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Lead Closed
This opportunity is no longer accepting submissions.
2023 Professionals
BID #: 1
ISSUED: 11/3/2022
DUE: 11/29/2022
VALUE: TBD
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Executive Summary
This is a Request for Proposals (RFP) issued by the Township of East Amwell, seeking professional services for various appointed professional roles for the year 2023. The Township is looking to engage qualified individuals and firms to fill positions such as Township Attorney, Planning Board Attorney, Township Engineer, Planning Board Engineer, Township Planner and Board of Health Attorney. Proposals were due on November 29, 2022, at 9:00 AM. The RFP outlines the scope of work, qualifications, submission requirements, and selection criteria for each position, emphasizing compliance with New Jersey statutes and regulations.
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Bid Postings • 2023 Professionals Skip to Main Content Create a Website Account - Manage notification subscriptions, save form progress and more. Website Sign In Government Services Community Business How Do I... Search Home Bid Postings Print Sign up to receive a text message or email when new bids are added! Print Bid Number: RFP 22-02 Bid Title: 2023 Professionals Category: RFP - Professional Services Status: Closed Description: Click here for Bid Notice Publication Date/Time: 11/3/2022 10:00 AM Closing Date/Time: 11/29/2022 9:00 AM Related Documents: RFP 22-02 2023 Professionals Return To Main Bid Postings Page Live Edit Agendas & Minutes FAQ's Forms Notify Me® Sign up for email alerts Property Tax Payments Report a Concern Contact Us East Amwell Township 1070 Route 202/31 Ringoes, NJ 08551 Phone: 908-782-8536 Fax: 908-782-1967 Office Hours: Monday -Friday - 8:30am - 3:00pm Tuesday Evening Hours 5:00pm - 7:30pm (Tax Assessor) 5:30pm-7:30pm (Tax Collector & Zoning Officer) Helpful Links Property Tax Lookup Committee Volunteer Application Form OPRA Form Ordinance Code Book Financial Documents Job Postings /QuickLinks.aspx Site Links Home Site Map Contact Us Accessibility Copyright Notices /QuickLinks.aspx Government Websites by CivicPlus® Loading Loading Do Not Show Again Close Arrow Left Arrow Right [] Slideshow Left Arrow Slideshow Right Arrow
Document Text
--- Document: RFP 22-02 2023 Professionals ---
Township of East Amwell
COUNTY OF Hunterdon
STATE OF NEW JERSEY
PROFESSIONAL SERVICES SOLICITATION
FAIR & OPEN PUBLIC SOLICITATION PROCESS PURSUANT
TO N.J.S.A. 19:44A-20.5 ET SEQ.
PROFESSIONAL SERVICE: 2023 APPOINTED PROFESSIONALS
(VARIOUS TITLES)
November 29, 2022 at 9:00A.M.
Mark Castellano, Mayor
Tara Ramsey, Deputy Mayor
John Mills, Committeeperson
Jenna Casper-Bloom, Committeeperson
Rick Wolfe , Committeeperson
REQUEST FOR PROPOSALS
Notice is hereby given by the Township of East Amwell that a Request for Proposals in
accordance with N.J.S.A 19:44A-20.5 et seq., in a fair and open manner, are sought by the
Township of East Amwell. RFPs will be received by the Township on November 29, 2022 at 9:00
A.M. prevailing time publicly broadcast [and recorded on zoom and conducted on electronic
platform], in accordance with N.J.A.C. 5:34-1 et. Seq., on BIDNET at
www.bidnetdirect.com//eastamwelltownship :
RFP 22-02 2023 PROFESSIONALS
In accordance with N.J.S.A. 40A:11-5
Township Attorney
Planning Board Attorney
Board of Health Attorney
Township Engineer
Planning Board Engineer
Township Planner
NOTE:
It is the bidder’s responsibility to ensure that the bid package is uploaded to the e- procurement
site by the bid opening date and time. Any bid document received after the deadline established
by the Department of Purchasing will not be accepted, regardless of the method of delivery.
For information on attending the publicly broadcast opening contact the Qualified Purchasing Agent
at scanning@TheCanningGroup.org.
Bidders must comply with the requirements of N.J.S.A. 10:5-31 et seq., and
N.J.A.C. 17:27 et seq.,
This procurement has been advertised in accordance with the “Fair and Open Basis” and nothing
further shall be required under the Pay-to-Play Legislation (N.J.S.A. 19:44A-20.5).
Date: October 27, 2022
Sean Canning QPA, MPA
Purchasing Agent Township of East Amwell
SEALED SUBMISSION LABEL FOR PROPOSAL
NAME, COMPANY & ADDRESS:
TO:
QUALIFIED PURCHASING
AGENT
Township of East Amwell
22-02 (FILL IN TITLE)
Township of East Amwell
PUBLIC NOTICE FOR THE SOLICITATION OF A PROFESSIONAL SERVICE CONTRACT
SCOPE OF WORK
The following is a description of the professional services needed,
including, where appropriate, a description of tasks involved:
1.0
Township Attorney
1.1
Township Attorney shall be an attorney at law of New Jersey. Will be responsible as the
corporation counsel for all typical municipal attorney functions, including, when requested,
attending all Township Committee regular and special meetings (the regular meetings are the
second Thursday of each month), meeting with the Township Office Manager and other staff,
preparing reports and memos on closed session and legal matters, attending other committee
or working group meetings as needed, being available or having staff available to answer
time-sensitive legal questions for the Township Committee and for Township staff on a daily
basis.
2.0 Township Planner
2.1 The Planning Board Planner and the Township Planner shall be a New Jersey licensed
professional planner with certification from the American Institute of Certified Planners (AICP). The
Planning Board Planner shall provide general planning services, and expert testimony when
required, and attend regular and special Planning Board meetings as requested by the Planning
Board Chair. The Planning Board generally meets the second Wednesday of each month. The
Planning Board Planner shall review all development applications and prepare written and oral
reports of all findings and recommendations. The Planning Board Planner shall assist and advise
on other planning matters such as master plan development, land use ordinances, farmland
preservation, natural resource protection and conservation, affordable housing, open space and
recreation, economic development and downtown revitalization, and historic preservation. The
Planning Board Planner shall render opinions orally or in writing on all planning issues as may be
requested by the Planning Board Chair. The Township Planner shall also assist and advise the
Township Office Manager and Mayor and Committee on matters of general land use planning and
land development regulation as appropriate and requested. The Township Planner shall represent
the Township Committee as directed in meetings with other State, County and local agency
officials.
3.0 Planning Board Attorney
3.1 The Planning Board Attorney shall be an attorney at law of New Jersey with experience
representing Planning Boards, Zoning Boards of Adjustment and Land Use Boards. The
Planning Board Attorney shall attend all regular and special Planning Board meetings as
requested by the Planning Board Chair. The Planning Board generally meets the second
Wednesday of each month. Special Sessions are held as the need arises. The Planning Board
Attorney shall provide legal advice, research and assistance on any matters which the
Planning Board may require to be addressed by the attorney, which shall include routine
phone calls with Planning Board Chair, other
Planning Board professionals and Township staff. The Planning Board Attorney shall draft all
legal planning documents as may be required including Resolutions of Approval/Denial,
Developers Agreements, and land use ordinances, in addition to reviewing and advising the
Planning Board on matters related to deeds, covenants, easements, agreements, etc. The
Planning Board Attorney shall prepare and defend all litigation affecting the Planning Board or
any member of it, which is the result of decisions made on applications or in the normal
performance of their official duties pursuant to the Municipal Land Use Law. The Planning
Board Attorney shall represent or advise the Planning Board on any matter in which the
Planning Board may have a present or future interest.
