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Planning Board Engineer 2017
BID #: 16
ISSUED: 11/10/2016
DUE: 12/2/2016
VALUE: TBD
100
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Executive Summary
The City of Summit Planning Board is seeking Qualification Statements from firms or organizations for the provision of Engineering Services. The RFQ outlines the required capabilities and expectations for providing high-quality services. Respondents must demonstrate professional, financial, and administrative capabilities and agree to work under compensation terms that benefit Summit taxpayers. The selection process is not subject to the bidding provisions of the Local Public Contracts Law but is subject to the New Jersey Local Unit Pay-to-Play Law. Qualification Statements must be received by December 2, 2016, at 4:00 p.m. prevailing time, by hand delivery or regular mail, and an electronic copy must also be submitted.
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Document Text
--- Document: PB_Engineer_2017 ---
NOTE: The City of Summit Planning Board will consider proposals only from firms or organizations
that have demonstrated the capability and willingness to provide high quality services in the manner
described in this Request for Qualifications.
REQUEST FOR QUALIFICATIONS
FOR THE PROVISION OF:
ENGINEERING SERVICES TO & FOR THE CITY OF SUMMIT PLANNING BOARD
ISSUE DATE: November 10, 2016
DUE DATE: December 2, 2016
Issued by:
City of Summit Planning Board
2
GLOSSARY
The following definitions shall apply to and are used in this Request for Qualifications:
"Principals" mean persons possessing an ownership interest in the Respondent. If the Respondent is a corporation, principals
shall include each investor who would have any amount of operational control over the Respondent and every stockholder
having an ownership interest of ten percent (10%) or more in the firm
"Qualification Statement" - refers to the complete responses to this RFQ submitted by the Respondents
"Qualified Respondent" - refers to those Respondents who (in the sole judgment of the Board) have satisfied the
qualification criteria set forth in this RFQ
"Respondent" or "Respondents" - refers to the interested firm (or firms) that submit a Qualification Statement
“Review Team” – Members of the Planning Board, and its legal and/or financial advisors who shall review the Qualification
Statements
"RFQ" - refers to this Request for Qualifications, including any amendments thereof or supplements thereto
"City" - refers to the City of Summit
"Board" - refers to the City of Summit Planning Board
3
SECTION 1
INTRODUCTION AND GENERAL INFORMATION
Section 1.1
Introduction and Purpose
The Board is soliciting Qualification Statements from interested persons and/or firms for the provision of Engineering
Services to and for the City of Summit Planning Board, as more particularly described herein. Through a Request for
Qualification process described herein, persons and/or firms interested in assisting the Board with the provision of such
services must prepare and submit a Qualification Statement in accordance with the procedures and schedules in this RFQ.
The Board will review Qualification Statements only from those firms that submit a Qualification Statement which includes
all the information required to be included as described herein (in the sole judgment of the Board). The Board intends to
qualify person(s) and/or firm(s) that: (a) possesses the professional, financial and administrative capabilities to provide the
proposed services, and (b) will agree to work under the compensation terms and conditions determined by the Board to
provide the greatest benefit to the taxpayers of Summit.
Section 1.2
Procurement Process and Schedule
The selection of Qualified Respondents is not subject to the bidding provisions of the Local Public Contracts Law, N.J.S.A.
40A:11-1 et seq. The selection is subject to the New Jersey Local Unit Pay-to-Play Law, N.J.S.A. 19:44A-20.4 et seq. The
Board has structured a procurement process that seeks to obtain the desired results described above, while establishing a
competitive process to assure that each person and/or firm is provided with an equal opportunity to submit a Qualification
Statement in response to the RFQ. Qualification Statements will be evaluated in accordance with the criteria set forth in
Section 5 of this RFQ, which will be applied in the same manner to each Qualification Statement received. Respondents
agree to at all times abide by all requirements of New Jersey law, including, but not limited to the aforementioned “Pay to
Play” laws, as well as any and all relevant Executive Orders and the New Jersey Election Law Enforcement Commission
disclosure requirements.
