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HillsideGreen Risk

ClosedProfessional Services

Health Insurance Brokerage Services

BID #: N/A

DUE: 3/31/2026

VALUE: TBD

100

Rating

Risk Rank

Green Risk

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Executive Summary

The Township of Hillside, NJ is soliciting proposals for Health Insurance Brokerage Services through a fair and open public solicitation process. The selected firm will replace the Township's existing insurance policies, including Health, Dental, and Prescription coverage, which expires on March 31, 2026. The contract period will run from April 1, 2026, through March 31, 2027. Key requirements include professional errors and omission coverage with minimum limits of $20 million, the capability to market and service the Township's account, and licensure as an insurance broker in New Jersey. Proposals must include qualifications, experience, references, and a compensation proposal. Submission deadline is March 31, 2026, at 11:00 A.M. to the Township Clerk's Office.

Web Content

Health_Insurance_Brokerage_Services.pdf - Source: https://www.hillsidenj.us/rfp---rfq-bids

Document Text

--- Document: Health Insurance Brokerage Services Document ---
TOWNSHIP OF HILLSIDE
COUNTY OF UNION
STATE OF NEW JERSEY
REQUEST FOR PROPOSALS FOR VARIOUS
PROFESSIONAL SERVICES
Health Insurance Brokerage Services
FAIR AND OPEN PUBLIC SOLICITATION PROCESS
SUBMISSION DEADLINE: March 31, 2026, AT 11:00 Α.Μ.
TOWNSHIP OF HILLSIDE
PUBLIC NOTICE
FOR THE SOLICITATION OF PROFESSIONAL SERVICES
NOTICE IS HEREBY GIVEN that, in accordance with NJSA 19:44-20.5 et seq. through a fair and open process
that sealed submissions will be received by the Township of Hillside, County of Union, State of New Jersey
March 31, 2026 at 11:00 am, prevailing time, in the Municipal Courtroom, located at the Township of
Hillside Municipal Building, 1409 Liberty Avenue, Hillside Township, NJ 07205 then publicly opened and
read aloud for the following:
1. Outside Legal Counsel (Environmental Law, Land Use (Planning & Zoning) and Alcoholic
Beverage Control)
2. Engineering Services (Township Engineer, Environmental Engineer and Land Use (Planning &
Zoning)
3. Professional Planner
4. Health Insurance Brokerage Services
5. Real Estate Appraisal Services
6. Title Insurance Services
Proposals/Submissions will be received by the Township Clerk's Office on the date and time noted above. Firms
do not need to be present and may mail or deliver proposal package to the attention of Hope M. Smith, Business
Administrator at the above address prior to date and time above. Envelopes/packages must be
conspicuously marked RFP for "specify category." Standardized submission requirements and selection
criteria are on file and available on the Township website www.hillsidenj.us and in the Clerk's Office during
regular business hours, 8:00 AM to 4:00 PM, Monday through Friday, excluding holidays. Addenda will also
be posted on the Township website.
All professional service contractors are required to comply with the requirements of N.J.S.A. 52:32-44
(Business Registration of Public Contractors), N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq. (Contract
Compliance and Equal Employment Opportunities in Public Contracts).
Submissions by Corporations and Partnerships shall include a completed Disclosure of Ownership form
(N.J.S.A. 52:25-24.2) and shall include a completed Non-Collusion Affidavit.
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 same.
TOWNSHIP OF HILLSIDE
SOLICITATION OF PROFESSIONAL SERVICE CONTRACTS
UNDER THE FAIR AND OPEN PROCESS
STANDARDIZED SUBMISSION RULES AND INSTRUCTIONS
1. The Township of Hillside is soliciting proposals for the provision of professional services to the
Township for the contract period April 1, 2026 through March 31, 2027. Proposals will be
accepted for the specific professional services set forth in the Public Notice, a copy of which is
attached hereto.
2. The applicant understands and agrees that its proposal is submitted on the basis of the
requirements prepared by the Township. The applicant accepts the obligation to become
familiar with these requirements.
3. Applicants are expected to examine the requirements with care. Ambiguities, errors or
omissions noted by applicants should be promptly reported in writing to the Township. In the
event the applicant fails to notify the Township of such ambiguities, errors or omissions, the
applicant shall be bound by its proposal.
4. No oral interpretation of the meaning of the specifications will be made to any applicant. Every
request for an interpretation shall be in writing, addressed to the Township Clerk. In order to be
given consideration, written requests for interpretation must be received at least five (5) days
prior to the date fixed for receipt of the proposals. Any and all such interpretations and any
supplemental instructions will be in the form of written addenda to the specifications and will be
distributed to all prospective applicants in accordance with NJSA 40A:11-23. All addenda so