4.0Township Engineer
4.1The Township Engineer shall be a New Jersey licensed professional engineer and shall
perform all activities as per NJSA 40A:9- 140 and detailed below and in a subsequent
contract with the Township, generally encompassing typical municipal engineering services.
4.2The Township Engineer shall have the following qualifications:
4.2.1 Is multi-disciplined with at least five years’ experience in all aspects of municipal
engineering (the appointed engineer may be assisted by employees with lesser levels
of experience).
4.2.2 That the Engineer has been P.E. licensed in the State of New Jersey for at least three
(3) years;
4.2.3 That the Engineer has at least three (3) years prior experience as a Municipal
Engineer or working in a municipal engineering office;
4.2.4 That the Engineer, and/or firm, has sufficient staff to satisfy this scope of services;
4.2.5 The Engineer has experience in road construction, construction management, land-use
law experience, planning and landscaping engineers on staff, experience in
environmental studies assessments (wetlands, archaeological, endangered species,
hydrologic studies, storm water management), GIS, materials testing, surveying, traffic
studies, drainage, and extensive knowledge of New Jersey Department of
Environmental Protection rules and regulations
4.2.6 Engineer or firm submitting the response to this proposal carries professional
liability insurance in an amount of at least$1,000,000.00 with a carrier that has AAA
rating by Best Insurance Digest;
4.2.7 Engineer must be in good standing within the Professional Engineering
Community.
4.2.8 That the Engineer or engineering firm submitting this proposal has not represented
within the past three years and does not represent any adverse
parties and claims whether administrative, civil, criminal, or otherwise, against the
Township.
4.2.9 The Township Engineer (and other engineers, if any) shall perform the following
minimum duties as well as those prescribed by NJSA 40A:9-140, all applicable law
and any subsequent agreements, subject to the supervision and review of the
Township Office Manager and the Mayor and Council:
4.2.10 Provide engineering services as requested;
4.2.11 Perform such duties as are prescribed by general law and ordinance;
4.2.12 Prepare, or cause to be prepared, plans, designs, and specifications for
publicworks projects and other improvements undertaken by the Township;
4.2.13 Prepare regular, professionally organized reports and project plans to the
Township Office Manager;
4.2.14 Attend all twice-monthly department head meetings and attend other regular or special
Mayor and Council meetings as required;
4.2.15 When requested, to reply and work directly on issues with residents and other
stakeholders, managing and communicating in a timely and professional manner;
4.2.16 Work with Administration and department heads on budgeting, including
managing and assisting in plans or preparation of plans for infrastructure,
facilities, roadways and other related assets;
4.2.17 Shall provide services necessary to review, assess conformity to requirements and
take necessary action with respect to issuance of certificates, permits, licenses and
similar regulatory documents;
4.2.18 Shall provide services necessary to observe, assess conformity to statutory or
other ordinance requirements and report upon the installation of site improvements
and subdivision public improvements in connection with Township or other site
developments;
4.3Successful candidates will be enthusiastic about performing diligent and comprehensive work, be
organized, accountable, and able to self-organize without intervention, possess professional
communication and time management skills, and commitment to ethics, purchasing, and other
best practices, and be excited to work in a fast- paced, evidence-based team environment.
5.0Planning Board Engineer
5.1The planning board engineer shall perform the following minimum duties as well as those
prescribed by applicable law, subject to the review and approval of the planning board’s
chairman. The engineer shall provide planning services as requested, perform such duties as
are prescribed by general law and ordinance, prepare, or cause to be prepared, plans, designs
and specifications for public works and improvements undertaken by the planning board and
attend regular meetings requested.
5.2The Planning Board Engineer shall have the following qualifications:
5.2.1 Is multi-disciplined with at least five years’ experience in all aspects of municipal
engineering (the appointed engineer may be assisted by employees with lesser levels
of experience);
5.2.2 That the Engineer has been P.E. licensed in the State of New Jersey for at least three
(3)years;
5.2.3 That the Engineer has at least three (3) years prior experience as a Planning
Board Engineer or working in a municipal engineering office;
5.2.4 That the Engineer, and/or firm, has sufficient staff to satisfy this scope of
services;
5.2.5 The Engineer has experience in road construction, construction management, land-
use law experience, planning and landscaping engineers on staff, experience in
environmental studies assessments (wetlands, archaeological, endangered species,
hydrologic studies, storm water management), GIS, materials testing, surveying,
traffic studies, drainage, and extensive knowledge of New Jersey Department of
Environmental Protection rules and regulations
5.2.6 Engineer or firm submitting the response to this proposal carries professional
liability insurance in an amount of at least$1,000,000.00 with a carrier that has AAA
rating by Best Insurance Digest;
5.2.7 Engineer must be in good standing within the Professional Engineering
Community.
5.2.8 That the Engineer or engineering firm submitting this proposal has not represented
within the past three years and does not represent any adverse parties and claims
whether administrative, civil, criminal, or otherwise, against the Township.
6.0 Board of Health Attorney
6.1 The Board of Health Attorney shall be an attorney at law of New Jersey with experience
representing Boards of Health. The Board of Health Attorney shall attend all regular and special
Board of Health meetings as requested by the Board of Health Chair. Special Sessions are held
as the need arises. The Board of Health Attorney shall provide legal advice, research and
assistance on any matters which the Board of Health may require to be addressed by the
attorney, which shall include routine phone calls with Board of Health Chair, other Board of Health
professionals and Township staff. The Board of Health Attorney shall draft all legal documents as
may be required including Resolutions, in addition to reviewing and advising the Board of Health
on all matters pertaining to Public Health.
7.0 Cost Details
7.1.1 If applicable, cost details including the hourly rates of each of the individuals who will be
performing services, and all expenses.
8.0 Technical Process and Equipment
8.0Description of technical process and equipment used in performing the task(s).
9.0Completion of Submissions
9.1Each submission must be provided on a Standardized Submission Form as supplied in the
submission package and signed by the professional services entity or principal thereof and
shall contain the name, address, and telephone number of the professional services entity.
All prices and amounts must be written in ink or preferably typewritten. Each signatory to the
submission must initial all erasures or corrections. Each submission, including all copies and
CD/DVD (if requested), shall be contained in a sealed envelope using the label supplied with
this submission package. If using a courier or mail service, the submission is to be clearly
marked “Sealed Submission Enclosed” and must be delivered at the place and time required
or mailed so as to be received prior to the opening time set in the advertisement.
Submissions received after the hour herein named, or in unsealed envelopes, shall not be
considered. A label has been provided for your use at the end of this document.
9.2The Township will not be responsible for submissions forwarded through the U.S. Mail or
any delivery service if lost in transit at any time before submission opening, or if hand-
delivered to incorrect location.
9.3The submission shall be accompanied by all forms listed in the Checklist and be
completed in their entirety.
10.0
Errors in submissions
10.0 If applicable, in the event there is a discrepancy between the unit prices and the extended totals,
the unit prices shall govern or if between the correct sums of the extended totals and the total
submission submitted, the correct sum shall govern. Amounts written in words shall govern over the
amounts written in numerals.
11.0
Time for Award of Contract
11.1 The contracting unit shall award the contract or reject all submissions within such time as may
be specified in the invitation for submission, but in no case more than 60 days, except that the
submissions of any professional services entities who consent thereto may, at the request of the
contracting unit, be held for consideration for such longer period as may be agreed
11.2The award of the Contract for this service will not be made unless the Township Chief Financial
Officer has certified the necessary funds in a lawful manner.
12.0 Right to reject Submissions
12.1
The right is reserved to reject any or all submissions in whole or in part if not
in compliance with the standardized submission requirements.
