Start your 7-day free trial — unlock full access instantly.

Lead Closed

This opportunity is no longer accepting submissions.

Ship BottomGreen Risk

ClosedGoods, Vehicles & Equipment

August 29, 2023 T-Shirt Bids

BID #: N/A

ISSUED: 8/19/2023

DUE: 8/29/2023

VALUE: $44,000

100

Rating

Risk Rank

Green Risk

AI-Powered Lead Insights

Executive Summary

The Borough of Ship Bottom is seeking bids for custom printed shirts for the 2023 Police Pickleball Event and the 2023 Day at the Bay Event. The bid requires specific quantities, colors, and sizes for each event's shirts. Bids are due by 10:00 a.m. on Tuesday, August 29, 2023, and must be submitted to the Municipal Clerk's Office. Bid documents and specifications are available at the Municipal Clerk's Office and on the Borough's website.

Web Content

Automated discovery link found on Ship Bottom website.

Document Text

--- Document: August 29, 2023 T-Shirt Bids Document ---
PUBLIC NOTICE IS HEREBY GIVEN that sealed bids will be received by the Mayor and Council of the
Borough of Ship Bottom in the Municipal Clerk's Office, 1621 Long Beach Boulevard, Ship Bottom, New
Jersey 08008 for the following bids:
2023 Police Pickleball Event and 2023 Day at the Bay Event Custom Printed Shirts
Until Tuesday August 29, at 10:00 a.m. at which time and place they will be publicly opened and read
aloud in the Municipal Court Room. Bids pursuant to this notice must be received by the Mayor and
Council of the Mayor and Council of the Borough of Ship Bottom in the Municipal Clerk's Office no later
than 10:00 a.m. Tuesday, August 29, 2023. Copies of the Bid Documents and Specification may be
obtained at the Municipal Clerk's Office of the Borough of Ship Bottom 1621 Long Beach Blvd, Ship
Bottom, New Jersey, 08008; 609-494-2171. Bid documents are available at no charge on the Borough of
Ship Bottom's municipal website www.shipbottom.org. The mailing of bid documents shall be made at
the bidder's cost.
All bids shall be submitted in a sealed envelope clearly marked with name, address and phone number of
the bidder with the designation "2023 Police Pickleball Event and Day at the Bay Event Custom Printed
Shirts"." Whether submitted by hand delivery or mail, all such bids must be received in the Municipal
Clerk's Office no later than Tuesday, August 29, 2023, at 10:00 a.m. Any delay caused by the US Postal or
Private Delivery Service shall be the sole responsibility of the bidder. No bids shall be accepted after the
time designated. All bids shall remain sealed until the bid opening time set forth.
All bid Addenda will be issued on the website. Therefore, all interested bidders should check the above
website now through the bid opening. It is the sole responsibility of the respondent to be knowledgeable
of all addenda related to this procurement.
Bidders are required to comply with the requirements N.J.S.A. 10:5-31, et seq. and N.J.A.C. 17:27-1. Et
seq., if applicable.
The Minimum Wage rates, if applicable, for labor employed on these contracts shall be as specified in
the "New Jersey Prevailing Wage Determination", of the New Jersey Department of Labor.
The Borough of Ship Bottom shall have sixty days (60) within to accept or reject bids. Submitted bidders
shall be required to keep their bids open for that period of time and agree that they shall not withdraw
or reverse their prices therein.
Multiple awards may be made and the Borough of Ship Bottom reserves the right to reject any or all bids
submitted pursuant to N.J.S.A. 40A:11-13.2. Any contract award will be to the lowest responsible bidder
based on the lowest Total Bid Amount and the Mayor and Council shall make such awards or take such
actions as may be in the best interest of the Borough.
Any questions concerning the bid specifications and/or procedure should be directed to Kathleen
Flanagan.
BOROUGH OF SHIP BOTTOM
Gateway to Long Beach Island
1621 Long Beach Blvd.
Ship Bottom, Ocean County, N.J. 08008
(609)494-2171 OR 2172 FAX (609) 494-7763
Requesting Department:
Purchasing Dept.
Contact Person: Kathleen Flanagan, Borough Coordinator, CFO, QPA
Request for Quotes
Bidder:
Date Issued: August 19, 2023
Date Due: August 29, 2023
Time Due: By 10:00 am
Quotes may be faxed by the due date & time to 609/494-7763 or email to kflanagan@shipbottom.org.
Specifications:
Quantity
Units
Description
Unit
Price
Total
Pickleball Shirts - 120
One Color on Front
8 Small
24 Medium
38 Large
35 XL
15 LLX
Day at the Bay Shirts -150
Small Logo on front Pocket area
Two Colors: one color on back of
shirt for sponsors; one color on
front pocket area
15 Small
30 Medium
45 Large
40 XL
20 XXL
F.O.B. Destination
This is NOT an order
Bid Valid for
days.
Quotation Prepared By:
Sub-Total:
Shipping Charge:
Grand Total:
Important: This is a bid on the goods and services shown, subject to the Terms and Conditions Accompanying
this form. Any changes by Bidder to the Borough of Ship Bottom's Terms and Conditions will cause Bidder's bid
to be requested.
Signature of Bidder's Authorized Representative:
Kathleen Flanagan, Borough Coordinator, CFO, QPA
Borough of Ship Bottom
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP BOTTOM DOCUMENT CHECKLIST*
Required by
owner
Submission Requirement
Initial each
required entry
and if required
submit the item
Non-Collusion Affidavit
[pg. P-1]
X
New Jersey Business Registration
(must be submitted prior to contract award)
[pg. P-2]
X
References
[pg. P-3]
Mandatory Affirmative Action
X
Language (pg. AA1-AA2)
[pg. P-4 & P-5]
Americans with Disabilities Act of 1990
Language (pg. AD-1)
[P-6]
X
Insurance Certificates
[P-7]
Disclosure of Investment
X
[Pg. P-8 & P-9]
Activities in Iran
X
W-9 Request for Taxpayer Identification
Number and Certification
[Pg. P-10]
X
Non-Fair & Open Contribution Prohibition
Language
[Pg. P-11]
X
Business Entity Disclosure Form
[Pg. P-12 & P-13]
X
Political Contribution Disclosure
Certification
[Pg. P-14 & P-17]
X
Stockholder Disclosure Statement
[Pg. P-18 & P-19]
Reporting to the Office of the
X
New Jersey State Comptroller
[Pg. P-20]
X
NFO Proposal Pricing Sheets
[Pg. 21 to 24]
Read Only
X
Provide the Required Form(s)
*This form need not be submitted. It is provided for bidder's use in assuring compliance with all required
documentation.
BDC-1
Borough of Ship Bottom-, - not to exceed $44,000.00
For Calendar Year 2020 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
NON-COLLUSION STATEMENT
Upon request, the bidder will be expected to amplify the foregoing statements as necessary to satisfy
the Borough concerning his ability to successfully perform the work in a satisfactory manner.
The undersigned bidder submitting this proposal or bid certifies and affirms that such bid is genuine
and is not the result of collusion. Said bidder has not colluded, conspired, connived. or agreed, directly
or indirectly, with any bidder or person, to put in a false bid, or that such other persons shall refrain
from bidding. Said bidder has not in any manner, directly or indirectly, sought by agreement or
collusion, or communication or conference, with any person, to fix overhead, profit or cost element of
said bid price, or that of any other bidder, or to secure any advantage against the Borough or any
person interested in the proposed contract. Further, such bidder has not, directly or indirectly,
submitted this bid, or the contents thereof, or divulged information or data relative thereto to any
association or to any member or agent thereof; and, that no Borough official or employee is interested
directly or indirectly in the bid or in any portion of the bid, nor in the contract or in any part of the
contract which may be awarded the undersigned on the basis of such bid.
Signed this
day of
(Bidder)
By
Signature of Authorized Individual, Partner or Officer
Signing the Proposal
Print Name:
Title:
Date:
P-1
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
BUSINESS REGISTRATION CERTIFICATE
TAXPAYER NAME:
STATE OF NEW JERSEY
BUSINESS REGISTRATION CERTIFICATE
FOR STATE AGENCY AND CASINO SERVICE CONTRACTOR
TAX REGISTRATION TEST ACCOUNT
TAXPAYER IDENTIFICATION:
970-097-382/500
APRESS:
3LING A
TRENON NJ OBF
VE DA
キム
LININA
Getaway Se
Taxpayer Name:
Trade Nome:
Address:
PARISAE
18:03 OF
TRAI AMI
CLIENT PREGISTRAT 10
SEOLIENCE NUMBER
0107330
ISSUANCE DATE:
07/14/04
5
Jurs Tuth
THEyed al above 5
STATE OF NEW JERSEY
BUSINESS REGISTRATION CERTIFICATE
TAX REG TEST ACCOUNT
Certificate Number:
Date of lesuances
847 ROEBLING AVE
TRENTON, NJ 08611
1093907
October 14, 2004
For Office Use Only:
20041014112823533
Reforms to the Business Registration Certificate Filing: permits filing prior to award of contracts if not
filed with bid. Effective with bids received and contracts awarded after January 18, 2010, this law
removes the requirement of the Local Public Contracts Law (N.J.S.A. 40A:11-23.2) that required a bid
to be rejected if the bidder failed to include a BRC with the bid, even though it may have been the
otherwise lowest responsible bid. The law now allows the BRC to be filed any time prior to award of the
contract and the bidder had to have obtained the BRC prior to receipt of bids. This permits the BRC to
be required with a bid, or submitted subsequently. If a BRC is required in a bid, but not submitted with
the bid, it would an immaterial defect; curable by being filed prior to award of the contract. A BRC is
obtained from the New Jersey Division of Revenue. Information on obtaining a BRC is available on the
