that any corrections, additions and/or deletions have been initialed and
dated in this Submission Package.
                                                                        
____________________________________
        (Signature)
                                                                        
____________________________________
(Type or Print of affiant and Title, under Signature)
  
____________________________________
(Date)


26
STATEMENT OF INDEBTEDNESS
Bidders shall provide as part of their bid a statement under oath that (a) they are not indebted to
the City of Orange Township, (b) are not in breach of any contract previously awarded by the City
and (c) are not a party to any pending action either at law or equity in which they are assessing an
affirmative claim for damages or other relief against the City of Orange Township.
Failure to provide the required statement shall disqualify the bidder.
_____________________________________
     (Name of Contractor)
         _____________________________________
        (Type or print name of affiant under signature)
Subscribe and sworn to
Before me this _____ day
Of ___________ 2023
____________________________________
Notary Public of _______________________
My Commission Expires _________________


27
CITY OF ORANGE TOWNSHIP, NEW JERSEY
AGREEMENT FOR PAYMENT OF COMMODITY
The contractor or vendor realizes that as a Municipality, payment cannot be made on a bill
presented basis.  Therefore, the contractor or vendor, hereby agrees to accept payment within a
reasonable time after presentation of invoice and properly executed documentation as well as
signed vouchers pertaining to same.
Payment in the normal circumstance should not exceed 60 days.
                                                                         
 ________________________________
Name of Official for Company
                                                                           
________________________________
Name of Company or Business
                                                                            
________________________________
Address
Date:  ____________________


28
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
COMPANY NAME:  _____________________________________________
_____________________________________________________________________________________
PART 1: CERTIFICATION
BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX.
FAILURE TO CHECK ONE OF THE BOXES WILL RENDER THE PROPOSAL NON-
RESPONSIVE.
Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise
proposes to enter into or renew a contract must complete the certification below to attest, under penalty
of perjury, that neither the person or entity, nor any of its parents, subsidiaries, or affiliates, is identified
on the Department of Treasury’s Chapter 25 list as a person or entity engaging in investment activities in
Iran. 
The 
Chapter 
25 
list
is 
found 
on 
the
Division’s 
website 
at
http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Bidders must review this list prior to
completing the below certification. Failure to complete the certification will render a bidder’s
proposal non-responsive. If the Director finds a person or entity to be in violation of law, s/he shall
take action as may be appropriate and provided by law, rule or contract, including but not limited to,
imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking
debarment or suspension of the party
PLEASE CHECK THE APPROPRIATE BOX:

I certify, pursuant  to Public  Law  2012, c. 25, that neither  the bidder  listed above nor  any
of  the bidder’s parents, subsidiaries, or affiliates is listed on the N.J. Department of the
Treasury’s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L.
2012, c. 25 (“Chapter 25 List”). I further certify that I am the person listed above, or I am an officer
or representative of the entity listed above and am authorized to make this certification on its behalf.
I will skip Part 2 and sign and  complete the Certification below.
OR

I  am  unable  to  certify  as  above  because  the  bidder  and/or  one  or  more  of  its  parents,  subsidiaries,  or  
affiliates  is  listed  on  the  Department’s  Chapter  25  list.  I  will  provide  a  detailed,  accurate  and  precise  
description  of  the  activities  in  Part  2  below  and  sign  and  complete  the  Certification  below.  Failure  
to  provide  such  will  result  in  the  proposal  being  rendered  as  non-  responsive and appropriate penalties, 
fines and/or sanctions will be assessed as provided by law.


29
Disclosure of Investment Activities in Iran (cont’d)
PART 2:
PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN
You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of 
its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the 
boxes below.
EACH BOX WILL PROMPT YOU TO PROVIDE INFORMATION RELATIVE TO THE ABOVE
QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION.  IF YOU NEED TO
MAKE ADDITIONAL ENTRIES, CLICK THE “ADD AN ADDITIONAL ACTIVITIES ENTRY”
BUTTON
Name:  __________________________________Relationship to Bidder/Offeror: _________________
Description of Activities:  ______________________________________________________________
____________________________________________________________________________________
Duration of Engagement:  _________________   Anticipated Cessation Date:______________________
Bidder/Offeror Contact Name:  ________________  Contact Phone Number:______________________
Certification: I, being duly sworn upon my oath, hereby represent that the foregoing information and any
attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to
execute this certification on behalf of the bidder; that the State of New Jersey is relying on the information contained
herein and that I am under a continuing obligation from the date of this certification through the completion of any
contracts with the State to notify the State in writing of any changes to the information contained herein; that I am
aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I
am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with
the State, permitting the State to declare any contract(s) resulting from this certification void and unenforceable.
Full Name (Print):  _____________________________  Signature:  ______________________________
Do Not Enter PIN as a Signature
Title:  ________________________________________  Date:  _________________________________