13.0 Method of Award
13.1The right is reserved by the Township of East Amwell to award submissions on a
“service by service” basis, “per project” basis, in part or in whole as determined by the
Township of East Amwell.
14.0 Right to Waive Informalities
14.1The Township expressly reserves the right to waive any informality in any submission,
and to accept the submission, which in the Township of East Amwell's judgment serves its
best interests.
15.0 Professional Services Referred to Laws
15.1The attention of the professional services entity is especially directed to the provisions of
Federal, State, County and Local Government statutes and regulations that may apply
to the work.
16.0 Payment
16.1Checks are processed by the Township of East Amwell's Finance Department
approximately on the 15th and 30th day of each month. It is necessary that the approved
signed vouchers be accompanied by an invoice and be submitted in advance of these
dates. Separate invoices must be submitted for all services that may be ascribed to an
escrow account. No more than one escrow account may be included on any single
invoice.
16.2
NO MINIMUM PAYMENT IS IMPLIED OR GUARANTEED.
17.0 Transitional Period
17.1In the event that a new contract has not been awarded prior to the contract expiration
date, it shall be incumbent upon the professional services entity to continue the contract
under the same terms and conditions until a new contract(s) can be completely
operational. At no time shall this transition period extend more than ninety
(90) days beyond the expiration date of the contract.
18.0 Cancellation of Contract/ Agreement
18.1Township of East Amwell shall have the right to cancel any contract entered into upon
thirty (30) days advance written notice.
19.0 Contract Term
19.1Pursuant to N.J.S.A. 40A:11-3(b), …” contracts for professional services pursuant to
subparagraph (i) of paragraph (a) subsection (1) of section 5 of P.L. 1971, c.198
(N.J.S.A. 40A:11-5) may be awarded for a period not exceeding twelve (12)
consecutive months”. This contract term shall run for the calendar year2022.
20.0 INSURANCE
20.1Worker's Compensation and Employer's Liability Insurance. This insurance shall be
maintained in force during the life of this contract by the bidder covering all
employees engaged in performance of this contract in accordance with the
applicable statute. Minimum Employer's Liability $100,000.
20.2General Liability Insurance. This insurance shall have limits of not less than $1,000,000 any
one person and $1,000,000 any one accident for bodily injury and $2,000,000 aggregate
for property damage and shall be maintained in force during the life of the contract by the
bidder.
20.3Automobile Liability Insurance. This insurance covering bidder for claims arising from owned,
hired and non-owned vehicles with limits of not less than $1,000,000any one person and
1,000,000 any one accident for bodily injury and $1,000,000each accident for property
damage, shall be maintained in force during the life of this contract by the bidder
20.4Certificate of Insurance. The contractor shall provide Certificates of the Required Insurance as
listed above along with the contract as evidence covering Comprehensive General Liability,
Comprehensive Automobile Liability, and where applicable, necessary Worker's
Compensation and Employer's Liability Insurance. Such coverage shall be with acceptable
insurance companies operating on an admitted basis in the State of New Jersey and shall
name the Township as an additional insured. Said Certificates of Insurance shall state
specifically that the Indemnification cited below is guaranteed by the policy. If such statement
is not included in the body of the policy shall be typed on the face or back of the certificate.
20.5Indemnification. Successful bidder will indemnify and hold harmless the Township of East
Amwell from all claims, suits or action and damages or costs of every name and description
to which the Township may be subjected or put by reason of injury to the person or property
of another, or the property of the Township, including attorney’s fees and costs relating to
the defense of such claims, resulting from negligent acts or omissions on the part of the
bidder, the bidder's agents, servants or subcontractors in the delivery of materials and
supplies, or in the performance of the work under this agreement.
20.6
The Township of East Amwell shall be named “Additionally Insured” on the contractor’s
insurance policy.
21.0 Vendors Documentation Retention N.J.A.C. 17:44-2.2
21.1The vendor shall maintain all documentation related to products, transaction or services
under this contract for a period of five (5) years from the date of final payment. Such
records shall be made available to the New Jersey Office of the State Comptroller upon
request.
STANDARDIZED SUBMISSION REQUIREMENTS & SELECTION CRITERIA
(FAIR & OPEN PUBLIC SOLICITATION PROCESS FOR PROFESSIONAL SERVICES)
The Township of East Amwell is seeking sealed submissions in response to a
Public Notice for the Solicitation of a Professional Service Contract.
The standardized submission requirements shall include:
Names and roles of the individuals who will perform the services/tasks and
descriptions of their experience with projects similar to the services contained herein
including their education,degrees and certifications.
References and record of success of same or similar service.
Description of ability to provide the services in a timely fashion (including staffing,
familiarity and location of key staff).
Cost details: including the hourly rates of each of the individuals who will perform
services and time estimates for each individual, all expenses and total cost of “not to
exceed” amount.
The selection criteria to be used in awarding contracts shall include:
Qualifications of the individuals who will perform theservices/tasks and the
amounts of their respective participation.
Experience and references.
Ability to perform the services/tasks in a timely fashion,including staffing and
familiarity with the subject matter.
Cost consideration - including, but not limited to, historicalcosts for similar
professional services, expertise involved and comparable costs for comparable
public entities.
Township OF East Amwell
PROFESSIONAL SERVICE ENTITY INFORMATION
FORM
If the Professional Service Entity is an INDIVIDUAL , sign name and give the following information:
Name:
Address:
Telephone No.: Social Security No.:
Fax No.: E-Mail:
If individual has a TRADE NAME, give such trade name:
Trading As: Telephone No.:
*******************************************************************************************************
*********************************************** If the Professional Service Entity is a
PARTNERSHIP , give the following information:
Name of Partners:
Firm Name:
Address:
Telephone No.: Federal I.D. No.:
Fax No.: E-Mail:
Social Security Nos.:
Signature of authorized agent:
******************************************************************************************************
*********************************************** If the Professional Service Entity is
INCORPORATED , give the following information:
State under whose laws incorporated:
Location of principal office:
Telephone No.: Federal I.D. No.:
Fax No.: E-Mail:
Name of agent in charge of said office upon whom notice may be legally served:
Telephone No.: Name of Corporation:
Signature: By:
Title: Address:
Township OF East Amwell
SUBMISSION FORM
(Additional sheets may be used but please use item number)
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 of success of same or 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, include the hourly rates (rate schedule) of each of the individuals who will
perform services and all expenses for the period of 12 months:
Firm: Date:
Authorized Representative (Print):
Signature: Title:
Telephone #: Fax #:
Email:
EXHIBIT A
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L.1975, c.127)
N.J.A.C. 17:27 et seq.
GOODS, GENERAL SERVICES, AND PROFESSIONAL SERVICES 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 Public Agency Compliance Officer setting
forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements
for employees placed by or on behalf of the contractor, state that all qualified applicants
will receive consideration for employment without regard to age, race, creed, color, national
origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression,
disability, nationality or sex.
The contractor or subcontractor will send to each labor union, with which it has a collective
bargaining agreement, a notice, to be provided by the agency contracting officer, advising
the labor union of the contractor's commitments under this chapter 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 meet targeted 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,
and labor unions, that it does not discriminate on the basis of age, race, 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 targeted 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, race, 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 shall submit to the public agency, after notification of award but prior
to execution of a goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval;
Certificate of Employee Information Report; or
Employee Information Report Form AA-302 (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 and its subcontractors shall furnish such reports or other documents to
the Division of Purchase & Property, CCAU, EEO Monitoring Program as may be requested
by the office from time to time in order to carry out the purposes of these regulations,
and public agencies shall furnish such information as may be requested by the Division of
Purchase & Property, CCAU, EEO Monitoring Program for conducting a compliance investigation
pursuant to N.J.A.C. 17:27-1.1 et seq
NEW JERSEY ANTI-DISCRIMINATION PROVISIONS
N.J.S.A. 10:2-1 ET SEQ.
