14-File K- CERTIFICATE OF INSURANCE.pdf

This is a Certificate of Insurance Experience form for the Township of Stafford, New Jersey, related to Bid #2026-049A-W/S for the Ocean Acres Booster Pump Replacement Phase 2 and Well No. 5 Redevelopment project. The form requires bidders to certify their insurance experience and document work performed within the preceding two years. The project involves furnishing all labor, materials, equipment, tools, and supervision necessary to rehabilitate existing Well No. 5 and replace two existing high service booster pumps with associated motor rehabilitation. The high service pumps are located at 327 Golfview Drive, Manahawkin, New Jersey, 08050, while existing Well No. 5 is situated at 181 Stafford Avenue, Manahawkin, New Jersey, 08050. All well rehabilitation work must be performed under the direct supervision of a New Jersey Licensed Master Well Driller in accordance with all pertinent State of New Jersey Department of Environmental Protection (NJDEP) requirements.

The certificate form requires bidders to list insurance information including the type of work performed, the insurance provider company name, contact information, and whether insurance was cancelled. Bidders must complete the form with their organization name, authorized representative signature, and title. The form includes fifteen numbered lines for bidders to document their relevant insurance experience and certifications, providing a structured mechanism for the Township of Stafford to evaluate contractor qualifications and insurance history prior to contract award.