30
LETTER OF INTENT
(Note:
To be typed on Respondent’s Letterhead.  No Modifications may be 
made to this letter).
[insert date]
Gracia Robert Montilus, Esq.
City Attorney
City of Orange Township
29 North Day Street, Room 303
Orange, New Jersey 07050
RE:
Request for Qualifications
Legislative Research Officer
Dear Mr. Montilus:
The undersigned as Respondent, has (have) submitted the attached Qualification Statement
in response to a Request for Qualifications (RFQ), issued by the City of Orange (hereafter “City”),
dated November 22, 2023, in connection with the City’s need for Legislative Research Officer
Services.
Name of Respondent HEREBY STATES:
1.
The Qualification Statement contains accurate, factual and complete information.
2.
(Name of Respondent) agrees (agree) to participate in good faith in the procurement
process as described in the RFQ and to adhere to the City’s procurement schedule.
3.
(Name of Respondent) acknowledges (acknowledge) that all costs incurred by it (them)
in connection with the preparation and submission of the Qualification Statement and any
proposal prepared and submitted in response to the RFQ, or any negotiation which results
therefrom shall be borne exclusively by the Respondent.
4.
(Name of Respondent) hereby declares (declare) that the only persons participating in this
Qualification Statement as Principals are named herein and that no person other than those
herein mentioned has any participation in this Qualification Statement or in any contract to
be entered into with respect thereto.  Additional persons may subsequently be included as
participating Principals, but only if acceptable to the City.
5.
(Name of Respondent) declares that this Qualification Statement is made without
connection with any other person, firm or parties who has submitted a Qualification
Statement, except as expressly set forth below and that it has been prepared and has been
submitted in good faith and without collusion or fraud.


31
6.
(Name of Respondent) acknowledges and agrees that the City may modify, amend,
suspend and/or terminate the procurement process (in its sole judgment).  In any case, the
City shall not have any liability to the Respondent for any costs incurred by the Respondent
with respect to the procurement activities described in this RFQ.
7.
(Name of Respondent) acknowledges that any letter of engagement executed with respect
to the provision of [insert services] must comply with all applicable affirmative action and
similar laws.  Respondent hereby agrees to take actions as are required in order to comply
with such applicable laws.
(Respondent shall sign and complete the space provided below. If a joint
venture, appropriate officers of each company shall sign.)
 (Signature of Chief Executive Officer)
            (Typed Name and Title)
            (Typed Name of Firm*)
Dated:
* If joint venture, partnership or other formal organization is submitting a qualification statement, each participant shall
execute this Letter of Intent.


32
LETTER OF QUALIFICATION
(Note:
To be typed on Respondent’s Letterhead.  No Modifications may be made to 
this letter).
[insert date]
Gracia Robert Montilus, Esq.
City Attorney
City of Orange Township
29 North Day Street, Room 303
Orange, New Jersey
RE:
Request for Qualifications
Legislative Research Officer Services
Dear Mr. Montilus:
The undersigned have reviewed the Qualification Statement submitted in response to the
Request for Qualifications (RFQ) issued by the City of Orange, dated November 22, 2023, in
connection with the City’s need for Legislative Research Officer services.
We affirm that the contents of our Qualification Statement (which Qualification Statement
is incorporated herein by reference) are accurate, factual and complete to the best of our knowledge
and belief and that the Qualification Statement is submitted in good faith upon express
understanding that any false statement may result in the disqualification of (Name of
Respondent).
(Respondent shall sign and complete the spaces provided below.  If a joint venture,
appropriate officers of each company shall sign.)
(Signature of Chief
(Signature of Chief
Executive Officer)
Financial Officer)
(Typed Name and Title)
(Typed Name and Title)
(Typed Name of Firm*)
(Typed Name of Firm*)
Dated:                                      
Dated:
* If joint venture, partnership or other formal organization is submitting a qualification statement, each participant shall execute 
this Letter of Qualification.


33
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, NEW JERSEY
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) 


34
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, NEW JERSEY
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 the date of reorganization 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).
Dwayne D. Warren, Esq., Mayor
Hon. Kerry J. Coley
Hon. Adrienne K. Wooten
Hon. Tency A. Eason
Hon. Clifford R. Ross
Hon. Quantavia L. Hilbert
Hon. Jamie Summers-Johnson
Hon. Weldon M. Montague
Part II – Ownership Disclosure Certification
o I 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
oCorporation
 oSole Proprietorship
oSubchapter S Corporation
oLimited Partnership
oLimited 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:                                                                                                                                             
Signed:                                                                                               Title:                                                                   
Print Name:                                                                                        Date:                                                                   
Subscribed and sworn before me the ___________ 
day of
__________________________________, 20   .
My Commission expires:
______________________________________________
___
(Affiant)
______________________________________________
(Print name & title of affiant)   (Corporate Seal)