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Mount HollyGreen Risk

ClosedProfessional Services

Notice Of Request For Qualifications/ Request For Proposals For Professional Services

BID #: N/A

DUE: 4/15/2026

VALUE: TBD

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Green Risk

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Executive Summary

Mount Holly Township is soliciting Requests for Qualifications (RFQ) and Requests for Proposals (RFP) from qualified professionals for calendar year 2026 appointments. The specific positions sought are Joint Land Use Board Attorney, Land Use Planner, and Land Use and Planning Engineer. This procurement aims to identify service providers based on qualifications, merit, and cost-effectiveness under a fair and open process. Prospective contractors must meet stringent licensing and experience requirements for each position, including specific years of practice and relevant municipal land use experience in New Jersey. Submissions are required to detail qualifications, proposed fee structures, and include proof of professional liability/malpractice insurance with minimum limits of $1,000,000. Proposals must be received by the Township Clerk no later than April 15, 2026, at 2:00 PM. Submissions require one original, one unbound copy, and one electronic copy on a CD or USB drive, sealed and clearly marked for the specific position being applied for.

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Document Text

--- Document: Notice Of Request For Qualifications/ Request For Proposals For Professional Services Document ---
 
1
MOUNT HOLLY TOWNSHIP 
BURLINGTON COUNTY 
 
PUBLIC NOTICE 
 
NOTICE OF REQUEST FOR QUALIFICATIONS/ 
REQUEST FOR PROPOSALS FOR PROFESSIONAL SERVICES 
 
PLEASE BE ADVISED that the Township of Mount Holly will accept proposals for the 
following positions for 2026:  Joint Land Use Board Attorney, Land Use Planner, Land Use and 
Planning Engineer 
 
To obtain a copy of the RFQ/RFP, contact Township Clerk, Sherry Marnell, 23 Washington 
Street, Mount Holly, New Jersey 08060, telephone number (609) 845-1101 or visit our website at 
www.twp.mountholly.nj.us.  All proposals submitted to the Township must be submitted 
pursuant to the said RFQ/RFP. 
 
Contractors are required to comply with the requirements of P.L. 1975, c. 127 (N.J.A.C. 17:27) 
and N.J.S.A. 10:5-31. 
 
Contractors are required to comply with the requirements of P.L. 1999, c. 238, where applicable. 
 
To be considered, a proposal for any of the above positions must be received on or before April 
15, 2026 AT 2:00 P.M.  Please submit one (1) original, one (1) unbound copy and one (1) 
electronic copy on a CD or USB drive in a sealed envelope marked “Submission of 
Qualifications/Proposal for {Name of Position}” clearly marked on the outside.  Hand delivered 
packages will be accepted during the hours of 9AM to 3PM Monday through Thursday.  A drop 
box is also located in front of the building where bids may be deposited. 
 
 
Sherry Marnell  
Township Clerk 
Mount Holly Township 
 


 
2
Township of Mount Holly 
23 Washington Street 
Mount Holly, New Jersey 08060 
 
This is a combined Request for Qualifications (RFQ) and Request for Proposal (RFP) form.  This 
form will be used by the Mount Holly Township as a basis for making professional service 
appointments. 
 
Requests for these forms should be made to the Township Clerk Sherry Marnell, 23 Washington 
Street, Mount Holly, New Jersey 08060, at (609) 845-1101 or smarnell@twp.mountholly.nj.us. 
 
THIS PROPOSAL IS BEING SOLICITED THROUGH A FAIR AND OPEN PROCESS IN 
ACCORDANCE WITH N.J.S.A. 19:44-20.5 et seq. 
 
REQUESTS FOR QUALIFICATIONS/PROPOSALS 
 
Purpose and Scope of Work: 
 
The following process is designed to find qualified service providers in a fair and open manner 
for the provision of professional or other service contracts based on qualifications, merit and cost 
effectiveness. The general requirements set forth below must be met in order for any proposer to 
be considered to provide such services, exempt from public bidding pursuant to N.J.S.A 40A: 
11-5 and within the scope of N.J.S.A. 19:44A-20.5 et seq., to the Township.   
 
Response to the Request for Qualifications (RFQ) shall be used to determine what proposers 
meet or exceed the minimum qualifications for the position and offer the municipality quality 
professional or other exempt services best meeting the needs of the Township. 
 
