Start your 7-day free trial — unlock full access instantly.
← Back to Search
Lead Closed
This opportunity is no longer accepting submissions.
Public Notice for the Request for Qualifications/Proposals for Renewable Energy Consulting Services
BID #: N/A
ISSUED: 3/31/2025
DUE: 4/11/2025
VALUE: TBD
100
Rating
Risk Rank
Green Risk
AI-Powered Lead Insights
Executive Summary
The City of Linden is soliciting sealed submissions for Professional Service Contracts to secure Renewable Energy Consulting Services. The selected consultant will advise the City on energy-saving practices, strategies, and evolving technologies, including renewable energy programs and waste management. Key responsibilities include identifying emerging technologies, evaluating permit requirements, preparing and submitting applications, and attending meetings as needed. The contract term is from May 1, 2025, through December 31, 2025. Proposals must be submitted to the Purchasing Agent, Jessica L. Slawinski, by April 11, 2025, at 10:00 A.M.
Web Content
Public Notice for the Request for Qualifications/Proposals for Renewable Energy Consulting Services Home / Notices / Public Notice for the Request for Qualifications/Proposals (RFQ/RFP) of Professional Service Contracts beginning May 1, 2025. Notice is hereby given that in accordance with N.J.S.A. 19:44-20.5 et seq. through a fair and open process, the City of Linden is requesting sealed submissions for Professional Service Contracts. Sealed submissions will be received by the Purchasing Agent, Jessica L. Slawinski, of the City of Linden, on Friday, April 11, 2025 at 10:00 A.M. prevailing time, in the 1st Floor Purchasing Department, City Hall, City of Linden, 301 North Wood Avenue, Linden, NJ 07036 then publicly opened and read aloud for the following: Renewable Energy Consulting Services Proposals must be submitted in a sealed envelope clearly marked REQUEST FOR QUALIFICATIONS/PROPOSALS, for (Position Number as Listed Above, Name of Position) and bearing the name and address of the proposer on outside; addressed to the Purchasing Agent, Jessica L. Slawinski, City of Linden, City Hall, Purchasing Department, 301 North Wood Avenue, 1st Floor, Linden, NJ 07036. Standardized submission requirements and selection criteria are on file and available in the Purchasing Department, City Hall, 301 North Wood Avenue, Linden, NJ 07036. Submission packages may be obtained by clicking here . In addition to full compliance with N.J.S.A. 19:44A-20.4 et. seq. (“Pay To Play”), individuals or firms awarded contracts under these procedures will be required to comply with the requirements of N.J.S.A. 52:32-44 (Business Registration of Public Contractors), 42 U.S.C. Section 12101 et. seq. (Americans with Disabilities Act of 1990), 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) Any RFQ/RFP Addenda will be issued on the website and processed in accordance with N.J.S.A. 40A11- 23(c)(1). All interested respondents should check the website from now through RFQ/RFP opening. It is the sole responsibility of the respondent to be knowledgeable of all addenda related to this procurement. Submission 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 City of Linden reserves the right to reject any or all submissions due to any defects of waive informalities and accept any submissions that in their judgment will be in the best interest of the City of Linden. The City of Linden shall award the contract or reject all submissions no later than 60 days from receipt of the same. Jessica L. Slawinski , Purchasing Agent To view and/or download the paper version of the RFP Notice, click here . To see all active RFP and job opportunities with the City of Linden, including those in the notice above, click here . March 31, 2025 by City of Linden in RFQ/RFI rfq
Document Text
--- Document: Public Notice ---
CITY OF LINDEN
Public Notice for the Request for Qualifications/Proposals (RFQ/RFP) of Professional Service Contracts
beginning May 1, 2025. Notice is hereby given that in accordance with N.J.S.A. 19:44-20.5 et seq.
through a fair and open process, the City of Linden is requesting sealed submissions for Professional
Service Contracts. Sealed submissions will be received by the Purchasing Agent, Jessica L.Slawinski, of
the City of Linden, on Friday, April 11, 2025 at 10:00 A.M. prevailing time, in the 1st Floor Purchasing
Department, City Hall, City of Linden, 301 North Wood Avenue, Linden, NJ 07036 then publicly opened
and read aloud for the following:
RENEWABLE ENERGY CONSULTING SERVICES
Proposals must be submitted in a sealed envelope clearly marked REQUEST FOR
QUALIFICATIONS/PROPOSALS, for (Position Number as Listed Above, Name of Position) and bearing
the name and address of the proposer on outside; addressed to the Purchasing Agent, Jessica L.
Slawinski, City of Linden, City Hall, Purchasing Department, 301 North Wood Avenue, 1st Floor, Linden,
NJ 07036.
Standardized submission requirements and selection criteria are on file and available in the Purchasing
Department, City Hall, 301 North Wood Avenue, Linden, NJ 07036.
Submission packages may be obtained on The City of Linden’s website @ www.linden-nj.gov
In addition to full compliance with N.J.S.A. 19:44A-20.4 et. seq. (“Pay To Play”), individuals or firms
awarded contracts under these procedures will be required to comply with the requirements of N.J.S.A.
52:32-44 (Business Registration of Public Contractors), 42 U.S.C. Section 12101 et. seq. (Americans with
Disabilities Act of 1990), 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)
Any RFQ/RFP Addenda will be issued on the website and processed in accordance with N.J.S.A. 40A11-
23(c)(1). All interested respondents should check the website from now through RFQ/RFP opening. It is
the sole responsibility of the respondent to be knowledgeable of all addenda related to this procurement.
Submission 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 City of Linden reserves the right to reject any or all submissions due to any defects of waive
informalities and accept any submissions that in their judgment will be in the best interest of the City of
Linden. The City of Linden shall award the contract or reject all submissions
no later than 60 days from receipt of the same.
Jessica L. Slawinski
Purchasing Agent
Publication Date: Monday, March 31, 2025
--- Document: Renewable Energy Consulting Services ---
CITY OF LINDEN
REQUEST FOR QUALIFICATIONS FOR
RENEWABLE ENERGY CONSULTING SERVICES
CITY OF LINDEN
Contract Term
May 1, 2025 through December 31, 2025
SUBMISSION DEADLINE
10:00 A.M.
