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Request for Quotation - Fireworks Display - July 4th Celebration
BID #: 4
ISSUED: 1/17/2020
DUE: 2/19/2020
VALUE: $17,500
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Executive Summary
The Township of East Brunswick is seeking quotations for a fireworks display to be held on July 4, 2020, as part of the Township’s Independence Day Celebration, with a rain date of July 5, 2020. The contract includes providing fireworks, qualified personnel for transportation, installation, discharge, and removal, appropriate safety equipment, and proof of insurance and licenses. The fireworks show cost is not to exceed $17,500.00. Quotes must be received by the Township’s Designated Contact Person, via mail or hand delivery, by 11:00 a.m. prevailing time on February 19, 2020.
The selected vendor will be awarded a contract for 2020, with the option to extend the contract to 2021 and 2022 based upon mutual agreement. Contractors must meet specific qualifications, including a minimum of five years of experience in the fireworks/explosives field, a 100% accident-free history, and a 100% performance rating in honoring contracts. The Fire Marshall has final decision making responsibility and shall oversee all activities related to the display.
Proposals should include fireworks program details outlining a show cost not to exceed $17,500.00, references and total cost of program. The working budget has been provided to give prospective bidders a level playing field for designing their proposals and to assist in consistency during the review process. The Township of East Brunswick reserves the right to lower the show budget is necessary.
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Bid Postings • Request for Quotation - Fireworks Display - J Skip to Main Content Home Contact Us Accessibility Site Map /QuickLinks.aspx About EB Community Departments Government Recreation & Parks Public Safety Search Township Home Page Recreation & Parks Public Safety Township Clerk Home Bid Postings Print Sign up to receive a text message or email when new bids are added! Print Bid Title: Request for Quotation - Fireworks Display - July 4th Celebration Category: Request for Quotes Status: Closed Publication Date/Time: 1/17/2020 12:00 AM Closing Date/Time: 2/19/2020 10:59 AM Related Documents: 2020 RFQ July 4 Fireworks (PDF) Return To Main Bid Postings Page Live Edit Legal Notices & Public Documents Recreation & Parks Registration Solid Waste & Recycling Taxes, Utilities & Online Payments EB Codebook Ice Arena Contact Us East Brunswick Municipal Building 1 Jean Walling Civic Center Drive | East Brunswick, NJ 08816 Phone Directory | Email Home Contact Us Accessibility Site Map /QuickLinks.aspx Quick Links Bid Opportunities OPRA Requests Job Vacancies CivicReady Alerts Public Documents & Legal 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: 2020 RFQ July 4 Fireworks (PDF) ---
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Township of East Brunswick Phone: (732) 390-6850
1 Civic Center Drive Fax: (732) 238-8848
East Brunswick, New Jersey 08816-1081 www.eastbrunswick.org
TOWNSHIP OF EAST BRUNSWICK
REQUEST FOR QUOTATION
Fireworks Display– July 4th Celebration
QUOTE OPENING DATE: February 19, 2020 at 11:00 A.M.
Issue Date: January 17, 2020
FAIR AND OPEN PROCESS IN ACCORDANCE WITH
N.J.S.A. 19:44A-20.4 et seq.
Legal Publication Date: East Brunswick Township website January 17, 2020
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A. PROJECT BACKGROUND:
The Township of East Brunswick (“Township”) wishes to provide an aerial fireworks display in
conjunction with the Township’s Independence Day Celebration. The fireworks display shall occur on July
4, 2020 with a rain date of July 5, 2020.
This contract shall include the Contractor providing fireworks for the display, qualified personnel to
transport, install, discharge, and remove display, provide appropriate safety equipment, provide proof of all
required insurances, state, and federal licenses.
Quotes must be received by the Township’s Designated Contact Person, via mail or hand delivery, by 11:00
a.m. prevailing time on February 19, 2020. Quotes received after 11:00 a.m. on the Due Date will be
returned unopened.
