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Third Party Administrator - Liability & Worker's Comp
BID #: 70
ISSUED: 10/24/2025
DUE: 12/4/2025
VALUE: TBD
100
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Executive Summary
The City of Orange Township is seeking qualifications from firms to provide Third-Party Administrator services for its General Liability and Worker's Compensation self-insured program. The selected TPA will handle claims investigation and adjustment services, managed care, litigation management, and subrogation, adhering to relevant regulations and reporting requirements. The initial contract term is for three years, with an option to extend for two additional one-year terms. Proposals are due by 1:00 PM on December 4, 2025, and must be submitted to the Office of Procurement.
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Document Text
--- Document: RFQ -Third Party Administrator - Liability and Workers Comp -2026 ---
Department of Law
Gracia Robert Montilus, City Attorney
Municipal Building
29 North Day Street, Second Floor
Orange, New Jersey 07050
REQUEST FOR
QUALIFICATIONS
T h i r d
P a r t y
A d m i n i s t r a t o r
f o r
G e n e r a l
L i a b i l i t y
a n d
W o r k e r ’ s
C o m p e n s a t i o n
January 1, 2026 - December 31, 2026
SUBMISSION DEADLINE
1:00 PM – December 4, 2025
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 1
PLEASE TAKE NOTICE, City of Orange Township (“The City”) requests qualifications for the
services set forth below in accordance to the “fair and open process” pursuant to N.J.S.A. 19:44A-20.5,
et seq.:
1. Financial Consulting/Auditing
2. Risk Management Consultants
3. Public Information and Community Relations Services
4. General Environmental Consulting Services
5. Third Party Claims Administrator & Managed Care Services
6. Investigative Services Regarding Sick/injury Leave
7. Financial Software Maintenance
Request for qualification (“RFQ”) responses shall be submitted to, and be received by the Office of
Procurement, via mail or hand delivery, by 1:00 p.m. on December 4, 2025. Qualification Statements
will not be accepted by facsimile or e-mail transmissions. Qualification Statement shall be opened in
the City Attorney’s Office, located on the 2nd floor of Orange City Hall, Orange, New Jersey.
Responses must be enclosed in a sealed envelope. The service provider must indicate the following on
the outside of the envelope: (1) the name and address of the service provider; (2) the service for which
the response is submitted; and (3) “Sealed RFQ Response”. Responses may be delivered by hand,
overnight courier or mail. The envelope containing the response must be received by the City by the
date and time set forth above. No later responses will be accepted.
If awarded a contract, the service provider shall be required to comply with the requirements of N.J.S.A.
10:5-31, et seq. (P.L. 1975, c. 127 as amended) and N.J.A.C. 17:27-1.1 et seq.
Contracts will be awarded based on the most advantageous responses as determined by the City. The
City reserves the right to reject any or all responses.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 2
CITY OF ORANGE CRITERIA FOR SERVICES
THIRD PARTY CLAIMS ADMINISTRATION & MANAGED CARE
SERVICES
This Criteria for Services applies to the City of Orange Township (“the City”) Request for
Qualifications (“RFQ”) for third party claims administration & managed care services.
A. Evaluation Factors
Responses from potential vendors (hereinafter referred to as “TPA’s”) will be evaluated by
the City on the basis of the following factors:
1. Experience and reputation in the field;
2. Knowledge of the City of Orange Township, matters concerning the City of Orange
Township, and the subject matter to be addressed under the contract;
3. Availability to attend to the City of Orange meetings and other matters as required;
4. Availability of personnel, managed care providers, and other resources to provide such
services;
5. Ability to provide both third party administration and managed care services;
6. Other factors if demonstrated to be in the best interests of the City; and
7. Compensation proposal.
B. Contract Award
The contract will be awarded on the basis of which response is most advantageous to the
City, price and other factors considered.