APRIL 11, 2025
1ST FLOOR PURCHASING DEPARTMENT
ADDRESS ALL PROPOSALS TO:
PURCHASING DEPARTMENT
CITY HALL, 301 NORTH WOOD AVENUE
LINDEN, NEW JERSEY 07036
ATTN: JESSICA SLAWINSKI, PURCHASING AGENT
CITY OF LINDEN
Public Notice for the Request for Qualifications/Proposals (RFQ/RFP) of Professional Service Contracts
beginning May 1, 2025. Notice is hereby given that in accordance with N.J.S.A. 19:44-20.5 et seq.
through a fair and open process, the City of Linden is requesting sealed submissions for Professional
Service Contracts. Sealed submissions will be received by the Purchasing Agent, Jessica L.Slawinski, of
the City of Linden, on Friday, April 11, 2025 at 10:00 A.M. prevailing time, in the 1st Floor Purchasing
Department, City Hall, City of Linden, 301 North Wood Avenue, Linden, NJ 07036 then publicly opened
and read aloud for the following:
RENEWABLE ENERGY CONSULTING SERVICES
Proposals must be submitted in a sealed envelope clearly marked REQUEST FOR
QUALIFICATIONS/PROPOSALS, for (Position Number as Listed Above, Name of Position) and bearing
the name and address of the proposer on outside; addressed to the Purchasing Agent, Jessica L.
Slawinski, City of Linden, City Hall, Purchasing Department, 301 North Wood Avenue, 1st Floor, Linden,
NJ 07036.
Standardized submission requirements and selection criteria are on file and available in the Purchasing
Department, City Hall, 301 North Wood Avenue, Linden, NJ 07036.
Submission packages may be obtained on The City of Linden’s website @ www.linden-nj.gov
In addition to full compliance with N.J.S.A. 19:44A-20.4 et. seq. (“Pay To Play”), individuals or firms
awarded contracts under these procedures will be required to comply with the requirements of N.J.S.A.
52:32-44 (Business Registration of Public Contractors), 42 U.S.C. Section 12101 et. seq. (Americans with
Disabilities Act of 1990), 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)
Any RFQ/RFP Addenda will be issued on the website and processed in accordance with N.J.S.A. 40A11-
23(c)(1). All interested respondents should check the website from now through RFQ/RFP opening. It is
the sole responsibility of the respondent to be knowledgeable of all addenda related to this procurement.
Submission 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 City of Linden reserves the right to reject any or all submissions due to any defects of waive
informalities and accept any submissions that in their judgment will be in the best interest of the City of
Linden. The City of Linden shall award the contract or reject all submissions
no later than 60 days from receipt of the same.
Jessica L. Slawinski
Purchasing Agent
Publication Date: Monday, March 31, 2025
GENERAL INFORMATION & SUMMARY
ORGANIZATION REQUESTING PROPOSAL
CITY OF LINDEN
301 NORTH WOOD AVENUE
LINDEN, NJ 07036
CONTACT PERSON
All questions must be in writing and sent no later than Thursday, April 3, 2025.
Please email Daniel Antonelli, ESQ, City Attorney @ dantonelli@linden-nj.gov.
for any and all questions relating to said Request for Qualifications.
Please email Ms. Jessica Slawinski, Purchasing Agent @jslawinski@linden-nj.gov for all
procurement related questions.
JESSICA SLAWINSKI
PURCHASING AGENT
PURCHASING DEPARTMENT – 1ST FLOOR
(908) 474-8444
PURPOSE OF REQUEST
The City of Linden is requesting proposals from qualified individuals and firms to provide renewable
energy consulting services of a specialized nature to the City. Proposals will be evaluated in accordance
with the criteria set forth in this RFQ. One or more individuals/firms may be selected to provide
services.
PERIOD OF CONTRACT
May 1, 2025 through December 31, 2025
CONTRACT FORM
The successful proposer shall be required to execute the City’s form contract, which includes the
indemnification, insurance, termination and licensing provisions.
It is also agreed and understood that the acceptance of the final payment by Contractor shall be
considered a release in full of all claims against the City arising out of, or by reason of, the work done
and materials furnished under this Contract.
DETAILED REQUIREMENTS OF THE REQUEST FOR
PROPOSALS FOR RENEWABLE ENERGY CONSULTING SERVICES
1. CITY OF LINDEN FACTS AND FIGURES – The City of Linden is a municipal governmental
entity. The City was incorporated in 1925. The legislative authority and responsibilities of the City
of Linden is vested in the elected eleven-member Council. The Governing Body sets policy,
adopts the operating and capital budgets for the City, enacts ordinances and sets the direction of
how the City of Linden will provide government services. The Mayor is the City’s chief executive
officer and carries out the policies adopted by the Council. The City’s population is approximately
43,738 and it consists of approximately 11 square miles of area. The City employs approximately
684 people in about 25 departments and agencies. It owns administration buildings, and parks and
recreation facilities. The City’s operating budget is approximately $127,637,261.56. It provides
significant and diverse services to its residents, including those in the senior, disabled, veterans
and other communities.
2. NATURE/ SCOPE OF SERVICES –
The City is seeking qualifications from individuals and firms for a knowledgeable and experienced
renewable energy consultant to advise the City on energy-saving practices, strategies and new and
evolving technologies. The renewable energy consultant’s responsibilities include identifying
emerging technologies including but not limited to renewable energy programs that touch upon
processing all types of waste management (i.e. waste, recycling, grass clippings, leaves, computers,
paper, aluminum and plastics of all types). The renewable energy consultant should also be familiar
with suitable vendors across all facets of renewable energy sources as well as manufacturers of same
that sell the raw materials or machinery required for the implementation of renewable energy
projects.
The City of Linden is requesting proposals for Renewable Energy Consulting Services,
including construction inspections, engineering reporting and design services on an “as
needed” basis and will have a close working relationship with the Mayor’s Office, Division of
Engineering, Division of Public Works, and any other City Department/Divisions required.
The Renewable Energy Consultant firm must demonstrate the ability to:
Provide renewable energy consultant services as requested by the City of Linden, including but not
limited to studies, design and inspection for:
● Site, land use and environmental planning.
● Facility, infrastructure and project design, construction and operation
● Building Systems Evaluations
● Mechanical Design services
● Transportation and traffic signals
● Storm and sanitary sewers and watercourses.
● Airports
● Landfill
● Railway
● Solar
● Development of as built plans, treatability and process evaluation and
feasibility and comparative cost review.
● Review and evaluate permit requirements
● Prepare and submit applications, correspondence and the like to the New Jersey
Department of Transportation, New Jersey Department of Environmental Protection and
any other application regulatory agency, as required.
● Attend regular, special and emergency meetings of the City of Linden, if required.
● Attend all other meetings and bid related conferences and the City of Linden deems
necessary.
● Prepare and/or review of reports, permits, applications and bid documents as
requested by the City of Linden.
● Review of all correspondence referred by the City of Linden and prepare correspondence
on behalf of the City of Linden, if requested.
● Interact with applicable City personnel and other governmental agencies,
as required.
● Provide a range of other specialized engineering services which may be needed
by the City.
● Combined Certification: Prohibited Activities in Russia and Belarus &
Investment Activities in Iran.
3. STANDARD REQUIREMENTS OF TECHNICAL PROPOSAL – Proposers should
submit a technical proposal which contains the following:
A. The name of the proposer, the principal place of business and, if different, the place where
the services will be provided.
B. Proposer must have a minimum of five (5) years of experience in renewable energy
services servicing governmental entities.
