SARA BID Forms Packet

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This document is a comprehensive bid forms packet issued by the South Amboy Redevelopment Agency, designed to assist prospective bidders in preparing compliant submissions. It outlines a checklist of mandatory documentation required for various contracts, including goods, services, and professional services. Key requirements include a Stockholder Disclosure Certification, Non-Collusion Affidavit, and an affidavit confirming the bidder is not debarred by the State of New Jersey. Furthermore, bidders must provide Affirmative Action Compliance notices, Professional Service Entity Information, and acknowledge Mandatory Equal Employment Opportunity Language and Americans with Disabilities Act provisions. The packet also details requirements for Insurance, Disclosure of Investigations, Investment Activities in Iran, and a Business Registration Certificate. The packet serves as a guide for bidders to ensure all necessary forms and certifications are included with their actual bid proposals to the South Amboy Redevelopment Agency.

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--- Document: SARA BID Forms Packet Document ---
SOUTH AMBOY REDEVELOPMENT AGENCY
BID DOCUMENT CHECKLIST*
Stockholder Disclosure Certification
Non-Collusion Affidavit
Bidder's Affidavit Indicating They Are Not Debarred Suspended and
Disqualified By the State of New Jersey
Affirmative Action Compliance Notice – Goods And Services Contracts
(Including Professional Services)
Professional Service Entity Information Form
Mandatory Equal Employment Opportunity Language
Insurance Requirements and Acknowledgement Form (as applicable)
Americans with Disabilities Act of 1990 Language
Disclosure of Investigations and Other Actions Involving Bidder Form
Disclosure of Investment Activities In Iran
Business Registration Certificate
Submission Label
........
.....
*This form need not be submitted. It is provided for bidder's use in assuring compliance
with all required documentation.
STOCKHOLDER DISCLOSURE CERTIFICATION
This Statement Shall Be Included with Bid Submission
Name of Business
I certify that the list below contains the names and home addresses of all stockholders
holding 10% or more of the issued and outstanding stock of the undersigned.
OR
I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the
undersigned.
If a corporation owns all or part of the stock of the corporation or partnership submitting
the bid, then the statement shall include a list of the stockholders who own 10% or more
of the stock of any class of that owning coporation. If no one owns 10% or more stock,
attest to that.
Check the box that represents the type of business organization:
Partnership
Limited Partnership
Subchapter S Corporation
Corporation
Limited Liability Corporation
Sole Proprietorship
Limited Liability Partnership
Sign and notarize the form below, and, if necessary, complete the stockholder list below.
Stockholders:
Name:
Home Address:
Name:
Home Address:
Name:
Home Address:
Name:
Home Address:
Name:
Home Address:
Subscribed and sworn before me this
(Notary Public)
2
My Commission expires:
day of
Name:
Home Address:
(Affiant)
(Print name & title of affiant)
(Corporate Seal)
BIDDER'S AFFIDAVIT INDICATING THEY ARE NOT DEBARRED,
SUSPENDED, or DISQUALIFIED BY THE STATE OF NEW JERSEY
I,
and the State of
depose and say that:
I am
of the Local Government Unit of
in the County of
being of full age, being duly sworn according to law, on my oath
an officer of the firm(s) of
the bidder making the proposal for the aforementioned work, and I executed the said proposal with full
authority to do so; Said bidder, at the time of making this bid, [as applicable, circle "is" or "is not"] included
on the New Jersey Treasurer's List of Debarred, Suspended, and Disqualified Bidders; and
All statements contained in said proposal and in this affidavit are true and correct and made with the full
knowledge that
as the Local Government Unit, relies upon the truth of
the statements contained in said proposal and the statements contained in this affidavit in awarding the
contract for the work. The undersigned further warrants that should the name of the firm making this bid
appear on the New Jersey Treasurer's List of Debarred, Suspended, and Disqualified Bidders at any time
prior to and/or during the life of the contract, including the guarantee period, the Township/City shall be
immediately so notified by the signatory of this affidavit.
The undersigned understands that the firm making the bid as a contractor is subject to debarment,
suspension, and/or disqualification in contracting with the State of New Jersey and the New Jersey
Department of Environmental Protection if the contractor, pursuant to N.J.A.C. 7:1-5.2, commits any of the
acts listed therein, and as determined according to applicable law and regulation.