Proposals should include fireworks program details outlining a show cost not to exceed $17,500.00,
references and total cost of program. The working budget has been provided to give prospective bidders a
level playing field for designing their proposals and to assist in consistency during the review process. The
Township of East Brunswick reserves the right to lower the show budget is necessary. The successful
vendor shall be awarded a contract for 2020 with the option to extend the contract to 2021 and 2022 based
upon mutual agreement between the Township and Vendor.
Designated Contact Person:
Nennette Perry, Municipal Clerk
Township of East Brunswick
1 Jean Walling Civic Center Drive
East Brunswick, NJ 08816-1081
It is the Contractor’s obligation to examine and familiarize themselves with all the requirements of this
Request for Quotation prior to submitting a proposal. Contractor may contact the Director of Recreation,
Parks and Community Services at 732-390-6797, weekdays between the hours of 8:30 a.m. and 4:30 p.m.,
with questions regarding this request.
B. SCOPE OF WORK:
The Township is issuing this request for quotation via a fair and open process in accordance with N.J.S.A
19:44A-20.4 et seq.
Scope of Service
1. Payment to Other Parties. The Contractor shall not obligate the Township to make any payments
to another party, not make any promises or representations to another party for, or in behalf of, the
Township without prior written approval of the Director of Recreation, Parks and Community
Services or his authorized representative.
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2. Provision of Labor, Tools, and Equipment. The Contractor agrees to furnish and pay all necessary
expenses for all labor, tools, and equipment in conjunction with the fireworks display.
3. Description of Work. Provide a safe and entertaining fireworks display at the Township’s
Independence Day Celebration at the Community Arts Center, 721 Cranbury Road, East
Brunswick, NJ 08816. Specifications for the work to be performed by this Contract will be as
follows:
a. Shells – shells shall not be larger than 4” in diameter and a variety of colors
b. Show – shall include an Opening, Main Body, and Finale in a continuous flow with no
breaks in the shooting for a period of time between 18 and 20 minutes
c. Transportation and Security of Fireworks
i. Shall provide, deliver, and secure fireworks to the designated location of the
fireworks shooting zone
ii. Shall provide copy of hazardous materials on CDL 30 days in advance of shoot
iii. Shall transport fireworks in D.O.T. approved and regulated vehicles
iv. All devices shall have their EX numbering, as required by Bureau of Explosives
and D.O.T.
v. Shall provide certification and biography of shooter to Township’s Fire Marshall
30 days in advance of shoot for Fire Marshall’s inspection and approval
vi. Shall provide resume/CV of all assistants to the shooter to the Fire Marshall 5 days
in advance of shoot for Fire Marshall’s inspection and approval
vii. Shall provide a detailed and itemized inventory of shells shipped for the display to
the Fire Marshall
viii. Shall inspect and inventory check the delivered shells with the Fire Marshall at a
mutually agreed upon time, at least 8 hours prior to the shoot time
ix. All fireworks packages shall be clearly labeled as to size, type, quantity, and
country of origin
x. Shall provide written procedures outlining plans for delivery, set up, discharge,
and removal of display
xi. Provide all safety equipment and personnel that Township’s Fire Marshall deems
necessary to shoot safely with 30 days’ notice from Fire Marshall
xii. Responsible for policing the fireworks display and searching for and disposing of
unfired fireworks as required under NFPA 1123, 1995 Edition, Section 4-1.12
xiii. Shall provide a Post Display Release Report that all shells have been removed and
secured at the end of the show
4. Schedule of Event. Contractor is required to perform show on July 4, 2020. Should the Fire
Marshall, Director of Recreation, Parks and Community Services or Contractor deem the weather
unfit for a safe show on July 4, 2020 the Contractor will perform contracted show on July 5, 2020.
Should July 5, 2020 also be deemed unfit for a safe show by the Fire Marshall, Director of
Recreation, Parks and Community Services or Contractor, the Contractor agrees to perform the
contracted show at a mutually agreed upon date in 2020 with a minimum of 14 days’ notice between
the Township and Contractor.