Pursuant to N.J.S.A. 10:2-1, if awarded a contract, the contractor agrees that:
a. In the hiring of persons for the performance of work under this contract or any subcontract
hereunder, or for the procurement, manufacture, assembling or furnishing of any such
materials, equipment, supplies or services to be acquired under this contract, no contractor,
nor any person acting on behalf of such contractor or subcontractor, shall, by reason of race,
creed, color, national origin, ancestry, marital status, gender identity or expression, affectional
or sexual orientation or sex, discriminate against any person who is qualified and available to
perform the work to which the employment relates;
b. No contractor, subcontractor, nor any person on his behalf shall, in any manner,
discriminate against or intimidate any employee engaged in the performance of work under
this contract or any subcontract hereunder, or engaged in the procurement, manufacture,
assembling or furnishing of any such materials, equipment, supplies or services to be acquired
under such contract, on account of race, creed, color, national origin, ancestry, marital status,
gender identity or expression, affectional or sexual orientation or sex;
c. There may be deducted from the amount payable to the contractor by the contracting public
agency, under this contract, a penalty of $50.00 for each person for each calendar day during
which such person is discriminated against or intimidated in violation of the provisions of the
contract; and
d. This contract may be canceled or terminated by the contracting public agency, and all
money due or to become due hereunder may be forfeited, for any violation of this section of
the contract occurring after notice to the contractor from the contracting public agency of any
prior violation of this section of the contract.
Forni AA302
Rev. l l/l I
STATE OF NEW JERSEY
Division of Purchase & Property
Contract Compliance Audit Unit
EEOMonitoring Program
EMPLOYEE INFORMATION REPORT
IMPORTANT-READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM. FAILURE TO PROPERLY COMPLETE THE ENTIRE FORM AND TO SUBMIT TI-IE REQUIRED
$1 S0.00 FEE MAY DELAY ISSUANCE OF YOUR CERTIFICATE. DO NOT SUBMIT EE0-1 REPORT FOR SECTION B, ITEM 11. For lnst1uctions on completing th(> form, go to:
http://www.state.nj.us/t1easmy/cont1act compliance/pdf/aa302ins.pdf
SECTION A· COMPANY IDENTIFICATION
l. FID. NO. OR SOCIAL SECURJTY
2. TYPE OF BUSrNESS
3. TOTAL NO. EMPLOYEES rN THE ENTIRE
D 101.F4 RET L2.cr: ER D 3.WHOLESALE
COMPANY
4. COMPANY NAME
5. STREET
CITY
COUNTY
STATE
ZIPCODE
6. NAME OF PARENT OR AFFILIATED COMPANY (IF NONE, SO INDICATE)
CITY
STATE
ZIP CODE
9. TOTAL NUMBER OF EMPLOYEES AT ESTABLISHMENT WHJCH HAS BEEN AWARDED 1l-lE CONTRACT
IO. PUBLIC AGENCY AWARDING (X)NTRACT
CITY
COUNTY
STATE
ZIP CODE
Official Use Only
DATE RECEIVED tNAUG.DAJE
ASSIGNED CERTIFICATION NlJMBER
SECTION R - EMPI DYMENT DATA
11. Report all pennanem. temporary and part-time employees ON YOUR OWN PAYROLL. Enter the appropriate figures on all lines and in all columns. Where there are
no employees in a particular calegory. enter a zero. Include ALL employees. not just those in minority/non-minority categories. in columns I. 2. & 3. DO NOT SUBMIT
ANEEO-I REl'rnT
I
SECTION C- SIGNATURE AND IDENTIFICATION
17. ADDRESS NO. & STREET
OTY
COUNTY
STATE
ZIP CODE PHONE (AR.EA CODE, NO.,E.-XTENSION)
JOB
CATEGORIES
IA.LL EMPLOYEES
······ ·...
_•• ,.,..,...,,TV ... ,...,,..,.urr
COL. I
TOTAL
(Cols.2 &3)
COL. 2
IMALE
COL.3
FEMALE
"'"'"'"'"'"'"'"'"' MALE"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"' "'"'"'"'"'"'"'"'"'"'"'"'"'FEMAI
BLACK
msPANIC
AMER.
NDIA1'
ASIAN
NON
MIN.
BLACK
HISPANIC AMER.
INDIAN
ASIAN
NON
MIN.
Offlclals/ Managers
Professionals
Technicians
Sales Workers
Office & Clerical
Craftworkers
(Skilled)
Operatives
(Semi-skilled)
Laborers
(Unskllled)
Service Workets
TOTAL
Tolalemploymenl
From previous
Reoort llf anvl
Temporary & Parl•
Time Employees
Thedata below shal.JNOT be included in the figures for the appropriate categories above.
12. HOW WAS INFORMATION ASTORACEORETHNICGROUPINSECTIONB OBTAINED'
D I. Visual Suivey D2. Employment Record
D3- Other (Specify)
14. ISTIIISTHEFIRST
Employee Infonnation
Report SubmiUcd?
I.YES!
2.NO!
15. IFNO, DATE LAST
REPORT SUB?vllTI'ED
MOIDATEAR
"·
DATES OF PAYROLL PERIOD USED
From·
To:
SAMPLE CERTIFICATE OF EMPLOYEE INFORMATION REPORT
New Jersey Business Registration Certification
Pursuant to N.J.S.A. 52:32-44, The Township of East Amwell (“Contracting
Agency”) is prohibited from entering into a contract with an entity unless the
bidder/proposer/contractor, and each subcontractor that is required by law to be named
in a bid/proposal/contract has a valid Business Registration Certificate on file with the
Division of Revenue and Enterprise Services within the Department of the Treasury.
Prior to contract award or authorization, the contractor shall provide the
Contracting Agency with its proof of business registration and that of any named
subcontractor(s).
Subcontractors named in a bid or other proposal shall provide proof of business
registration to the bidder, who in turn, shall provide it to the Contracting Agency prior to
the time a contract, purchase order, or other contracting document is awarded or
authorized.
During the course of contract performance:
(1) the contractor shall not enter into a contract with a subcontractor unless the
subcontractor first provides the contractor with a valid proof of business
registration.
(2) the contractor shall maintain and submit to the Contracting Agency a list of
subcontractors and their addresses that may be updated from time to time.
(3) the contractor and any subcontractor providing goods or performing services
under the contract, and each of their affiliates, shall collect and remit to the
Director of the Division of Taxation in the Department of the Treasury, the use
tax due pursuant to the Sales and Use Tax Act, (N.J.S.A. 54:32B-1 et seq.) on
all sales of tangible personal property delivered into the State. Any questions in
this regard can be directed to the Division of Taxation at (609)292-6400. Form
NJ-REG can be filed online at
http://www.state.nj.us/treasury/revenue/busregcert.shtml.
Before final payment is made under the contract, the contractor shall submit to the
Contracting Agency a complete and accurate list of all subcontractors used and their
addresses.
Pursuant to N.J.S.A. 54:49-4.1, a business organization that fails to provide a copy of a
business registration as required, or that provides false business registration
information, shall be liable for a penalty of $25 for each day of violation, not to exceed
$50,000, for each proof of business registration not properly provided under a contract
with a contracting agency.
Emergency Purchases or Contracts
For purchases of an emergent nature, the contractor shall provide its Business
Registration Certificate within two weeks from the date of purchase or execution of the
contract or prior to payment for goods or services, whichever is earlier.