Qualification Statements will be reviewed and evaluated by the Board and its legal and/or financial advisors (collectively, the
"Review Team"). The Qualification Statements will be reviewed to determine if the Respondent has met the minimum
professional, administrative and financial criteria described in this RFQ. Under no circumstances will a member of the
Review Team review responses to an RFQ for a position which they or their firm submitted a response. Based upon the
totality of the information contained in the Qualification Statement, including information about the reputation and
experience of each Respondent, the Board will (in its sole judgment) determine which Respondents are qualified from
professional, administrative and financial standpoints. Each Respondent that meets the requirements of the RFQ (in the sole
judgment of the Board) will be designated as a Qualified Respondent and will be given the opportunity to participate in the
selection process.
The RFQ process commences with the issuance of this RFQ. The steps involved in the process and the anticipated
completion dates are set forth in Table 1, Procurement Schedule. The Board reserves the right to, among other things,
amend, modify or alter the Procurement Schedule upon notice to all potential Respondents.
All communications concerning this RFQ or the RFQ process shall be directed to the Board’s designated contact person, in
writing.
Designated Contact Person:
Cynthia Kiefer
Land Use Assistant
City of Summit
512 Springfield Avenue
Summit NJ 07901
4
Qualification Statements must be submitted to, and be received by, the Board, by hand delivery or regular mail, by 4:00 p.m.
prevailing time on December 2, 2016. Qualification Statements will not be accepted by facsimile transmission. An
electronic copy of the Qualifications statement must also be submitted. Subsequent to issuance of this RFQ, the Board
(through the issuance of addenda to all firms that have received a copy of the RFQ) may modify, supplement or amend the
provisions of this RFQ in order to respond to inquiries received from prospective Respondents or as otherwise deemed
necessary or appropriate by, and in the sole judgment of, the Board.
TABLE 1
ANTICIPATED PROCUREMENT SCHEDULE
ACTIVITY
DATE
1.
Issuance of Request for Qualifications
November 10, 2016
2.
Receipt of Qualification Statements
December 2, 2016
3.
Completion of Evaluation of Qualification Statements by the Review Team
December 9, 2016
4.
Board Review of Review Team Recommendations
December 19, 2016
5.
Approval of Professional Services Resolutions by the Board
(Retroactive to January 1, 2017)
January 30, 2017
Section 1.3
Conditions Applicable to RFQ.
Upon submission of a Qualification Statement in response to this RFQ, the Respondent acknowledges and consents to the
following conditions relative to the submission and review and consideration of its Qualification Statement:
•
This document is an RFQ and does not constitute an RFP.
•
This RFQ does not commit the Board to issue an RFP.
•
All costs incurred by the Respondent in connection with responding to this RFQ shall be borne solely by
the Respondent.
•
The Board reserves the right, in its sole judgment, to reject for any reason, any and all responses and
components thereof and to eliminate any and all Respondents responding to this RFQ from further
consideration for this procurement.
•
The Board reserves the right, in its sole judgment, to reject any Respondent that submits incomplete
responses to this RFQ, or a Qualification Statement that is not responsive to the requirements of this RFQ.
•
The Board reserves the right, without prior notice, to supplement, amend, or otherwise modify this RFQ, or
otherwise request additional information.
•
All Qualification Statements shall become the property of the Board and will not be returned.
•
All Qualification Statements will become public documents in accordance with applicable law.
•
The Board may request Respondents to send representatives for interviews.
5
•
Any and all Qualification Statements not received by the Board by 4:00 p.m. prevailing time on December
2, 2016 will be rejected.
•
Neither the Board, its consultants or advisors, nor their respective staffs, including, but not limited to, the
Review Team, shall be liable for any claims or damages resulting from the solicitation or preparation of the
Qualification Statement, nor will there be any reimbursement to Respondents for the cost of preparing and
submitting a Qualification Statement or for participating in this procurement process.
Section 1.4
Rights of the Board.
The Board reserves, holds and may exercise, at its sole discretion, the following rights and options with regard to this RFQ
and the procurement process in accordance with the provisions of applicable law:
•
To determine that any Qualification Statement received complies or fails to comply with the terms of this
RFQ.
•
To supplement, amend or otherwise modify the RFQ through issuance of addenda to all prospective
Respondents who have received a copy of this RFQ.
•
To waive any technical non-conformance with the terms of this RFQ.
•
To change or alter the schedule for any events called for in this RFQ upon the issuance of notice to all
prospective Respondents who have received a copy of this RFQ.
•
To conduct investigations of any or all of the Respondents, as the Board deems necessary or convenient, to
clarify the information provided as part of the Qualification Statement and to request additional information
to support the information included in any Qualification Statement.