5. Time of Event. Fireworks display is to begin at 9:30pm. Contractor must have display set up and
inspected by Fire Marshall by 7:30pm. In the event the Contractor is not ready to begin display by
9:30pm a 5% penalty will be assessed for every 5 minutes in delay to the start of the display.
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6. Weather Cancellation/Postponement. Township shall make a decision by 12:00pm on July 4, 2020
to show or postpone the display until July 5, 2020 with no penalty. Should the Township decide
after 12:00pm to postpone the display from July 4, 2020, a 5% rescheduling fee shall be made to
Contractor.
7. Equipment and Supplies. Contractor is responsible for providing, maintaining and transporting all
equipment and supplies in connection with display in a safe manner in compliance with all State,
Federal, and D.O.T. rules and regulations.
8. Personnel. Contractor shall provide qualified employees to perform work required of display and
provide proof of fireworks/explosives certifications and drivers licenses. All Contractor employees
shall dress appropriately for a family-friendly event and in safe manner for handling explosives.
Smoking, vaping, and consumption of alcohol are not permitted on Township property – Contractor
will ensure that all employees will refrain from these activities while on Township property and
any violator may be removed from facility and face legal charges deemed appropriate by local law
enforcement. Contractor must supply at least one employee who is fluent in English and has the
ability to communicate with other members of Contractor’s crew.
9. Supervision. Township Fire Marshall shall have final decision making responsibility and shall
oversee all activities related to display. Fire Marshall shall consult with Contractor, Director of
Recreation, Parks and Community Services, and Director of Emergency Services throughout the
day of event to maintain and evaluate a safe setting for display.
10. Accident and Hazard Prevention. Contractor shall exercise precaution at all times and adhere to all
Federal, State, and Local rules and regulations concerning fireworks/explosives to maintain a safe
environment for all employees and celebration guests. Contractor is responsible to pay for any
damage to public property that results from fireworks display. Contractor will safely remove all
unused or unexploded devices from facility after approval received from Fire Marshall.
11. Termination of Contract. The Township has cause to terminate contract if Contractor fails to
perform its obligations under the terms of the contract in a timely and proper manner.
12. Proposal Maximum. Proposal may not exceed $17,500.
13. Payment for Services. Contractor shall submit an invoice and will be paid in the following manner:
a. Upon satisfactory performance of services, the Contractor shall be paid in full following
the complete execution of services required. Invoice must include all fees for explosives
and personnel and be net of any and all discounts and penalties assigned or incurred by
Township. Invoice must be submitted to Director of Recreation, Parks and Community
Services and shall be paid within 30 days of completion of display and accurate submittal
of paperwork, whichever is later.
14. Permits. Contractor will contact the Clerk’s office and apply for a Fireworks Permit. Also, a permit
must be obtained from Fire District No. 1.
C. QUALIFICATIONS:
1. Contractor shall meet and submit all necessary documents to satisfy all Federal, State, and Local
certifications and requirements to perform a fireworks/explosive display in NJ. All requirements
of the Central Jersey Joint Insurance Fund shall be adhered to as required.
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2. Contractor shall have a minimum of five (5) years of experience in the fireworks/explosives field
and provide documentation indicating this experience and any award recipients.
3. Contractor must have a 100% accident-free history in transportation and discharging of fireworks
during the past five (5) years and provide documentation indicating this safety record.
4. Contractor must have a 100% performance rating in honoring contracts for shows during the past
five (5) years and shall provide documentation indicating the successful completion of all shows
during this time period.
5. Contractor shall provide references of past displays within the Northeast region within the past 5
years.