C. Scope of Services
The third party administration and managed care services to be provided by the TPA shall
include the following:
1. Reviewing all the City’s claim forms submitted by the City of Orange and providing
complete handling of all loss adjustments, and medical case management in compliance
with industry standards;
2. Having the TPA’s key local personnel conduct service calls, as needed, to the City for the
purpose of establishing lines of communication and reporting procedures;
3. Establishing and maintaining estimated reserve figures for each claim file and
consulting with the City with respect to payment of any claim;
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 3
4. Furnishing claim forms necessary for proper claims administration, in
accordance with the Tort Claims Act, Title 59, of New Jersey Statutes;
5. Maintaining claim files for each reported claim throughout the life of the claim and to
retain all closed files for a period of three (3) years following closing of the file, or as
otherwise required by applicable law or regulation;
6. Transmitting to the City, on a weekly basis, a list of all medical/indemnify benefits and
allocated expenses and/or all claim expenses, awards, etc., to be paid;
7. Issuing checks in payment of benefits and allocated expenses. Said checks to be paid from
an account maintained by the City at a bank of its choice and any fee or charges in
connection with said account shall be the responsibility of the City.
8. Notifying the City and excess insurance carriers and reinsurers (specifically, but not
limited to, New Jersey Municipal Self-Insurers’ Joint Insurance Fund, Municipal Excess
Liability Fund and XL Insurance) of any specific claim that may involve the City’s excess
coverage, carriers or reinsurers. The TPA will comply with all reasonable claim reporting
requirements of the insurance funds excess carriers, reinsurers and the City;
9. Indemnifying, defending and holding the City harmless for the TPA’s acts or omissions;
10. Attending any regularly scheduled City claims meetings to review claims;
11. Aggressively pursuing subrogation claims on behalf of the City and providing any
necessary services related to subrogation claims, or the litigation of subrogation claims.
Said services shall not include litigation costs such as expert fees or attorneys fees, and the
City reserves the right to direct and control the assignment of counsel for subrogation
claims and litigation;
12. Being present at informal claims hearings, when necessary;
13. Obtaining the approval of the City before settling any claims;
14. Maintaining records of attorneys, making recommendations, and cooperating with the
City’s excess carriers and reinsurer’s defense counsel regarding lawsuits or hearings
involving the subject exposures. Monitoring all claims referred to defense counsel and
keeping the City advised on a continuing basis as to the status of the litigated cases, any
settlement proposals or recommendations, and the actual and anticipated cost relating
to said legal defense. The City reserves the right to direct and control the assignment of
counsel as to any subject exposure;
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 4
15. Subject at all times to the approval of the City, maintaining a roster of physicians and other
treatment facilities for treatment of industrial o r casualty accidents on a first aid and
specialized basis, as well as maintaining or establishing a liaison with the treating
physicians.
Also, at the direction of the City, the TPA will recruit specific
providers/facilities for participation in the TPA’s managed care organization. In addition,
the TPA will coordinate rehabilitation and medical treatment and will if appropriate, retain
rehabilitation coordinators on behalf of the City with express approval of the City.
16. Upon request by the City of Orange Township, making recommendations to the City
regarding risk management, reserves, and having a representative available to the City for
purposes of establishing, conducting and coordinating a risk management program;
17. Hiring appropriate assessors to evaluate property damage in all litigated and non-litigated
matters as directed by the City.
18. Providing to the City written claims reporting procedures, including occurrences occurring
after normal business hours, during holidays or on weekends;
19. Submitting monthly loss run reports by fund year and by line of coverage to the City and
the joint insurance fund administrator within ten (10) calendar days following the end of
each month. Copies shall further be submitted to the fund actuary, fund auditor and fund
attorney on a quarterly and annual basis;
20. At its own cost and expense, maintaining in full force and effect during the entire term of
the contract, the following insurance coverages, with the City being named as an additional
inured where applicable:
a) Workers’ Compensation: Statutory – in compliance with the Workers’ Compensation
Laws of the State of New Jersey;
b) General Liability: A minimum limit of liability of $1 million per occurrence for bodily
injury and a minimum of $250,000 per occurrence for property damage;
c) Automobile Liability: A minimum limit of liability of $1 million per occurrence for
bodily injury and a minimum of $250,000 per occurrence for property damage. This
insurance must include coverage for owned, hired and non-owned automobiles; and
d) Errors & Omissions: A minimum limit of liability of $1 million per occurrence.
