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RFQ Notice: Risk Management Consulting Services
BID #: 178
ISSUED: 11/18/2025
DUE: 12/17/2025
VALUE: TBD
100
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Green Risk
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Executive Summary
The Township of East Brunswick is seeking qualifications from firms to provide Risk Management Consulting Services. The selected consultant will assist the Township in identifying insurable exposures, recommending risk reduction methods, reviewing insurance coverages, and assisting with insurance budget preparation. The consultant will also attend safety committee meetings and assist in claims settlement, in addition to coordinating with Township employees. The contract term is for three years, from January 2, 2026, to January 1, 2029. Qualification statements must be received by December 17, 2025, at 11:00 a.m. and must be submitted via mail or hand delivery; no email or fax submissions will be accepted.
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Document Text
--- Document: RFQ Risk Management Services - 2026 - 2029 ---
TOWNSHIP OF EAST BRUNSWICK
REQUEST FOR QUALIFICATIONS
****
RISK MANAGEMENT CONSULTING SERVICES
ISSUE DATE: November 18, 2025
DUE DATE: December 17, 2025, at 11:00 a.m.
T o w n s h i p o f E a s t B r u n s w i c k
1 J e a n W a l l i n g C i v i c C e n t e r
E a s t B r u n s w i c k , N e w J e r s e y 0 8 8 1 6
T e l . ( 7 3 2 ) 3 9 0 - 6 8 5 0
F a x . ( 7 3 2 ) 2 3 8 - 8 8 4 5
w w w . e a s t b r u n s w i c k . o r g
L e g a l P u b l i c a t i o n D a t e :
E a s t B r u n s w i c k T o w n s h i p w e b s i t e
N o v e m b e r 1 8 , 2 0 2 5
1 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
R i s k M a n a g e m e n t C o n s u l t i n g S e r v i c e s
THE TOWNSHIP OF EAST BRUNSWICK
REQUEST FOR QUALIFICATIONS
RISK MANAGEMENT CONSULTING SERVICES
NOTICE IS HEREBY GIVEN, that the Township of East Brunswick desires to appoint a Risk
Management Consultant who will be responsible for assisting the Township in identifying its insurable
exposures and to recommend professional methods to reduce, assume, or transfer the risk loss. The Consultant
shall review with the Township any additional coverages that the Consultant feels should be carried but are not
available from the Middlesex County Municipal Joint Insurance Fund (hereinafter “Fund”) and, subject to the
Township’s authorization, place such coverages out of the Fund. The Consultant shall assist the Township in
the preparation of applications, renewals, statement of values and similar documents requested by the Fund.
The Consultant shall review the Township’s assessment as prepared by the Fund and assist the Township in
the preparation of its annual insurance budget.
The selection is subject to the “New Jersey Local Unit Pay-to-Play Law, N.J.S.A. 19:44A-20.4, et seq.
The Township has structured a procurement process to establish a competitive process to assure that each
person and/or firm is provided an equal opportunity to submit a Qualification Statement in response to the
RFQ. The factors to be considered by the Township include, but not limited to; (i) experience and reputation
in the profession; (ii) knowledge of the subject matter to be addressed under contract; (iii) availability to
accommodate any required meetings of the Township or Township agency; (iv) any other factors demonstrated
to be in the best interest of the Township of East Brunswick.
Instructions and qualification documents are available on the Township’s website and can be requested
through the Township Clerk’s Office which is also the designated contact for this RFQ:
Township of East Brunswick
Township Clerk’s Office
Attn: Tamar Lawful
1 Civic Center Drive
East Brunswick, NJ 08816
Tele: 732-390-6850
Email: Tlawful@Eastbrunswick.org
SUBMISSION DUE DATE:
Wednesday, December 17, 2025, by 11:00 a.m.
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OBTAINING A SUBMISSION PACKAGE
Instructions and qualification documents are available on the Township’s website (www.Eastbrunswick.org)
and can also be obtained through the Township Clerk’s Office during regular business hours, Monday –Friday,
from 8:30 a.m. to 4:30 p.m. The submission package can also be requested by phone or via email: 732-390-
6850 /Tlawful@Eastbrunswick.org.
SUBMISSION BY FACSIMILE OR EMAIL – NOT PERMITTED:
Qualification Statements will not be accepted by facsimile transmission or email.