D. FAIR AND OPEN CRITERIA:
STANDARDIZED SUBMISSION REQUIREMENTS & SELECTION CRITERIA
1. The solicitation of qualifications for any contract to be determined in excess of $17,500, and for
which a bid solicitation shall not be required under the Local Public Contracts Law shall be
advertised by the Township on the Township website at least ten (10) days prior to the date set for
the receipt of said quote. The published notice shall set forth a description of the requested goods
or services, the time, date and place that proposals must be submitted, the contact information for
obtaining a proposal document, and a statement that the proposals are being solicited through the
fair and open process, in accordance with N.J.S.A. 19:44A-20.4 et seq.
2. The Township shall review the responses to the request for quotes and appoint or award a contract
to a business entity for the goods or services advertised subsequent to such review. Contracts
awarded under this process shall be publicly announced and awarded. The resolution awarding the
contract shall state that the contract was awarded after a fair and open process and shall state the
number of responses received.
3. Contracts subject to the fair and open process delineated herein are subject to additional
Requirements and any other applicable laws including, but not limited to, the Local Public
Contracts Law.
E. SELECTION CRITERIA:
Quotations will be evaluated on the basis of the most advantageous, price and other factors considered. The
evaluation will consider:
a. Experience, technical expertise, professional execution and reputation in the field;
b. Knowledge of the Township of East Brunswick and the subject matter to be addressed under the
contract;
c. Availability to accommodate any required meetings of the Township and the ability to work well
with the Township;
d. Compensation proposal;
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e. Other factors if demonstrated to be in the best interest of the Township of East Brunswick;
f. Creative vision, display impact, appreciation and respect for the program.
F.
INSURANCE REQUIREMENTS:
1. Indemnification
The contractor agrees to indemnify and save harmless the Township, its officers, agents and employees,
hereinafter referred to as indemnitees, from all suits, including attorney’s fees and costs of litigation,
actions, loss damage, expense, cost of claims, of any character or on account of any act, claim or amount
arising or recovered under Worker’s Compensation law, or arising out of failure of the Contractor or those
acting under Contractor to conform to any statutes, ordinances, regulations, law or court decree. It is the
intent of the parties to this contract that the indemnities shall, in all instances, except for loss or damage
resulting from the sole negligence of the indemnitee, be indemnified against all liability, loss or damage of
any nature whatsoever.
2. Insurance Requirements:
A. Worker’s Compensation and Employer’s Liability Insurance
This insurance shall be maintained in full force during the life of this contract by the contractor covering
all employees engaged in performance of this contract pursuant to N.J.S.A. 34:15-12(a) and N.J.A.C.
12:235-1.6. Minimum Employer’s Liability $1,000,000.00.
B. General Liability Insurance
This insurance shall have limits of not less than $3,000,000.00 any one person and $3,000,000.00 any
one accident for bodily injury and $3,000,000.00 aggregate for property damage, and shall be
maintained in force during the life of the contract.
C. Automobile Liability Insurance
This insurance covering contractor for claims arising from owned, hired and non-owned vehicles with
limits of not less than $3,000,000.00 any one person and $3,000,000.00 any one accident for bodily
injury and $3,000,000.00 each accident for property damage, shall be maintained in force during the
life of this contract by the contractor.
D. Professional Liability/Malpractice Insurance Policy (if applicable)
Coverage in the amount of $2,000,000.00/occurrence, $4,000,000.00 aggregate and assurance that each
such policy for each staff member remains full and in effect while providing services for Township.
The contractor shall provide the Township with a Certificate of Insurance naming the Township of East
Brunswick as additionally insured, evidencing the existence of required insurance prior to the
commission of work. Rain Date shall also be shown on the description section of the Certificate of
Insurance. Said insurance must include coverage for complete operations, contractual insurance and
independent contractor or subcontractor insurance, where and if applicable.
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E. Errors and Omissions Insurance
a. The contractor shall purchase and maintain during the entire period of this contract, errors and
omissions insurance that shall protect the contractor and the Township from any and all claims
that may arise out of or result from the contractor’s performance of this contract. Specifically,
the errors and omissions insurance shall have limits of not less than $2,000,000.00 dollars per
occurrence and $4,000,000.00 dollars in the aggregate.
b. Certificates of the Required Insurance
Certificates as listed above shall be submitted along with the contract as evidence covering
Errors and Omissions insurance. Such coverage shall be with acceptable insurance companies
operating on an admitted basis in the State of New Jersey.