C. The education, qualifications, experience, and training of all persons who would be assigned
to provide services along with their names and titles.
D. A listing of all other engagements where services of the types being proposed were provided
in the past five (5) years. This should include other levels of government. Contact information
for the recipients of the similar services must be provided. The City may obtain references
from any of the parties listed.
E. A description of all other areas of renewable energy consulting services of the proposer, with
emphasis on a description of those services of interest to the City.
F. Statement that neither the firm nor any individuals assigned to this engagement are disbarred,
suspended, or otherwise prohibited from professional practice by any federal, state, or local
agency.
G. An Affirmative Action Statement
H. A completed Non-Collusion Affidavit (copy of form attached).
I. A copy of the proposer’s Business Registration Certificate.
J. Disclosure of Investment Activities in Iran.
K. Certification of Non-Involvement in Prohibited Activities in Russia or Belarus.
4.
COST PROPOSAL - Proposers should submit a cost proposal which would include any
proposed retainer, the services to be provided for the retainer, if services will be provided at a flat rate, if
all or any services will be billed through hourly rates and what are the established rate(s). The City does
not provide payment for or reimbursement for travel expenses.
5.
PROPOSAL EVALUATION – The City will compile a list of consultants to be used based
upon the most advantageous proposals on all of the evaluation factors set forth at the end of this RFQ.
The City will retain consultants from those approved.
Each proposal must satisfy the objectives and requirements detailed in this RFQ. The successful
proposer shall be determined by an evaluation of the total content of the proposal submitted. The City
reserves the right to:
a.
Not select any of the proposals;
b.
Select only portions of a particular proposer’s proposal for further consideration;
(However, proposers may specify portions of the proposal that they consider “bundled”.)
c.
Award a contract for the requested services at any time during the calendar year after
all RFQ’s have been reviewed and a list of qualified engineers selected by the City. Every
proposal should be valid through this time period.
The City shall not be obligated to explain the results of the evaluation process to any proposer.
The City may require proposers to demonstrate any services described in their proposal prior
to award.
6.
PROPOSAL LIMITATIONS - This RFQ is not intended to be an offer, order or contract and
should not be regarded as such, nor shall any obligation or liability be imposed on the City by issuance
of this RFQ. The City reserves the right at the City’s sole discretion to refuse any proposal submitted.
7.
USE OF INFORMATION - Any specifications, drawings, sketches, models, samples, data,
computer programs, documentation, technical or business information and the like (“Information”)
furnished or disclosed by the City to the proposer in connection with this RFQ shall remain the property
of the City. When in tangible form, all copies of such information shall be returned to the City upon
request. Unless such information was previously known to the proposer, free of any obligation to keep it
confidential, or has been or is subsequently made public by the City or a third party, it shall be held in
confidence by the proposer, shall be used only for the purposes of this RFQ, and may not be used for
other purposes except upon such terms and conditions as may be mutually agreed upon in writing.
8. GENERAL TERMS AND CONDITIONS –
A. The City reserves the right to reject any or all proposals, if necessary, or to waive any
informalities in the proposals, and, unless otherwise specified by the proposer, to accept any
item, items or services in the proposals should it be deemed in the best interest of the City to
do so.
B. In case of failure by the successful proposer, the City of Linden may procure the articles or
services from other sources, deduct the cost of the replacement from money due to the
proposer under the contract and hold the proposer responsible for any excess cost occasioned
thereby.
C. The proposer shall maintain sufficient insurance to protect against all claims under
Workmen's Compensation, General, Professional and Automobile Liability.
D. Each proposal must be signed by the person authorized to do so.
E. The contract shall be in effect through December 31, 2025 unless otherwise stated.
F. Proposals may be hand delivered or mailed consistent with the provisions of the legal notice
to proposers. In the case of mailed proposals, the City assumes no responsibility for proposals
received after the designated date and time and will return late proposals unopened. Proposals
will not be accepted by facsimile or e-mail.
G. In accordance with Affirmative Action Law, P.L. 1975, c.127 (N.J.A.C. 17:27) with
implementation of July 10, 1978, successful proposers must agree to submit individual
employer certifications and numbers or complete Affirmative Action employee information
reports (form AA-302). Also, during the performance of this contract, the contractor agrees
as follows: (a) The contractor or subcontractor where applicable, will not discriminate against
any employee because of age, race, creed, color, national origin, ancestry, marital status or
affectional or sexual orientation. 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, sex or handicap. 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 section for training,
including apprenticeship. The contractor agrees to post in conspicuous places, available to
employees and applicants for employment, notice to be provided by the Public Agency
Compliance Officer setting forth provisions of this non-discrimination clause: (b) 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, sex or handicap; (c) 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 worker's representative of the
contractor's commitments under this act and shall post copies of the notice; (d) the contractor
or subcontractor, where applicable, agrees to comply with any regulations promulgated by the
treasurer pursuant to the P.L. 1975, c.127, as amended and supplemented from time to time.
H. By submission of the proposal, the proposer certifies that the service to be furnished will not
infringe upon any valid patent, trademark or copyright and the successful proposer shall, at
its expense, defend any and all actions or suits charging such infringement, and will save the
City harmless in any case of any such infringement.
I. No proposer shall influence, or attempt to influence, or cause to be influenced, any city
officer or employee to use his/her official capacity in any manner which might tend to impair
the objectivity or independence of judgment of said officer or employee.
J. No proposer shall cause or influence, or attempt to cause or influence, any county officer or
employee to use his/her official capacity to secure unwarranted privileges or advantages for
the proposer or any other person.
K. Should any difference arise between the contracting parties as to the meaning or intent of
these instructions or specifications, the City Law Department’s decision shall be final and
conclusive.
L. The City of Linden shall not be responsible for any expenditure of monies or other expenses
incurred by the proposer in making its proposal.
M.The checklist, affidavits, notices and the like presented at the end of this Request for
Qualifications are a part of this Request for Qualifications and shall be completed and
submitted as part of this proposal.
END OF GENERAL INSTRUCTIONS
BASIS OF AWARD
(To be completed by City evaluation committee)
EVALUATION FACTORS
A. Relevance and Extent of Qualifications, Experience, Reputation and Training of Personnel to
be assigned
B. Knowledge of the City of Linden and the subject matter to be addressed under this engagement
C. Relevance and Extent of Similar Engagements performed
D. Technical Proposal contains all required information
E. Reasonableness of Cost Proposal
REQUEST FOR QUALIFICATIONS CHECKLIST
THIS CHECKLIST MUST BE COMPLETED AND SUBMITTED WITH YOUR PROPOSAL:
A PROPOSAL SUBMITTED WITHOUT THE FOLLOWING DOCUMENTS IS CAUSE FOR
REFUSAL.
Please initial below, indicating that your proposal includes the itemized document.
A.
An original and four (4) signed copies of your complete proposal.
B.