issued shall become part of the contract documents and shall be acknowledged by the applicant
in the proposal. The Township's interpretations or corrections thereof shall be final.
5. The proposal shall be addressed to the Township Clerk's Office at the Township of Hillside, 1409
Liberty Avenue, Hillside, New Jersey 07205 and shall be received in the Clerk's Office no later
than March 31, 2026 at 11:00 A.M. Respondents must submit an ORIGINAL responsive
submission, ONE (1) unbound copy of the responsive submission and ONE (1) copy on CD in
pdf format.
6. The proposal form shall be submitted in a sealed envelope bearing the name and
address of the applicant written on the face of the envelope.
7. It is the applicant's responsibility to see that proposals are presented to the Township on the
hour and at the place designated. Proposals may be hand delivered or mailed; however, the
Township disclaims any responsibility for proposals forwarded by regular or overnight mail. If
the proposal is sent by overnight mail, the designation in paragraph 6 above must also appear
on the outside of the delivery company envelope. PROPOSALS RECEIVED AFTER THE
DESIGNATED TIME AND DATE WILL BE RETURNED UNOPENED.
8. All proposals shall include, at a minimum, the name, address and all contact information of the
person or firm making the proposal; a statement of qualifications, including all applicable
professional licenses held; a statement of experience in rendering such professional services
to public entities; references; and a proposal for compensation or a schedule of fees to be
charged for such professional services.
9. All proposals will be evaluated by the Evaluation Team of the Township of Hillside.
10. Proposals will be evaluated by the Evaluation Team of the Township of Hillside on the basis of the
proposals deemed to be most advantageous, price and other factors considered. The evaluation
may consider:
a) Experience and reputation in the field of professional services;
b) Knowledge and experience with the Township's form of government which is Mayor-Council
Plan of the Optional Municipal Charter Law (NJSA 40:69A-1 et seq.);
c) Knowledge of the Township of Hillside and the subject matter to be addressed under the
contract;
d) Availability to accommodate any required meetings;
e) Ability of the firm to perform the services on a timely basis, including staffing and familiarity
with the subject matter;
f) Compensation proposal;
g) References; and
h) Other factors, if determined to be in the best interest of the Township of Hillside and its
agencies.
11. Any applicant successfully awarded a contract must agree to indemnify and hold the Township
harmless from any liability to subcontractors and suppliers concerning payment for work
performed or goods supplied and must also add the Township of Hillside as a named insured to
any applicable insurance policies.
12. The successful respondent will be notified of the award of contract upon a favorable
decision by the governing body.
13. Certificate of Professional Liability Insurance in a minimum of $1,000,000 to be submitted
with the proposal submission.
GENERAL DESCRIPTION OF PROFESSIONAL SERVICES NEEDED
The following are brief descriptions of some of the requirements necessary and may include other
functions as may be directed by the Township of Hillside and their respective departments:
SCOPE OF SERVICE
The Insurance Brokerage firm shall replace the insurance policies that constitutes the Township's
insurance program which expires on March 31, 2026, and subsequent policy years. The Township's
insurance program includes: Health, Dental, Prescription. In addition to the above, the broker must
possess the minimum qualifications listed below as well as be able to provide some or all of the
services identified below at the request of the Township:
1. Have professional errors and omission coverage with minimum limits of $20 million
underwritten by companies acceptable to the Township.
2. Be in sound financial condition.
3. Be capable of marketing and servicing the Township's account.
4. Be a licensed insurance broker in the State of New Jersey in good standing.
5. Annually design, market and implement the Township's insurance program renewals to
provide adequate coverage for the Township, it's employees, members and all
Township-owned properties in a cost-effective manner. Multiple insurance coverage
options (for each type of insurance policy marketed) should be presented to the
Township to ensure sufficient market inquiry for the best coverage and the best price.
6. Identify the data that will need to be submitted to the underwriters, assist the Township
in gathering the data and prepare the submission to the underwriters for review and
approval by the Township.
7. Meet with the Township as often as the Township deems necessary, prior to the policy
renewals to develop a strategy for marketing the Township's insurance program renewal
for the upcoming renewal period. Such strategy will address risks to be covered, markets