•
To suspend or terminate the procurement process described in this RFQ at any time in the Board’s sole
discretion. If terminated, the Board may determine to commence a new procurement process or exercise
any other rights provided under applicable law without any obligation to the Respondents.
The Board shall be under no obligation to complete all or any portion of the procurement process described in this RFQ.
Section 1.5
Addenda or Amendments to RFQ.
During the period provided for the preparation of responses to the RFQ, the Board may issue addenda, amendments or
answers to written inquiries. Those addenda will be noticed by the Board and will constitute a part of the RFQ. All
responses to the RFQ shall be prepared with full consideration of the addenda issued prior to the proposal submission date.
Section 1.6
Costs of Proposal Preparation.
Each proposal and all information required to be submitted pursuant to the RFQ shall be prepared at the sole cost and
expense of the respondent. There shall be no claims whatsoever against the Board, its staff, its consultants or such
consultants’ staff, for reimbursement for the payment of costs or expenses incurred in the preparation of the Qualification
Statement or other information required by the RFQ.
Section 1.7
Proposal Format.
Responses should cover all information requested in the questions to be answered in this RFQ.
Responses which in the judgment of the Board fail to meet the requirements of the RFQ or which are in any way conditional,
incomplete, obscure, contain additions or deletions from requested information, or contain errors may be rejected.
6
SECTION 2
SCOPE OF SERVICES
It is the intent of the Board to solicit Qualification Statements from Respondents that have expertise in the provision of
Engineering Services to and for the City of Summit Planning Board. Firms and/or persons responding to this RFQ
shall be able to demonstrate that they will have the continuing capabilities to perform these services.
SECTION 3
SUBMISSION REQUIREMENTS
Section 3.1
General Requirements.
The Qualification Statement submitted by the Respondent must meet or exceed the professional, administrative and financial
qualifications set forth in this Section 3 and shall incorporate the information requested below.
In addition to the information required as described below, a Respondent may submit supplemental information that it
believes may be useful in evaluating its Qualification Statement. Respondents are encouraged to be clear, factual, and
concise in their presentation of information.
Section 3.2
Administrative Information Requirements.
The Respondent shall, as part of its Qualification Statement, provide the following information:
1.
An executive summary (not to exceed two (2) pages) of the information contained in all the other parts of
the Qualification Statement.
2.
An executed Letter of Qualification (See Appendix A to this RFQ).
3.
Name, address and telephone number of the firm or firms submitting the Qualification Statement pursuant
to this RFQ, and the name of the key contact person.
4.
A description of the business organization (i.e., corporation, partnership, joint venture, etc.) of each firm, its
ownership and its organizational structure.
(a)
Provide the names and business addresses of all Principals of the firm or firms submitting the
Qualification Statement. For purposes of this RFQ, "Principals" means people possessing an
ownership interest in the Respondent. If the Respondent is a corporation, "Principals" shall
include each investor who would have any amount of operational control over the Respondent and
every stockholder having an ownership interest of ten percent (10%) or more in the firm.
(b)
If a firm is a partially owned or a fully-owned subsidiary of another firm, identify the parent
company and describe the nature and extent of the parents' approval rights over the activities of the
firm submitting a Qualification Statement. Describe the approval process.
(c)
If the Respondent is a partnership or a joint venture or similar organization, provide comparable
information as required in (b) above for each member of the partnership, joint venture or similar
organization.
(d)
A statement that the Respondent has complied with all applicable affirmative action (or similar)
requirements with respect to its business activities, together with evidence of such compliance
7
5.
An executed Letter of Intent (See Appendix B).
6.
An executed Payment Conditions and Rate Schedules Form (See Appendix C).
7.
An executed Americans with Disabilities Act of 1990 Acknowledgement Form (See Appendix D).
8.
A completed Business Entity Disclosure Form, Political Contribution Disclosure Form & a Stockholder
Disclosure Certification (Appendices E, F & G).
9.
The number of years the business organization has been in business under its present name.
10.
The number of years the business organization has been under its current management.
11.
Any judgments, claims or suits within the last three (3) years in which Respondent has been adjudicated
liable for professional malpractice. If yes, please explain.
12.
Whether the business organization is now or has been involved in any bankruptcy or re-organization
proceedings in the last ten (10) years. If yes, please explain.