Response to the Request for Proposal (RFP) shall be used to determine whether the costs or fees 
proposed to provide the services are fair and reasonable, both in terms of the Township’s 
budgetary interest, the general market rate for the requested services, and the level of experience, 
breadth of services, and expertise of the proposer. 
 
Appointments shall be for the calendar year 2026. 
 
Submissions: 
 
Submission shall address how the proposer meets the qualifications for the desired position and 
shall outline fees proposed, fee schedule (including attendance at regular monthly or special   
meetings), or other basis for compensation sought.  Please, where applicable, indicate hourly 
rates, monthly or other retainers, per project fees, or such other manner of compensation proposer 
deems appropriate to the services to be provided. 
 
1. 
Submissions must be sent by mail or delivery service to the Township Clerk, 
Sherry Marnell; Please submit (1) original, one (1) unbound copy and one (1) 
electronic copy on a CD or USB drive in a sealed envelope marked “Submission 


 
3
of Qualifications/Proposal for {Name of Position}” clearly marked on the outside. 
 Submissions may NOT be sent by fax, or transmitted over the telephone.   
 
2. 
Submissions must be received no later than April 15, 2026 at 2:00 p.m. Late 
submissions will not be accepted or considered.  The Township assumes no 
responsibility for submissions misdirected in delivery or delayed in transmission. 
 
3. 
The Township reserves the right to conduct an interview or interviews with the 
proposer to discuss the scope of the project as outlined in its proposal.  
 
4. 
If awarded a contract, your company/firm shall be required to comply with the 
requirements of (N.J.S.A. 10:5-31) et seq. and (N.J.A.C. 17:27) Affirmative 
Action, (N.J.A.C. 52:25-24.2) Statement of Ownership, (N.J.S.A. 52:32-44) New 
Jersey Business Registration and Disclosure of Investments with Iran (Public Law 
2012, c. 25) and (N.J.S.A. 52:32-60.1) Entities Engaged in Prohibited Activities 
in Russia and Belarus. 
 
5. 
Proof of insurance for professional liability/malpractice coverage with limits as to 
liability acceptable to the Township will be required prior to the award of any 
contract. 
 
6. 
All awards are subject to availability of funds.  Acceptance of a contract will be 
by Resolution acted on by the Township Land Use Board at a Township Planning 
Board Meeting. 
 
7. 
The Township will not guarantee any minimum level of activity or business. 
 
By submitting a proposal, the proposer agrees and understands that the Township reserves the 
right and may exercise at its sole discretion the following rights and options with respect to this 
RFQ/RFP: 
 
 To accept or reject any or all proposals; 
 To amend this RFQ/RFP; 
 To issue additional solicitations for proposals; 
 To waive any irregularities in proposals should it be in the best interest of the Township;   
 To enter into an agreement for only portions (or not enter into an agreement for any) of 
the services contemplated by the proposals; 
 To select the proposal that best satisfies the interests of the Township and not necessarily 
on the basis of price or any other single factor.  
 
 
 
 
 
 
 
 


 
4
 
 
 
Evaluation: 
 
The following criteria, not necessarily listed in the order of importance, will be used to review 
the proposals.  The Township reserves the right to weigh its evaluation criteria in any manner it 
deems appropriate for the best interest of the Township: 
 
 Experience and reputation in the field 
 Qualification of the individual(s) who will perform the service or activity 
 Knowledge of the Township and the subject matter to be addressed by the contract 
 Availability to accommodate any required meetings 
 Compensation proposal 
 Other factors, if demonstrated to be in the best interest of the Township 
 
REQUIREMENTS TO QUALIFY: 
 
The requirements listed below are the minimum levels expected from the professional indicated. 
If Proposer is a firm, it shall designate one professional within the firm to represent the Township 
and provide the qualifications of that individual in addition to the firm’s credentials. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
5
 
 
For Joint Land Use Board Attorney 
 
The Board Attorney must be licensed to practice law in the State of New Jersey and appear 
before all state and federal courts and administrative offices of the State of New Jersey for a 
period of not less than ten (10) years.  The Attorney must have a minimum of seven (7) years 
experiences as a joint land use board attorney, planning board attorney, or zoning board attorney, 
or shall have appeared on behalf of applicants before such boards regularly for at least seven (7) 
years, with experience in all aspects of planning, zoning, and municipal land use law.  Extensive 
work and knowledge of the MLUL, experience in devising Master Plans, and some COAH 
experience is required.  Proposer must have a bona fide office in the State of New Jersey. 
 
