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RFQ - Special Counsel Services for Election Matters -2026
BID #: 84
ISSUED: 1/29/2026
DUE: 2/12/2026
VALUE: TBD
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Executive Summary
The City of Orange Township is seeking proposals from qualified individuals and firms to provide Special Legal Counsel Services for election matters. The awarded contract term will not exceed one year from the date of award. Qualification Statements must be submitted to the City Clerk’s Office via mail or hand delivery by February 12, 2026, at 1:00 p.m.
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Document Text
--- Document: RFQ - Special Counsel Services for Election Matters -2026 ---
Municipal Council
of the City of Orange Township
City Clerk ’s Office
Municipal Building
29 North Day Street, Second Floor
Orange, New Jersey 07050
REQUEST FOR QUALIFICATIONS
S p e c i a l
L e g a l
C o u n s e l
S e r v i c e s
F o r
E l e c t i o n
M a t t e r s
O r a n g e
M u n i c i p a l
C o u n c i l
January 1, 2026 - December 31, 2026
SUBMISSION DEADLINE
1:00 PM – February 12, 2026
PURPOSE OF REQUEST
The City of Orange Township (hereafter the “City”) is requesting proposals from qualified individuals
and firms to provide Special Legal Counsel Services. Proposals will be evaluated in accordance with the
criteria set forth in this Request for Qualifications (RFQ). One of more individual/firms may be selected to
provide services. If selected, the governing body will approve a resolution listing the individual and/or firms
as approved Special Legal Counsel. 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 Contract by the City
Council, which includes term, amount, indemnification, insurance, termination and licensing provisions. It
is also agreed and understood that the execution of the Contract and 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.
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 professional 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.
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 (or his designee).
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 City Clerk’s Office via mail
or hand delivery on Thursday, February 12, 2026 at 1:00 p.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.
TABLE 1
ANTICIPATED PROCUREMENT SCHEDULE
ACTIVITY DATE
1.
Issuance of Request for Qualifications: January 29, 2026.
2.
Receipt of Qualification Statements: February 12, 2026.
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 an 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 Clerk’s Office by 1:00 p.m. on
Thursday, February 12, 2026, 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 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.
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 Council to solicit Qualification Statements from Respondents that have
expertise in the provision of professional legal services 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 Council of the City of Orange Township is seeking an attorney and/or law firm that will handle
special legal matters as directed by the City Attorney only when it is deemed that a conflict of legal
interest exist, which legally and ethically conflicts the Law Department from rendering legal advice.
The Special Legal Counsel Attorney (and other attorneys, if any) shall perform the following duties,
when only when it is deemed by that a conflict of interest exists, which legally and ethically conflicts
the Law Department from rendering legal advice to the City Council:
A. Defend claim relative to the City Council
B. File lawsuits and defend same on behalf of the City Council, prepare reports and provide
advice and counsel to the City Council regarding issues that arise, that include, but are not
limited to: litigation, regulations and ordinances
C. Interact with the City Administration on related legal issues
D. Interact with the City’s insurance carrier, regarding liability issues;
E. Attend meetings as requested by the Mayor and Council.
SECTION 3
SUBMISSION REQUIREMENTS
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.
The Respondent shall, as part of its Qualification Statement, provide the following information:
1.
An executive summary (not to exceed two (2) pages) of the information contained in all the other
parts of the Qualification Statement.
2.
An executed Letter of Qualification.
3.
Name, address and telephone number of the Respondent submitting a Qualification Statement
pursuant to this RFQ, and the name of the key contact person.
4.
A description of the business organization (i.e., corporation, partnership, joint venture, etc.) of
each Respondent, its ownership and its organizational structure.
a.
Provide the names and business addresses of all Principals of the Respondent
submitting the Qualification Statement. For purposes of this RFQ, “Principals” means persons
possessing an ownership interest in the Respondent. If the Respondent is a corporation,
“Principals” shall include each investor who has any operational control over the Respondent,
and every stockholder having an ownership interest of 10% or more in the firm.
b.