13.
Confirm appropriate state licenses to perform activities by submitting a copy of their designated employees
New Jersey issued professional license and/or the Firm’s New Jersey issued statement of endorsement to
practice in the state of New Jersey.
Section 3.3
Professional Information Requirements.
1.
Respondent shall submit a description of its overall experience in providing the type of services sought in
the RFQ. At a minimum, the following information on past experience should be included as appropriate
to the RFQ:
a.
Description and scope of work by Respondent;
b.
Name, address and contact information of references; and
c.
Explanation of perceived relevance of the experience to the RFQ.
2.
Describe the services that Respondent would perform directly.
3.
Respondent shall designate one employee to the board and provide their resume.
3.
Describe those portions of the Respondent’s services, if any, that are sub-contracted out. Identify all
subcontractors the Respondent anticipates using in connection with this project.
4.
Does the Respondent normally employ union or non-union employees?
5.
Resumes of key employees.
6.
A narrative statement of the Respondents understanding of the Boards’ needs and goals.
7.
List all immediate relatives of Principal(s) of Respondent who are Board or City of Summit employees or
elected officials of the City. For purposes of the above, “immediate relative” means a spouse, parent,
stepparent, brother, sister, child, stepchild, direct-line aunt or uncle, grandparent, grandchild, and in-laws by
reason of relation.
SECTION 4
INSTRUCTIONS TO RESPONDENTS
8
Section 4.1
Submission of Qualification Statements
Respondents must submit an original, one (1) copy, and one (1) electronic copy of their Qualification Statement to the
Designated Contact Person:
Cynthia Kiefer
Land Use Assistant
City of Summit
512 Springfield Avenue
Summit NJ 07901
Qualification Statements must be received by the Board no later than 4:00 p.m. (prevailing time) on December 2, 2016 and
must be mailed or hand-delivered (an electronic file copy must also be submitted). Qualification Statements forwarded by
facsimile will not be accepted. Qualification statement submitted after the deadline will not be accepted. Qualification
statements that do not include an original, once (1) copy, and one (1) electronic copy by the deadline will not be accepted.
To be responsive, Qualification Statements must provide all requested information, and must be in strict conformance with
the instructions set forth herein. Qualification Statements and all related information must be bound, and signed and
acknowledged by the Respondent.
SECTION 5
EVALUATION
The Board’s objective in soliciting Qualification Statements is to enable it to select a firm or organization that will provide
high quality and cost effective services to the citizens of Summit. The Board will consider Qualification Statements only
from firms or organizations that, in the Board’s judgment, have demonstrated the capability and willingness to provide high
quality services to the citizens of the City in the manner described in this RFQ.
Proposals will be evaluated by the Board on the basis of the most advantageous, all relevant factors considered. The
evaluation will consider:
1.
Experience and reputation in the field;
2.
Knowledge of the City and the subject matter addressed under the contract;
3.
Availability to accommodate the required meetings of the Board; and
4.
Other factors relevant to the performance of duties demonstrated to be in the best interest of the City.
9
APPENDIX A
LETTER OF QUALIFICATION
(Note: To be typed on Respondent's Letterhead. No modifications may be made to this letter)
[INSERT DATE]
ATTN: Cynthia Kiefer
Land Use Assistant
City of Summit
512 Springfield Avenue
Summit NJ 07901
Dear Ms. Kiefer:
The undersigned has reviewed its Qualification Statement submitted in response to the Request for Qualifications (RFQ)
issued by the City of Summit Planning Board (“Board”), dated __________________, in connection with the Board’s need
for Engineering Services to and for the City of Summit Planning Board.
We affirm that the contents of our Qualification Statement (which Qualification Statement is incorporated herein by
reference), are accurate, factual and complete to the best of our knowledge and belief and that the Qualification Statement is
submitted in good faith upon the express understanding that any false statement may result in the disqualification of (Name
of Respondent).
(Respondent shall sign and complete the spaces provided below. If a joint venture, appropriate officers of each company
shall sign.)