21. Generating reports in any format reasonably requested by the City of Orange Township;
22. Preparing reports required pursuant to any New Jersey statutes and any regulations enacted
pursuant thereto;
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 5
23. Providing such other services as m a y be required by the City of Orange Township, the
joint insurance funds by laws to which the City is subject, the City’s risk management
plan and the statutes and regulations pertaining to the City.
24. Providing all necessary personnel to perform the services stated herein;
25. Providing a complete accounting for the program which at all times is subject to review by
the City;
26. Investigating to determine cause, compensability, liability and any opportunity for
subrogation or recovery. Investigative services include, but are not limited to, subrogation
evaluation; notification of liens; obtaining witness statements; conducting medical records
research and evaluation; preparing and obtaining releases; preparing three-point contacts
with the client, claimant, and provider; arranging and coordinating on the client’s behalf
scene photographs and/or diagrams; obtaining police reports; obtaining expert reports;
canvassing; providing field case management; obtaining independent appraisals; obtaining
surveillance; and arranging independent medical evaluations for claim evaluation and
defense purposes;
27. Filing First Report of Injury (“FROI”) and Subsequent Report of Injury (“SROI”) forms;
28. Doing year end 1099 reporting;
29. Preparing and conducting Central Bureau Index and related searches;
30. Providing clinical review by an in-house medical director for complicated/severe and high
cost cases; in conjunction with the approved medical service provider.
31. Referring qualifying hospital bills, treating physician bills, dental bills, and pharmacy bills
for audits for repricing purposes. “Qualifying” shall mean bills where the audit for
repricing purposes is more likely than not to result in a price reduction of at least $200;
and
32. At all times, applying the largest available discount to City of any adverse changes in
provider negotiated discounts.
33. Coordinate with approved medical service provider to schedule IMEs’, checkups,
treatment plans and physical therapy.
D. Payment of Claims and Expenses
The TPA will not be required to advance its own funds to pay losses or allocated expenses,
such as attorneys’ fees, expert fees, surveillance fees and fees for independent medical
examinations.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 6
E.
Existing Claims (Tail) & Start Up Costs
The TPA shall be responsible for taking over all existing managed care services and
claims, whether in litigation or not, and this shall be made part of the TPA’s price proposal.
The TPA shall also include administrative and data conversion services in its price
proposal.
F. Contract Duration
The contract awarded will be for three (3) years. The term of the contract may be
extended for two additional one-year terms, at the option of the City.
G. Price Proposal
The TPA shall submit as part of its response to this RFQ a fixed monthly fee which shall
cover the entire scope of services required, including, but not limited to, all start up
services, conversion of all existing claims, repricing of medical bills, Electronic Data
Interchanges (“EDI”) and reports for Medicare set asides. Any additional fees or charges
the vender will charge the City over and above the fixed monthly fee shall and be set forth.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 7
CITY OF ORANGE TOWNSHIP
REQUEST FOR QUALIFICATIONS FOR THIRD-PARTY ADMINISTRATOR FOR ITS
LIABILITY AND WORKER’S COMPENSATION FOR SELF-INSURED PROGRAM
Three copies of Responses to this Request for Qualifications including all required
documentation must be received by the City of Orange Township’s Law Department, Attention:
Gracia Robert Montilus, City Attorney, Orange City Hall, 29 North Day Street, Ste. 202, City Hall,
Orange, New Jersey 07050 no later than 1:00 p.m. on the 4th of December, 2025. Late Responses will
not be considered.