Please explain how you or your firm meets the minimum requirements.   
(Attach additional sheets, if necessary.) 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
Completed Form Received by Township on: _____________________ 
 
______ Meets Minimum Qualifications 
_______ Does Not Meet Minimum Qualifications 
 
PROPOSAL 
 
The undersigned individual, firm, or corporation, hereby proposes to serve as LUPB Board 
Attorney based upon the following compensation: 
 
[Please outline your fees proposed, fee schedule (including attendance at regular monthly or 
special meetings), or other basis for compensation that you seek.  Please, where applicable, 
indicate hourly rates, monthly or other retainers, per project fees, or such other manner of 
compensation you deem appropriate to the services to be provided.] 
 


 
6
 
For Land Use Planning Board Engineer 
 
The Township Planning Board Engineer appointment shall be made in accordance with N.J.S.A. 
40:55D-24.  Applicant must be a New Jersey licensed engineer with at least ten (10) years 
experience reviewing subdivision and site plans including preparation of written reports setting 
forth compliance with municipal ordinances and with accepted planning and engineering design 
practices; providing filed observation to assure compliance with Board requirements and 
preparing plans, studies and reports as requested by the Board.  
 
Please explain how you or your firm meets the minimum requirements.   
(Attach additional sheets, if necessary.) 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
Completed Form Received by Township on: _____________________ 
 
______ Meets Minimum Qualifications 
_______ Does Not Meet Minimum Qualifications 
 
PROPOSAL 
 
The undersigned individual, firm, or corporation, hereby proposes to serve as LUPB Engineer 
based upon the following compensation: 
 
[Please outline your fees proposed, fee schedule (including attendance at regular monthly or 
special meetings), or other basis for compensation that you seek.  Please, where applicable, 
indicate hourly rates, monthly or other retainers, per project fees, or such other manner of 
compensation you deem appropriate to the services to be provided.] 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
7
For Land Use Planner 
 
The Land Use Planner shall be a Professional Planner licensed in the State of New Jersey with at 
least ten (10) years experience in all aspects of municipal planning including extensive work with 
and knowledge of the MLUL, COAH and consulting with respect to drafting, and revising 
Master Plans, COAH Housing Elements and Fair Share Plans, Redevelopment Planning, and 
Strategic and Functional Land Use Planning.  
 
Please explain how you or your firm meets the minimum requirements.   
(Attach additional sheets, if necessary.) 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
Completed Form Received by Township on: _____________________ 
 
______ Meets Minimum Qualifications 
_______ Does Not Meet Minimum Qualifications 
 
PROPOSAL 
 
The undersigned individual, firm, or corporation, hereby proposes to serve as Township Planner 
based upon the following compensation: 
 
[Please outline your fees proposed, fee schedule (including attendance at regular monthly or 
special meetings), or other basis for compensation that you seek.  Please, where applicable, 
indicate hourly rates, monthly or other retainers, per project fees, or such other manner of 
compensation you deem appropriate to the services to be provided.] 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
8
MOUNT HOLLY TOWNSHIP 
BURLINGTON COUNTY 
 
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE 
N.J.S.A. 10:5-31 et seq. (Pl. 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 take affirmative action to ensure that such 
applicants are recruited and employed, and that employees are treated during employment, 
without regard to their age, race, creed, color, national origin, ancestry, marital status, 
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. 
Such action shall include, but not be limited to the following: employment, upgrading, 
demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of 
pay or other terms of compensation; and selection for training, including apprenticeship. The 
contractor agrees to post in conspicuous places, available to employees and applicants for 
employment, notices to be provided by the Public Agency Compliance Officer setting forth 
provisions of this nondiscrimination clause. 
 
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for 
employees placed by or on behalf of the contractor, state that all qualified applicants will receive 
consideration for employment without regard to age, race, creed, color, national origin, ancestry, 
marital status, affectional or sexual orientation, gender identity or expression, disability, 
nationality or sex. 
 
The contractor or subcontractor, where applicable, will send to each labor union or 
representative or workers with which it has a collective bargaining agreement or other contract 
or understanding, a notice, to he 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 American with Disabilities Act. 
 
The contractor or subcontractor agrees to make. good faith efforts to employ minority and 
women workers consistent with the applicable county employment goals established in 
accordance with N.J.A.C. 17:27-5.2, or a binding determination of the applicable county 
employment goals determined by the Division, pursuant to N.J.A.C. I7:27-5.2. 