SAMPLE BUSINESS REGISTRATION CERTIFICATE
TOWNSHIP OF EAST AMWELL
Disclosure of Investment Activities in Iran
Bidder Name:
Part 1: Certification
BIDDERS ARE TO COMPLETE PART 1 BY CHECKING EITHER BOX.
Pursuant to Public Law 2021, c. 4, 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
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 may 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.
CHECK THE APPROPRIATE BOX:
I certify, pursuant to Public Law 2021, c. 4, 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. 2021, c. 4
("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 sign and complete the Certification below.
Failure to provide such will result in the proposal being rendered as nonresponsive and
appropriate penalties, fines and/or sanctions will be assessed as provided by law.
Part 2: Additional Information
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 activates in Iran
on additional sheets provided by you.
Part 3: Certification
I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any
attachments there to the best of my knowledge are true and complete. I attest that I am authorized to
execute this certification on behalf of the above-referenced person or entity. I acknowledge that the
Township is relying on the information contained herein and thereby acknowledge that I am under a
continuing obligation from the date of this certification through the completion of any contracts with the
Township to notify the Township in writing of any changes to the answers of information contained
herein. I acknowledge 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 recognize that I am subject to criminal prosecution
under the law and that it will also constitute a material breach of my agreement(s) with the Township and
that the Township at its option may declare any contract(s) resulting from this certification void and
unenforceable.
Full Name (Print): Title:
Signature: Date:
PHILIP D. MURPHY
Governor
SHEILA Y. OLIVER
Lt. Governor
State of New Jersey
DEPARTMENT OF THE TREASURY
DIVISION OF PURCHASE AND PROPERTY
OFFICE OF THE DIRECTOR
33 WEST STATE STREET
P. O. BOX 039
TRENTON, NEW JERSEY 08625-0039
https://www.njstart.gov
Telephone (609) 292-4886 / Facsimile (609) 984-2575
ELIZABETH MAHER MUOIO
State Treasurer
MAURICE A. GRIFFIN
Acting Director
The following list represents entities determined, based on credible information available to the public,
to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 (“Chapter 25”):
1.
AK Makina Ltd.
2.
Amona
3.
Bank Markazi Iran (Central Bank of Iran)
4.
Bank Mellat
5.
Bank Melli Iran
6.
Bank Saderat PLC
7.
Bank Sepah
8.
Bank Tejarat
9.
China International United Petroleum & Chemicals Co.,
Ltd. (Unipec)
10.
China National Offshore Oil Corporation (CNOOC)
11.
China National Petroleum Corporation (CNPC)
12.
China National United Oil Corporation (ChinaOil)
13.
China Oilfield Services Limited
14.
China Petroleum & Chemical Corporation (Sinopec)
15.
China Precision Machinery Import-Export Corp.
(CPMIEC)
16.
Indian Oil Corporation
17.
Kingdream PLC
18.
Naftiran Intertrade Company (NICO)
19.
National Iranian Tanker Company (NITC)
20.
Oil and Natural Gas Corporation (ONGC)
21.
Oil India Limited
22.
Persia International Bank
23.
Petroleos de Venezuela (PDVSA Petróleo, SA)
24.
PetroChina Company, Ltd.
25.
Sameh Afzar Tajak Co. (SATCO)
26.
Shandong Fin Cnc Machine Company, Ltd.
27.
Sinohydro Co., Ltd.
28.
SK Energy Co. Ltd.
29.
SKS Ventures
30.
Som Petrol AS
31.
Zhuhai Zhenrong Company
List Date: January 10, 2022
CERTIFICATION OF NON-INVOLVEMENT IN PROHIBITED ACTIVITIES
IN RUSSIA OR BELARUS PURSUANT TO P.L.2022, c.3
CONTRACT / BID SOLICITATION TITLE
CONTRACT / BID SOLICITATION No.
CHECK THE APPROPRIATE BOX
I, the undersigned, am authorized by the person or entity seeking to enter into or renew the contract identified above, to
certify that the Vendor/Bidder is not engaged in prohibited activities in Russia or Belarus as such term is defined in P.L.2022,
c.3,1 section 1.e, except as permitted by federal law.
I understand that if this statement is willfully false, I may be subject to penalty, as set forth in P.L.2022, c.3, section 1.d.
OR
I, the undersigned am unable to certify above because the person or entity seeking to enter into or renew the contract
identified above, or one of its parents, subsidiaries, or affiliates may have engaged in prohibited activities in Russia or
Belarus. A detailed, accurate and precise description of the activities is provided below.
Failure to provide such description will result in the Quote being rendered as non-responsive, and the Department/Division
will not be permitted to contract with such person or entity, and if a Quote is accepted or contract is entered into without
delivery of the certification, appropriate penalties, fines and/or sanctions will be assessed as provided by law.
Description of Prohibited Activity
Attach Additional Sheets If Necessary.
If you certify that the bidder is engaged in activities prohibited by P.L. 2022, c. 3, the bidder shall have 90 days to cease engaging in any
prohibited activities and on or before the 90th day after this certification, shall provide an updated certification. If the bidder does not
provide the updated certification or at that time cannot certify on behalf of the entity that it is not engaged in prohibited activities, the State
shall not award the business entity any contracts, renew any contracts, and shall be required to terminate any contract(s) the business
entity holds with the State that were issued on or after the effective date of P.L. 2022, c. 3.
Signature of Vendor’s Authorized Representative
Date
Print Name and Title of Vendor’s Authorized Representative
Vendor Name
Vendor Phone Number
Vendor Address (Street Address)
Vendor Fax Number
Vendor Address (City/State/Zip Code)
Vendor Email Address for Authorized Representative
1 Engaged in prohibited activities in Russia or Belarus” means (1) companies in which the Government of Russia or Belarus has any direct equity share;
(2) having any business operations commencing after the effective date of this act that involve contracts with or the provision of goods or services to the
Government of Russia or Belarus; (3) being headquartered in Russia or having its principal place of business in Russia or Belarus, or (4) supporting,
assisting or facilitating the Government of Russia or Belarus in their campaigns to invade the sovereign country of Ukraine, either through in-kind support
or for profit.
NJ Rev. 6.8.2022
OWNERSHIP DISCLOSURE FORM
ALL PARTIES ENTERING INTO A CONTRACT ARE REQUIRED TO PROVIDE THE INFORMATION
REQUESTED PURSUANT TO N.J.S.A. 52:25-24.2.
PLEASE NOTE THAT IF THE VENDOR/BIDDER IS A NON-PROFIT ENTITY, THIS FORM IS NOT REQUIRED.
PART 1
YES
NO
Are there any individuals, partners, members, stockholders, corporations, partnerships, or limited
liability companies owning a 10% or greater interest in the Vendor {Bidder}?
If you answered, “YES” above, you must disclose the following: (a) the names and addresses of all stockholders in the corporation
who own 10 percent or more of its stock, of any class; (b) all individual partners in the partnership who own a 10 percent or
greater interest therein; or, (c) all members in the limited liability company who own a 10 percent or greater interest therein.
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
Attach Additional Sheets If Necessary.
BID SOLICITATION #:
VENDOR {BIDDER}:
PART 2
YES
NO
Of those entities disclosed above owning a 10% or greater interest in the Vendor {Bidder}, are
there any individuals, partners, members, stockholders, corporations, partnerships, or limited
liability companies owning a 10% or greater interest of those listed entities?
If you answered, “YES” above, you must disclose the following: (a) the names and addresses of all stockholders in the corporation
who own 10 percent or more of its stock, of any class; (b) all individual partners in the partnership who own a 10 percent or
greater interest therein; or, (c) all members in the limited liability company who own a 10 percent or greater interest therein.