If a Respondent is a partially owned or a fully owned subsidiary of another firm,
identify the parent company and describe the nature and extent of the parents’ approval rights
over the activities of the Respondent submitting a Qualification Statement. Describe the
approval process.
c.
If the Respondent is a partnership or a joint venture or similar organization, provide
comparable information as required in (b) above for each member of the partnership, joint
venture or similar organization.
d.
A statement that the Respondent has complied with all applicable affirmative action
(or similar) requirements with respect to its business activities, together with evidence of such
compliance.
5.
The number of years Respondent has been in business under the present name.
6.
The number of years Respondent has been under the current management.
7.
Any judgments within the last three (3) years in which Respondent has been adjudicated liable for
professional malpractice. If yes, please explain.
8.
Whether the Respondent is now or has been involved in any bankruptcy or reorganization
proceedings in the last ten (10) years. If yes, please explain.
9.
Confirm appropriate federal and state licenses to perform activities.
10. An executed letter of intent.
3.3.
Professional Information Requirements.
a.
Respondent shall submit a description of its overall experience in providing the type of
services sough in the RFQ. At a minimum, the following information on past experience
should be included as appropriate to the RFQ:
1. Description and scope of work by Respondent.
2. Name, address and contact information of references.
3. Explanation of perceived relevance of the experience to the RFQ.
b. Brief description of Respondent’s relevant clients including municipal government clients
during the last three (3) years.
c.
Resumes of key employees.
d. Names and resumes of attorneys who will be assigned to provide legal services to the City.
e.
A narrative statement of the Respondent’s understanding of the City’s needs goals.
f.
List of all immediate relatives of Principal(s) of Respondent who are City employees or elected
officials of the City. For purposes of the above, “immediate relative” means a spouse, parent,
stepparent, brother, sister, child, stepchild, direct-line aunt or uncle, grandparent, grandchild
and in-laws.
g. Limits of Malpractice insurance coverage.
h. A listing of all other engagements where services of the types being offered were provided in
the past five (5) years. This should include other municipal governments and other levels of
government. Contact information for the recipients of similar services must be provided. The
city may obtain references from any of the parties listed.
i.
Respondents must demonstrate a proven record of litigation experience in either the Superior
Court of New Jersey (including the Appellate Division), or the United States District Court for
the District of New Jersey.
11. Respondents must list all cases where they represented the City or in which they sued the City or
in which they represented a client that sued the City within the last five (5) years.
SECTION 4
INSTRUCTIONS TO RESPONDENTS
Submission of Qualification Statements.
Respondents must submit an original and two (2) copies of their Qualification Statement to the
Designated Contact Person:
Qualification Statements must be received by the City no later than Thursday, February 12, 2026 at
1:00 p.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 New Jersey 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.
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.
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
LETTER OF QUALIFICATION
(Note: To be typed on Respondent’s Letterhead. No Modifications may be made to this letter.)
Date
City of Orange Township
Office of City Clerk
29 North Day Street, Fourth Floor
Orange, New Jersey, 07050
ATTN: Trisha A. Scipio
RE:
Request for Qualifications
Special Legal Counsel Services for Election Matters
Dear Ms. Scipio:
The undersigned has reviewed the Qualification Statement submitted in response to the Request for
Qualifications (RFQ) issued by the City of Orange Township (“City”), dated ________________, 2026, in
connection with the City’s need for Special Legal Counsel Services for Election Matters.
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
(Type Name of Firm) *
(Type Name of Firm)*
Dated:
Dated:
*
If a joint venture, partnership or other formal organization is submitting a RFQ, each participant
shall execute this Letter of Qualification.
LETTER OF INTENT
Date
City of Orange Township
Office of City Clerk
29 North Day Street, Fourth Floor
Orange, New Jersey, 07050
ATTN: Trisha A. Scipio
RE:
Request for Qualifications
Special Legal Counsel Services for Election Matters
Dear Ms. Scipio:
The undersigned has reviewed the Qualification Statement submitted in response to the Request for
Qualifications (RFQ) issued by the City of Orange Township (“City”), dated ___________________, 2026,
in connection with the City’s need for Special Legal Counsel Services for Election Matters.