 
9
 
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies 
including, but not limited to, employment agencies, placement bureaus, colleges, universities, 
labor unions, that it does not discriminate on the basis of age, creed, color, national origin, 
ancestry, marital status affectional or sexual orientation, gender identity or expression, disability, 
nationality or sex, and that it will discontinue use of any recruitment agency which engages in 
direct or indirect discriminatory practices.   
 
The contract 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 applicable employment goals, the contractor or subcontractor agrees to 
review all procedures relating to transfer, upgrading, downgrading and  layoff  to ensure that all 
such actions are taken without regard to age, creed, color, national origin, ancestry, marital status, 
affectional or sexual orientation, gender identity or expression, disability, nationality or sex, 
consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal 
law and applicable Federal court decisions. 
 
The contractor shall submit to the public agency, after notification of award but prior to 
execution of a goods and services contract, one of the following three documents: 
 
1. Letter of Federal Affirmative Action 
 
2. Certificate of Employee Information  Report 
 
3. Employee Information Report Form AA302 
 
The contractor and its subcontractors shall furnish such reports or other documents to the 
Division of Contract Compliance & EEO as may be requested by the office from time to time in 
order to carry out the purposes of these regulations, and public agencies shall furnish such 
information as may be requested by the 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. 
 
  
 
 
 
 
______________________________________ 
 
___________________ 
Signature 
 
 
 
 
 
 
Date  


 
10
AMERICANS WITH DISABILITIES ACT OF 1990 
Equal Opportunity for Individuals with Disability 
 
 
The contractor and the Township of Mount Holly, (hereafter “owner”) do hereby agree that the 
provisions of Title 11 of the Americans With Disabilities Act of 1990 (the "Act") (42 U.S.C. S121 01 
et seq.), which prohibits discrimination on the basis of disability by public entities in all services, 
programs, and activities provided or made available by public entities, and the rules and regulations 
promulgated pursuant there unto, are made a part of this contract. In providing any aid, benefit, or 
service on behalf of the owner pursuant to this contract, the contractor agrees that the performance 
shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, 
employees, or subcontractors violate or are alleged to have violated the Act during the performance 
of this contract, the contractor shall defend the owner in any action or administrative proceeding 
commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the 
owner, its agents, servants, and employees from and against any and all suits, claims, losses, 
demands, or damages, of whatever kind or nature arising out of or claimed to arise out of the alleged 
violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for 
legal services and any and all costs and other expenses arising from such action or administrative 
proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the 
owner’s grievance procedure, the contractor agrees to abide by any decision of the owner which is 
rendered pursuant to said grievance procedure. If any action or administrative proceeding results in 
an award of damages against the owner, or if the owner 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 owner 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 owner or any of its agents, servants, and employees, 
the owner shall expeditiously forward or have forwarded to the contractor every demand, complaint, 
notice, summons, pleading, or other process received by the owner or its representatives. 
 
It is expressly agreed and understood that any approval by the owner of the services provided by the 
contractor pursuant to this contract will not relieve the contractor of the obligation to comply with 
the Act and to defend, indemnify, protect, and save harmless the owner pursuant to this paragraph. 
 
It is further agreed and understood that the owner assumes no obligation to indemnify or save 
harmless the contractor, its agents, servants, employees and subcontractors for any claim which may 
arise out of their performance of this Agreement. Furthermore, the contractor expressly understands 
and agrees that the provisions of this indemnification clause shall in no way limit the contractor’s 
obligations assumed in this Agreement, nor shall they be construed to relieve the contractor from any 
liability, nor preclude the owner from taking any other actions available to it under any other 
provisions of the Agreement or otherwise at law. 
 


 
11
Representative’s Name/Title 
(Print): ______________________________________________________________________ 
 
 
Representative’s  
Signature: ____________________________________________________________________ 
 
Name of 
Company:  
_____________________________________________________________________ 
 
 
Telephone No.:  
_________________________________________________________________ 
 
 
Date:  ________________________________ 


 
12
TOWNSHIP OF MOUNT HOLLY 
INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT 
FORM 
Certificate(s) of Insurance shall be filed with the Township Clerk’s Office upon award of 
contract by the Township Land Use Board. 
 
The minimum amount of insurance to be carried by the selected Professional Service Entity shall 
be as follows: 
Professional Liability Insurance 
 
Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each 
policy period. 
 