Please note that this disclosure shall be continued until names and addresses of every non-corporate stockholder, and individual
partner, and member, exceeding the 10 percent ownership criteria established in this act, has been identified.
Name of the entity listed above to which the disclosure below applies:
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
NAME
ADDRESS 1
ADDRESS 2
CITY
STATE
ZIP
Attach Additional Sheets If Necessary.
PART 3
As an alternative to completing this form, a Vendor {Bidder} with any direct or indirect parent entity which is publicly traded may
submit the name and address of each publicly traded entity and the name and address of each person that holds a 10 percent or
greater beneficial interest in the publicly traded entity as of the last annual filing with the federal Securities and Exchange Commission
or the foreign equivalent, and, if there is any person that holds a 10 percent or greater beneficial interest, also shall submit links to
the websites containing the last annual filings with the federal Securities and Exchange Commission or the foreign equivalent and
the relevant page numbers of the filings that contain the information on each person that holds a 10 percent or greater beneficial
interest.
CERTIFICATION
I, the undersigned, certify that I am authorized to execute this certification on behalf of the Vendor {Bidder}, that the foregoing
information and any attachments hereto, to the best of my knowledge are true and complete. I acknowledge that the TOWNSHIP is
relying on the information contained herein, and that the Vendor {Bidder} is under a continuing obligation from the date of this
certification through the completion of any contract(s) with the TOWNSHIP to notify the TOWNSHIP 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. If I do so, I will be subject to criminal prosecution under the law, and it will constitute a material breach of my agreement(s)
with the TOWNSHIP permitting the TOWNSHIP to declare any contract(s) resulting from this certification void and unenforceable.
Signature (Do not enter vendor ID as a signature)
Date
Print Name and Title
FEIN/SSN
PAY TO PLAY ADVISORY
Disclosure Requirement
P.L. 2005, Chapter 271, Section 3 Reporting
(N.J.S.A. 19:44A – 20.27)
Any business entity that has received $50,000 or more in contracts from government
entities in a calendar year will be required to file an annual disclosure report with ELEC.
The report will include certain contributions and contract information for the current
calendar year.
At a minimum, a list of all business entities that file an annual disclosure report will be
listed on ELEC’s website at www.elec.state.nj.us.
If you have any questions please contact ELEC at: 1-
888-313-ELEC (toll free in NJ) or
609-292-8700
An analyst from ELEC’s Special Programs Section will assist you.
Initials
Americans with Disabilities Act of 1990
The CONTRACTOR and the OWNER do hereby agree that the provisions of Title 11 of the Americans With
Disabilities Act of 1990 (the "ACT") (42 U.S.C~ S12101 et seq.), which prohibits discrimination on the basis of
disability by public entities in all services, programs, and activities provided or made available by public entities,
and the rules and regulations promulgated pursuant thereunto, are made a part of this contract. In providing any act
benefit, or service on behalf of the OWNER pursuant to this contract, the CONTRACTOR agrees that the
performance shall be in strict compliance with the Act. In the event that the Contractor, its agents, servants,
employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract,
the CONTRACTOR shall defend the OWNER in any action or administrative proceeding commenced pursuant to
this Act. The Contractor shall indemnify, protect, and save harmless the OWNER, its agents, servants, and
employees from and against any and all suits, claims, losses, demands, or damages, of whatever kind or nature
arising out of or claimed to arise out of the alleged violation. The CONTRACTOR shall, at its own expense, appear,
defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such
action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant
to the OWNER grievance procedure, the CONTRACTOR agrees to abide by any decision of the OWNER which is
rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of
damages against the OWNER or if the OWNER must any expense to cure a violation of the ADA which has been
brought pursuant to its grievance procedure, the CONTRACTOR shall satisfy and discharge the same at its OWN
expense.
The OWNER shall, as soon as practicable after a claim has been made against it, give written notice thereof
to the CONTRACTOR along with frill and complete particulars of the claim. if any action or administrative
proceedings is brought against the OWNER or any of its agents, servants, and employees, the OWNER
shall expeditiously forward or have forwarded to the CONTRACTOR every demand, complaint, notice,
summons, pleading, or other process received by the OWNER or its representatives.
It is expressly agreed and understood that any approval by the OWNER of the services provided by the
CONTRACTOR pursuant to this contract will not relieve the CONTRACTOR of the obligation to comply
with the Act and to defend, indemnify, protect, and save harmless the OWNER pursuant to this paragraph.
It is further agreed and understood that the OWNER assumes no obligation to indemnify or save harmless
the CONTRACTOR, its agents, servants, employees and subcontractors for any claim which may arise out
of their performance of this Agreement. Furthermore, the CONTRACTOR expressly understands and
agrees that the provisions of this indemnification clause shall in no way limit the CONTRACTOR'S
obligations assumed in this Agreement, nor shall they be construed to relieve the CONTRACTOR from
any liability, nor preclude the OWNER from taking any other actions available to it under any other
provisions of the Agreement or otherwise at law.
Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall
in no way limit the contractor’s obligations assumed in this Agreement, nor shall they be construed to relieve the
contractor from any liability, nor preclude the owner from taking any other actions available to it under any other
provisions of the Agreement or otherwise at law.
Business Name (Print):
Representative’s Name (Print):
Representative’s Title:
Representative’s Signature:
Phone:
Date:
--- Document: Committee Volunteer Application Form ---
VOLUNTEER APPLICATION
FOR APPOINTMENT TO BOARDS OR COMMITTEES
E-mail or hand deliver this application with your resume to:
Linda Giliberti, Township Clerk
1070 Route 202/31
Ringoes, NJ 08551
Phone: 908/782-8536, X19
lgiliberti@eastamwelltownship.com
NAME:
DATE:
HOME
BUSINESS
ADDRESS:
ADDRESS:
PHONE:
BUS. PHONE:
FAX:
BUS FAX:
E-MAIL ADDRESS:
I would like to be considered for appointment to the following Board or Committee as a volunteer member.
Planning Board
Board of Health
Recycling Committee
Agricultural Advisory Committee
Historic Preservation Committee
Farmland and Open Space Committee
Ringoes Village Advisory Committee
Environmental Commission
Parks & Recreation Advisory Committee
1st CHOICE:
2nd CHOICE:
Please complete the following and attach resume.
1. EDUCATIONAL BACKGROUND:
2. RELEVANT WORK/PROFESSIONAL EXPERIENCE:
3. INVOLVEMENT IN PROFESSIONAL AND COMMUNITY ORGANIZATIONS:
4. PREVIOUS SERVICE ON ANY BOARD, COMMISSION OR POSITION:
5. DESCRIBE BRIEFLY WHY YOU ARE SEEKING THE APPOINTMENT:
REFERENCES: (Please provide details of two people, not related to you,whom we may ask for a
reference)
Name:_______________________________________________________________
Address:_____________________________________________________________
Telephone No:________________________________________________________
Relationship to you:___________________________________________________
Name:_______________________________________________________________
Address:_____________________________________________________________
Telephone No:________________________________________________________
Relationship to you:___________________________________________________
To process your application, we may need to disclose the information we receive from you to others.
I agree to East Amwell Township processing and retaining the personal information contained on this
form for any purposes connected to my application or my health and safety while on the premises.
SIGNATURE:
DATE:
Your details may be kept in a volunteer file and we may use the data to keep you up to date with other
volunteer opportunities.