1. Introduction
In accordance with N.J.S.A. 44A:20.4 et seq. the City of Orange Township is issuing this Request for
Qualifications (RFQ) to firms capable of providing Third-Party Administrator for its Liability and
Worker’s Compensation Services for the City of Orange Township Self-Insured Program as described
in Section 3, SCOPE OF SERVICES, for a period of three (3) years with an option to extend the
contract for a further two-year period. The original contract shall be from January 1, 2026 through
December 31, 2029.
The Third-Party Administrators will provide services for Worker’s Compensation Claims, General
Liability Claims and Managed Care Services. The City will award a single contract for the provision
of these services.
This Request for Qualifications provides the requirements for all providers of said Services who wish
to be considered for the contract. Proposals received in response to this RFQ will be evaluated in
accordance with the criteria set forth below at Section 4, CRITERIA FOR EVALUATION OF
PROPOSALS.
Negotiations as to cost of the Services will follow with the firm receiving the highest score under the
Selection Criteria.
2. Qualification Requirements
The Third-Party Administrator must obtain and maintain any licenses, certifications or regulatory
approvals necessary and/or required by law, for the services requested for themselves and for any
other staff who may be providing services to the City as part of the contract. At no time may said
licenses and/or certifications have been suspended or revoked in New Jersey or any other state.
The Submitter must have provided services as described herein for a minimum of ten (10) years to a
county in the State of New Jersey or to a municipality/city in the State of New Jersey with a population
comparable to City of Orange Township.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 8
Third-Party Administrator must be bonded and insured.
3. Scope of Services
Claims Processing
The Third-Party Administrator shall provide claims investigation and adjustment services for General
Liability and workers’ compensation claims filed in the State of New Jersey. Said services are to be
in accordance with the requirements of any regulating authority having jurisdiction.
The Third-Party Administrator will record and adjust claims arising out of the Program and reported
to it by the City of Orange Township for the life of the contract or life of the claim whichever come
first. The self-insured lines covered by this contract include general liability, public official, property
and worker’s compensation.
The Third Administrator will handle all run off files for City of Orange Township that were open
prior to January 1, 2026 including all open worker’s compensation files.
The Third-Party Administrator will process claims in accordance with the following standards:
Beginning on January 1, 2026 and for the term of the contract, the Third-Party Administrator shall
accept and review all claims reported to the City.
The Third-Party Administrator will conduct an investigation as it deems necessary and appropriate
for any loss in order to determine compensability. If the City believes that additional investigation is
necessary, the City may instruct the Third-Party Administrator the authority to do such further
investigation.
The Third-Party Administrator will make payment as required for all allocated loss adjustment
expenses, indemnity payments and program expenses from an account established and funded by the
City. The City will grant the awarded Third-Party Administrator the authority to exercise its discretion
and to further incur, settle and pay any individual claim or expenses equal to or less than $10,000.00.
The City will receive a weekly check register itemizing payments out of this account.
The Third-Party Administrator will establish a reserve for each claim in good faith based on
information that is documented in the claim file. The Third-Party Administrator will review the
reserves with the City.
The Third-Party Administrator will conduct appropriate settlement negotiations on legitimate claims
and endeavor to conclude such claims on favorable terms.
The Third-Party Administrator will furnish all claims forms necessary to proper claim administration.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 9
Managed Care Service
The Third-Party Administrator shall provide managed care services for Workers’ Compensation and
General Liability Claims that are filed against the City filed in the State of New Jersey. The Third-
Party Administrator shall provide its services in accordance with the requirements of any regulatory
authority having jurisdiction.
Service will be provided to a conclusion of the Worker’s Compensation or General Liability Claim.
Service shall include but not be limited to:
1.
Direct reporting service with a dedicated toll-free line to report injuries 24 hours per day,
365 days per year. This shall include the completion and filing of the Employer’s First
Report of Accidental Injury or Occupational Illness Report.
2.
Provide medical bill review and re-pricing.
3.
Provide field base medical/vocational case management with the approval of the City.
4.
Provide Telephonic Case Management Services.
