24-06 ELECTRICAL SERVICES MAINTENANCEN AND REPAIR BID.pdf

Willingboro

Municipal Utilities

Authority

COUNTY OF

BURLINGTON

STATE OF NEW JERSEY

Chair - Patricia Lindsay-Harvey

Vice Chair

Diallyo Diggs

Commissioners

Carl Turner

Kevin McIntosh

James Boyer

Alternates

William Weston, 1st Alt.

Kimbrali Davis, 2nd Alt.

Executive Director

James Mackie

BID # 24-06

ELECTRICAL SERVICES MAINTENANCE AND REPAIR BID

Due

April 15, 2025, at 10:00am

LEGAL NOTICE

Notice is hereby given by the Willingboro Municipal Utilities Authority that an invitation to bid in accord with N.J.S.A. 40A:11-

1 et. Seq., will be received by the Authority on April 15, 2025, at 10:00am prevailing time conducted on electronic platform, in accord with N.J.A.C. 5:34-1 et. Seq., on BIDNET at www.bidnetdirect.com//wmua

BID 24-06 ELECTRICAL SERVICES MAINTENANCE AND REPAIR BID

NOTE:

It is the bidder’s responsibility to ensure that the bid package is uploaded onto the e-procurement site by the bid opening date and time. Any bid document received after the deadline established by the Department of Purchasing will not be accepted, regardless of the method of delivery.

Bidders must comply with the requirements of N.J.S.A. 10:5-31 et seq., and N.J.A.C. 17:27 et. Seq., For information on attending the publicly broadcast opening contact the Purchasing Agent at scanning@TheCanningGroup.org.

This procurement has been advertised in accordance with the “Fair and Open Basis” (N.J.S.A. 19:44A-20.5).

James Mackie April 1, 2025

Executive Director http://www.bidnetdirect.com/wmua mailto:scanning@TheCanningGroup.org

ADMINISTRATIVE DOCUMENTS

Applicable to Bid if marked “X”

DOCUMENTATION REQUIRED OR REVIEWED

Initials

When Due if not submitted with Bid

Bid Guarantee (Bid Bond or Certified/Cashier’s Check) (with POA for full amount of Bid Bond)

With Bid

Submission

Consent of Surety (Certificate from Surety company)

Performance Bond and Labor and Material Payment Bond (Required from the Awarded Contractor)

At signing of contract

Maintenance Bond in the Amount of 100 % for a period indicated in

“General Conditions” Required from the Awarded Contractor Upon

Acceptance of Project

Upon

Acceptance of

Project

Acknowledgement of Receipt of Addenda (To be Completed if

Addenda are Issued)

X Ownership Disclosure Form With Bid

Submission

Named Subcontractors in Bid for Listed Specialty Trades With Bid

Submission

X Public Works Contractor Registration Certificate(s) for the Bidder and all Sub Contractors

Prior to Award, but effective at time of bid

X Business Registration Certificate – Bidder and all Sub Contractors Prior to Contract

Award

Non-Collusion Affidavit Prior to Contract

Award

X Experience and Background Questionnaire Prior to Contract

Award

X Insurance and Indemnification Certificate Prior to Contract

Award

Disclosure of Investment Activities in Russia Form Prior to Contract

Award

Disclosure of Investment Activities in Iran Form Prior to Contract

Award

X Federal debarment Form Prior to Contract

Award

X

EEO/AA Form AA-201

After Notice of

Award, Prior to

Signing Contract

EEO/AA Form AA-302 or Letter of Federal Approval or Certificate of Employee Information Report

After Notice of

Signing Contract

X Bidder’s Checklist Prior to Contract

Award x Fair Inclusion Questionnaire Prior to Contract

Award

X W9 Form

After Notice of

Signing Contract

This checklist is provided for bidder’s use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications.

Bidder Name: Date:

Authorized

Representative:

Signature:

Print Name &

Title:

ALL RESPONSES AND QUESTIONS ARE TO BE CONDUCTED ON THE CITY’S E-PROCUREMENT SITE AT

BIDNET at www.bidnetdirect.com//wmua

NO PHYSICAL OR EMAILED PROPOSAL RESPONSES SHALL BE ACCEPTED

Bidder:

The undersigned has reviewed the proposal submitted in response to Bid#24-06 issued by the

Willingboro Municipal Utilities Authority in connection with the need for the following:

Bid 24-06 ELECTRICAL SERVICES MAINTENANCE AND REPAIR BID Standby NJ Licensed Electrician Services

We affirm that the content of the proposal (which proposal is incorporated herein by reference) is accurate, factual and complete to the best of our knowledge and belief and that the proposal is submitted in good faith upon express understanding that any false statements may result in the disqualification of our proposal.