--- Document: OPRA Form ---
Township of East Amwell
OPEN PUBLIC RECORDS ACT REQUEST FORM
1070 Route 202/31, Ringoes, NJ 08551
(908) 782-8536 & (908) 782-8536 (Fax)
lgiliberti@eastamwelltownship.com
Linda Giliberti
Requestor Information – Please Print
Payment Information
Record Request Information: Please be as specific as possible in describing the records being requested. Also, please note that your preferred
method of delivery will only be accommodated if the custodian has the technological means and the integrity of the records will not be
jeopardized by such method of delivery.
Note: If you confirmed above that the records sought are in connection with a legal proceeding, identification of that proceeding is
required below.
AGENCY USE ONLY
AGENCY USE ONLY
AGENCY USE ONLY
Est. Document Cost
Est. Delivery Cost
Est. Extras Cost
Total Est. Cost
Deposit Amount
Estimated Balance
Deposit Date
Disposition Notes
Custodian: If any part of request cannot be
delivered in seven business days,
detail reasons here.
In Progress
-
Open
Denied
-
Closed
Filled
-
Closed
Partial
-
Closed
Tracking Information
Final Cost
Tracking #
Total
Rec’d Date
Deposit
Ready Date
Balance Due
Total
Pages
Balance Paid
Records Provided
Custodian Signature
Date
Important Notice
The last page of this form contains important information related to your rights concerning government records. Please read it carefully.
First Name
MI
Last Name
E-mail Address
Mailing Address
City
State
Zip
Telephone
FAX
Preferred Delivery:
Pick
Up
US Mail
On-Site
Inspect
Fax
E-mail
Under penalty of N.J.S.A. 2C:28-3, I certify that
1.
I
HAVE /
HAVE NOT been convicted of any indictable offense under the laws of New Jersey, any
other state, or the United States;
2.
I, or another person,
WILL /
WILL NOT use the requested government records for a commercial
purpose;
3.
I
AM /
AM NOT seeking records in connection with a legal proceeding.
Signature
Date
Maximum Authorization Cost $
Select Payment Method
Cash
Check
Money Order
Fees:
Letter size pages - $0.05
per page
Legal size pages - $0.07
per page
Other materials (CD, DVD,
etc) – actual cost of material
Delivery: Delivery / postage fees
additional depending upon
delivery type.
Extras:
Special service charge
dependent upon request.
DEPOSITS
The custodian may require a deposit against costs for reproducing documents whenever the custodian anticipates that the documents requested
will cost in excess of $5 to reproduce. N.J.S.A. 47:1A-5(f).
Where a special service charge is warranted under OPRA, that amount will be communicated to you as required under the statute. You have
the opportunity to review and object to the charge prior to it being incurred. If, however, you approve of the fact and amount of the special
service charge, you may be required to pay a deposit or pay in full prior to reproduction of the documents.
YOUR REQUEST FOR RECORDS IS DENIED FOR THE FOLLOWING REASON(S):
(To be completed by the Custodian of Records – check the box of the numbered exemption(s) as they apply to the records requested. If
multiple records are requested, be specific as to which exemption(s) apply to each record. Response is due to requestor as soon as
possible, but no later than seven (7) or fourteen (14) business days. See page 5 for additional response details)
N.J.S.A. 47:1A-1.1
Inter-agency or intra-agency advisory, consultative or deliberative material
Legislative records
Law enforcement records:
Medical examiner photos
Criminal investigatory records (however, N.J.S.A. 47:1A-3(b) lists specific criminal investigatory information which must be
disclosed)
Victims’ records and/or OPRA requests submitted by victims seeking their own records
Personal firearms records or personal identifying information connected to any license authorizing hunting with a firearm.
Trade secrets and proprietary commercial or financial information
Any record within the attorney-client privilege
Administrative or technical information regarding computer hardware, tablets, telephones, electronic computing devices, software
applications, and networks or devices operation them which, if disclosed would jeopardize computer security
Emergency or security information or procedures for any buildings or facility which, if disclosed, would jeopardize security of the building
or facility or persons therein
Security measures and surveillance techniques which, if disclosed, would create a risk to the safety or persons, property, electronic
data or software
Security alarm system activity and access reports, including video footage the disclosure of which does not compromise the integrity of
the security system
Information which, if disclosed, would give an advantage to competitors or bidders including detailed or itemized cost estimates prior to
bid opening
Information generated by or on behalf of public employers or public employees in connection with:
Any sexual harassment complaint filed with a public employer
Any grievance filed by or against an employee
Collective negotiations documents and statements of strategy or negotiating
Information that is a communication between a public agency and its insurance carrier, administrative service organization or risk
management office
Information that is to be kept confidential pursuant to court order
Certificate of honorable discharge issued by the United States government (commonly Form DD-214 or NGB-22) filed with a public
agency
Oath of allegiance, oath of office, or other affirmation; except that full name, title, and oath date.
Privacy Information:
Social security numbers
Credit card or debit card numbers
Bank account information
Month and day of birth
Personal e-mail address required by a public agency for government applications, services, or programs
Telephone numbers
Drivers’ license numbers
Primary or secondary addresses for covered persons or immediate family members per N.J.S.A. 47:1B-1 (Daniel’s Law)
Portion of any document disclosing personal information of any person provided to a public agency for sole purpose of receiving official
notifications
Lists (including personal information) of persons identifying as in need of special assistance in the event of an emergency maintained
by a municipality or county
Portion of any record disclosing the personal identifying information of a person under 18 years old
Personal identifying information contained on domestic animal permits, license, and registrations.
Metadata
New Jersey Firemen’s Association financial relief applications
Owner and maintenance manuals
HIPAA information and indecent or graphic images of a person’s intimate parts as defined in N.J.S.A. 47:1A-5.2
Certain records of higher education institutions:
Research records
Questions or scores for exam for employment or academics
Charitable contribution information
Rare book collections gifted for limited access
Admission applications
Student records, grievances or disciplinary proceedings revealing a students’ identification
Biotechnology trade secrets N.J.S.A. 47:1A-1.2
Convicts requesting their victims’ records N.J.S.A. 47:1A-2.2
Ongoing investigations of non-law enforcement agencies (must prove disclosure is inimical to the public interest) N.J.S.A. 47:1A-3(a)
Public defender records N.J.S.A. 47:1A-5(k)
Upholds exemptions contained in other State or federal statutes and regulations, Executive Orders, Rules of Court, and privileges
created by State Constitution, statute, court rule or judicial case law N.J.S.A. 47:1A-9
Personnel and pension records (however, the following information must be disclosed:
An individual’s name, title, position, salary, payroll record, length of service, date of separation and the reason for such
separation, and the amount and type of any pension received
When required to be disclosed by another law, when disclosure is essential to the performance of official duties of a person
duly authorized by this State or the US, or when authorized by an individual in interest
Data contained in information which disclose conformity with specific experiential, educational or medical qualifications
required for government employment or for receipt of a public pension, but not including any detailed medical or psychological
information N.J.S.A. 47:1A-10
N.J.S.A. 47:1A-1
“a public agency has a responsibility and an obligation to safeguard from public access a citizen's personal information with which it
has been entrusted when disclosure thereof would violate the citizen's reasonable expectation of privacy.”
Burnett v. County of Bergen, 198 N.J. 408 (2009). Without ambiguity, the court held that the privacy provision “is neither a preface nor
a preamble.” Rather, “the very language expressed in the privacy clause reveals its substantive nature; it does not offer reasons why
OPRA was adopted, as preambles typically do; instead, it focuses on the law’s implementation.” “Specifically, it imposes an obligation
on public agencies to protect against disclosure of personal information which would run contrary to reasonable privacy interests.”