Subscribed and Sworn
before me on this
day
20
of
Notary Public
My commission expires
20
Name and Address of Contractor
Name and Title of Affiant
Signed:
By:
Signature of Officer or Individual
BIDDER'S AFFIDAVIT INDICATING THEY ARE NOT DEBARRED,
SUSPENDED, or DISQUALIFIED BY THE STATE OF NEW JERSEY
If BIDDER is:
By
(SEAL)
Doing business as
Business Address:
Phone Number:
(Individual's Name)
An Individual
By
(SEAL)
(Firm Name)
Business Address:
(General Partner)
A Partnership
Phone Number:
A Corporation
By
(SEAL)
(Corporation Name)
(State of Incorporation)
By
(Name of Person Authorized to Sign)
(Title)
(Corporate Seal)
Attest
(Secretary)
Business Address:
Phone Number:
A Joint Venture
By
(Name)
By
(Address)
(Name)
(Address)
(Each joint venture must sign. The manner of signing for each individual, partnership, and corporation that
is party to the joint venture should be in the manner indicated above.)
NON-COLLUSION AFFIDAVIT
State of New Jersey
County of
ss:
1,
(name of affiant)
in the County of
residing in
(name of municipality)
and State of
being duly sworn according to law on my oath depose and say that:
I am
entitled
(title or position)
(title of bid proposal)
of the firm of
(name of firm)
the bidder making this Proposal for the bid
and that I executed the said proposal with
full authority to do so that said bidder has not, directly or indirectly entered into any agreement, participated
in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the
above named project; and that all statements contained in said proposal and in this affidavit are true and
correct, and made with full knowledge that the
the truth of the statements contained in said Proposal
(name of contracting unit)
and in the statements contained in this affidavit in awarding the contract for the said project.
relies upon
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
Subscribed and sworn to
before me this day
Signature
2
(Type or print name of affiant under signature)
Notary public of
My Commission expires
(Seal)
AFFIRMATIVE ACTION COMPLIANCE NOTICE
N.J.S.A. 10:5-31 and N.J.A.C. 17:27
GOODS AND SERVICES CONTRACTS
(INCLUDING PROFESSIONAL SERVICES)
This form is a summary of the successful bidder's requirement to comply with the requirements of N.J.S.A. 10:5-
31 and N.J.A.C. 17:27-1 et seq.
The successful bidder shall submit to the public agency, after notification of award but prior to execution of this
contract, one of the following three documents as forms of evidence:
(a) A photocopy of a valid letter that the contractor is operating under an existing
Federally approved or sanctioned affirmative action program (good for one year from the
date of the letter);
OR
(b) A photocopy of a Certificate of Employee Information Report approval, issued in
accordance with N.J.A.C. 17:27-4;
OR
(c) A photocopy of an Employee Information Report (Form AA302) provided by the
Division and distributed to the public agency to be completed by the contractor in
accordance with N.J.A.C. 17:27-4.
The successful vendor may obtain the Affirmative Action Employee Information Report (AA302) from the
contracting unit during normal business hours.
The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and
Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public
agency, and the vendor copy is retained by the vendor.
The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements of
N.J.S.A. 10:5-31 and N.J.A.C. 17:27.1 et seq. and agrees to furnish the required forms of evidence.
The undersigned vendor further understands that his/her bid shall be rejected as non-responsive if said contractor
fails to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27-1 et seq.
COMPANY:
PRINT NAME:
DATE:
SIGNATURE:
TITLE:
PROFESSIONAL SERVICE ENTITY INFORMATION FORM
If the Professional Service Entity is an INDIVIDUAL, sign name and give the following information:
Name:
Address:
Telephone No.:
Fax No.:
Social Security No.:
E-Mail:
If individual has a TRADE NAME, give such trade name:
Trading As:
********
Telephone No.:
If the Professional Service Entity is a PARTNERSHIP, give the following information:
Name of Partners:
Firm Name:
Address:
Telephone No.:
Fax No.:
Social Security No.:
Signature of authorized agent:
Federal I.D. No.:
E-Mail:
*************************************************************************************************
If the Professional Service Entity is INCORPORATED, give the following information:
State under whose laws incorporated:
Location of principal office:
Telephone No.:
Fax No.:
Federal I.D. No.:
E-Mail:
Name of agent in charge of said office upon whom notice may be legally served:
Telephone No.:
Signature:
Title:
Name of Corporation:
By:
Address:
**
*****
RETURN WITH BID PAGE 1 OF 2
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 take
affirmative action to ensure that such applicants are recruited and employed, and that employees are
treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital
status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such
action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer;
recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation;
and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places,
available to employees and applicants for employment, notices to be provided by the Public Agency
Compliance Officer setting forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for
employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital
status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor, where applicable, will send to each labor union or representative or
workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to
be provided by the agency contracting officer advising the labor union or workers' representative of the
contractor's commitments under this act and shall post copies of the notice in conspicuous places available
to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by
the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and
the Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to employ minority and women
workers consistent with the applicable county employment goals established in accordance with N.J.A.C.