The undersigned hereby agrees to furnish all labor, materials, supplies, supervision, equipment and other means as necessary to perform all the work and furnish all the materials in accordance with the specifications

CATEGORY

A

Standard Hourly Rate

Overtime Hourly Rate

Sunday & Holiday Hourly Rate

Foreman

Journeyman

Business Name:

Representative's Name(print):

Representative's Signature:

http://www.bidnetdirect.com/wmua

WILLINGBORO MUNICIPAL UTILITIES AUTHORITY

NJ LICENSED ELECTRICIAN SERVICES

SCOPE OF SERVICES

The Willingboro Municipal Utilities Authority requires a standby electrician to provide electrical services on an as- needed basis in accordance with the following specifications. This bid package consists of the following service categories:

CATEGORY "A"

This is defined as work consisting of general electrical service in and for the Willingboro

Municipal Utilities Authority. The bidder must have a business permit number active for five (5) years and a minimum of five (5) years of experience in working on facilities similar to those of the Willingboro Municipal Utilities Authority. The Authority also possesses and operates a water and sewer utility. The bidder must be able to provide service to the Authority Water & Sewer facilities and must be familiar with utility equipment. The bidder must have a business permit number active for five (5) years and a minimum of five

(5) years of experience in working with pumps, motors, panels and controls typical to the operation of water and sewer facilities as well as the ability to complete all work. The bidder must be able to provide service to all Authority departments for work including but not limited to:

• Installation of utility poles

• Installation and maintenance of area lighting

• Installation of underground utilities.

• Interior electrical modifications, installation and repair

• Installation of new services to Authority facilities

• Service, installation or coordination of service of generators or uninterrupted power supply systems.

WILLINGBORO

MUNICIPAL

UTILITIES

AUTHORITY

SERVICE LOCATIONS

The physical location of business must be within a fifteen mile radius of the Authority borders of the Willingboro Municipal Utilities Authority, as measured by directions route under Google Maps. The successful vendor must be capable of rapid response for:

• The operation of all locations of the Authority, which includes, but is not limited to the following:

• Water treatment plants (four)

• Wastewater treatment plant (one)

• Groundwater wells (six)

• Pumping stations (four)

• Administrative Building (one)

• Elevated tanks (two)

• The operation with limited interruption of service facilities and the fuel depot is critical to ensuring essential services.

• The operation of Water and Sewer facilities with limited interruption is critical to ensuring essential services.

RESPONSE TIME

Service must be provided and completed in a timely manner (not to exceed 72 hours unless the scope of work is such, or approval has been given by the Executive

Director or a designee). The Authority reserves the right to contact another service provider should the bidder's availability be unacceptable, and conditions warrant prompt response in the opinion of the Executive Director or designee.

Bidder must be available for emergency services as required:

• Must provide a twenty-four (24) hour contact number(s).

• Must respond to emergency calls with a call back within sixty (60) minutes.

• Must be able to respond to location of emergency within no more than thirty (30) minutes of being notified by Authority Officials.

WILLINGBORO

MUNICIPAL

UTILITIES

AUTHORITY

CERTIFICATIONS

Bidder must be a licensed electrician by the State of New Jersey. Proof of certification/license number required. Bidder must also provide certifications for subcontractors at the time of bid submission.

Bidder must be certified with the following OSHA certifications:

• Confined Space work as defined by OSHA, proof of certification required.

• Lock-out Tag-out work as defined by OSHA, proof of certification required.

• Operation of aerial lifts / bucket trucks, proof of certification required.

INVOICE & PAYMENT

Invoices for work completed must be received for payment no later than 30 days after completion of said work; ultimately, invoices are due the 5th of every month or the first Monday, whichever comes first. The Willingboro Municipal Utilities Authority will pay the contractor material cost plus ten (10%) for all materials used to complete work.

Bids are to be submitted on a straight time hourly prevailing wage rate with a premium time hourly rate not to exceed one and one-halftimes (1 ½) the straight time hourly rate.