Litigation Management
The Third-Party Administrator will coordinate and cooperate with all assigned defense counsel to all
litigated claims reported to it and will communicate with excess liability carriers and/or the New
Jersey Counties Excess JIF and assigned defense counsel as necessary to effectuate proper handling
of claims. The Third-Party Administrator will monitor any developments in the case and insure that
counsel is attentive to the matter and report to the City as necessary or as requested. The Third-Party
Administrator will establish individual case reserves as it deems appropriate. The City reserves the
right to take over the handling of any litigated claim and agrees to notify the Third-Party Administrator
of its decision to do so at the earliest practical time.
Subrogation
The Third-Party Administrator will itself or with the assistance of outside legal counsel, evaluated
potential subrogation rights of the City and will assert those rights that it believes are likely to yield a
benefit to the City. Notwithstanding any judgment made by the Third-Party Administrator about
whether to pursue a subrogation claim, the City reserves the right to instruct the Third-Party
Administrator to assert or not to assert any meritorious claim.
Records
The Third-Party Administrator will maintain reasonable records relating to its responsibilities under
this contract. The Third-Party Administrator will forward any or all records in its possession relating
to this contract upon request from the City.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 10
The Third-Party Administrator shall maintain finalized claim files as each claim is concluded until requested
by the City to transmit the same to the City or other party or three (3) years after the expiration of the contract
whichever occurs first.
Reports
The Third-Party Administrator will provide the City with a monthly report itemizing all claims processed
during the preceding month, including reports giving the status of losses, payments to date, estimated reserve
amounts and other details relating to losses for purposes of loss analysis.
The Third-Party Administrator shall file any required reports due to the State of New Jersey concerning the
worker’s compensation reports.
The City shall acquire and forward to the Third-Party Administrator audited payroll information. The Third-
Party Administrator shall submit all forms necessary for proper claims administration and regulatory
compliance.
Upon request of the City, the Third-Party Administrator, being provided with the details of any reinsurance
agreements, will provide claim information to reinsurers on an individual loss basis and/or aggregate basis, if
necessary.
Note: The Third-Party Administrator will be responsible for any claims as of the date the bid is awarded and
approved by the City Council.
5.
Submission of Qualifications
The Submission of Qualifications of those seeking to be awarded as the Third-Party Administrator must
include:
a.
The name, address, contact person and contact telephone number of each county or
municipality/city in the State of New Jersey for whom the Submitter has provided services similar
to those described in this RFQ.
b. Copies of all required New Jersey Department of Insurance licenses/certifications required in this
RFQ. Any revocation or suspension of licenses must be disclosed.
c.
A complete description of the experience of the Submitter in providing third- party administrator
services described in this RFQ as well as the experience of any principal or staff member who
would provide services to the City.
Submitter shall provide resumes and experience of all adjusters, account managers and/or managed
care service providers who will be providing services to the City.
Submitter shall describe their knowledge and experience, and that of their staff, if any, with regard
to providing the services described herein to the City of Orange Township and any other
governmental entities.
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 11
Submitter shall submit a brief history of their company.
Submitter shall provide the location of their office(s) that would be serving the City.
Submitter shall address their ability to provide the services and responsibility requested.
d. A certification in the form provided stating that the candidate has no conflicts of interest, actual or
apparent, that would compromise its independence of judgment in the performance of the
designated services.
e.
A certification disclosing any financing arrangements the submitter has made with third party
vendors, such as managed care and bill repricing vendors. Full disclosure of such agreements and
compensation must be submitted. Moreover the submitter must certify that if it enters into such
agreements during the course of its contract with the City of Orange Township it will immediately
notify the City.
f.
Proof of compliance with the requirements of N.J.S.A. 10:5-31 et seq. and
N.J.A.C. 17:27.
g. Proof of compliance with the New Jersey Business Registration Act.
h. Statement of Ownership, N.J.S.A. 52:25-24.2.
i.
Proof of the following insurance requirements which must be maintained throughout the term of
the contract.