17:27-5.2, or a binding determination of the applicable county employment goals determined by the
Division, pursuant to N.J.A.C. 17:27-5.2.
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies
including, but not limited to, employment agencies, placement bureaus, colleges, universities, labor unions,
that it does not discriminate on the basis of age, creed, color, national origin, ancestry, marital status,
RETURN WITH BID PAGE 2 OF 2
EXHIBIT A, Continued
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
affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will
discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure
that all personnel testing conforms with the principles of job-related testing, as established by the statutes
and court decisions of the State of New Jersey and as established by applicable Federal law and
applicable Federal court decisions.
In conforming with the applicable employment goals, the contractor or subcontractor agrees to
review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions
are taken without regard to age, creed, color, national origin, ancestry, marital status, affectional or sexual
orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and
court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court
decisions.
The contractor shall submit to the public agency, after notification of award but prior to execution of a
goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval
Certificate of Employee Information Report
Employee Information Report Form AA302
The contractor and its subcontractors shall furnish such reports or other documents to the Div. of
Contract Compliance & EEO as may be requested by the office from time to time in order to carry out the
purposes of these regulations, and public agencies shall furnish such information as may be requested by
the Div. of Contract Compliance & EEO for conducting a compliance investigation pursuant to Subchapter
10 of the Administrative Code at N.J.A.C. 17:27.
COMPANY:
PRINT NAME:
DATE:
SIGNATURE:
TITLE:
APPENDIX A
AMERICANS WITH DISABILITIES ACT OF 1990
Equal Opportunity for Individuals with Disability
The contractor and the City of South Amboy, (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.
COMPANY:
PRINT NAME:
DATE:
SIGNATURE:
TITLE:
STATE OF NEW JERSEY -- DIVISION OF PURCHASE AND PROPERTY
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
Quote Number:
Bidder/Offeror:
PART 1: CERTIFICATION
BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX.
FAILURE TO CHECK ONE OF THE BOXES WILL 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 Division's 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 will render a bidder's proposal
non-responsive. If the Director finds a person or entity to be in violation of law, s/he shall take 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
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, с. 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 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 non-
responsive 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.
EACH BOX WILL PROMPT YOU TO PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE
THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, CLICK THE "ADD AN ADDITIONAL
ACTIVITIES ENTRY" BUTTON.
Name
Description of Activities
Duration of Engagement
Bidder/Offeror Contact Name
ADD AN ADDITIONAL ACTIVITIES ENTRY
Relationship to Bidder/Offeror
Anticipated Cessation Date
Contact Phone Number
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; that the State of New Jersey is relying on the information contained herein and that I am under a
continuin g obligation from the date of this certification through the completion of any contracts 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, 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 State, permitting the State to declare any contract(s) resulting from this certification void and unenforceable.
Full Name (Print):
Title:
Signature:
Do Not Enter PIN as a Signature
Date:
SOUTH AMBOY REDEVELOPMENT AGENCY
SEALED SUBMISSION LABEL FOR BID/PROPOSAL
Please Tape This Label To The Front Of Your Sealed Submission
DO NOT OPEN
IMPORTANT - SEALED SUBMISSION ENCLOSED
NAME
COMPANY
ADDRESS
ADDRESS
ATTENTION:
TO:
SOUTH AMBOY REDEVELOPMENT AGENCY
C/O: CITY OF SOUTH AMΒΟΥ
140 North Broadway
South Amboy, NJ 08879
TITLE OF SUBMISSION
PUBLIC OPENING ON