Non-Collusion Affidavit properly notarized
C.
Authorized signatures on all forms.
D.
Business Registration Certificate(s)
E.
Affirmative Action Statement
F.
W-9 form
G.
Statement of Ownership Disclosure
H.
Disclosure of Investment Activities in Iran
I.
Acknowledgement of Receipt of Addenda
J.
Certification of Non-Involvement in Prohibited Activities in Russia or Belarus
Note: N.J.S.A 52:32-44 provides that the City shall not enter into a contract for goods or
services unless the other party to the contract provides a copy of its business registration
certificate and the business registration certificate of any subcontractors at the time that it
submits its proposal. The contracting party must also collect the state use tax where applicable.
THE UNDERSIGNED HEREBY ACKNOWLEDGES THE
ABOVE LISTED REQUIREMENTS.
NAME OF PROPOSER:
Person, Firm or Corporation
BY:
(NAME)
(TITLE)
EXHIBIT A
N.J.S.A. 10:5-31 and N.J.A.C. 17:27
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
Goods, Professional Services and General Service
Contracts (Mandatory Affirmative Action Language)
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 or sex. Except with respect to affectional or sexual orientation, 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 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 for the
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 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 city employment goals established in accordance with N.J.A.C. 17:27-5.2 or
a binding determination of the applicable city 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 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.
Exhibit A (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 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 Division of
Contract Compliance and EEO as may be requested by the Division 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 Contract Compliance & EEO for conducting a compliance
investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.
STATE OF NEW JERSEY
City of Linden
NON-COLLUSION AFFIDAVIT
ss:
I AM
OF THE FIRM OF
UPON MY OATH, I DEPOSE AND SAY:
1.
THAT I EXECUTED THE SAID PROPOSAL WITH FULL AUTHORITY SO TO DO;
2.
THAT THIS PROPOSER HAS NOT, DIRECTLY OR INDIRECTLY ENTERED INTO ANY
AGREEMENT, PARTICIPATED IN ANY COLLUSION, OR OTHERWISE TAKEN ANY ACTION IN
RESTRAINT OF FAIR AND OPEN COMPETITION IN CONNECTION WITH THIS ENGAGEMENT;
3.
THAT ALL STATEMENTS CONTAINED IN SAID PROPOSAL AND IN THIS AFFIDAVIT
ARE TRUE AND CORRECT, AND MADE WITH FULL KNOWLEDGE THAT THE CITY OF LINDEN
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 ENGAGEMENT; AND
4.
THAT NO PERSON OR SELLING AGENCY HAS BEEN EMPLOYED TO SOLICIT OR
SECURE THIS ENGAGEMENT AGREEMENT OR UNDERSTANDING FOR A COMMISSION,
PERCENTAGE, BROKERAGE OR CONTINGENT FEE, EXCEPT BONA FIDE EMPLOYEES OR
BONA FIDE ESTABLISHED COMMERCIAL SELLING AGENCIES OF THE PROPOSER.
(N.J.S.A.52: 34-25)
SUBSCRIBED AND SWORN
TO BEFORE ME THIS
DAY OF
20
.
NOTARY PUBLIC OF
(TYPE OR PRINT NAME OF AFFIANT UNDER SIGNATURE)
MY COMMISSION EXPIRES:
, 20
STATEMENT OF OWNERSHIP DISCLOSURE
N.J.S.A. 52:2524.2 (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 of 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
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 noncorporate 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 <name of
contracting unit> 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 <type of
contracting unit> to notify the <type of contracting unit> 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 <type of
contracting unit> to declare any contract(s) resulting from this certification void and unenforceable.
Full Name (Print):
Title:
Signature:
Date:
CERTIFICATION
I, the undersigned, certify that I am authorized to execute this certification
on behalf of the Vendor/Bidder, that the foregoing information and any
attachments hereto, to the best of my knowledge are true and complete. I
acknowledge that the State of New Jersey is relying on the information
contained herein, and that the Vendor/Bidder is under a continuing
obligation from the date of this certification through the completion of
any contract(s) with the State to notify the State in writing of any changes
to the information contained herein; that I am aware that it is a criminal
offense to make a false statement or misrepresentation in this certification.
If I do so, I will be subject to criminal prosecution under the law, and it
will constitute a material breach of my agreement(s) with the State,
permitting the State to declare any contract(s) resulting from this
certification void and unenforceable.
Signature
Date
Print Name and Title
DPP
Rev. 2.1.2021
Form W-9 (Rev. March 2024)
Department of the Treasury Internal Revenue
Service
Request for
Taxpayer
Identification
Number and
Certification
Go to www.irs.gov/FormW9 for
instructions and the latest information.
Give form to the requester.
Do not send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
1
Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the
business/disregarded entity’s name on line 2.)
2
Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual
whose name is entered on line 1. Check only one of the following seven
boxes.
Individual/sole proprietor
C corporation
S corporation
Partnership
Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P
= Partnership)
.
.
.
.
Note: Check the “LLC” box above and, in the entry space, enter the
appropriate code (C, S, or P) for the tax classification of the LLC, unless
it is a disregarded entity. A disregarded entity should instead check the
appropriate box for the tax classification of its owner.
Other (see instructions)
3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC”
and entered “P” as its tax classification, and you are providing this form to a
partnership, trust, or estate in which you have an ownership interest, check
this box if you have any foreign partners, owners, or beneficiaries. See
instructions . . . . . . . . .
4 Exemptions (codes apply only to certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code
(if any)
(Applies to accounts maintained outside the United States.)
5
Address (number, street, and apt. or suite no.). See instructions.
Requester’s name and address (optional)
6
City, state, and ZIP code
7
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Part II
Certification
Enter your TIN in the appropriate box. The TIN provided must match the
name given on line 1 to avoid backup withholding. For individuals, this is
generally your social security number (SSN). However, for a resident alien,
sole proprietor, or disregarded entity, see the instructions for Part I, later. For
other entities, it is your employer identification number (EIN). If you do not
have a number, see How to get a TIN, later.
Note: If the account is in more than one name, see the instructions for line
1. See also What Name and Number To Give the Requester for guidelines
on whose number to enter.
Social security number
–
–
or
Under penalties of perjury, I certify that:
1.The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2.I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I
am no longer subject to backup withholding; and
3.I am a U.S. citizen or other U.S. person (defined below); and
4.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest
paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally,
payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for
Part II, later.
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted after
they were published, go to www.irs.gov/FormW9.
What’s New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the appropriate
box for the tax classification of its owner. Otherwise, it should check the
“LLC” box and enter its appropriate tax classification.
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form
W-9 to another flow-through entity in which it has an ownership
interest. This change is intended to provide a flow-through entity
with information regarding the status of its indirect foreign partners,
owners, or beneficiaries, so that it can satisfy any applicable
reporting requirements. For example, a partnership that has any
indirect foreign partners may be required to complete Schedules
K-2 and K-3. See the Partnership Instructions for Schedules K-2
and K-3 (Form 1065).