The contractor shall provide the Township with a Certificate of Insurance naming the
Township, its employees, officers, and agents as additionally insured, and evidencing the
existence of required insurance prior to the commission of work.
The Township will not accept Mutual Limitation of Liability terms.
F. OTHER REQUIREMENTS:
1. Proof of N.J. Business Registration Certificate N.J.S.A. 52:32-44
Pursuant to N.J.S.A. 52:32-44, the Township is prohibited from entering into a contract with an entity unless
the bidder/respondent/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 proposal shall provide proof of business registration to the bidder, who in
turn, shall provide it to the Contracting Agency prior to the time of 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 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 in the State. Any questions in this
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regard can be directed to the Division of Taxation at (609) 292-6400. Form NJ-REG can be filed
online at 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 $25.00 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.
2. Form W-9
Successful contractor shall complete W-9 Form and submit to the Municipal Clerk prior to contract award.
The form is available at the following link: www.irs.gov/pub/irs-pdf/fw9.pdf
3. Certification Of Political Contributions - Pay to Play – Notice of Disclosure Requirement
Township Ordinance No. 06-13 Establishing Restrictions on the Award of Contracts to Professional Entities
and Certain Other Entities Who Make Certain Political Contributions, and pursuant to Section 3 (a) thereof,
requires that Respondents confirm that they have not made any contributions in violation of Section 1 of
Ordinance No. 06-13.
Business entities are advised of their responsibility to file an annual disclosure statement of political
contributions with the New Jersey Election Law Enforcement Commission (ELEC) pursuant to N.J.S.A.
19:44A-20.27 if they receive contracts in excess of $50,000 from public entities in a calendar year.
Business entities are responsible for determining if filing is necessary. Additional information on this
requirement is available from ELEC at 888-313-3532 or at www.elec.state.nj.us.
H. PAYMENTS
The Contractor shall invoice the Department Recreation, Parks and Community Services of the Township
and payment will be processed in a timely manner upon receipt of accurate and complete paperwork.
I. QUESTIONS
Any person who has questions or who needs additional information should contact Nennette Perry,
Municipal Clerk, at (732) 390-6850.
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Fireworks Display– July 4th 2020 Celebration
QUOTATION FORM
Township of East Brunswick
1 Jean Walling Civic Center
Middlesex County, New Jersey 08816
Attn: Purchasing
QUOTATION OF: ________________________________________________________________
ADDRESS: ____________________________________________
FOR: Fireworks Display– July 4th 2020 Celebration
We, the Undersigned Service Provider, acting through our authorized officers and intending to be legally
bound, agree that this Quotation proposal shall constitute an offer by the Undersigned to enter into a
Contract and with the Township of East Brunswick to furnish the necessary goods, services, material and/or
equipment called for in the Quotation. This Quotation shall be irrevocable for sixty (60) calendar days
from the date of receipt hereof.
We further declare that we have carefully examined the Instructions of the Quotation, Specifications, and
Quotation Documents herein referred to and propose to furnish, deliver, install and/or provide all necessary
services specified and in the manner and time prescribed.
Total Price
$__________________________
Name of Provider: ____________________________________________________________________
Address: ______________________________________________________________________
Phone Number: _____________________ E-Mail:______________________________________
**If a corporation, give the State of Incorporation, using the phrase: "A corporation organized under the
laws of ______________________________________."
If a partnership, give names of the partners, using also the phrase: "Co-partners trading and doing business
under the firm name and style of_________________________________________________.”
If an individual using a trade name, give individual name, also using the phrase:
"An individual doing business under the firm name and style of _________________________.”