Executive Order No. 21 (McGreevey 2002)
Records where inspection, examination or copying would substantially interfere with the State's ability to protect and defend the State
and its citizens against acts of sabotage or terrorism, or which, if disclosed, would materially increase the risk or consequences of
potential acts of sabotage or terrorism.
Records exempted from disclosure by State agencies’ proposed rules.
Executive Order No. 26 (McGreevey 2002)
Certain records maintained by the Office of the Governor
Resumes, applications for employment or other information concerning job applicants while a recruitment search is ongoing
Records of complaints and investigations undertaken pursuant to the Model Procedures for Internal Complaints Alleging Discrimination,
Harassment or Hostile Environments
Information relating to medical, psychiatric or psychological history, diagnosis, treatment or evaluation
Information in a personal income or other tax return
Information describing a natural person's finances, income, assets, liabilities, net worth, bank balances, financial history or activities, or
creditworthiness, except as otherwise required by law to be disclosed
Test questions, scoring keys and other examination data pertaining to the administration of an examination for public employment or
licensing
Records in the possession of another department (including NJ Office of Information Technology or State Archives) when those records
are made confidential by regulation or EO 9.
Other Exemption(s) contained in a State statute, resolution of either or both House of the Legislature, regulation, Executive Order,
Rules of Court, any federal law, federal regulation or federal order pursuant to N.J.S.A. 47:1A-9(a).
(Please provide detailed information regarding the exemption from disclosure for which you are relying to deny access to government records.
If multiple records are requested, be specific as to which exemption(s) apply to each record.)
REQUEST FOR RECORDS UNDER THE COMMON LAW
If, in addition to requesting records under OPRA, you are also requesting the government records under the common law, please check the
box below.
A public record under the common law is one required by law to be kept, or necessary to be kept in the discharge of a duty imposed by law, or
directed by law to serve as a memorial and evidence of something written, said, or done, or a written memorial made by a public officer authorized
to perform that function, or a writing filed in a public office. The elements essential to constitute a public record are that it be a written memorial,
that it be made by a public officer, and that the officer be authorized by law to make it.
Yes, I am also requesting the documents under common law.
If the information requested is a "public record" under common law and the requestor has a legally recognized interest in the subject matter
contained in the material, then the material must be disclosed if the individual's right of access outweighs the State's interest in preventing
disclosure.
Please set forth your interest in the subject matter contained in the requested material:
Note that any challenge to a denial of a request for records under the common law cannot be made to the Government Records
Council, as the Government Records Council only has jurisdiction to adjudicate challenges to denials of OPRA requests. A challenge
to the denial of access under the common law can be made by filing an action in Superior Court.
1.
All “government records” as defined in N.J.S.A. 47:1A-1.1 are subject to public access under the Open Public Records Act
(“OPRA”), unless specifically exempt.
2.
A request for access to a government record under OPRA must be in writing, hand-delivered, mailed, transmitted electronically,
or otherwise conveyed to the appropriate custodian. N.J.S.A. 47:1A-5(g). In accordance with OPRA, custodians will generally
have seven (7) business days to respond, unless:
•
The requestor seeks “immediate access” records as outlined in N.J.S.A. 47:1A-5(e); where the custodian must
respond “immediately” disclosing responsive records not to exceed twenty-four (24) months old.
•
The requestor seeks information required to be disclosed by N.J.S.A. 47:1A-3(b), where the custodian must respond
disclosing the information within twenty-four (24) hours or as a soon as practical;
•
The requestor is a seeking records for a “commercial purpose” as defined in N.J.S.A. 47:1A-1.1, where the response
time frame is fourteen (14) business days, but the custodian shall notify the requestor of the additional time within
seven (7) business days. N.J.S.A. 47:1A-5(i). However, the response time frame can be reduced to seven (7)
business days upon payment of no more than two times the cost to produce the responsive records.
•
The requestor is seeking records requiring review for compliance with “Daniel’s Law” (N.J.S.A. 47:1B-1, et seq.),
where the response time frame is fourteen (14) business days, but the custodian shall notify the requestor of the
additional time within seven (7) business days. N.J.S.A. 47:1A-5(i).
•
Fire district employing one or fewer full-time employees serving as custodians may add seven (7) business days to
the seven (7) or fourteen (14) business day response time frames.
The applicable response time does not commence until the custodian receives the request form. N.J.S.A. 47:1A-5(h). If you
submit the request form to any other officer or employee, the recipient must either forward the request to the appropriate
custodian or direct you to the appropriate custodian. Id.
3.
Requestors are not required to use this OPRA request form; however, a written equivalent not containing the form requirements
of N.J.S.A. 47:1A-5(f) and N.J.S.A. 47:1A-5(g) may be denied by a custodian.
4.
Requestors may submit requests anonymously. A request submitted anonymously shall not be considered incomplete.
N.J.S.A. 47:1A-5(f). If you elect not to identify yourself accurately or provide an accurate address, e-mail address, or telephone
number, the custodian is not required to respond until you reappear before the custodian seeking a response to the original
request. Further, anonymous requestors are prohibited from filing a complaint with either the GRC or the Courts. N.J.S.A.
47:1A-6.
5.
The fees for duplication of a “government record” in printed form are listed on page 1 of this form. The custodian will notify you
of any special service charges or other additional charges authorized by State law or regulation before processing your request.
Payment shall be made by cash, check or money order payable to the responding agency.
6.
You may be charged a prepayment or deposit when a request for copies exceeds $5.00. The custodian will contact you and
advise you of any deposit requirements. You agree to pay the balance due upon delivery of the records.
7.
Under OPRA, a custodian must deny access to a person who has been convicted of an indictable offense in New Jersey, any
other state, or the United States, and who is seeking government records containing personal information pertaining to the
person’s victim or the victim’s family. N.J.S.A. 47:1A-2.2. This includes anonymous requests for said information.
8.
By law, the responding agency must notify you that it grants or denies a request for access to government records within
applicable response time frame after the custodian receives the request. If the record requested is in storage, the custodian
will advise you within seven (7) or fourteen (14) business days after receipt of the request when the record can be made
available and the estimated cost for reproduction within no more than twenty-one (21) business days from date of notification.
N.J.S.A. 47:1A-5(i).
9.
You may be denied access to a government record if your request would substantially disrupt agency operations and the
custodian is unable to reach a reasonable solution with you. N.J.S.A. 47:1A-5(g).
10. If the custodian is unable to comply with your request for access to a government record, they will indicate the specific bases
for denial on the request form or other written correspondence and send it to you.
11. Except as otherwise provided by law or by agreement with the requester, if the custodian fails to respond to you in writing
within seven (7) or fourteen (14) business days of receiving a request, the failure to respond is a deemed denial of your request.
N.J.S.A. 47:1A-5(g); N.J.S.A. 47:1A-5(i).
12. If your request for access to a government record has been denied or unfilled within the seven (7) or fourteen (14) business
days required by law, you have a right to challenge the decision by the responding agency to deny access. At your option, you
may either: 1) institute a proceeding in the Superior Court of New Jersey; or 2) file a complaint with the Government Records
Council (“GRC”) by completing the Denial of Access Complaint Form. All questions regarding complaints filed in Superior Court
should be directed to the Court Clerk in your County. Questions regarding the GRC’s Denial of Access Complaint process can
directed to the GRC toll-free telephone at 866-850-0511, by mail at PO Box 819, Trenton, NJ, 08625, by e-mail at
Government.Records@dca.nj.gov, or at their web site at www.state.nj.us/grc. The Council can answer general inquiries about
OPRA.
13. Information provided on this form may be subject to disclosure under the Open Public Records Act.
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Sean Canning
Purchasing Agent · Township of East Amwell
hidden@email.com
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