SUBMISSION ENVELOPE
Completed Qualification Statements must be submitted in the manner designed and outlined in the submission
package. The envelope or package must be enclosed in a sealed envelope bearing the name and address of the
Respondent, and the name of the specific professional service of interest, addressed to the Township of East
Brunswick. Each interested firm or professional must submit a separate qualification statement for each area
of interest. One qualification statement for multiple services will not be accepted. Please enclose one (1)
original, (marked original), and two (2) copies (each marked copy) of the proposal being submitted for each
professional service of interest.
Qualification Statements must be received by the Township’s Designated Contact Person, via mail or
hand delivery, by 11:00 A.M. prevailing time on the Due Date. Qualification Statements received after
11:00 A.M. on the Due Date will be returned unopened.
Note: The Township of East Brunswick will consider proposals only from firms or organizations that have
demonstrated the capability and willingness to provide high-quality services in the manner described in this
Request for Qualification. The Township reserves the right to reject any or all submissions due to any defects
or waive informalities and accept any submissions that, in their judgment, will be in the best interest of the
Township. The Township shall award the contract or reject all submissions no later than 60 days from receipt
of the same.
All Respondents are required to comply with the affirmative action and non-discrimination provisions of
N.J.S.A. 10:5-31 et seq. and N.J.A.C. 14:27.
BY THE ORDER OF THE TOWNSHIP COUNCIL OF THE TOWNSHIP OF EAST BRUNSWICK.
Tamar Lawful, RMC/CMR
TOWNSHIP OF EAST BRUNSWICK
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GLOSSARY
The following definitions shall apply to and are used in this Request for Qualifications:
• “Township” – refers to the Township of East Brunswick, its officers and elected and appointed
officials, employees and advisors and consultants.
• "Due Date" - refers to the date and time by which Qualification Statements must be received by the
Township in order to be considered for award of the contract or position.
• "Qualification Statement" - refers to a Respondent’s complete response to this RFQ.
• "Qualified Respondent" - refers to those Respondents who (in the sole judgment of the Township) have
satisfied the qualification criteria set forth in this RFQ.
• "RFQ" - refers to this Request for Qualifications, including any amendments thereof or supplements
thereto.
• "Respondent" or "Respondents" - refers to the interested individuals and firms that submit Qualification
Statements.
• “Services” – refers to the professional services the Township seeks in this RFQ process.
• “Successful Respondent” – refers to the Respondent selected by the Township to perform the Services.
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ANTICIPATED PROCUREMENT SCHEDULE
ACTIVITY
DATE
1.
Issuance of Request for Qualifications
November 18, 2025
2.
Receipt of Qualification Statements/ Due Date
December 17, 2025
3
Completion of Evaluation of Qualification Statements
December 30, 2026
4.
Award of Professional Services Agreements
January 12, 2026
5.
Term of Contract
January 2, 2026 – January 1, 2029
1.3
Conditions Applicable to RFQ.
Upon submitting a Qualification Statement in response to this RFQ, the Respondent acknowledges and
consents to the following conditions:
•
This document is an RFQ and does not constitute an RFP.
•
This RFQ does not commit the Township to issue an RFP.
•
All costs incurred by the Respondent in connection with responding to this RFQ shall be borne
solely by the Respondent. There shall be no claims whatsoever against the Township, its staff
or consultants for reimbursement or payment of costs or expenses incurred in the preparation of
the Qualification Statement or other information required by the RFQ.
•
The Township reserves the right to reject for any reason any and all responses and components
thereof.
•
The Township reserves the right to reject any Respondent that submits incomplete responses to
this RFQ, or a Qualification Statement that is not responsive to the requirements of this RFQ.
•
The Township reserves the right, without prior notice, to supplement, amend, or modify this
RFQ, or to request additional information.
•
All Qualification Statements shall become the property of the Township and will not be
returned.
•
All Qualification Statements will be made available to the public at the appropriate time, as
determined by the Township in accordance with law.
•
Any Qualification Statements not received by the Township timely will be rejected.
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•
The Township shall not be liable for any claims or damages alleged to have been incurred as a
result of this RFQ process, including the Township’s review of Qualification Statements and its
award of contracts.
1.4
Rights of Township.
The Township reserves the following rights with regard to this RFQ and the procurement process in
accordance with the provisions of applicable law:
•
To determine that any Qualification Statement received complies or fails to comply with the
terms of this RFQ.
•
To supplement, amend or otherwise modify the RFQ through issuance of addenda to all
prospective Respondents who have received a copy of this RFQ.