to be solicited and insurance limits/layers.
8. Before binding the specific insurance coverage the Township wishes to purchase,
disclose in writing a summary of all quotes, any interest the Successful Proposer may
have in or contractual arrangements with any of the prospective insurers; and the
maximum amount or percentage rate of compensation which the Successful Proposer,
its parent companies, subsidiaries or affiliates may receive in connection with the
placement of the insurance coverage, if applicable.
9. Review all policies, binders, certificates, endorsements or other documents delivered by
insurers or intermediaries, for the purpose of confirming their accuracy and conformity
to negotiated specifications and the Township's instructions and advise the Township of
any errors in or recommended changes to such parties.
10. Keep and maintain proper and adequate records related to policy history, premium rates,
claims & loss history and provide certificates of insurance on request. Such records shall
be retained for at least five (5) years after expiration of the term of engagement, the
termination of the service engagement and/or during any dispute or claim between the
Township, the broker and/or insurance provider(s). The Township, its employees,
officers or representatives shall have the right upon written request and reasonable
notice to inspect and examine all books and records related to this specific broker
service agreement and insurance program procurement.
11. Inform the Township of the reporting requirements for claims, including where claims
should be reported and the method of reporting to be used.
12. Assist the Township in establishing claims reporting procedures, report
claims/losses/occurrences or other events required by insurance policies on the
Township's behalf to the appropriate underwriters. At the Township's request, support
the Township's claims position and advocate claims negotiations and settlements
favorable to the Township.
13. Assist the Township in recovering deductible amounts form appropriate entities.
14. Advise, provide updates, recommendations, presentations and answer questions
regarding marketing and insurance coverage as they arise.
STATUTORY AND OTHER REQUIREMENTS
A. Mandatory Affirmative Action Certification
No firm may be issued a contract unless it complies with the affirmative action
regulations of N.J.S.A. 10:5-32 et seq. (Pl. 1975, с.127).
1. Procurement, Professional and Service Contracts All successful vendors must submit, within seven days after the
receipt of the notice of intent to award the contract or the receipt of the contract, one of the following:
a. A photocopy of a valid letter for an approved Federal AffirmativeAction Plan (good for one year from the
date of the letter), or
b.
A photocopy of an approved Certificate of Employee Information Report, or
C.
If the vendor has none of the above, the public agency is required to provide the vendor with an initial
Affirmative Action Employee Information Report (AA-302).
B. Stockholder Disclosure
Chapter 33 of the Public Laws of 1977 provides that no corporation or partnership shall be awarded any contract for the
performance of any work or the furnishing of any materials or supplies, unless, prior to the receipt of the proposal or
accompanying the proposal of said corporation or partnership, there is submitted a statement setting forth the names and
addresses of all stockholders in the corporation or partnership who own ten percent or more of its stock of any class, or of
all individual partners in the partnership who own a ten percent or greater interest therein. Form of Statement is enclosed
and shall be completed and returned with proposal.
C. Non-Collusion Affidavit
The Non-Collusion Affidavit, which is enclosed with this RFP, shall be properly executed and submitted with the proposal.
D. New Jersey Business Registration Requirements Non-Construction Contracts
NJSA 52:32-44 requires that each vendor submit proof of business registration with the RFP package. Proof of
registration shall be a copy of the Business Registration Certificate (BRC). A BRC is obtained from the New Jersey
Division of Revenue on-line at www.nj.gov/njbgs or by phone at 609-292-1730.
The Township reserves the right to reject any or all proposals if the evidence submitted by, or investigation of such
respondent fails to satisfy the owner that such respondent is properly qualified to carry out the obligation of the RFP and
to complete the work contemplated therein. The owner reserves the right to waive any minor informality in the RFP.
Notice of Award
The successful respondent will be notified of the award of contract upon a favorable decision by the Governing Body.
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)
N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or
applicant for employment because of age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with
respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure
that equal employment opportunity is afforded to such applicants in recruitment and employment, and
that employees are treated during employment, without regard to their age, race, creed, color, national
origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability,
nationality or sex. Such equal employment opportunity shall include, but not be limited to the following:
employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection for training, including
apprenticeship. The contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the Public Agency Compliance Officer setting
forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for
employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital
status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor will send to each labor union, with which it has a collective bargaining
agreement, a notice, to be provided by the agency contracting officer, advising the labor union of the
contractor's commitments under this chapter and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated
by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time
and the Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment
goals established in accordance with N.J.A.C. 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, and labor
unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry,
marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or
sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect
discriminatory practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure
that all personnel testing conforms with the principles of job-related testing, as established by the
statutes and court decisions of the State of New Jersey and as established by applicable Federal law
and applicable Federal court decisions.
In conforming with the targeted employment goals, the contractor or subcontractor agrees to review
all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions
are taken without regard to age, race, creed, color, national origin, ancestry, marital status, affectional
or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the
statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable
Federal court decisions.
The contractor shall submit to the public agency, after notification of award but prior to execution of a
goods and services contract, one of the following three documents:
1. Letter of Federal Affirmative Action Plan
2. Approval Certificate of Employee Information Report
3. Employee Information Report Form AA302 (electronically provided by the Division and distributed
the public agency through
to
www.state.nj.us/treasury/contract compliance.)
the
Division's
website
The contractor and its subcontractors shall furnish such reports or other documents to the Division of
Public Contracts Equal Employment Opportunity Compliance as may be requested by the office from
time to time in order to carry out the purposes of these regulations, and public agencies shall furnish
such information as may be requested by the Division of Public Contracts Equal Employment
Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of the
Administrative Code at N.J.A.C. 17:27.
at
TOWNSHIP OF HILLSIDE
AMERICANS WITH DISABILITIES ACT OF 1990
EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABILITY
The CONTRACTOR and the TOWNSHIP OF HILLSIDE (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 seg.), which prohibits discrimination on the basis of disability by public entities in all services,
programs and activities provided or made available by public entities, and the rules and regulations
promulgated pursuant thereunto, are made a part of this contract. In providing any aid, benefit, or
service on behalf of the TOWNSHIP pursuant to this contract, the CONTRACTOR agrees that the
performance shall be in strict compliance with the Act. In the event the CONTRACTOR, its agents,
servants, employees, or subcontractors violate or are alleged to have violated the Act during the
performance of this contract, the CONTRACTOR shall defend the TOWNSHIP in any action or
administrative proceeding commenced pursuant to this Act. The CONTRACTOR 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 or claimed
to arise out of the alleged violation. The CONTRACTOR shall, at its own expense, appear, defend, and
pay any and all charges for legal services and any and all costs and other expenses arising from such
action or administrative proceeding or incurred in connection therewith. In any and all complaints
brought pursuant to the TOWNSHIP'S grievance procedure, the CONTRACTOR agrees to abide by
any decision of the TOWNSHIP, which is rendered pursuant to, said grievance procedure. If any action
or administrative proceeding results 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 CONTRACTOR 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 CONTRACTOR 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 CONTRACTOR
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 CONTRACTOR pursuant to this contract will not relieve the CONTRACTOR of the obligation to