\
By: ___________________________________
(Signature of Individual, Partner or Officer of Provider)
___________________________________
Title
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EXHIBIT A - MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE PER
N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-1.1 et seq.
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or
applicant for employment because of age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with
respect to affectional or sexual orientation and gender identity or expression, the contractor will take
affirmative action to ensure that such applicants are recruited and employed, and that employees are treated
during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such action
shall include, but not be limited to the following: employment, upgrading, demotion, or transfer;
recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation;
and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places,
available to employees and applicants for employment, notices to be provided by the Public Agency
Compliance Officer setting forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for
employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital
status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor, where applicable, will send to each labor union or representative or
workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to
be provided by the agency contracting officer advising the labor union or workers' representative of the
contractor's commitments under this act and shall post copies of the notice in conspicuous places available
to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by
the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the
Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to employ minority and women
workers consistent with the applicable county employment goals established in accordance with N.J.A.C.
l7:27-5.2, or a binding determination of the applicable county employment goals determined by the
Division, pursuant to N.J.A.C. 17:27-5.2.
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.
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Continued
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 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
Employee Information Report Form AA302
The contractor and its subcontractors shall furnish such reports or other documents to the Div. of
Contract Compliance & EEO 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 Div. of Contract Compliance & EEO for conducting a compliance investigation pursuant to Subchapter
10 of the Administrative Code at N.J.A.C. 17:27-1.1 et seq.
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STATEMENT OF OWNERSHIP DISCLOSURE
N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)
This statement shall be completed, certified to, and included with all bid and proposal submissions.
Failure to submit the required information is cause for automatic rejection of the bid or
proposal.
Name of Organization: _________________________________________________________
Organization Address: __________________________________________________________
Part I - Check the box that represents the type of business organization:
□Sole Proprietorship (skip Parts II and III, execute certification in Part IV)
□ Non-Profit Corporation (skip Parts II and III, execute certification in Part IV)
□ For-Profit Corporation (any type) □Limited Liability Company (LLC)
□ Partnership □ Limited Partnership □ Limited Liability Partnership (LLP)
□ Other (be specific): __________________________________________
Part II
□ The list below contains the names and addresses of all stockholders in the corporation who own 10
percent or more if its stock, of any class, or of all individual partners in the partnership who own a 10
percent or greater interest therein, or of all members in the limited liability company who own a 10
percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION)
OR
□ No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no
individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the
limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART
IV)
(Please attach additional sheets if more space is needed):
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Name of Individual or Business Entity
Home Address (for Individuals) or Business Address
Part III - DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC
MEMBERS LISTED IN PART II
If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10
percent 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 federal Securities and
Exchange Commission (or foreign equivalent) that contain the name and address of each person holding
a 10% 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
more space is needed.
Website (URL) containing the last annual SEC (or foreign equivalent) filing
Page #’s
Please list the names and addresses of each stockholder, partner or member owning a 10 percent or
greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed
in Part II other than for any publicly traded parent entities referenced above. The 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 pursuant to N.J.S.A. 52:25-24.2 has been
listed. Attach additional sheets if more space is needed.
Stockholder/Partner/Member and
Corresponding
Entity Listed in Part II
Home Address (for Individuals) or Business
Address
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Part IV - Certification
I, being duly sworn upon my oath, hereby represent that the foregoing information and any
attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I
am authorized to execute this certification on behalf of the bidder/proposer; that the Township
of East Brunswick is relying on the information contained herein and that I am under a continuing
obligation from the date of this certification through the completion of any contracts with
Township of East Brunswick to notify the Township of East Brunswick in writing of any changes
to the information contained herein; that I am aware that it is a criminal offense to make a false
statement or misrepresentation in this certification, and if I do so, I am subject to criminal
prosecution under the law and that it will constitute a material breach of my agreement(s) with
the, permitting the Township of East Brunswick to declare any contract(s) resulting from this
certification void and unenforceable.