•
To waive any technical non-conformance with the terms of this RFQ.
•
To change or alter the schedule for any events called for in this RFQ upon the issuance of notice
to all prospective Respondents who have received a copy of this RFQ.
•
To conduct investigations of any or all of the Respondents, as the Township deems necessary
or convenient, to clarify the information provided as part of a Qualification Statement, and to
request additional information to support the information included in any Qualification
Statement.
•
To suspend or terminate the procurement process described in this RFQ at any time, commence
a new procurement process, or exercise any other rights provided under applicable law without
any obligation to the Respondents.
The Township shall be under no obligation to complete all or any portion of the procurement process
described in this RFQ.
1.5
Addenda or Amendments to RFQ.
After the issuance of the RFQ, but no later than seven (7) business days prior to the Due Date, the
Township may issue an addenda, amendments or answers to written inquiries. Addenda will be noticed by the
Township and will constitute a part of the RFQ. All responses to the RFQ shall be prepared with full
consideration of any addenda issued.
1.6
Proposal Format.
Responses should cover all information requested in Section 3 of this RFQ. Responses that do not meet
the requirements of the RFQ or which are in any way conditional, incomplete, obscure, contain additions or
deletions from requested information, or contain errors may be rejected.
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SECTION 2
SCOPE OF SERVICES
The Township seeks Qualification Statements from Respondents that have expertise in the provision
of services as outlined in the Notice of Solicitation.
Refer to Appendix A for Scope of Services by particular profession – See page 28 -29.
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SECTION 3
SUBMISSION REQUIREMENTS
3.1
General Requirements.
Respondent’s Qualification Statement must meet or exceed the professional, administrative
and financial qualifications set forth in this Section 3 and shall incorporate the information requested
below.
In addition to the information described below, Respondents are invited to submit supplemental
information that may be useful to the Township in evaluating the Qualification Statement. This information
may include, for example, a firm profile or brochure. Respondents are encouraged to be clear, factual, and
concise in their presentation of information.
3.2
Administrative Information Requirements.
The Respondent shall, as part of its Qualification Statement, provide the following documentation and
information:
1.
An executive summary (not to exceed two (2) pages) of the information contained in all
the other parts of the Qualification Statement.
2. An executed Letter of Intent (See Exhibit A).
3.
Name, address and telephone number of the individual or firm submitting the
Qualification Statement and the name of the key contact person.
4.
A statement that the Respondent has complied with all applicable affirmative action (or
similar) requirements with respect to its business activities (e.g., N.J.S.A. 10:5-31 et seq. and N.J.A.C.
17:27 as amended) and evidence of such compliance. (See Exhibit B)
5.
The number of years Respondent has been in practice.
6.
Any judgments within the last three years in which Respondent has been adjudicated liable
for professional malpractice. If any, please provide the docket numbers.
7.
Whether Respondent or its firm is now or has been involved in any bankruptcy or re-
organization proceedings in the last ten years. If so, please provide the docket
numbers.
8.
A statement that principals have no immediate relatives who are Township employees or
elected officials.
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3.3
Professional Information Requirements.
1.
Respondent shall submit a description of its overall experience in providing the same or similar
Services. At a minimum, the following information should be included as appropriate:
a.
Description and scope of Respondent’s work experience.
b.
Three business references, including contact information.
c.
Explanation of perceived relevance of Respondent’s experience to the RFQ.
2.
Describe those portions of the Respondent’s services, if any, that are sub-contracted. Identify
all subcontractors the Respondent anticipates using in connection with the Services.
3.
Resumes of key employees who will be assigned to provide the Services.
3.4
Services Fees.
1.
Refer to Scope of Services (on page 28-29).
2.
Respondents should take careful note of the following:
a.
Respondent shall be reimbursed for out-of-pocket expenses that shall include, but not
be limited to:
(i)
Faxes and conference calls;
(ii)
Payment of filing, application fees, review fees and similar charges;
(iii)
Outside printing, reproduction, binding, collating, graphic services;
(iv)
Messenger service and overnight mail.
Charges incurred under (iii) and (iv) must be pre-approved by the Township.
b.
Respondent shall send monthly invoices to the Township detailing the Services
performed.
c.