(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 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 the 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.
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 contract executed with respect to the provision
of [insert services] must comply with all applicable affirmative action and similar laws. Respondent hereby
agrees to take such 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)
(Type Name of Firm)
Dated:___________
*If a joint venture, partnership or other formal organization is submitting a RFQ, each participant shall
execute this Letter of Intent.
ALL OF THE
FOLLOWING
DOCUMENTS
MUST BE
INCLUDED
WITH
PROPOSAL
REQUEST FOR QUALIFICATIONS
S p e c i a l
L e g a l
C o u n s e l
S e r v i c e s
F o r
E l e c t i o n
M a t t e r s
January 1, 2026 - December 31, 2026
S U B M I S S I O N CHECKLIST
This checklist must be completed and submitted along with all Qualification Statements. A submission
that does not contain all items listed in the checklist will be rejected.
Qualification Statement
Proof of Required Insurance Coverage
Mandatory Equal Employment Opportunity Compliance Statement
Federal Letter of Approval of Equal Employment Opportunity Policies, New Jersey Certificate of
Employee Information Report or AA-302 Employee Information Report
Americans with Disabilities Act Compliance Statement
Non-Collusion Affidavit
Business Ownership Disclosure
Political Contribution Disclosure
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 Affidavit
Submission Form
Acknowledgement of Corrections, Additions or Deletion Form
Disclosure of Investment Activities in Iran
Certification of Non-Involvement in Prohibited Activities in Russia or Belarus
Statement of Indebtedness Form
Agreement for Payment of Commodity/Service Form
Authorized signatures on all documents (and notarized, as applicable)
Letter of Intent
Letter of Qualification
1 bound original and 2 paper copies.
* NOTE: N.J.S.A. 52:32-44 prohibits the City from entering any contract for goods or services unless the other party
to the contract provides a copy of valid business registration certificates for itself and any subcontractors it intends
to utilize in providing services.
The undersigned hereby acknowledges the above listed requirements.
For
(Individual or Firm Name)
By:
(Signature)
(Date)
(Printed Name)
(Title)
CITY OF ORANGE TOWNSHIP
EEO/AFFIRMATIVE ACTION COMPLIANCE NOTICE
N.J.S.A. 10:5-31 and N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
All successful bidders are required to submit evidence of appropriate affirmative action compliance to the City
and Division of Public Contracts Equal Employment Opportunity Compliance. During a review, Division
representatives will review the City files to determine whether the affirmative action evidence has been
submitted by the vendor/contractor. Specifically, each vendor/contractor shall submit to the City, prior to
execution of the contract, one of the following documents:
Goods and General Service Vendors
1. Letter of Federal Approval indicating that the vendor is under an existing Federally approved or sanctioned
affirmative action program. A copy of the approval letter is to be provided by the vendor to the City and the
Division. This approval letter is valid for one year from the date of issuance.
Do you have a federally-approved or sanctioned EEO/AA program? Yes ____ No _____
If yes, please submit a photostatic copy of such approval.
2. A Certificate of Employee Information Report (hereafter “Certificate”), issued in accordance with N.J.A.C.
17:27-1.1 et seq. The vendor must provide a copy of the Certificate to the City as evidence of its compliance
with the regulations. The Certificate represents the review and approval of the vendor’s Employee Information
Report, Form AA-302 by the Division. The period of validity of the Certificate is indicated on its face.
Certificates must be renewed prior to their expiration date in order to remain valid.
Do you have a State Certificate of Employee Information Report Approval? Yes ____ No_____
If yes, please submit a photostatic copy of such approval.
3. The successful vendor shall complete an Initial Employee Report, Form AA-302 and submit it to the Division
with $150.00 Fee and forward a copy of the Form to the City. Upon submission and review by the Division,
this report shall constitute evidence of compliance with the regulations. Prior to execution of the contract, the
EEO/AA evidence must be submitted.