1)
Commercial General Liability, including Product Completed Operations, coverage for Personal
Injury and Property Damage Liability of not less than one million dollars ($1,000.000.00)
combined single limit for each occurrence/two million dollars $2,000,000) aggregate; and
2)
Errors and omissions insurance coverage of not less than one million dollars ($1,000,000) per
occurrence/two million dollars ($2,000,000) aggregate with the City of Orange Township
named as a certificate holder and with an attached contractual liability endorsement from the
insurer stating that the errors and omissions coverage applies to the services of the Third Party
Administrator.
3)
All statutory worker’s compensation and employer liability coverage required to be held b y
law; and
4)
Fidelity Bond in the amount of three million dollars ($3,000,000).
The Third-Party Administrator shall provide the City with a Certificate of Insurance evidencing that
said insurance is and will be in effect during the term of the contract and naming the City of Orange
Township as an Additional Insured.
Each Certificate of Insurance shall contain a statement that the policy applies to all services provided
by the Third-Party Administrator which are undertaken by the insured during the term of the contract.
In addition, each Certificate of Insurance shall contain the following information or statements:
RFQ: Third Party Administrator for General
Liability and Worker’s Compensation
January 1, 2026 - December 31, 2026
Page 12
1) Name and address of insured.
2) A statement that the City of Orange Township is an Additional Insured under the
Commercial General Liability coverage.
3) The number and description of each policy in force on the date of the Certificate.
4) The expiration date of each policy shown as well as the amount of coverage for each policy.
5) The name and number of this contract as shown on the cover of this package.
6) A statement showing the method of cancellation. If cancellation may be effected by the
giving of notice to the insured and the City of Orange by the insurer, the policy and
Certificate must provide that cancellation shall not be effective until ten (10) days after
receipt of such notice by the City of Orange Township.
During the term of the contract, it shall be the responsibility of the Third-Party
Administrator to provide the City with additional Certificates of Insurance in compliance
with the above showing current coverage when any insurance policy for the above-listed
coverage expires.
Submission of proof of the required insurance coverage in the form of a Certificate or
Certificates of Insurance is a condition precedent to the execution of the contract by the
City.
j.
COST PROPOSAL-Responders should submit a cost proposal which would include all details of
any fees to be paid to responder. The City does not provide payment for or reimbursement for
travel expenses.
CITY OF ORANGE
THIRD-PARTY ADMINISTRATOR FOR ITS LIABILITY AND WORKER’S COMPENSATION
FOR SELF-INSURED PROGRAM
Date: _,
To:
The undersigned hereby submits this Response to the Qualifications for Third-Party Administrator
for its liability and Worker’s Compensation for Self-Insured Program with the understanding that
the terms of the Request for Proposal and the Proposal with all required submittals shall be the
basis for award of contract.
Date:
(Name of Service Provider)
Attest:
(Signature)
(Signature)
(Type or print name and title)
(Type or print name and title)
(Address)
(City, state, zip code)
END OF GENERAL INSTRUCTIONS
REQUEST FOR QUALIFICATIONS
T h i r d
P a r t y
A d m i n i s t r a t o r
f o r
G e n e r a l
L i a b i l i t y
a n d
W o r k e r ’ s
C o m p e n s a t i o n
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
New Jersey Business Registration Certificate*
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)
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, , (“contractor” or “subcontractor”,
as appropriate), agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for
employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual
orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or
sexual orientation and gender identity or expression, the contractor will ensure that equal employment
opportunity is afforded to such applicants in recruitment and employment, and that employees are treated
during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal
employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion,
or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of
compensation; and selection for training, including apprenticeship. The contractor agrees to post in
conspicuous places, available to employees and applicants for employment, notices to be provided by the 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.
[REMAINDER OF PAGE INTENTIONALLY BLANK]
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 S T A T E M E N T (cont’d)
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
The contractor or subcontractor shall furnish such reports or other documents to the City as may be requested
from time to time in order to carry out the purposes of these regulations, and the City may furnish such
information as may be requested by the New Jersey Division of Purchase & Property, Contract Compliance
Administration Unit, EEO Monitoring Program for purposes of conducting a compliance investigation pursuant
to N.J.A.C. 17:27-10 et seq.