The Township shall require that upon performing Services totaling 70 percent of
the encumbered amount, whether or not all Services have been invoiced to the
Township, the Respondent shall provide the Township with an estimate of
additional funds that may be necessary to conclude the matter. Additional funds
must be approved by resolution of the Township Council. The Township expects
its professional service providers to maintain time-management control systems
to ensure compliance with this RFQ requirement.
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SECTION 4
INSTRUCTIONS TO RESPONDENTS
4.1
Submission of Qualification Statements.
Each interested firm or professional must submit a separate Qualification Statement for each area of
interest to the Designated Contact Person. One qualification statement for multiple services will not be
accepted. Please enclose one (1) original, (marked original), and two (2) copies (each marked copy) of the
proposal being submitted for each professional service of interest:
Township of East Brunswick
1 Jean Walling Civic Center Drive
East Brunswick, New Jersey 08816-1081
Attn: Tamar Lawful, Municipal Clerk
To be responsive, Qualification Statements must provide all requested information, and must be in strict
conformance with the instructions set forth herein:
1.
Qualification Statements must be received by the Township no later than the Due Date and
must be mailed or hand delivered. Qualification Statements forwarded by facsimile or email
will not be considered. Qualification statements received after the designated time on the Due
Date will be returned, unopened, to the sender. The Respondent is solely responsible for delays
in delivery.
2.
Qualification Statements and all Forms (Exhibits A through J) and other related information must
be stapled or bound and signed by the Respondent. If Respondent is other than a natural person,
the Qualification Statement must be signed by an individual with power to bind the
Respondent.
3.
The name of the Respondent and the position or contract for which the submission is being made
must be printed on the outside of the package containing Respondent's submission. The
Township will, in its sole discretion, determine whether to qualify more than one Respondent
for the Services.
4.
Respondents are reminded that the forms attached to this RFQ must be completed and
submitted with their Qualifications Statements. See also, Exhibit C for a list of documents that
must be submitted with the proposal and those that that successful Respondents must present
to the Township prior to the Township’s executing a contract for services with the Respondent.
4.2
Legislation Compliance
Respondents are to submit a Certification of Political Contribution pursuant to N.J.S.A. 19:44A-20.4
et seq. with their proposals. A Certification form is provided as Exhibit G.
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SECTION 5
EVALUATION
The Township's objective in soliciting Qualification Statements is to enable it to select a firm,
individual, or organization that will provide high quality and cost-effective services to the taxpayers of the
Township. The Township will consider Qualification Statements only from firms, individuals, or organizations
that, in the Township's judgment, have demonstrated the capability and willingness to provide high quality
services to the taxpayers of the Township in the manner described in this RFQ. The Township will consider
all relevant factors, including, but not limited to:
1.
Qualifications of firm, specifically as they relate to this Project.
2.
Related project experience of the firm(s) and the individuals who would be assigned to
the Project.
3
Familiarity with the Township.
4.
Available resources to complete project. This criterion would include the analytical,
design tools, personnel, resources or methodologies commonly used by the firm that may be
applicable to the project categories.
5.
Other factors determined to be in the best interest of the Township.
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Exhibit A
LETTER OF INTENT
(To be prepared on Respondent's Letterhead. No modifications may be made to this letter)
Date: _______________________
Township of East Brunswick
1 Jean Walling Civic Center Drive
East Brunswick, New Jersey 08816-1081
Tamar Lawful, Municipal Clerk
Re: Letter of Intent
Dear Ms. Lawful:
The undersigned, as Proposer, has (have) submitted the attached Proposal in response to a Request for
Proposals\Qualifications (RFP\RFQ) for ____________________________ (service), issued by the Township of East
Brunswick dated_______________________________ in connection with the “Scope of Services”. The undersigned
hereby states:
1. The Proposal contains accurate, factual and complete information to the best of our knowledge and belief. The
Proposal is submitted in good faith. I/we understand that any false statement may result in my/our
disqualification.
2. Proposer agrees to participate in good faith in the procurement process described in the RFP and to adhere to the
Township's procurement schedule.
3. Proposer acknowledges that all costs incurred by it (them) in connection with the preparation and submission of
the Proposal, amendments thereto, and any other documents prepared and submitted in response to the RFP, or
any negotiation which results therefrom shall be borne exclusively by the Proposer
4. Proposer hereby declares that the only persons anticipated by Proposer to perform the professional services for
which this Proposal is submitted are named herein and that no person other than those herein named participated
in this Proposal or will participate in any contract to be entered into between Proposer and the Township.