(Signature of Chief
Executive Officer)
(Typed Name and Title)
(Type Name of Firm)
Dated: ___________________
H:\DCS\DCS Shared Files\Planning and Zoning\2017 RFQs&Contracts&Appoints\PB_Engineer_2016.doc
APPENDIX B
LETTER OF INTENT
(Note: To be typed on Respondent's Letterhead. No modifications may be made to this letter)
[INSERT DATE]
ATTN: Cynthia Kiefer
Land Use Assistant
City of Summit
512 Springfield Avenue
Summit NJ 07901
Dear Ms. Kiefer:
The undersigned, as Respondent, has (have) submitted the attached Qualification Statement in response to a Request for
Qualifications (RFQ), issued by the City of Summit Planning Board (“Board”), dated __________________in connection with
the Board’s need for Engineering Services to and for the City of Summit Planning Board.
(Name of Respondent) HEREBY STATES:
1.
The Qualification Statement contains accurate, factual and complete information.
2.
(Name of Respondent) agrees (agrees) to participate in good faith in the procurement process as described in
the RFQ and to adhere to the Board’s procurement schedule.
3.
(Name of Respondent) acknowledges (acknowledge) that all costs incurred by it (them) in connection with the
preparation and submission of the Qualification Statement and any proposal prepared and submitted in
response to the RFQ, or any negotiation which results therefrom shall be borne exclusively by the Respondent.
4.
(Name of Respondent) hereby declares (declare) that the only persons participating in this Qualification
Statement as Principals are named herein and that no person other than those herein mentioned has any
participation in this Qualification Statement or in any contract to be entered into with respect thereto.
Additional persons may subsequently be included as participating Principals, but only if acceptable to the
Board. (Name of Respondent) declares that this Qualification Statement is made without connection with any
other person, firm or parties who has submitted a Qualification Statement, except as expressly set forth below
and that it has been prepared and has been submitted in good faith and without collusion or fraud.
5.
(Name of Respondent) acknowledges and agrees that the Board may modify, amend, suspend and/or terminate
the procurement process (in its sole judgment). In any case, the Board shall not have any liability to the
Respondent for any costs incurred by the Respondent with respect to the procurement activities described in
this RFQ.
6.
(Name of Respondent) acknowledges that any contract executed with respect to the provision of Engineering
Services to and for the City of Summit Planning Board must comply with all applicable affirmative action
and similar laws. Respondent hereby agrees to take such actions as are required in order to comply with such
applicable laws.
(Respondent shall sign and complete the space provided below. If a joint venture, appropriate officers of each company shall
sign.)
(Signature of Chief Executive Officer)
(Typed Name and Title)
(Type Name of Firm)
Dated: ________________
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APPENDIX C
PAYMENT CONDITIONS AND RATE SCHEDULES
1.
The City of Summit Planning Board wishes to approve the qualifications of an engineering firm or firms to provide
Engineering Services to and for the Board for 2017. Upon appointment to the position of Board Engineer, no work or
compensation is guaranteed, however. Instead, the Board will approve proposals for projects (including compensation terms) on
an as needed basis. This will be done by a Resolution of the Planning Board. By submitting a response to this RFQ, the
Respondent acknowledges that it will not propose or charge hourly rates that exceed those listed below:
Partner .................................................................................................................. $145.00 Per Hour
Principal ............................................................................................................... $140.00 Per Hour
Project Manager ................................................................................................... $130.00 Per Hour
Professional Engineer ........................................................................................... $120.00 Per Hour
Project Engineer ................................................................................................... $110.00 Per Hour
Project Engineer ................................................................................................... $100.00 Per Hour
Senior Design Engineer .......................................................................................... $90.00 Per Hour
Design Engineer ..................................................................................................... $80.00 Per Hour
Senior Engineering Technician .............................................................................. $70.00 Per Hour
Survey Crew – 2 Person ....................................................................................... $200.00 Per Hour
Regularly Scheduled Board Meeting ........................................................ Hourly Rate/$200.00 min
Other meeting per request.............................................................................................. Hourly Rate
2.
The Professional shall be reimbursed at cost for expenses incurred for duplication, filing fees and other reasonable out-
of-pocket expenses advanced and/or incurred by them. The Professional shall be reimbursed for direct charges including
disbursements that are actual expenses incurred by the Professional and or/their associated Firm in connection with such
engineering services, and shall include, but not be limited to:
a.
Telegrams, faxes and long distance (Out-of-State) telephone calls;
b.
Payment of filing, application fees, review fees and similar charges;
c.
Computer expenses including time and proprietary program charges;
d.