Full Name (Print):
Title:
Signature:
Date:
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NON-COLLUSION AFFIDAVIT
I, ________________________________ of the City of ___________ _____,
In the County of _______________________, and the State of _________________, of full age, being duly
sworn according to law on my oath depose and say that:
I am ____________________________________________________________of the firm of
_____________________________________________________________, the Proposer herein, and I
executed the Proposer with full authority to do so; that the Proposer has not directly or indirectly, entered
into any agreement, participated in any collusion, or otherwise taken any action in restraint of free,
competitive proposing in connection with the above-named Vendor, and that all statements contained in
the Proposal and in this affidavit are true and correct, and made with full knowledge that the Township
of East Brunswick relies upon the truth of the statements contained in the Proposal and the statement in
this affidavit in awarding the contract.
I further warrant that no person or selling agency has been employed or retained to solicit or
secure a contract upon an agreement or understanding for a commission, percentage, brokerage or
contingent fee, except bona fide employees or bona fide established commercial or selling agencies
maintained by __________________________________. (Name of Vendor)
____________________________
Signature
____________________________
Print or Type Name and Title
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AMERICANS WITH DISABLITIES ACT OF 1990
EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABLITY
The RESPONDENT and the TOWNSHIP OF EAST BRUNSWICK (herein referred to as the
TOWNSHIP) 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 regulation promulgated pursuant thereunto, are made a part of this contract. In providing any aid,
benefit, or service on behalf of the TOWNSHIP pursuant to this contract, the RESPONDENT agrees that
the performance shall be in strict compliance with the Act. In the event the RESPONDENT, its agents,
servants, employees, or subcontractors violate or are alleged to have violated the Act during the
performance of this contract, the RESPONDENT shall defend the TOWNSHIP in any action or
administrative proceeding commenced pursuant to this Act. The RESPONDENT shall indemnify, protect,
and save harmless the TOWNSHIP, 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 the alleged violation. The
RESPONDENT 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 TOWNSHIP’S grievance
procedure, the RESPONDENT agrees to abide by any decision of the TOWNSHIP, which is rendered
pursuant to, said grievance procedure. If any action or administrative proceeding result in an award of
damages against the TOWNSHIP or if the TOWNSHIP incurs any expense to cure a violation of the ADA
which has been brought pursuant to its grievance procedure the RESPONDENT shall satisfy an discharge
the same at its own expense.
The TOWNSHIP shall, as soon as practicable after a claim has been made against it, give written
notice thereof to the RESPONDENT along with full and complete particulars of the claim. If any action or
administrative proceeding is brought against the TOWNSHIP or any of its agents, servants, and employees,
the TOWNSHIP shall expeditiously forward or have forwarded to the RESPONDENT every demand,
complaint, notice, summons, pleading, or other process received by the TOWNSHIP or its representatives.
It is expressly agreed and understood that any approval by the TOWNSHIP of the services provided
by the RESPONDENT pursuant to this contract will not relieve the RESPONDENT of the obligation to
comply with the Act and to defend, indemnify, protect, and save harmless the TOWNSHIP pursuant to this
paragraph.
It is further agreed and understood that the TOWNSHIP assumes no obligation to indemnify or
save harmless the RESPONDENT, its agents, servants, employees and subcontractors for any claim which
may arise out of their performance of this Agreement. Furthermore, the RESPONDENT expressly
understands and agrees that the provisions of this indemnification clause shall in no way limit the
RESPONDENT’S obligations assumed in this Agreement, nor shall they be construed to relieve the
RESPONDENT from any liability, nor preclude the TOWNSHIP from taking any other actions available
to it under any other provisions of this Agreement or otherwise at law.
C. 271 POLITICAL CONTRIBUTION DISCLOSURE
FORM
Contractor Instructions
Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to
a “fair and open” process (defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of P.L. 2005, c.
271, s.2 (N.J.S.A.