comply with the Act and to defend, indemnify, protect, and save harmless the TOWNSHIP pursuant to
this paragraph.
It is further agreed and understood that the TOWNSHIP assumes no obligation to indemnify or save
harmless the CONTRACTOR, its agents, servants, employees and subcontractors for any claim which
may arise out of their performance of this Agreement. Furthermore, the CONTRACTOR expressly
understands and agrees that the provisions of this indemnification clause shall in no way limit the
CONTRACTOR'S obligations assumed in this Agreement, nor shall they be construed to relieve the
CONTRACTOR from any liability, nor preclude the TOWNSHIP from taking any other actions available
to it under any other provisions of this Agreement or otherwise at law.
TOWNSHIP OF HILLSIDE
STANDARDIZED SUBMISSION REQUIREMENTS & SELECTION CRITERIA
(FAIR & OPEN PUBLIC SOLICITATION PROCESS FOR PROFESSIONAL SERVICES)
The Township of Hillside is seeking sealed submissions in response to a Public Notice for the Solicitation
of a Professional Service Contracts.
The standardized submission requirements shall include:
1. Names and roles of the individuals who will perform the services/tasks and descriptions
of their experience with projects similar to the services contained herein including their
education, degrees and certifications.
2. References and record of success of same or similar service.
3. Description of ability to provide the services in a timely fashion (including staffing,
familiarity and location of key staff).
4. Cost details; including the hourly rates of each of the individuals who will perform
services and time estimates for each individual, all expenses and total cost of "not to
exceed" amount.
The selection criteria to be used in awarding contracts shall include:
1. Qualifications of the individuals who will perform the services/tasks and the amounts
of their respective participation.
2. Experience and references.
3. Ability to perform the services/tasks in a timely fashion, including staffing and familiarity with the
subject matter.
4. Cost consideration - including, but not limited to, historical costs for similar professional
services, expertise involved and comparable costs for comparable public entities.
Please Note this Additional Requirement:
Professional services entities shall submit one (1) original (clearly mark the original copy), one
(1) unbound copy of their sealed submission and one (1) copy on CD in pdf format, on the date
of the public opening and reading.
TOWNSHIP OF HILLSIDE
CHECKLIST
The following items, as indicated below (X), shall be provided with the receipt of sealed submissions:
1. Non-Collusion Affidavit
2. Disclosure of Ownership Form
3. Insurance Requirement Acknowledgement Form
4. Mandatory Equal Employment Opportunity Notice Acknowledgement
5. Copy of your Business Registration Certificate as issued by the State of New Jersey,
Department of Treasury, Division of Revenue (Strongly suggested that this be submitted
with submission)
6. Professional Service Entity Information Form
7. Submission Form...
8. Acknowledgement of Corrections, Additions or Deletions Form
9. Acknowledgement of Receipt of Addenda
10. Vendor Documentation Retention.
11. Disclosure of Investment Activities in Iran
Reminder
Please submit one (1) original, one (1) unbound copy of your proposal, one
(1) copy on CD in pdf format and all required documents, in A SEALED
ENVELOPE labeled with your name & the title of submission.
TOWNSHIP OF HILLSIDE
NON-COLLUSION AFFIDAVIT
State of New Jersey
County of
SS:
residing in
(Name of affiant)
in the County of
and State of
age, being duly sworn according to law on my oath depose and say that:
I am
(Title or position)
(Name of municipality)
of
full
of the firm of
(Name of firm)
the bidder making this Proposal for the RFP entitled
(Title RFP)
and that I executed the said proposal with full authority to do so that said bidder has not, directly or indirectly
entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free,
competitive bidding in connection with the above named project; and that all statements contained in said
proposal and in this affidavit are true and correct, and made with full knowledge that the Township of
Hillside relies upon the truth of the statements contained in said Proposal and in the statements contained
in this affidavit in awarding the contract for the said project.
I further warrant that no person or selling agency has been employed or retained to solicit or secure such
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 Business Entity)
Subscribed and sworn before me this day
of
20
Signature
(Type or print name under signature)
Notary public of
My Commission expires
(Seal)
TOWNSHIP OF HILLSIDE
DISCLOSURE OF OWNERSHIP FORM
N.J.S.A. 52:25-24.2 reads in part that "no corporation or partnership shall be awarded any contract by
the State, County, Municipality or School District, or any subsidiary or agency thereof, unless prior to
the receipt of the submission of the corporation or partnership, there is provided to the public contracting