internet at www.nj.gov/njbgs or by phone at (609) 292-1730.
N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that
knowingly provide goods or perform services for a contractor fulfilling this contract:
1) The contractor shall provide written notice to its subcontractors and suppliers to submit proof of
business registration to the contractor;
2) Subcontractors through all tiers of a project must provide written notice to their subcontractors and
suppliers to submit proof of business registration and subcontractors shall collect such proofs of
business registration and maintain them on file;
3) Prior to receipt of final payment from a contracting agency, a contractor must submit to the
contacting agency an accurate list of all subcontractors or attest that none was used;
4) During the term of this contract, the contractor and its affiliates shall collect and remit, and shall
notify all subcontractors and their affiliates that they must collect and remit to the Director, New
Jersey Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A.
54:32B-1 et seq.) on all sales of tangible personal property delivered into this State.
A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false
business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed
$50,000 for each business registration not properly provided or maintained under a contract with a
contracting agency. Information on the law and its requirements is available by calling (609) 292-1730.
P-2
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
REFERENCES
Please list three (3) references below:
1.
2.
3.
Signature:
Print Name:
Title:
Date:
P-3
(REVISED 4/10)
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
EXHIBIT A
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)
N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant
for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or
sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to
affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal
employment opportunity is afforded to such applicants in recruitment and employment, and that employees
are treated during employment, without regard to their age, race, creed, color, national origin, ancestry,
marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
Such equal employment opportunity shall include, but not be limited to the following: employment,
upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay
or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to
post in conspicuous places, available to employees and applicants for employment, notices to be provided by
the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees
placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for
employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or
sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor will send to each labor union, with which it has a collective bargaining
agreement, a notice, to be provided by the agency contracting officer, advising the labor union of the
contractor's commitments under this chapter and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the
Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the
Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals
established in accordance with N.J.A.C. 17:27-5.2.
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including,
but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it
does
not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or
sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the
use of any recruitment agency, which engages in direct or indirect discriminatory practices.
P-4
(REVISED 4/10)
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
EXHIBIT A continued
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all
personnel testing conforms with the principles of job-related testing, as established by the statutes and court
decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal
court decisions.
In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all
procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken
without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual
orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court
decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions.
The contractor shall submit to the public agency, after notification of award but prior
to execution of a goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval
• Certificate of Employee Information Report
•
Employee Information Report Form AA302 (electronically provided by the
Division and distributed to the public agency through the Division's website at
www.state.nj.us/treasury/contract compliance)
The contractor and its subcontractors shall furnish such reports or other documents to the Division of