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file
an information return with the IRS is giving you this form because
they
Cat. No. 10231X
Form W-9 (Rev. 3-2024)
Form W-9 (Rev. 3-2024)
must obtain your correct taxpayer identification number (TIN), which may
be your social security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN), to report on an information return
the amount paid to you, or other amount reportable on an information
return. Examples of information returns include, but are not limited to, the
following.
• Form 1099-INT (interest earned or paid).
•
Form 1099-DIV (dividends, including those from stocks or
mutual funds).
•
Form 1099-MISC (various types of income, prizes, awards,
or gross proceeds).
• Form 1099-NEC (nonemployee compensation).
•
Form 1099-B (stock or mutual fund sales and
certain other transactions by brokers).
• Form 1099-S (proceeds from real estate transactions).
• Form 1099-K (merchant card and third-party network transactions).
•
Form 1098 (home mortgage interest), 1098-E (student loan
interest), and 1098-T (tuition).
• Form 1099-C (canceled debt).
• Form 1099-A (acquisition or abandonment of secured property).
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
Caution: If you don’t return Form W-9 to the requester with a TIN, you
might be subject to backup withholding. See What is backup withholding,
later.
By signing the filled-out form, you:
1.
Certify that the TIN you are giving is correct (or you are waiting for
a number to be issued);
2.Certify that you are not subject to backup withholding; or
3.
Claim exemption from backup withholding if you are a U.S.
exempt payee; and
4.
Certify to your non-foreign status for purposes of withholding
under chapter 3 or 4 of the Code (if applicable); and
5.
Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting is correct. See What Is
FATCA Reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TIN, you must use the requester’s form if it
is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
•
A partnership, corporation, company, or association created
or organized in the United States or under the laws of the United
States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Establishing U.S. status for purposes of chapter 3 and chapter 4
withholding. Payments made to foreign persons, including certain
distributions, allocations of income, or transfers of sales proceeds, may
be subject to withholding under chapter 3 or chapter 4 of the Code
(sections 1441–1474). Under those rules, if a Form W-9 or other
certification of non-foreign status has not been received, a withholding
agent, transferee, or partnership (payor) generally applies presumption
rules that may require the payor to withhold applicable tax from the
recipient, owner, transferor, or partner (payee). See Pub. 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities.
The following persons must provide Form W-9 to the payor for
purposes of establishing its non-foreign status.
•
In the case of a disregarded entity with a U.S. owner, the U.S.
owner of the disregarded entity and not the disregarded entity.
•
In the case of a grantor trust with a U.S. grantor or other U.S.
owner, generally, the U.S. grantor or other U.S. owner of the grantor trust
and not the grantor trust.
•
In the case of a U.S. trust (other than a grantor trust), the
U.S. trust and not the beneficiaries of the trust.
See Pub. 515 for more information on providing a Form W-9 or a
certification of non-foreign status to avoid withholding.
Page 2
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person (under
Regulations section 1.1441-1(b)(2)(iv) or other applicable section for
chapter 3 or 4 purposes), do not use Form W-9. Instead, use the
appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a
qualified foreign pension fund under Regulations section
1.897(l)-1(d), or a partnership that is wholly owned by qualified
foreign pension funds, that is treated as a non-foreign person for
purposes of section 1445 withholding, do not use Form W-9.
Instead, use Form W-8EXP (or other certification of non-foreign
status).
Nonresident alien who becomes a resident alien. Generally, only
a nonresident alien individual may use the terms of a tax treaty to
reduce or eliminate U.S. tax on certain types of income. However,
most tax treaties contain a provision known as a saving clause.
Exceptions specified in the saving clause may permit an exemption
from tax to continue for certain types of income even after the
payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an
exemption from U.S. tax on certain types of income, you must
attach a statement to Form W-9 that specifies the following five
items.
1.
The treaty country. Generally, this must be the same
treaty under which you claimed exemption from tax as a
nonresident alien.
2.The treaty article addressing the income.
3.
The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
4.
The type and amount of income that qualifies for the
exemption from tax.
5.
Sufficient facts to justify the exemption from tax under the
terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows
an exemption from tax for scholarship income received by a
Chinese student temporarily present in the United States. Under
U.S. law, this student will become a resident alien for tax purposes
if their stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty
(dated April 30, 1984) allows the provisions of Article 20 to continue
to apply even after the Chinese student becomes a resident alien of
the United States. A Chinese student who qualifies for this
exception (under paragraph 2 of the first Protocol) and is relying on
this exception to claim an exemption from tax on their scholarship
or fellowship income would attach to Form W-9 a statement that
includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the
requester the appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments
to you must under certain conditions withhold and pay to the IRS
24% of such payments. This is called “backup withholding.”
Payments that may be subject to backup withholding include, but
are not limited to, interest, tax-exempt interest, dividends, broker
and barter exchange transactions, rents, royalties, nonemployee
pay, payments made in settlement of payment card and third-party
network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on
your tax return.
Payments you receive will be subject to backup withholding if:
1.You do not furnish your TIN to the requester;
2.
You do not certify your TIN when required (see the
instructions for Part II for details);
3.The IRS tells the requester that you furnished an incorrect TIN;
4.
The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only); or
5.
You do not certify to the requester that you are not
subject to backup withholding, as described in item 4 under “By
signing the filled- out form” above (for reportable interest and
dividend accounts opened after 1983 only).
Form W-9 (Rev. 3-2024)
Certain payees and payments are exempt from backup withholding. See
Exempt payee code, later, and the separate Instructions for the Requester
of Form W-9 for more information.
See also Establishing U.S. status for purposes of chapter 3 and
chapter 4 withholding, earlier.
What Is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating
foreign financial institution to report all U.S. account holders that are
specified U.S. persons. Certain payees are exempt from FATCA reporting.
See Exemption from FATCA reporting code, later, and the Instructions for
the Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed
to be an exempt payee if you are no longer an exempt payee and anticipate
receiving reportable payments in the future from this person. For example,
you may need to provide updated information if you are a C corporation
that elects to be an S corporation, or if you are no longer tax exempt. In
addition, you must furnish a new Form W-9 if the name or TIN changes for
the account, for example, if the grantor of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester,
you are subject to a penalty of $50 for each such failure unless your failure
is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no backup
withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties including
fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account maintained
by a foreign financial institution (FFI)), list first, and then circle, the name of
the person or entity whose number you entered in Part I of Form W-9. If
you are providing Form W-9 to an FFI to document a joint account, each
holder of the account that is a U.S. person must provide a Form W-9.
•
Individual. Generally, enter the name shown on your tax return.
If you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note for ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1a. This should also be the same as the
name you entered on the Form 1040 you filed with your application.
•
Sole proprietor. Enter your individual name as shown on your
Form 1040 on line 1. Enter your business, trade, or “doing business as”
(DBA) name on line 2.