unit a statement setting forth the names and addresses of all individual who own 10% or more of the
stock or interest in the corporation or partnership".
1. If the professional service entity is a partnership, then the statement shall set forth the names and
addresses of all partners who own a 10% or greater interest in the partnership.
2. If the professional service entity is a corporation, then the statement shall set forth the names and
addresses of all stockholders in the corporation who own 10% or more of its stock of any class.
3. If a corporation owns all or part of the stock of the corporation or partnership providing the
submission, then the statement shall include a list of the stockholders who own 10% or more of
the stock of any class of that corporation.
4. If the professional service entity is other than a corporation or partnership, the contractor shall
indicate the form of corporate ownership as listed below
COMPLETE ONE OF THE FOLLOWING STATEMENTS:
1. Stockholders or Partners owning 10% or more of the company providing the submission:
NAME: ADDRESS:
SIGNATURE:
DATE:
II. No Stockholder or Partner owns 10% or more of the company providing this submission:
SIGNATURE:
DATE:
III. Submission is being provided by an individual who operates as a sole proprietorship:
SIGNATURE:
DATE:
IV. Submission is being provided by a corporation or partnership that operates as a (check one of the following):
Limited Partnership_
Limited Liability Corporation
Limited Liability Partnership_
_ Subchapter S Corporation
SIGNATURE:
DATE:
TOWNSHIP OF HILLSIDE
INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM
Certificate(s) of Insurance shall be filed with the Township's Clerk's Office upon award of contract by the Township.
The minimum amount of insurance to be carried by the Professional Service Entity shall be as follows:
A.
B.
C.
D.
Commercial General Liability (CGL)
1. CGL with limits of insurance of not less than $1,000,000 Each Occurrence, $2,000,000 Products -
Completed Operations Aggregate, $1,000,000 Personal & Advertising Injury, and $2,000,000 General
Annual Aggregate.
2. CGL coverage shall be written on a current version of ISO Occurrence Commercial General Liability
Coverage form CG 00 01 or a form providing equivalent coverage and shall cover liability arising from
premises, ongoing operations, independent contractors, products-completed operations, and personal
and advertising injury.
3. The Owner and all other parties required by the Owner, shall be named as additional insureds on the
CGL coverage part using Additional Insured - Owners, Lessees or Contractors CG 20 10, Additional
Insured - Owners, Lessees or Contractors - Completed Operations CG 20 37, or endorsements providing
equivalent coverage to the additional insureds. Coverage for the additional insureds shall be as broad as
the coverage provided for the named insured Professional Service Entity. It shall apply as primary and
non-contributory insurance before any other insurance or self-insurance, including any deductible,
maintained by, or provided to, the additional insured.
4. The Professional Service Entity shall maintain CGL coverage for itself and all additional insureds for
the duration of the contract.
Automobile Liability
1. Business Auto Liability with limits of at least $ 1,000,000 each accident.
2. Business Auto coverage must include coverage for liability arising out of all owned, leased, hired and
non-owned automobiles.
Commercial Umbrella
1. Umbrella limits must be at least $ 1,000,000 and must provide coverage over all underlying policies.
2. Umbrella coverage must include as additional insureds all entities that are additional insureds on the
CGL.
Workers Compensation and Employers Liability
1. Coverage A- Statutory
2. Coverage B -Employers Liability Insurance limits of at least $1,000,000 each accident for bodily injury
by accident, $1,000,000 each employee for injury by disease and $1,000,000 for total policy bodily injury
by disease.
3. Where applicable, U.S. Longshore and Harborworkers Compensation Act Endorsement shall be
attached to the policy.
4. Where applicable, the Maritime Coverage Endorsement shall be attached to the policy.
Ε.
Professional Liability Insurance
F.
Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy period.
Waiver of Subrogation (Waiver of Transfer of Rights of Recovery Against Others to Us)
Professional Service Entity shall waive all rights against Owner and their agents, officers, directors and
employees for recovery of damages to the extent these damages are covered by commercial general liability,
commercial umbrella liability, business auto liability or workers compensation and employers liability insurance
maintained per requirements stated above and where permitted by law.
G.
Certificates of Insurance
Professional Service Entity shall provide the Owner, prior to commencement of work, valid Certificates of
Insurance, and all applicable additional insured endorsements, verifying that the foregoing insurance requirements