Purchase & Property, CCAU, EEO Monitoring Program 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 Purchase & Property, CCAU, EEO Monitoring Program for conducting
a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.
Company
Signature
Title
Date
P-5
Borough of Ship Bottom-, - not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP BOTTOM
APPENDIX A
AMERICANS WITH DISABILITIES ACT OF 1990
Equal Opportunity for Individuals with Disability
The contractor and the Borough of Ship Bottom, (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.
P-6
Name of Bidder:
Borough of Ship Bottom-, - not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
INSURANCE CERTIFICATES
Address:
The Bidder is required to submit actual Certificate(s) of Insurance
establishing Insurance coverage of the type and amount required in
accordance with the procedure set forth by the Contract Documents.
(Documents to be submitted prior to the resolution of award)
☑2. GENERAL LIABILITY INSURANCE
General liability insurance shall be provided with limits of not less than $1,000,000.00 any one person and
$1,000,000.00 any one accident for bodily injury and $1,000,000.00 aggregate for property damage, and shall
be maintained in full force during the life of the contract.
✉3. AUTOMOTIVE LIABILITY INSURANCE
Automotive liability insurance covering contractor for claims arising from owned, hired and non-owned
vehicles with limits of not less than $1,000,000.00 any one person and $1,000,000.00 any one accident for
bodily injury and $1,000,000.00 each accident for property damage, shall be maintained in full force during
the life of the contract.
P-7
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP ВОТТОМ
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
PART 1: CERTIFICATION
BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX.
FAILURE TO CHECK ONE OF THE BOXES MAY RENDER THE PROPOSAL NON-RESPONSIVE.
Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal 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 of its
parents, subsidiaries, or affiliates, is identified on the Department of Treasury's Chapter 25 list as a person or entity engaging in
investment activities in Iran. The Chapter 25 list is found on the State of New Jersey, Department of Treasury, Division of Purchase
and Property website at http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Bidders must review this list prior to
completing the below certification. Failure to complete the certification may render a bidder's bid proposal non-responsive. If
the Borough of Ship Bottom determines that a person or entity has submitted a false certification concerning its engagement in
investment activities in Iran pursuant to section 4 of P.L. 2012, c.25 (C.52:32-58), the local contracting unit shall report to the New
Jersey Attorney General the name of that person or entity, and the Attorney General shall determine whether to bring a civil action
against the person to collect the penalty prescribed in paragraph (1) of subsection a. of section 5 of P.L. 2012, с.25 (С.52:32-59).
The Borough of Ship Bottom may also report to the municipal attorney or county counsel, as appropriate, the name of that person,
together with its information as to the false certification, and the municipal attorney or county counsel, as appropriate, may
determine to bring such civil action against the person to collect such penalty.
PLEASE CHECK THE APPROPRIATE BOX:
I certify, pursuant to Public Law 2012, c. 25, that neither the bidder listed above nor any of the bidder's parents, subsidiaries, or
affiliates 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 I 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 bidder and/or one or more of its parents, subsidiaries, or affiliates is listed on
the Department's Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below
and sign and complete the Certification below. Failure to provide such will result in the proposal being rendered as nonresponsive
and appropriate penalties, fines and/or sanctions will be assessed as provided by law.
PART 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN
You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its
parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes
below.
PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH
ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, ATTACH ADDITIONAL
PAGES.
Name
Description of Activities
Relationship to Bidder/Offeror
Duration of Engagement
Anticipated Cessation Date
Bidder/Offeror Contact Name
Contact Phone Number
P-8
Borough of Ship Bottom-, not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP BOTTOM
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
Certification:
I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto
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 Borough of Ship Bottom 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 Borough of Ship Bottom to notify the Borough of Ship Bottom 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 Borough of Ship
Bottom and that the Borough of Ship Bottom at its option may declare any contract(s) resulting from this certification
void and unenforceable.
I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any
attachments thereto 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.
Bidder:
Signature:
Print Name:
Title:
Date:
P-9
Borough of Ship Bottom-, - not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
BOROUGH OF SHIP
BOTTOM
Form
W-9
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Print or type
See Specific Instructions on page 2.
Request for Taxpayer
Identification Number and Certification
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/estate
Give Form to the
requester. Do not
send to the IRS.
Exemptions (see instructions):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
Requester's name and address (optional)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)►
Other (see instructions) ►
Address (number, street, and apt. or sulte no.)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TiN provided must match the name given on the "Name" line
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Part II
Certification
Under penalties of perjury, I certify that:
Social security number
Employer identification number
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 ali 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 on page 3.
Sign Signature of
Here U.S. person
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. The IRS has created a page on IRS.gov for information
about Form W-9, at www.irs.gov/w9. Information about any future developments
affecting Form W-9 (such as legislation enacted after we release it) willi be posted
on that page.
Purpose of Form
A person who is required to file an information return with the IRS must obtain your
correct taxpayer identification number (TIN) to report, for example, income paid to
you, payments made to you in settlement of payment card and third party network
transactions, real estate transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or contributions you made
to an IRA.
Use Form W-9 only if you are a U.S. person (Including a resident alien), to
provide your correct TIN to the person requesting it (the requester) and, when
applicable, to:
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. If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business is not subject to the
Date
withholding tax on foreign partners' share of effectively connected Income, and
4. Certify that FATCA code(s) entered on this form (If any) Indicating that you are
exempt from the FATCA reporting, is carrect.
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 crganized 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).
Special rules for partnerships. Partnerships that conduct a trade or business In
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable Income from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avold section 1446 withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 8-2013)
P-10
Borough of Ship Bottom-, - not to exceed $44,000.00
For Calendar Year 2023 for the Borough of Ship Bottom
Non-Fair and Open Contract Contribution Prohibition Language
Required pursuant to N.J.S.A. 19:44A-8 or 19:44A-16
BOROUGH OF SHIP ВОТТОМ
Political Contribution Disclosure. This contract has been awarded to
based on the merits and abilities of
Contractor Name
Contractor Name
To provide the goods or services as described herein. This contract was not awarded through
a "fair and open process" pursuant to N.J.S.A. 19:44A-20.4 et seq. As such, the undersigned
does hereby attest that its subsidiaries, assigns or principals
Contractor Name
Controlling in excess of 10% of the company has neither made a contribution, that is
reportable pursuant to the Election Law Enforcement Commission pursuant to N.J.S.A.
19:44A-8 or 19:44A-16, in the one (1) year period preceding the award of the contract that
would, pursuant to P.L. 2004, c.19, affect its eligibility to perform this contract, nor will it
make a reportable contribution during the term of the contract to any political party
committee in the Borough of Ship Bottom/Ocean County, if a member of that political party
is serving in an elective public office of that Borough of Ship Bottom/Ocean County when the
contract is awarded, or to any candidate committee of any person serving in an elective
public office of that Borough of Ship Bottom/Ocean County when the contract is awarded.