*Vendor / Firm shall not commence operations until Township has been furnished original certificate(s) of Insurance and 
certified original copies of endorsements or policies of insurance in the amounts and/or minimum coverage(s) required in this 
proposal. 
 
Acknowledgement of Insurance Requirement: 
 
 
 
________________________________________ ____________________________________ 
(Signature)  
 
 
 
 
 
(Date) 
 
 
 
 
(Printed Name and Title) 


 
13
STATEMENT OF OWNERSHIP DISCLOSURE 
N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43) 
 
This statement shall be completed, certified to, and included with all bid and proposal submissions. 
Failure to submit the required information is cause for automatic rejection of the bid or proposal. 
 
Name of Organization:_____________________________________________________________ 
 
Organization Address:_____________________________________________________________ 
 
Part I Check the box that represents the type of business organization: 
Sole Proprietorship (skip Parts II and III, execute certification in Part IV) 
Non-Profit Corporation (skip PartsII and III, execute certification inPart 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, 


 
14
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 entities of the last 
annual federal Security and Exchange Commission (SEC) or foreign equivalent filing, 
ownership disclosure can be met by providing links to the website(s) containing the last annual 
filing(s) with the federal Securities and Exchange Commission (or foreign equivalent)that contain the 
name and address of each person holding a 10% or greater beneficial interest in the publicly traded 
parent entity, along with the relevant page numbers of the filing(s) that contain the information on 
each such person. Attach additional sheets if more space is needed. 
 
Website (URL) containing the last annual SEC (or foreign equivalent) filing 
Page #’s 
 
 
 
 
 
 
 
Please list the names and addresses of each stockholder, partner or member owning a 10 percent or 
greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) 
listed in Part II other than for any publicly traded parent entities referenced above.  The 
disclosure shall be continued until names and addresses of every non-corporate stockholder, and 
individual partner, and member exceeding the 10 percent ownership criteria established pursuant to 
N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed. 
 
Stockholder/Partner/Member and 
Corresponding Entity Listed in Part II 
Home Address (for Individuals) or Business Address 
 
 
 
 
 
 
 
 


 
15
Part  IV - Certification 
 
I, being duly sworn upon my oath, hereby represent that the foregoing information and any 
attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am 
authorized to execute this certification on behalf of the bidder/proposer; that the Township of 
Mount Holly 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  Mount 
Holly Township  to notify the Township of Mount Holly in writing of any changes to the 
information contained herein; that I am aware that it is a criminal offense to make a false statement 
or misrepresentation in this certification, and if I do so, I am subject to criminal prosecution under 
the law and that it will constitute a material breach of my agreement(s) with the, permitting the 
Township of Mount Holly to declare any contract(s) resulting from this certification void and 
unenforceable. 
 
 
Full Name (Print): 
 
Title: 
 
Signature: 
 
 
Date: 
 
 
 
 
 
 


 
16
MOUNT HOLLY TOWNSHIP  
 
NON-COLLUSION AFFIDAVIT 
 
State of New Jersey  
County of _________________                                           ss: 
 
I, ________________________________ residing in ___________________________________      
                                                (name of affiant)                                                                                                (name of municipality) 
in the County of _______________________________ and State of _____________________of full 
age, being duly sworn according to law on my oath depose and say that: 
 
I am _____________________________________ of the firm of _________________________ 
                                        (title or position)  
 
 
 
 
 
         (name of firm) 
 
_____________________________________ the Professional Service Entity making the submission 
for  
 
the service entitled ______________________________, and that I executed the said proposal with  
                                
 
(Name of Professional Service  
full authority to do so that said; that said Professional Service Entity has not, directly or indirectly 
entered into any agreements, participated in any collusion, or otherwise taken any action in restraint of 
fair and open competition in connection with the above named service; and that all statements 
contained in said submission and in this affidavit are true and correct, and made with full knowledge 
that the Township of Mount Holly relies upon the truth of the statements contained in said submission 
and in the statements contained in this affidavit in awarding the contract for said Service. 
 
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 Professional Service Entity 
 
Subscribed and sworn to before me this day 
 
 
 
 
 
 
This __________ day _________of __________, 20_____ 
 
 
 
 
 
 
 
 
_____________________________________ 
 
 
 
 
 
 
 
 
 
 
 
Notary public, State of _______________________
________________________________________ 
 
 
 
 
 
 
(Signature of Professional) 
 
My Commission expires _________ 
______ _______________________________________ 
 
 
 
(Type or Print name of affiant and Title under signature) 
(Seal)