•
any State, county, or municipal committee of a political party
19:44A-20.26). This law provides that 10 days prior to the award of such a contract, the
contractor shall disclose contributions to:
•
any legislative leadership committee*
•
any continuing political committee (a.k.a., political action committee)
•
any candidate committee of a candidate for, or holder of, an elective office:
o of the public entity awarding the contract
o of that county in which that public entity is located
o of another public entity within that county
o or of a legislative district in which that public entity is located or, when the
public entity is a county, of any legislative district which includes all or part
of the county
The disclosure must list reportable contributions to any of the committees that exceed $300 per election
cycle that were made during the 12 months prior to award of the contract. See N.J.S.A.
19:44A-8 and
19:44A-16 for more details on reportable contributions.
N.J.S.A.
•
individuals with an “interest” ownership or control of more than 10% of the profits or assets
of a business entity or 10% of the stock in the case of a business entity that is a corporation
for profit
19:44A-20.26 itemizes the parties from whom contributions must be disclosed when a business
entity is not a natural person. This includes the following:
•
all principals, partners, officers, or directors of the business entity or their spouses
•
any subsidiaries directly or indirectly controlled by the business entity
•
IRS Code Section 527 New Jersey based organizations, directly or indirectly controlled by
the business entity and filing as continuing political committees, (PACs).
When the business entity is a natural person, “a contribution by that person’s spouse or child, residing
therewith, shall be deemed to be a contribution by the business entity.” [N.J.S.A.
Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed
by ELEC in an amount to be determined by the Commission which may be based upon the amount that
the business entity failed to report.
19:44A-20.26(b)] The
contributor must be listed on the disclosure.
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.
The contractor must also complete the attached Stockholder Disclosure Certification. This will assist the
agency in meeting its obligations under the law. NOTE: This section does not apply to Board of
Education contracts.
* N.J.S.A. 19:44A-3(s): “The term "legislative leadership committee" means a committee established, authorized to
be established, or designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the
General Assembly or the Minority Leader of the General Assembly pursuant to section 16 of P.L.1993, c.65
(C.19:44A-10.1) for the purpose of receiving contributions and making expenditures.”
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Required Pursuant To N.J.S.A. 19:44A-20.26
This form or its permitted facsimile must be submitted to the local unit
no later than 10 days prior to the award of the contract.
Part I – Vendor Information
Vendor Name:
Address:
City:
State:
Zip:
The undersigned being authorized to certify, hereby certifies that the submission provided herein represents
compliance with the provisions of N.J.S.A.
19:44A-20.26 and as represented by the Instructions accompanying this
form.
_________________________
____________________________
_________________________
Signature
Printed Name
Title
Part II – Contribution Disclosure
Disclosure requirement: Pursuant to N.J.S.A.
19:44A-20.26 this disclosure must include all reportable
political contributions (more than $300 per election cycle) over the 12 months prior to submission to the
committees of the government entities listed on the form provided by the local unit.
Check here if disclosure is provided in electronic form.
Contributor Name
Recipient Name
Date
Dollar Amount
$
Check here if the information is continued on subsequent page(s)
Continuation Page
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Required Pursuant To N.J.S.A.
19:44A-20.26
Page ___ of ______
Vendor Name:
Contributor Name
Recipient Name
Date
Dollar Amount
$
Check here if the information is continued on subsequent page(s)
List of Agencies with Elected Officials Required for Political Contribution Disclosure
N.J.S.A.
County Name:
19:44A-20.26
State: Governor, and Legislative Leadership Committees
Legislative District #s:
State Senator and two members of the General Assembly per district.
County:
Freeholders
County Clerk
Sheriff
{County Executive}
Surrogate
Municipalities (Mayor and members of governing body, regardless of title):
USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD
FROM WWW.NJ.GOV/DCA/LGS/P2P A COUNTY-BASED,
CUSTOMIZABLE FORM.
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Municipal Clerk · Clerk's Office
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Mar 31, 2026
Last Info Update
Apr 1, 2026
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