The Contractor shall be eligible for premium times when the work to be performed is deemed to be an emergency by the Executive Director or a designee there of and is authorized to be performed outside of the normal working hours. Normal Administrative working hours for Willingboro Municipal Utilities Authority are Monday through Friday, 9:00 AM to 4:30 PM; depending on the WMUA location (i.e., plant), the hours may vary.

Weekends and legal holidays shall be considered premium time.

All work to be performed by the contractor requires that the contractor furnish all labor, tools and other necessary equipment to accomplish the required services for a full and complete job. The contractor will be required to obtain permits for all jobs. The

Willingboro Municipal Utilities Authority will not pay the contractor for travel expenses to and from Willingboro.

The contractor shall notify the Executive Director or his designee prior to commencing work and upon completion of work on all Authority facilities.

The contractor must submit a completed work report which must be signed and approved by the Executive Director or his designee. This report must clearly identify work performed, location of work performed, materials used and man-hours expended between electrician(s) and helper(s) prior to invoice approval.

BID AWARD

Will be to the lowest responsible bidder.

CONTRACT DURATION

The contract is for two (2) years from date of execution with renewal extension in accord with New Jersey Local Publics Contract Law N.J.S.A.

40A:11-15.

EXHIBIT B

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE

N.J.S.A. 10:5-31 et seq. (P.L.1975, c.127)

N.J.A.C. 17:27-1.1 et seq.

CONSTRUCTION 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 applicant’s 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 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.

When hiring or scheduling workers in each construction trade, the contractor or subcontractor agrees to make good faith efforts to employ minority and women workers in each construction trade consistent with the targeted employment goal prescribed by N.J.A.C. l7:27-7.2; provided, however, that the Dept. of LWD, Construction EEO Monitoring Program, may, in its discretion, exempt a contractor or subcontractor from compliance with the good faith procedures prescribed by the following provisions, A, B, and C, as long as the Dept. of LWD, Construction EEO Monitoring Program is satisfied that the contractor or subcontractor is employing workers provided by a union which provides evidence, in accordance with standards prescribed by the

Dept. of LWD, Construction EEO Monitoring Program, that its percentage of active “card carrying” members who are minority and women workers is equal to or greater than the targeted employment goal established in accordance with N.J.A.C. 17:27-7.2. The contractor or subcontractor agrees that a good faith effort shall include compliance with the following procedures:

(A) If the contractor or subcontractor has a referral agreement or arrangement with a union for a construction trade, the contractor or subcontractor shall, within three business days of the contract award, seek assurances from the union that it will cooperate with the contractor or subcontractor as it fulfills its affirmative action obligations under this contract and in accordance with the rules promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et. seq., as supplemented and amended from time to time and the Americans with Disabilities Act. If the contractor or subcontractor is unable to obtain said assurances from the construction trade union at least five business days prior to the commencement of construction work, the contractor or subcontractor agrees to afford equal employment opportunities minority and women workers directly, consistent with this chapter. If the contractor's or subcontractor's prior experience with a construction trade union, regardless of whether the union has provided said assurances, indicates a significant possibility that the trade union will not refer sufficient minority and women workers consistent with affording equal employment opportunities as specified in this chapter, the contractor or subcontractor agrees to be prepared to provide such opportunities to minority and women workers directly, consistent with this chapter, by complying with the hiring or scheduling procedures prescribed under (B) below; and the contractor or subcontractor further agrees to take said action immediately if it determines that the union is not referring minority and women workers consistent with the equal employment opportunity goals set forth in this chapter.

(B) If good faith efforts to meet targeted employment goals have not or cannot be met for each construction trade by adhering to the procedures of (A) above, or if the contractor does not have a referral agreement or arrangement with a union for a construction trade, the contractor or subcontractor agrees to take the following actions:

(l) To notify the public agency compliance officer, the Dept. of LWD, Construction EEO Monitoring Program, and minority and women referral organizations listed by the Division pursuant to N.J.A.C. 17:27-5.3, of its workforce needs, and request referral of minority and women workers;

(2) To notify any minority and women workers who have been listed with it as awaiting available vacancies;

(3) Prior to commencement of work, to request that the local construction trade union refer minority and women workers to fill job openings, provided the contractor or subcontractor has a referral agreement or arrangement with a union for the construction trade;

(4) To leave standing requests for additional referral to minority and women workers with the local construction trade union, provided the contractor or subcontractor has a referral agreement or arrangement with a union for the construction trade, the State Training and Employment Service and other approved referral sources in the area;

(5) If it is necessary to lay off some of the workers in a given trade on the construction site, layoffs shall be conducted in compliance with the equal employment opportunity and nondiscrimination standards set forth in this regulation, as well as with applicable Federal and State court decisions;

(6) To adhere to the following procedure when minority and women workers apply or are referred to the contractor or subcontractor:

The contactor or subcontractor shall interview the referred minority or women worker.