The successful vendor may obtain the Affirmative Action Employee Information Report (AA302) on the
Division website www.state.nj.us/treasury/contract_compliance.
The successful vendor(s) must submit the AA302 Report to the Division of Public Contracts Equal Employment
Opportunity Compliance, with a copy to Public Agency.
The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements of
N.J.S.A. 10:5-31 and N.J.A.C. 17:27 and agrees to furnish the required forms of evidence.
The undersigned vendor further understands that his/her bid shall be rejected as non-responsive if said contractor
fails to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27.
COMPANY: ____________________________ SIGNATURE: __________________________ PRINT
NAME:__________________________TITLE: _____________________________
DATE: _________________
QUALIFICATION AFFIDAVIT
The City of Orange Township 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
CITY OF ORANGE TOWNSHIP
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):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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 #: _____________________________ 33
CITY OF ORANGE TOWNSHIP
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)
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.
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
Names:________________________________ 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: ________________________________
M A N D A T O R Y E Q U A L E M P L O Y M E N T O P P O R T U N I T Y C O M P L I A N C E STATEMENT
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, the contractor 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 City of Orange Township
(“City”) 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 City advising the labor union or workers’ representative of the contractor’s
commitments under the law, 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.
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 (electronically provided by the
Division and distributed to the public agency through the Division’s website at
http://www/state.nj.us/treasury/contract compliance).
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)
MANDATORY AMERICANS WITH DISABILITIES ACT COMPLIANCE STATEMENT
42 U.S.C. §§ 12101 et seq.
Goods, Professional Service and General Service Contracts
During the performance of this contract, , (“contractor”), agrees as follows:
The provisions of Tile 11 of the Americans With Disabilities Act of 1990 (“Act”), 42 U.S.C. §§ 12101 et
seq., which prohibit 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 City of Orange
Township (“City”) pursuant to this contract, the contractor agrees that performance shall be in strict compliance
with the Act. In the event that the contractor or subcontractor, or 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 City in any action or administrative proceeding commenced pursuant to this Act.
The contractor shall indemnify, protect, and save harmless the City, 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 administrative
proceeding or incurred in connection therewith. In any complaints brought pursuant to the City’s grievance
procedure, the contractor agrees to abide by any decision of the City rendered pursuant to said grievance
procedure. If any action or administrative proceeding results in an award of damages against the City, or if the
City incurs any expenses to cure a violation of the Act pursuant to its grievance procedure, the contractor
shall satisfy and discharge the same at its own expense.
The City 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 City or any of its agents, servants and employees, the City shall expeditiously
forward or have forwarded to the contractor every demand, complaint, notice summons, pleading, or other process
received by the City and/or its representatives.
It is expressly agreed and understood that any approval by the City 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, and save harmless the City pursuant hereto.
It is further agreed and understood that the City 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 contract. Furthermore, the contractor expressly understands and agrees that the provisions of
this indemnification shall in no-way limit the contractor’s obligations assumed in the contract, and shall not be
construed to relieve the contractor from any liability or preclude the City from taking any other actions
available to it under any other provisions of the contract or the law.
The undersigned hereby acknowledges the above listed requirements.
For
(Individual or Firm Name)
By:
(Signature)
(Date)
(Printed Name)
(Title)
N O N - C O L L U S I O N 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)
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 single 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 #
B U S I N E S S O W N E R S H I P D I S C L O S U R E C E R T I F I C A T I O N (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)
P O L I T I C A L C O N T R I B U T I O N 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”).
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 offic
e 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/orcandidate campaigncommittees 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]
P O L I T I C A L C O N T R I B U T I O N D I S C L O S U R E (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
S o u t h O r a n g e - M a p l e w o o d 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)
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)
BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To Ordinance §4-70, et seq.
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 Ordinance 4-70 et seq. that 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
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
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)
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Trisha A. Scipio
City Clerk’s Office
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Timeline
First Discovered
Mar 31, 2026
Last Info Update
Apr 30, 2026
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