•
Partnership, C corporation, S corporation, or LLC, other
than a disregarded entity. Enter the entity’s name as shown on the
entity’s tax return on line 1 and any business, trade, or DBA name on line
2.
•
Other entities. Enter your name as shown on required U.S.
federal tax documents on line 1. This name should match the name shown
on the charter or other legal document creating the entity. Enter any
business, trade, or DBA name on line 2.
•
Disregarded entity. In general, a business entity that has a
single owner, including an LLC, and is not a corporation, is disregarded
as an entity separate from its owner (a disregarded entity). See
Regulations section 301.7701-2(c)(2). A disregarded entity should check
the appropriate box for the tax classification of its owner. Enter the
owner’s name on line 1. The name of the owner entered on line 1 should
never be a disregarded entity. The name on line 1 should be the name
shown on the income tax return on which the income should be reported.
For
Page 3
example, if a foreign LLC that is treated as a disregarded entity for
U.S. federal tax purposes has a single owner that is a U.S. person,
the U.S. owner’s name is required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity’s name on line 2. If the owner of the disregarded
entity is a foreign person, the owner must complete an appropriate
Form W-8 instead of a Form W-9. This is the case even if the
foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or
disregarded entity name, enter it on line 2.
Line 3a
Check the appropriate box on line 3a for the U.S. federal tax
classification of the person whose name is entered on line 1. Check
only one box on line 3a.
IF the entity/individual on line 1
is a(n) . . .
THEN check the box for . . .
• Corporation
Corporation.
• Individual or
• Sole proprietorship
Individual/sole proprietor.
•
LLC classified as a
partnership for U.S. federal tax
purposes or
•
LLC that has filed
Form 8832 or 2553 electing to
be taxed as a corporation
Limited liability company
and enter the appropriate
tax classification:
P = Partnership,
C = C corporation,
or S = S
corporation.
• Partnership
Partnership.
• Trust/estate
Trust/estate.
Line 3b
Check this box if you are a partnership (including an LLC classified
as a partnership for U.S. federal tax purposes), trust, or estate that
has any foreign partners, owners, or beneficiaries, and you are
providing this form to a partnership, trust, or estate, in which you
have an ownership interest. You must check the box on line 3b if
you receive a Form W-8 (or documentary evidence) from any
partner, owner, or beneficiary establishing foreign status or if you
receive a Form W-9 from any partner, owner, or beneficiary that has
checked the box on line 3b.
Note: A partnership that provides a Form W-9 and checks box 3b
may be required to complete Schedules K-2 and K-3 (Form 1065).
For more information, see the Partnership Instructions for Schedules
K-2 and K-3 (Form 1065).
If you are required to complete line 3b but fail to do so, you may
not receive the information necessary to file a correct information
return with the IRS or furnish a correct payee statement to your
partners or beneficiaries. See, for example, sections 6698, 6722,
and 6724 for penalties that may apply.
Line 4 Exemptions
If you are exempt from backup withholding and/or FATCA
reporting, enter in the appropriate space on line 4 any code(s)
that may apply to you.
Exempt payee code.
•
Generally, individuals (including sole proprietors) are not
exempt from backup withholding.
•
Except as provided below, corporations are exempt
from backup withholding for certain payments, including
interest and dividends.
•
Corporations are not exempt from backup withholding
for payments made in settlement of payment card or third-party
network transactions.
•
Corporations are not exempt from backup withholding
with respect to attorneys’ fees or gross proceeds paid to attorneys,
and corporations that provide medical or health care services are
not exempt with respect to payments reportable on Form
1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space on line 4.
1—An organization exempt from tax under section 501(a), any
IRA, or a custodial account under section 403(b)(7) if the account
satisfies the requirements of section 401(f)(2).
Form W-9 (Rev. 3-2024)
2—The United States or any of its agencies or instrumentalities.
3—A state, the District of Columbia, a U.S. commonwealth or territory,
or any of their political subdivisions or instrumentalities.
4—A foreign government or any of its political subdivisions, agencies, or
instrumentalities.
5—A corporation.
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
territory.
7—A futures commission merchant registered with the Commodity
Futures Trading Commission.
8—A real estate investment trust.
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940.
10—A common trust fund operated by a bank under section 584(a).
11—A financial institution as defined under section 581.
12—A middleman known in the investment community as a nominee or
custodian.
13—A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may be exempt from
backup withholding. The chart applies to the exempt payees listed above,
1 through 13.
IF the payment is for . . .
THEN the payment is
exempt for . . .
• Interest and dividend payments
All exempt payees
except for 7.
• Broker transactions
Exempt payees 1 through 4 and
6 through 11 and all C
corporations. S corporations
must not enter an exempt payee
code because they are exempt
only for sales of noncovered
securities acquired prior to 2012.
•
Barter exchange
transactions and patronage
dividends
Exempt payees 1 through 4.
•
Payments over $600
required to be reported and
direct sales over
$5,0001
Generally, exempt
payees 1 through 5.2
•
Payments made in
settlement of payment card or
third-party network transactions
Exempt payees 1 through 4.
1 See Form 1099-MISC, Miscellaneous Information, and its instructions.
2 However, the following payments made to a corporation and reportable
on Form 1099-MISC are not exempt from backup withholding: medical
and health care payments, attorneys’ fees, gross proceeds paid to an
attorney reportable under section 6045(f), and payments for services paid
by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes apply
to persons submitting this form for accounts maintained outside of the
United States by certain foreign financial institutions. Therefore, if you are
only submitting this form for an account you hold in the United States, you
may leave this field blank. Consult with the person requesting this form if
you are uncertain if the financial institution is subject to these
requirements. A requester may indicate that a code is not required by
providing you with a Form W-9 with “Not Applicable” (or any similar
indication) entered on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37).
B—The United States or any of its agencies or instrumentalities.
C—A state, the District of Columbia, a U.S. commonwealth or territory,
or any of their political subdivisions or instrumentalities.
D—A corporation the stock of which is regularly traded on one or more
established securities markets, as described in Regulations section
1.1472-1(c)(1)(i).
E—A corporation that is a member of the same expanded affiliated group
as a corporation described in Regulations section 1.1472-1(c)(1)(i).
Page 4
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures,
forwards, and options) that is registered as such under the laws of
the United States or any state.
G—A real estate investment trust.
H—A regulated investment company as defined in section 851
or an entity registered at all times during the tax year under the
Investment Company Act of 1940.
I—A common trust fund as defined in section
584(a). J—A bank as defined in section 581.
K—A broker.
L—A trust exempt from tax under section 664 or described in
section 4947(a)(1).
M—A tax-exempt trust under a section 403(b) plan or section
457(g) plan.
Note: You may wish to consult with the financial institution
requesting this form to determine whether the FATCA code and/or
exempt payee code should be completed.