Proposer declares that this Proposal is made without connection with any other person, firm or parties who has
submitted a Proposal, except as expressly set forth below, and that it has been prepared and submitted in good
faith and without collusion or fraud.
5. Proposer acknowledges and agrees that the Township may modify, amend, suspend and/or terminate the
procurement process (in its sole judgment).
6. Proposer acknowledges that if it becomes the Successful Proposer and is awarded a contract to provide the
Services, it shall comply with all applicable affirmative action and equal employment opportunity laws
Signed: _________________________________
Printed: _________________________________
Title: _________________________________
*If a joint venture, partnership or organization other than a natural person is submitting a Proposal, this Letter of Qualification must be signed by
an individual with the authority to bind the organization.
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Exhibit B
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
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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.
Exhibit B, 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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Exhibit C
CHECKLIST FOR ITEMS TO BE SUBMITTED WITH QUALIFICATIONS STATEMENT
Read,
Acknowledged,
Signed & Submitted
Respondent’s Initial
FAILURE TO SUBMIT ANY OF THESE ITEMS IS MANDATORY CAUSE
FOR REJECTION OF RFP\RFQ
1
Letter of Intent (Ex. A)
2
Affirmative Action Letter, Certificate or Employee Information
Report AA-302 (Ex. B) (Submit Copy of State Certificate of
Employee Information Report Prior to
Contract Award)
3
Disclosure Statement (Ex. D)
4
Non-Collusion Affidavit (Ex. E)
5
Certification of Political Contributions (Ex. G)
6
Proposal Form (Ex. H)
7
Acknowledgement of Receipt of Addenda (Ex. I)
8
Prohibited Activities In Russia and Belarus & Investment
Activities in Iran (Ex. J)
DOCUMENTS REQUIRED PRIOR TO CONTRACT EXECUTION
1
Business Registration Certificate (BRC) from the State of New Jersey
Department of Treasury, Division of Revenue) (N.J.S.A. 52:32-44)
(SUBMISSION OF CERTIFICATE WITH RESPONSE
PREFERRED)
2
Certificate of Insurance Evidencing Comprehensive Liability,
Property/Casualty ($2 million aggregate/$1million per occurrence) (or
less if Umbrella coverage is present); Workers Compensation
(statutory limits); and Professional Malpractice (if applicable) ($2
million aggregate/$1 million per occurrence) naming Township as
additional insured.
READ ONLY
1
Americans With Disability Act of 1990 Language (Ex. F)
Signature: The undersigned hereby acknowledges that he/she has submitted the required
documents with the Qualifications Statement and will submit the remaining required
documents prior to execution of a contract with the Township.
Name of Respondent/ Firm: ____________________________________________
Print Name and Title: _________________________________________________
Signature: __________________________________________________________
Date: __________________________
15 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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EXHIBIT D
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):
Name of Individual or Business Entity
P.O. Box (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
16 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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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
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:
17 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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Exhibit E
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
18 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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Exhibit F
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 and 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.
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Exhibit G
CERTIFICATION OF POLITICAL CONTRIBUTIONS
Name of Business Entity: ___________________________________________________
(Proposer)
___________________________________________________
___________________________________________________
___________________________________________________
Contact Person:
___________________________________________________
(Name and Title)
Proposal Submitted for:
____________________________________________________
Date of Proposal:
____________________________________________________
STATE OF NEW JERSEY )
ss:
COUNTY OF __________ )
_______________________., being duly sworn, upon his/her oath deposes and says:
I am _________________________ of the Proposer referenced above.
(title)
Pursuant to N.J.S.A. 19:44A-8, I agree that I have not made any political contribution in excess of $200
to any political candidates or members of the Governing Body in the Township of East Brunswick in the
previous year or current year. Additionally, I acknowledge and understand that the award of contract prohibits
any reportable contributions through the term of the contract.
______________________________________
(Signature)
RISK MANAGEMENT CONSULTING SERVICES
20 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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Exhibit H
PROPOSAL FORM
COMPLETE IF REQUIRED BY SCOPE OF SERVICES
To the Municipal Clerk of the Township of East Brunswick for:
____________________________________________
Write or type the service of interest
The Proposer whose signature is below declares that he/she has reviewed the RFQ. In the event this Proposal
is accepted, and the Township awards a contract for the services as referenced above, the awarded firm or
individual agrees to perform the above- referenced services at the rate amount that shall not exceed the amount
as referenced in the scope of services for the appropriate professional services to be rendered.