Outside printing, reproduction, binding, collating and other graphic services;
e.
Messenger service, postage and handling of drawing and specifications, reports,
contracts and other bulky items.
3.
Monthly, itemized, invoices shall be submitted detailing all services performed.
Signature: The undersigned hereby acknowledges and accepts the established payment terms.
Name of Respondent/Firm:__________________________________
Print name and title:________________________________________
Signature:________________________________________________
Date:____________________________________________________
ATTEST:
________________________________
Witness
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APPENDIX D
AMERICANS WITH DISABILITIES ACT OF 1990
ACKNOWLEDGEMENT FORM
This form is an agreement of the successful Vendor’s obligation to comply with the requirements of 42 U.S.C. §121.01 et seq.,
referred to as the Americans Disability Act of 1990.
The undersigned Vendor hereby certifies that he/she is aware of the commitment to comply with the requirements of 42 U.S.C.
§121.01 et seq. and agrees to furnish any required forms as evidence of compliance.
The undersigned Vendor further certifies that he/she understands that his/her proposal shall be rejected as non-responsive and
any contract entered into shall be void and of no effect if said Vendor fails to comply with the requirements of 42 U.S.C.
§121.01 et seq.
COMPANY:___________________________ TITLE:______________________________
PRINT NAME: __________________________SIGNATURE:_______________________________
DATE: ______________________
H:\DCS\DCS Shared Files\Planning and Zoning\2017 RFQs&Contracts&Appoints\PB_Engineer_2016.doc
APPENDIX E
BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To N.J.S.A. 19:44A-20.8
CITY OF SUMMIT – 2016
Part I – Vendor Affirmation
The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that the (name of business
entity)__________________________________ has not made and will not make any reportable contributions pursuant to N.J.S.A. 19:44A-1 et
seq. that, pursuant to P.L. 2004, c. 19 would bar the award of this contract in the one year period preceding (date of scheduled award by the governing
body TO BE COMPLETED BY CITY) ________________, 2016, to any of the following named candidate committee, joint candidates
committee; or political party committee representing the elected officials of the CITY OF SUMMIT as defined pursuant to N.J.S.A. 19:44A-
3(p), (q) and (r).
•
Summit Municipal Democratic Committee
•
Nora Radest for Mayor
(Mayor Nora Radest, Council members B. David Naidu,
Richard Sun)
•
McTernan for Council
•
New Jersey State Democratic Committee
•
Summit Republican City Committee
(Council members Patrick Hurley, Sandra Lizza, Mike
McTernan, Mary Ogden, Robert Rubino)
•
Naidu for Council
•
Dickson, Smith, Dill and Ogden
•
Rubino for Council
•
Sun for Summit Council
Part II – Ownership Disclosure Certification
I certify that the list below contains the names and home addresses of all owners holding 10% or more of the issued and outstanding
stock of the undersigned.
Check the box that represents the type of business entity:
Partnership
Corporation
Sole Proprietorship
Subchapter S Corporation
Limited Partnership
Limited Liability Company
Limited Liability Partnership
Name of Stock or Shareholder
Home Address
Part 3 – Signature and Attestation:
The undersigned is fully aware that if I have misrepresented in whole or part this affirmation and certification, I and/or the business entity,
will be liable for any penalty permitted under law.
Name of Business Entity: ___________________________________________
Signed: ________________________________
Title: __________________________________
Print Name: ____________________________
Date: __________________________________
Subscribed and sworn before me this ___ day of ___________, 2
__.
My Commission expires:
_________________________________
(Affiant)
________________________________
(Print name & title of affiant) (Corporate Seal)
H:\DCS\DCS Shared Files\Planning and Zoning\2017 RFQs&Contracts&Appoints\PB_Engineer_2016.doc
BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To N.J.S.A. 19:44A-20.8
CITY OF SUMMIT
The following is statutory text related to the terms and citations used in the Business Entity Disclosure
Certification form.
“Local Unit Pay-To-Play Law” (P.L. 2004, c.19, as amended by P.L. 2005, c.51)
19:44A-20.6 Certain contributions deemed as contributions by business entity.
5. When a business entity is a natural person, a contribution by that person's spouse or child, residing therewith, shall be
deemed to be a contribution by the business entity. When a business entity is other than a natural person, a
contribution by any person or other business entity having an interest therein shall be deemed to be a contribution by
the business entity.