Line 5
Enter your address (number, street, and apartment or suite
number). This is where the requester of this Form W-9 will mail your
information returns. If this address differs from the one the
requester already has on file, enter “NEW” at the top. If a new
address is provided, there is still a chance the old address will be
used until the payor changes your address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien
and you do not have, and are not eligible to get, an SSN, your TIN
is your IRS ITIN. Enter it in the entry space for the Social security
number. If you do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter
either your SSN or EIN.
If you are a single-member LLC that is disregarded as an entity
separate from its owner, enter the owner’s SSN (or EIN, if the
owner has one). If the LLC is classified as a corporation or
partnership, enter the entity’s EIN.
Note: See What Name and Number To Give the Requester,
later, for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one
immediately. To apply for an SSN, get Form SS-5, Application for a
Social Security Card, from your local SSA office or get this form
online at www.SSA.gov. You may also get this form by calling
800-772-1213. Use Form W-7, Application for IRS Individual
Taxpayer Identification Number, to apply for an ITIN, or Form SS-4,
Application for Employer Identification Number, to apply for an EIN.
You can apply for an EIN online by accessing the IRS website at
www.irs.gov/EIN. Go to www.irs.gov/Forms to view, download, or
print Form W-7 and/or Form SS-4. Or, you can go to
www.irs.gov/OrderForms to place an order and have Form W-7
and/or Form SS-4 mailed to you within 15 business days.
If you are asked to complete Form W-9 but do not have a TIN,
apply for a TIN and enter “Applied For” in the space for the TIN,
sign and date the form, and give it to the requester. For interest and
dividend payments, and certain payments made with respect to
readily tradable instruments, you will generally have 60 days to get
a TIN and give it to the requester before you are subject to backup
withholding on payments. The 60-day rule does not apply to other
types of payments. You will be subject to backup withholding on all
such payments until you provide your TIN to the requester.
Note: Entering “Applied For” means that you have already applied
for a TIN or that you intend to apply for one soon. See also
Establishing U.S. status for purposes of chapter 3 and chapter 4
withholding, earlier, for when you may instead be subject to
withholding under chapter 3 or 4 of the Code.
Caution: A disregarded U.S. entity that has a foreign owner must
use the appropriate Form W-8.
Form W-9 (Rev. 3-2024)
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I should
sign (when required). In the case of a disregarded entity, the person
identified on line 1 must sign. Exempt payees, see Exempt payee code,
earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
1.
Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2.
Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing your
correct TIN to the requester, you must cross out item 2 in the certification
before signing the form.
3.
Real estate transactions. You must sign the certification. You
may cross out item 2 of the certification.
4.
Other payments. You must give your correct TIN, but you do
not have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. “Other payments” include
payments made in the course of the requester’s trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to a
nonemployee for services, payments made in settlement of payment
card and third-party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5.
Mortgage interest paid by you, acquisition or abandonment
of secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals (joint
account) other than an account
maintained by an FFI
The actual owner of the account or,
if
combined
funds,
the
first
individual on the account1
3. Two or more U.S. persons
(joint account maintained by an FFI)
Each holder of the account
4. Custodial account of a
minor (Uniform Gift to
Minors Act)
The minor2
5. a. The usual revocable savings trust
(grantor is also trustee)
The grantor-trustee1
b. So-called trust account that is
not a legal or valid trust under state
law
The actual owner1
6. Sole proprietorship or disregarded
entity owned by an individual
The owner3
7. Grantor trust filing under Optional
Filing Method 1 (see Regulations
section 1.671-4(b)(2)(i)(A))**
The grantor*
Page 5
For this type of account:
Give name and EIN of:
8. Disregarded entity not owned by
an individual
The owner
9. A valid trust, estate, or pension trust
Legal entity4
10. Corporation or LLC electing corporate
status on Form 8832 or Form 2553
The corporation
11. Association, club, religious, charitable,
educational, or other tax-exempt
organization
The organization
12. Partnership or multi-member LLC
The partnership
13. A broker or registered nominee
The broker or nominee
14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or prison)
that receives agricultural program
payments
The public entity
15. Grantor trust filing Form 1041 or
under the Optional Filing Method 2,
requiring Form 1099 (see
Regulations section
1.671-4(b)(2)(i)(B))**
The trust
1 List first and circle the name of the person whose number you
furnish. If only one person on a joint account has an SSN, that
person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name on line 1, and enter your
business or DBA name, if any, on line 2. You may use either your
SSN or EIN (if you have one), but the IRS encourages you to use
your SSN.
4 List first and circle the name of the trust, estate, or pension trust.
(Do not furnish the TIN of the personal representative or trustee
unless the legal entity itself is not designated in the account title.)
* Note: The grantor must also provide a Form W-9 to the trustee of
the trust.
** For more information on optional filing methods for grantor trusts,
see the Instructions for Form 1041.
Note: If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal
information, such as your name, SSN, or other identifying
information, without your permission to commit fraud or other
crimes. An identity thief may use your SSN to get a job or may file
a tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax return preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone
number printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but
you think you are at risk due to a lost or stolen purse or wallet,
questionable credit card activity, or a questionable credit report,
contact the IRS Identity Theft Hotline at 800-908-4490 or submit
Form 14039.
For more information, see Pub. 5027, Identity Theft Information
for Taxpayers.
Form W-9 (Rev. 3-2024)
Victims of identity theft who are
experiencing economic harm or a systemic
problem, or are seeking help in resolving tax
problems that
Privacy Act Notice
Page 6
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 877-777-4778 or TTY/TDD
800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to mimic
legitimate business emails and websites. The most common act is
sending an email to a user falsely claiming to be an established legitimate
enterprise in an attempt to scam the user into surrendering private
information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward
this message to phishing@irs.gov. You may also report misuse of the IRS
name, logo, or other IRS property to the Treasury Inspector General for
Tax Administration (TIGTA) at 800-366-4484. You can forward suspicious
emails to the Federal Trade Commission at spam@uce.gov or report them
at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft
or 877-IDTHEFT (877-438-4338). If you have been the victim of identity
theft, see www.IdentityTheft.gov and Pub. 5027.
Go to www.irs.gov/IdentityTheft to learn more about identity theft and
how to reduce your risk.
Section 6109 of the Internal Revenue Code requires you to
provide your correct TIN to persons (including federal agencies)
who are required to file information returns with the IRS to report
interest, dividends, or certain other income paid to you; mortgage
interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an
IRA, Archer MSA, or HSA. The person collecting this form uses
the information on the form to file information returns with the IRS,
reporting the above information.
Routine uses of this information include giving it to the Department
of Justice for civil and criminal litigation and to cities, states, the
District of Columbia, and U.S. commonwealths and territories for
use in administering their laws. The information may also be
disclosed to other countries under a treaty, to federal and state
agencies to enforce civil and criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism. You
must provide your TIN whether or not you are required to file a tax
return. Under section 3406, payors must generally withhold a
percentage of taxable interest, dividends, and certain other
payments to a payee who does not give a TIN to the payor. Certain
penalties may also apply for providing false or fraudulent
information.