have been met. Professional Service Entity understands the terms of this Insurance Requirements agreement and
acknowledges that it is part of any contract or as a standalone Insurance Requirements
Agreement.
(Signature)
(Printed Name and Title)
Acknowledgement of Insurance Requirement:
(Date)
TOWNSHIP OF HILLSIDE
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY NOTICE
(N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq.)
GOODS, PROFESSIONAL SERVICES AND GENERAL SERVICE CONTRACTS
This form is a summary of the successful professional service entity's requirement to comply with the requirements of
N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq.
The successful professional service entity shall submit to the Township of Hillside, after notification of award but prior to
execution of this contract, one of the following three documents as forms of evidence:
(a) A photocopy of a valid letter that the vendor is operating under an existing Federally approved or sanctioned
affirmative action program (good for one year from the date of the letter);
OR
(b) A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C.
17:27-1.1 et seq.;
OR
(c) A photocopy of an Employee Information Report (Form AA302) provided by the Division of Contract
Compliance and distributed to the Township of Hillside to be completed by the vendor in accordance with N.J.A.C.
17:27-1.1 et seq.
The successful professional service entity may obtain the Employee Information Report (AA302) from the Township of
Hillside during normal business hours.
The successful professional service entities must submit the white and canary copies of the AA302 (Employee Information
Report) to the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts (Division). The
pink Public Agency copy is submitted to the Township of Hillside, and the gold Vendor copy is retained by the professional
service entity.
The undersigned professional service entity certifies that he/she is aware of the commitment to comply
with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq. and agrees to furnish the
required forms of evidence.
The undersigned professional service entity further understands that his/her submission shall be
rejected as non-responsive if said professional service entity fails to comply with the requirements of
N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq.
COMPANY:
SIGNATURE:
TITLE:
PRINT NAME:
DATE:
SAMPLE CERTIFICATE OF EMPLOYEE INFORMATION REPORT
SAMPLE CERTIFICATE OF EMPLOYEE INFORMATION REPORT
GERTIFICATE OF EMPLOYEE INFORMATION REPORT
VOID
VOID
BUSINESS REGISTRATION CERTIFICATE
ATTENTION ALL PROFESSIONAL SERVICE ENTITIES
On June 29, 2004, Governor McGreevey signed P.L. 2004, c.57, Business Registration of Contractors with
Government Agencies, into law. Effective September 1, 2004, all business organizations that do business with
a local contracting agency (i.e. Township of Howell) are required to be registered with the State of New Jersey,
Department of Treasury, Division of Revenue, and provide proof of that registration to the contracting agency
before the contracting agency may enter into a contract with the business.
A "Business Organization" means an individual, partnership, association, joint stock company, trust, corporation
or other legal business entity or successor thereof.
Further information may be obtained by visiting the following web site at the State of New Jersey: www.nj.gov/
treasury/revenue/busregcert.htm
Goods & Services Contracts (including purchase orders):
N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly
provide goods or perform services for a contractor fulfilling this contract:
1) The contractor shall provide written notice to its subcontractors and suppliers to submit proof of business
registration to the contractor;
2) Prior to receipt of final payment from a contracting agency, a contractor must submit to the contracting
agency an accurate list of all subcontractors or attest that none were used;
3) During the term of this contract, the contractor and its affiliates shall collect and remit, and shall notify all
subcontractors and their affiliates, that they must collect and remit to the Director, New Jersey Division of
Taxation, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A. 54:32B-1 et seq.) on all sales of
tangible personal property delivered into this State.
A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false
business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed
$50,000 for each business registration not properly provided or maintained under a contract with a contracting
agency.
The Township of Hillside strongly suggests that a copy of the Business Registration Certificate issued by
the NJ Department of Treasury, Division of Revenue, be provided at the time of submission.
SAMPLE BUSINESS REGISTRATION CERTIFICATE
TAXPAYER NAME:
STATE NEW JERSEY
BUSINESS REGISTRATION CERTIFICATE
FOR STATE AGENCY AND CASING SERVICE CONTRACTOR
BAK REGISTRATION TEST ACCOUNT
TAXPAYER IDENTIFICATIONS
970-087-

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