If said individuals have never previously received any document or certification signifying a level of qualification lower than that required in order to perform the work of the construction trade, the contractor or subcontractor shall in good faith determine the qualifications of such individuals. The contractor or subcontractor shall hire or schedule those individuals who satisfy appropriate qualification standards in conformity with the equal employment opportunity and non-discrimination principles set forth in this chapter. However, a contractor or subcontractor shall determine that the individual at least possesses the requisite skills, and experience recognized by a union, apprentice program or a referral agency, provided the referral agency is acceptable to the Dept. of LWD, Construction EEO Monitoring Program. If necessary, the contractor or subcontractor shall hire or schedule minority and women workers who qualify as trainees pursuant to these rules. All of the requirements, however, are limited by the provisions of (C) below.

The name of any interested women or minority individual shall be maintained on a waiting list, and shall be considered for employment as described in (i) above, whenever vacancies occur. At the request of the Dept. of LWD, Construction EEO Monitoring Program, the contractor or subcontractor shall provide evidence of its good faith efforts to employ women and minorities from the list to fill vacancies.

If, for any reason, said contractor or subcontractor determines that a minority individual or a woman is not qualified or if the individual qualifies as an advanced trainee or apprentice, the contractor or subcontractor shall inform the individual in writing of the reasons for the determination, maintain a copy of the determination in its files, and send a copy to the public agency compliance officer and to the Dept. of LWD, Construction EEO Monitoring Program.

(7) To keep a complete and accurate record of all requests made for the referral of worker’s in any trade covered by the contract, on forms made available by the Dept. of LWD, Construction EEO Monitoring Program and submitted promptly to the Dept. of LWD, Construction EEO Monitoring Program upon request.

(C) The contractor or subcontractor agrees that nothing contained in (B) above shall preclude the contractor or subcontractor from complying with the union hiring hall or apprenticeship policies in any applicable collective bargaining agreement or union hiring hall arrangement, and, where required by custom or agreement, it shall send journeymen and trainees to the union for referral, or to the apprenticeship program for admission, pursuant to such agreement or arrangement. However, where the practices of a union or apprenticeship program will result in the exclusion of minorities and women or the failure to refer minorities and women consistent with the targeted county employment goal, the contractor or subcontractor shall consider for employment persons referred pursuant to (B) above without regard to such agreement or arrangement; provided further, however, that the contractor or subcontractor shall not be required to employ women and minority advanced trainees and trainees in numbers which result in the employment of advanced trainees and trainees as a percentage of the total workforce for the construction trade, which percentage significantly exceeds the apprentice to journey worker ratio specified in the applicable collective bargaining agreement, or in the absence of a collective bargaining agreement, exceeds the ratio established by practice in the area for said construction trade. Also, the contractor or subcontractor agrees that, in implementing the procedures of (B) above, it shall, where applicable, employ minority and women workers residing within the geographical jurisdiction of the union.

After notification of award, but prior to signing a construction contract, the contractor shall submit to the public agency compliance officer and the Dept. of LWD, Construction EEO Monitoring Program an initial project workforce report (Form AA-201) electronically provided to the public agency by the Dept. of LWD, Construction EEO Monitoring Program, through its website, for distribution to and completion by the contractor, in accordance with N.J.A.C. 17:27-7.

The contractor also agrees to submit a copy of the Monthly Project Workforce Report once a month thereafter for the duration of this contract to the Dept. of LWD, Construction EEO Monitoring Program, and to the public agency compliance officer.

The contractor agrees to cooperate with the public agency in the payment of budgeted funds, as is necessary, for on-the-job and/or off-the job programs for outreach and training of minorities and women.