All businesses MUST provide a copy of their Business Registration Certificate (BRC) for their
registration to be complete. Below are samples of a BRC Certificate. The Taxpayer Name on the BRC
must be the same as the name on the Vendor Registration and the W9 form.
Non-profit Organizations must provide proof of 501(c)(3) exemption instead of the BRC.
Online BRC Look-up: https://www1.state.nj.us/TYTR_BRC/jsp/BRCLoginJsp.jsp
Information on BRC Requirements:
http://www.state.nj.us/treasury/revenue/busregcert.shtml
STATE OF NEW JERSEY
BUSINESS REGISTRATION
CERTIFICATE
Taxpayer Name:
TAX REG TEST ACCOUNT
Trade Name:
Address:
847 ROEBLING AVE
TRENTON, NJ 08611
Certificate Number:
1093907
Date of Issuance:
October 14, 2004
For Office Use Only:
20041014112823533
CERTIFICATION OF NON‐INVOLVEMENT IN
PROHIBITED ACTIVITIES IN RUSSIA OR
BELARUS
Pursuant to N.J.S.A. 52:32-60.1, et seq. (L. 2022, c. 3) any person or entity (hereinafter “Vendori”) that seeks to enter into
or renew a contract with a State agency for the provision of goods or services, or the purchase of bonds or other
obligations, must complete the certification below indicating whether or not the Vendor is identified on the Office of Foreign
Assets
Control
(OFAC)
Specially
Designated
Nationals
and
Blocked
Persons
list,
available
here:
https://sanctionssearch.ofac.treas.gov/. If the Department of the Treasury finds that a Vendor has made a certification in
violation of the law, it shall take any action as may be appropriate and provided by law, rule or contract, including but not
limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking
debarment or suspension of the party.
I, the undersigned, certify that I have read the definition of “Vendor” below, and have reviewed the Office of Foreign Assets
Control (OFAC) Specially Designated Nationals and Blocked Persons list, and having done so certify:
(Check the Appropriate Box)
A.
That the Vendor is not identified on the OFAC Specially Designated Nationals and Blocked Persons list on
account of activity related to Russia and/or Belarus.
OR
B.
That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially
Designated Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.
OR
C.
That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially
Designated Nationals and Blocked Persons list. However, the Vendor is engaged in activity related to
Russia and/or Belarus consistent with federal law, regulation, license or exemption. A detailed description of
how the Vendor’s activity related to Russia and/or Belarus is consistent with federal law is set forth below.
(Attach Additional Sheets If Necessary.)
Signature of Vendor’s Authorized Representative
Date
Print Name and Title of Vendor’s Authorized Representative
Vendor’s FEIN
Vendor’s Name
Vendor’s Phone Number
Vendor’s Address (Street Address)
Vendor’s Fax Number
Vendor’s Address (City/State/Zip Code)
Vendor’s Email Address
i Vendor means: (1) A natural person, corporation, company, limited partnership, limited liability partnership, limited liability company,
business association, sole proprietorship, joint venture, partnership, society, trust, or any other nongovernmental entity, organization, or
group; (2) Any governmental entity or instrumentality of a government, including a multilateral development institution, as defined in
Section 1701(c)(3) of the International Financial Institutions Act, 22 U.S.C. 262r(c)(3); or (3) Any parent, successor, subunit, direct or
indirect subsidiary, or any entity under common ownership or control with, any entity described in paragraph (1) or (2).
NJ Rev. 1.22.2024
STANDARD BID DOCUMENT REFERENCE
Name of Form
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
Statutory
Referenc
e
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. 2012, c.25 prohibits the awarding of State and local public contracts for
goods and services with persons or entities engaging in certain investment
activities in energy or finance sectors of Iran. Prior to contract award, 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 Iran pursuant to P.L. 2012, c.
25 ("Chapter 25 List").
The Certification form requires the insertion of contracting unit identification information which
should be filled in (in italics on the form) prior to its use.
Disclosure of Investment Activities in Iran
Person or Entity
Part 1: Certification
COMPLETE PART 1 BY CHECKING EITHER BOX.
Pursuant to Public Law 2012, c. 25, any person or entity that is a successful bidder or proposer, or
otherwise proposes to enter into or renew a contract, must complete the certification below to attest, under
penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or affiliate is identified
on the State Department of Treasury's Chapter 25 list as a person or entity engaging in investment activities
in Iran. The list is found on Treasury’s website at www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.
The Chapter 25 list must be reviewed prior to completing the below certification. If a vendor or contractor
is found to be in violation of law, action may be taken as appropriate and as may 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.
□
I certify, pursuant to Public Law 2012, c. 25, that neither the person or entity
listed above, nor any parent entity, subsidiary, or affiliate thereof is listed on the
N.J. Department of the Treasury’s list of entities determined to be engaged in
prohibited activities in Iran pursuant to P.L. 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. I will skip Part 2 and sign and complete the
Certification below.
OR
□
I am unable to certify as above because the person or entity and/or a parent entity,
subsidiary, or affiliate thereof is listed on the N.J. Department of the Treasury’s
Chapter 25 list. I will provide a detailed, accurate and precise description of the
activities in Part 2 below sign and complete the Certification below.
Part 2: Additional Information
PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN.
You must provide a detailed, accurate and precise description of the activities of the person or entity, or a
parent entity, subsidiary, or affiliate thereof engaging in investment activates in Iran below and, if more
space is needed, on additional sheets provided by you.
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 Name of Contracting Unit is relying on the information contained herein
and thereby acknowledge that I am under a continuing obligation from the date of this certification
through the completion of any contracts with the Reference to Contracting Unit to notify the Reference
to 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, and if I do so, I recognize that I am subject to criminal
prosecution under the law and that it will also constitute a material breach of my agreement(s) with the
Name of Contracting Unit and that the Reference to Contracting Unit at its option may declare any
contract(s) resulting from this certification void and unenforceable.
Full Name
(Print)
Title
Signature
Date
Protected Document Content
Start your free trial to view the raw municipal bid documents and web text.
Unlock Full AccessDetailed Risk Breakdown
local preference
No Flags Found
performance bond
No Flags Found
liquidated damages
No Flags Found
Quick Actions
Contacts
Jessica L. Slawinski
Purchasing Agent · Purchasing Department
hidden@email.com
Unlock(***) ***-****
UnlockDaniel Antonelli, ESQ
City Attorney
hidden@email.com
UnlockExplore More
Timeline
First Discovered
Mar 19, 2026
Last Info Update
Apr 30, 2026
Start your 7-day free trial
Get instant notifications and full bid analysis. Existing users will be logged in automatically.
Start Free Trial