The undersigned hereby acknowledges the above listed requirements.
For
(Individual or Firm Name)
By:
(Signature)
(Date)
(Printed Name)
(Title)
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 office of the
City, the County of Essex, another public entity within the County of Essex, and/or
the legislative district where the City is located, (see Part B below).
The disclosure must list reportable contributions to any of the committees that exceed $200.00 per election cycle, made
during the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8; N.J.S.A. 19:44A-16. For business entities,
this requirement applies to:
•
individuals with an ownership interest or control of more than 10.00% of the
profits or assets of the business entity;
•
all principals, partners, officers, or directors of the business entity and their
respective spouses;
•
any subsidiaries directly or indirectly controlled by the business entity;
•
any New Jersey-based IRS Code § 527 organization, directly or indirectly controlled
by the business entity and filing as a continuing political committee (i.e., PAC).
When the contractor is a natural person, “a contribution by that person’s spouse or child, residing therewith, shall be
deemed to be a contribution [by the contractor].” N.J.S.A. 19:44A-20.26(b).
Any contractor that fails to comply with these disclosure provisions shall be subject to a fine imposed by the New Jersey
Election Law Enforcement Commission in an amount based upon the amount that the contractor failed to report.
The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official
and/or candidate campaign committees are affected by the disclosure requirement. It is the contractor’s responsibility
to identify the specific committees to which contributions may have been made and need to be disclosed. The disclosed
information may exceed the minimum requirement.
The enclosed form, a content-consistent facsimile, or an electronic data file containing the required details (along with a
signed cover sheet) may be used as the contractor’s submission and is disclosable to the public under the Open Public
Records Act, N.J.S.A. 47:1A-1 et seq.
B.
List of Agencies & Elected Officials Required for Disclosure
State:
Governor, and Legislative Leadership Committees
Legislative Districts:
21, 27, 28, 29, 34, 36, and 40
1 State Senator and 2 members of the General Assembly per district
County:
County Executive; Commissioners; County Clerk; Sheriff; Surrogate; Registrar of Deeds
Municipalities (mayor and members of governing body, regardless of title):
Belleville Township
Irvington Township
City of Orange Township
Bloomfield Township
Livingston Township
Roseland Borough
Caldwell Borough
Maplewood Township
South Orange Village
Cedar Grove Township
Millburn Township
Verona Township
City of East Orange
Montclair Township
West Caldwell Township
Essex Fells Borough
City of Newark
West Orange Township
Fairfield Township
North Caldwell Borough
Glen Ridge Borough
Nutley Township
[CONTINUED ON NEXT PAGE]
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)
LETTER OF QUALIFICATION
Date
Attn: Gracia Robert Montilus
City Attorney
City of Orange Township
29 N. Day Street
Orange, NJ 07050
RE:
Request for Qualifications
Dear Mr. Montilus:
The undersigned has reviewed our Qualification Statement submitted in response to the Request for
Qualifications (RFQ) issued by the City of Orange (“City”), dated October 23, 2025, in connection with the
City’s need for ___________________________________ 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
(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
Attn: Gracia Robert Montilus
City Attorney
City of Orange Township
29 N. Day Street
Orange, NJ 07050
RE:
Request for Qualifications
Dear Mr. Montilus:
The undersigned has reviewed our Qualification Statement submitted in response to the Request for
Qualifications (RFQ) issued by the City of Orange (“City”), dated October 23, 2025, in connection with the
City’s need for___________________________ Services.
(Name of Respondent)__ HEREBY STATES:
1.
The Qualification Statement contains accurate, factual and complete information.
2.
(Name of Respondent) agrees 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 that all costs incurred by it 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.
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Gracia Robert Montilus
City Attorney · Law Department
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Timeline
First Discovered
Mar 31, 2026
Last Info Update
Apr 30, 2026
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