$ _________________________________________
(Proposed Amount - in numbers)
__________________________________________
(Proposed Amount - in words)
Name of Proposer (Print)
Title
Signature
Date
21 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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Exhibit I
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA
The undersigned hereby acknowledges receipt of the following Addenda:
Addendum Number
Dated
_________________________
___________________
_________________________
___________________
□ I acknowledge Receipt of the above reference Addenda.
□ Check If Applicable. There was NO ADDENDA issued for this RFQ.
Acknowledged for ___________________________________
[Name of Proposer]
By_________________________________________________
Signature of Authorized Representative
Name_______________________________________________
(Print Name)
Title________________________________________________
22 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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EXHIBIT J
STANDARD BID DOCUMENT REFERENCE
Name of Form
COMBINED CERTIFICATION: PROHIBITED ACTIVITIES IN RUSSIA AND
BELARUS & INVESTMENT ACTIVITIES IN IRAN
Statutory
Reference
P.L. 2022, c. 3
N.J.S.A. 52:32-55 et seq.
N.J.S.A. 40A:11-2.1
N.J.S.A. 18A:18A-49.4
Applicability
Y/N
Mandatory
Optional
N/A
LPCL
Y
Goods and
Services
X
PSCL
Y
Construction
X
Instructions
Reference
Description
P.L. 2022, c. 3 prohibits the award, renewal, amendment, or extension of State and
local public contracts for goods or services with persons or entities engaging in
prohibited activities in Russia or Belarus. P.L. 2012, c.25 prohibits the award or
renewal of State and local public contracts for goods and services with persons or
entities engaged in certain investment activities in the energy or finance sectors of
Iran.
Before a goods and services contract can be entered into, vendors and contractors
must certify that neither they nor any parent entity, subsidiary, or affiliate is listed
on the New Jersey Department of the Treasury’s list of entities determined to be
engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c. 3
(“Russia-Belarus list”) or in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 list").
23 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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Prohibited Russia-Belarus Activities & Iran Investment Activities
Person or Entity
Part 1: Certification
COMPLETE PART 1 BY CHECKING ONE OF THE THREE BOXES BELOW
Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to
enter into or renew a contract, for goods or services must complete the certification below prior to contract
award to attest, under penalty of perjury, that neither the person or entity, nor any parent entity,
subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as
a person or entity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods
or services can be amended or extended, a person or entity must certify that neither the person or entity,
nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus
list. Both lists are found on Treasury’s website at the following web addresses:
https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf
www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.
As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the
below certification.
A person or entity unable to make the certification must provide a detailed, accurate, and precise
description of the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging
in prohibited activities in Russia or Belarus and/or investment activities in Iran. The person or entity must
cease engaging in any prohibited activities and provide an updated certification before the contract can be
entered into.
If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may
be 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.
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CONTRACT AWARDS AND RENEWALS
I certify, pursuant to law, that neither the person or entity listed above, nor any parent
entity, subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of
entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c.
3 or in investment activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 List"). I
further certify that I am the person listed above, or I am an officer or representative of
the entity listed above and am authorized to make this certification on its behalf. (Skip
Part 2 and sign and complete the Certification below.)
CONTRACT AMENDMENTS AND EXTENSIONS
I certify, pursuant to law, that neither the person or entity listed above, nor any parent
entity, subsidiary, or affiliate is listed on the N.J. Department of the Treasury’s lists of
entities determined to be engaged in prohibited activities in Russia or Belarus pursuant
to P.L. 2022, c. 3. 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. (Skip Part 2 and sign and complete the Certification below.)
IF UNABLE TO CERTIFY
I am unable to certify as above because the person or entity and/or a parent entity,
subsidiary, or affiliate is listed on the Department's Russia-Belarus list and/or Chapter
25 Iran list. I will provide a detailed, accurate, and precise description of the activities
as directed in Part 2 below, and sign and complete the Certification below. Failure to
provide such will prevent the award of the contract to the person or entity, and
appropriate penalties, fines, and/or sanctions will be assessed as provided by law.
25 | R e q u e s t f o r Q u a l i f i c a t i o n s [ R F Q ]
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Part 2: Additional Information
PLEASE PROVIDE FURTHER INFORMATION RELATED TO PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS
AND/OR INVESTMENT ACTIVITIES IN IRAN.