19:44A-20.7 Definitions relative to certain campaign contributions.
6. As used in sections 2 through 12 of this act:
“business entity" means any natural or legal person, business corporation, professional services corporation, limited
liability company, partnership, limited partnership, business trust, association or any other legal commercial entity
organized under the laws of this State or of any other state or foreign jurisdiction;
“interest" means the ownership or control of more than 10% of the profits or assets of a business entity or 10% of the
stock in the case of a business entity that is a corporation for profit, as appropriate;
Temporary and Executing
12. Nothing contained in this act shall be construed as affecting the eligibility of any business entity to perform a public
contract because that entity made a contribution to any committee during the one-year period immediately preceding the
effective date of this act.
~~~~~~~~~~~~~~~~~~~~~
The New Jersey Campaign Contributions and Expenditures Reporting Act (N.J.S.A. 19:44A-1 et seq.)
19:44A-3 Definitions. In pertinent part…
p. The term "political party committee" means the State committee of a political party, as organized pursuant to
R.S.19:5-4, any county committee of a political party, as organized pursuant to R.S.19:5-3, or any municipal committee
of a political party, as organized pursuant to R.S.19:5-2.
q. The term "candidate committee" means a committee established pursuant to subsection a. of section 9 of P.L.1973,
c.83 (C.19:44A-9) for the purpose of receiving contributions and making expenditures.
r. the term "joint candidates committee" means a committee established pursuant to subsection a. of section 9 of
P.L.1973, c.83 (C.19:44A-9) by at least two candidates for the same elective public offices in the same election in a
legislative district, county, municipality or school district, but not more candidates than the total number of the same
elective public offices to be filled in that election, for the purpose of receiving contributions and making expenditures.
For the purpose of this subsection: …; the offices of member of the board of chosen freeholders and county executive
shall be deemed to be the same elective public offices in a county; and the offices of mayor and member of the
municipal governing body shall be deemed to be the same elective public offices in a municipality.
19:44A-8 and 16 Contributions, expenditures, reports, requirements.
While the provisions of this section are too extensive to reprint here, the following is deemed to be the pertinent part affecting amounts of
contributions:
“The $300 limit established in this subsection shall remain as stated in this subsection without further adjustment by the
commission in the manner prescribed by section 22 of P.L.1993, c.65 (C.19:44A-7.2)
H:\DCS\DCS Shared Files\Planning and Zoning\2017 RFQs&Contracts&Appoints\PB_Engineer_2016.doc
APPENDIX F
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Contractor Instructions
Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a “fair and open” process
(defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of P.L. 2005, c. 271, s.2 (N.J.S.A. 19:44A-20.26). This law provides
that 10 days prior to the award of such a contract, the contractor shall disclose contributions to (see reverse for listing):
•
any State, county, or municipal committee of a political party
•
any legislative leadership committee*
•
any continuing political committee (a.k.a., political action committee)
•
any candidate committee of a candidate for, or holder of, an elective office:
o
of the public entity awarding the contract
o
of that county in which that public entity is located
o
of another public entity within that county
o
or of a legislative district in which that public entity is located or, when the public entity is a county, of any
legislative district which includes all or part of the county
The disclosure must list reportable contributions to any of the committees that exceed $300 per election cycle that were made during the
12 months prior to award of the contract. See N.J.S.A. 19:44A-8 and 19:44A-16 for more details on reportable contributions.
N.J.S.A. 52:34-25(b) itemizes the parties from whom contributions must be disclosed when a business entity is not a natural person.
This includes the following:
•
individuals with an “interest:” ownership or control of more than 10% of the profits or assets of a business entity or 10%
of the stock in the case of a business entity that is a corporation for profit
•
all principals, partners, officers, or directors of the business entity or their spouses
•
any subsidiaries directly or indirectly controlled by the business entity
•
IRS Code Section 527 New Jersey based organizations, directly or indirectly controlled by the business entity and filing
as continuing political committees, (PACs).
When the business entity is a natural person, “a contribution by that person’s spouse or child, residing therewith, shall be deemed to be
a contribution by the business entity.” [N.J.S.A. 19:44A-20.26(b)] The contributor must be listed on the disclosure.
Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed by ELEC in an amount to be
determined by the Commission which may be based upon the amount that the business entity failed to report.
