1-Ownership Disclosure.pdf

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Attached to
Expand the Pool - Real Estate Appraiser, to Provide “Review Appraisal” Services on an “As Needed” Basis for the Bergen County Department of Parks, Division of Land Management for the 2026 Calendar Year
Solicitation number
BC-RFQ-26-004.1
Issued by
Bergen County, New Jersey

About this file

Written by GovTribe AI ·

This is an Ownership Disclosure Certification form required for bid submission to the Bergen County Department of Parks, Division of Land Management in New Jersey. The form mandates that all bidders disclose the names and home addresses of stockholders holding 10% or more of issued and outstanding stock, or alternatively certify that no single stockholder owns 10% or more of the company. Bidders must also identify their business organization type, including options for partnership, corporation, sole proprietorship, limited partnership, limited liability corporation, limited liability partnership, and Subchapter S corporation. For publicly traded parent entities, respondents may submit SEC filings or foreign equivalents identifying beneficial interest holders instead of individual stockholders. The form requires the affiant's signature and printed name with title.

This certification document is a compliance requirement under N.J.S.A. 52:25-24.2 and must accompany all bid submissions. The form includes designated spaces for up to four stockholder entries with corresponding home address fields, as well as sections for documenting publicly traded parent company disclosures including SEC filing website URLs and applicable page numbers. The form appears designed to ensure transparency regarding business ownership structures and maintain regulatory compliance for state and local contracting in New Jersey.

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OWNERSHIP DISCLOSURE CERTIFICATION

This Statement Shall Be Included with Bid Submission (Use Additional Sheets as Necessary)

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. However if a parent entity holding 10% or more is a publicly traded entity, then the respondent in complying with N.J.S.A. 52:25-24.2 may submit the name and address of each publicly traded entity, and the name and address of each person holding 10% or more beneficial interest in the publicly traded entity as of the last the last annual filling with the Security Exchange Commission (SEC), or foreign equivalent.

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 Corporation Limited Liability Partnership

Subchapter S Corporation Other, Please List_______________

Sign the form below, and, if necessary, complete the stockholder list below. Stockholders:

Name: ______________________________ Name: ______________________________

Home Address: _______________________

Home Address: _______________________

Name: ______________________________ Name: ______________________________

Home Address: _______________________

Home Address: _______________________

Publicly Traded Parent Company Disclosure:

Submit the Website (URL) providing the last annual SEC, or foreign equivalent filing:

Please list the applicable page number(s) of the SEC or foreign equivalent filing:

(Affiant)

(Print name & title of affiant)

I certify that the list below contains the names and home addresses of all stockholders holding 10 or: Off
I certify that no one stockholder owns 10 or more of the issued and outstanding stock of the: Off
Partnership: Off
Limited Partnership: Off
Subchapter S Corporation: Off
Corporation: Off
Limited Liability Corporation: Off
Other Please List: Off
Sole Proprietorship: Off
Limited Liability Partnership: Off
undefined:
Name:
Name_2:
Home Address:
Home Address_2:
undefined_2:
undefined_3:
Name_3:
Name_4:
Home Address_3:
Home Address_4:
undefined_4:
undefined_5:
Print name title of affiant:
Name of Business:
URL of Annual SEC Filing:
Page Numbers:
Signature:

File details come from the government source that posted it. Updated .