You must provide a detailed, accurate, and precise description of the activities of the person or entity, or
of a parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or
investment activities in Iran in the space below and, if needed, on additional sheets provided by you.
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Part 3: Certification of True and Complete Information
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 Contracting Unit is relying on the information contained herein and hereby
acknowledge that I am under a continuing obligation from the date of this certification through the
completion of any contracts with the Contracting Unit to notify the Contracting Unit 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. 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 Contracting
Unit and that the Contracting Unit at its option may declare any contract(s) resulting from this
certification void and unenforceable.
Full Name
(Print)
Title
Signature
Date
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TOWNSHIP OF EAST BRUNSWICK
SEALED SUBMISSION LABEL FOR REQUEST FOR QUALIFICATIONS
Please Tape This Label To The Front Of Your Sealed Submission
DO NOT OPEN
IMPORTANT - SEALED SUBMISSION ENCLOSED
NAME COMPANY: ________________________________
ADDRESS: _______________________________________
_______________________________________
_______________________________________
TO: TOWNSHIP OF EAST BRUNSWICK
ATTN: MUNICIPAL CLERK
1 CIVIC CENTER DRIVE
EAST BRUNSWICK, NJ 08816-1081
TITLE OF SUBMISSION:
____________________________________________________________
____________________________________________________________
RISK MANAGEMENT CONSULTING SERVICES
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APPENDIX A
SCOPE OF SERVICE
RISK MANAGEMENT CONSULTANT:
The Township seeks Qualification Statements from Respondents that have expertise in the
provision of Risk Management Consultant. The Risk Management Consultant shall be appointed
by the Township (hereafter “Council”) by a majority vote of a quorum of its members and shall
serve for a term of three (3) years from the first day of January of the year of appointment and
until a successor has been appointed and qualified. The Risk Management Consultant shall be a
New Jersey licensed property/casualty insurance agent or broker with demonstrated prior
experience in the management of public insurance risks. The Risk Management Consultant shall
be an “Insurance Producer”, pursuant to N.J.S.A. 17:22A, but shall not be a Fund Commissioner.
DUTIES:
The Risk Management Consultant (hereinafter the “Consultant”) shall:
1. Assist Township in identifying its insurable property and casualty exposures and
recommend professional methods to reduce, assume or transfer the risk loss.
2. Conduct risk assessment and mitigation.
3. Evaluate insurance options, perform analysis of exclusions and deductibles.
4. Solicit insurance proposals to secure cost effective insurance coverage including general
liability, automobile, employment practices liability, boiler and machinery, worker
compensation, public official and police liability.
5. Familiar with the Joint Insurance Funds.
6. Assist the Township in understanding and selecting the various coverages available from
the Middlesex County Joint Insurance Fund and the Municipal Excess Liability Joint
Insurance Fund.
7. Review with the Township any additional coverage that the Consultant feels should be
carried but are not available from the Fund and subject to the Township’s authorization
place such coverages outside the Fund.
8. Review the Township’s assessment as prepared by the Fund and assist the Township in
the preparation of its annual insurance budget.
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9. Review the loss and engineering reports and generally assist the safety committee in loss
containment objectives. Also, attend majority of Municipal Safety Committee meetings
per annum to promote the safety objectives and goals of the municipality and the Fund.
10. Assist where needed in the settlement of claims, with the understanding that the scope of
Consultant’s involvement does not include the work normally done by a public adjustor.
Review Certificates of Insurance from contractors, vendors and professionals when
requested by the Township.
11. Attend meetings of the Township Council when requested.
12. Coordinate with Township employees as necessary and keep them informed.
13. Any other services required by the Fund’s Bylaws.
Contract Term:
The term of the contract between the Township and the successful Respondent will be for three
(3) years. The Township anticipates awarding a contract for the Services as stated in the
Procurement Schedule, Section 1.2 above (page 5). The Township shall reserve the right to
terminate the contract without cause on 15 days’ notice.
Service Fee:
As a member of a Joint Insurance Fund, the Township will not be directly responsible for service fees
paid to the Risk Manager. In the event the Township requests special services or projects from time
to time, including, but not limited to, enrollment or eligibility audits, specific statistical reports,
extraordinary reports, and so on, the Township and the Risk Manager will negotiate a fee in advance of
the special services being provided.
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First Discovered
Mar 31, 2026
Last Info Update
Apr 1, 2026
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