The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official and/or
candidate campaign committees are affected by the disclosure requirement. It is the contractor’s responsibility to identify the specific
committees to which contributions may have been made and need to be disclosed. The disclosed information may exceed the minimum
requirement.
The enclosed form or a content-consistent facsimile may be used as the contractor’s submission and is disclosable to the public under
the Open Public Records Act.
The contractor must also complete the attached Stockholder Disclosure Certification. This will assist the agency in meeting its
obligations under the law.
* N.J.S.A. 19:44A-3(s): “The term "legislative leadership committee" means a committee established, authorized to be established, or
designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the General Assembly or the Minority
Leader of the General Assembly pursuant to section 16 of P.L.1993, c.65 (C.19:44A-10.1) for the purpose of receiving contributions
and making expenditures.”
H:\DCS\DCS Shared Files\Planning and Zoning\2017 RFQs&Contracts&Appoints\PB_Engineer_2016.doc
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Required Pursuant To N.J.S.A. 19:44A-20.26
This form or its permitted facsimile must be submitted to the City of Summit
no later than 10 days prior to the award of the contract.
Part I – Vendor Information
Vendor Name:
Address:
City:
State:
Zip:
The undersigned being authorized to certify, hereby certifies that the submission provided herein represents
compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions
accompanying this form.
_________________________ _________________________ _________________________
Signature
Printed Name
Title
Part II – Contribution Disclosure
Disclosure requirement: Pursuant to N.J.S.A. 19:44A-20.26 this disclosure must include all
reportable political contributions (more than $300 per election cycle) over the 12 months prior to
submission to the committees of the government entities listed on the form provided .
Contributor Name
Recipient Name
Date
Dollar Amount
$
Check here if the information is continued on subsequent page(s)
DOUBLE SIDED DOCUMENT
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Continuation Page
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Required Pursuant To N.J.S.A. 19:44A-20.26
Page ___ of ______
Vendor Name: ___________________________________
Contributor Name
Recipient Name
Date
Dollar Amount
$
Check here if the information is continued on subsequent page(s)
H:\DCS\DCS Shared Files\Planning and Zoning\2017 RFQs&Contracts&Appoints\PB_Engineer_2016.doc
List of Agencies with Elected Officials Required for Political Contribution Disclosure
N.J.S.A. 52:34-25
County Name: Union
State: Governor, and Legislative Leadership Committees
Legislative District #: 21
State Senator and two members of the General Assembly per district.
County:
Freeholders
County Clerk
Sheriff
Surrogate
Municipalities (Mayor and members of governing body, regardless of title):
Berkeley Heights Township
Clark Township
Cranford Township
Elizabeth City
Fanwood Borough
Garwood Borough
Hillside Township
Kenilworth Borough
Linden City
Mountainside Borough
New Providence Borough
Plainfield City
Rahway City
Roselle Borough
Roselle Park Borough
Scotch Plains Township
Springfield Township
Summit City
Union Township
Westfield Town
Winfield Township
Boards of Education (Members of the Board):
Berkeley Heights Township
Clark Township
Cranford Township
Elizabeth City
Garwood Borough
Hillside Township
Kenilworth Borough
Linden City
Mountainside Borough
New Providence Borough
Plainfield City
Rahway City
Roselle Borough
Roselle Park Borough
Scotch Plains-Fanwood Regional
Springfield Township
Union Township
Westfield Town
Winfield Township
Fire Districts (Board of Fire Commissioners):
None
STOCKHOLDER DISCLOSURE CERTIFICATION
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.
Check the box that represents the type of business organization:
Partnership
Corporation
Sole Proprietorship
Limited Partnership
Limited Liability Company Limited Liability Partnership
Subchapter S Corporation
Sign and notarize the form below, and, if necessary, complete the stockholder list below.
Stockholders:
Name:
Name:
Home Address:
Home Address:
Name:
Name:
Home Address:
Home Address:
Name:
Name:
Home Address:
Home Address:
Subscribed and sworn before me this ___ day of ___________, 2
__.
(Notary Public)
My Commission expires:
_________________________________
(Affiant)
________________________________
(Print name & title of affiant)
(Corporate Seal)
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Cynthia Kiefer
Land Use Assistant · City of Summit
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Timeline
First Discovered
Mar 19, 2026
Last Info Update
Apr 30, 2026
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