(D) The contractor and its subcontractors shall furnish such reports or other documents to the Dept. of LWD, Construction EEO Monitoring Program as may be requested by the Dept. of LWD, Construction EEO Monitoring Program 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 Dept. of LWD, Construction EEO Monitoring Program for conducting a compliance investigation pursuant to N.J.A.C. 17:27-1.1 et seq.

NEW JERSEY ANTI-DISCRIMINATION PROVISIONS

N.J.S.A. 10:2-1 ET SEQ.

Pursuant to N.J.S.A. 10:2-1, if awarded a contract, the contractor agrees that:

a. In the hiring of persons for the performance of work under this contract or any subcontract hereunder, or for the procurement, manufacture, assembling or furnishing of any such materials, equipment, supplies or services to be acquired under this contract, no contractor, nor any person acting on behalf of such contractor or subcontractor, shall, by reason of race, creed, color, national origin, ancestry, marital status, gender identity or expression, affectional or sexual orientation or sex, discriminate against any person who is qualified and available to perform the work to which the employment relates;

b. No contractor, subcontractor, nor any person on his behalf shall, in any manner, discriminate against or intimidate any employee engaged in the performance of work under this contract or any subcontract hereunder, or engaged in the procurement, manufacture, assembling or furnishing of any such materials, equipment, supplies or services to be acquired under such contract, on account of race, creed, color, national origin, ancestry, marital status, gender identity or expression, affectional or sexual orientation or sex;

c. There may be deducted from the amount payable to the contractor by the contracting public agency, under this contract, a penalty of $50.00 for each person for each calendar day during which such person is discriminated against or intimidated in violation of the provisions of the contract; and

d. This contract may be canceled or terminated by the contracting public agency, and all money due or to become due hereunder may be forfeited, for any violation of this section of the contract occurring after notice to the contractor from the contracting public agency of any prior violation of this section of the contract.

SAMPLE CERTIFICATE OF EMPLOYEE INFORMATION REPORT

New Jersey Business Registration Certification

Pursuant to N.J.S.A. 52:32-44, The Willingboro Municipal Utilities Authority (“Contracting

Agency”) is prohibited from entering into a contract with an entity unless the bidder/proposer/contractor, and each subcontractor that is required by law to be named in a bid/proposal/contract has a valid Business Registration

Certificate on file with the Division of Revenue and Enterprise Services within the

Department of the Treasury.

Prior to contract award or authorization, the contractor shall provide the

Contracting Agency with its proof of business registration and that of any named subcontractor(s).

Subcontractors named in a bid or other proposal shall provide proof of business registration to the bidder, who in turn, shall provide it to the Contracting Agency prior to the time a contract, purchase order, or other contracting document is awarded or authorized.

During the course of contract performance:

(1) the contractor shall not enter into a contract with a subcontractor unless the subcontractor first provides the contractor with a valid proof of business registration.

(2) the contractor shall maintain and submit to the Contracting Agency a list of subcontractors and their addresses that may be updated from time to time.

(3) the contractor and any subcontractor providing goods or performing services under the contract, and each of their affiliates, shall collect and remit to the Director of the Division of Taxation in the Department of the

Treasury, 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 the State. Any questions in this regard can be directed to the Division of

Taxation at (609)292-6400. Form NJ-REG can be filed online at http://www.state.nj.us/treasury/revenue/busregcert.shtml.

Before final payment is made under the contract, the contractor shall submit to the Contracting Agency a complete and accurate list of all subcontractors used and their addresses.

Pursuant to N.J.S.A. 54:49-4.1, a business organization that fails to provide a copy of a business registration as required, or that provides false business registration information, shall be liable for a penalty of $25 for each day of violation, not to exceed $50,000, for each proof of business registration not properly provided under a contract with a contracting agency.

Emergency Purchases or Contracts

For purchases of an emergent nature, the contractor shall provide its Business

Registration Certificate within two weeks from the date of purchase or execution of the contract or prior to payment for goods or services, whichever is earlier.

http://www.state.nj.us/treasury/revenue/busregcert.shtml

SAMPLE BUSINESS REGISTRATION CERTIFICATE

PAY TO PLAY ADVISORY

Disclosure Requirement

P.L. 2005, Chapter 271, Section 3 Reporting

(N.J.S.A. 19:44A – 20.27)

Any business entity that has received $50,000 or more in contracts from government entities in a calendar year will be required to file an annual disclosure report with ELEC.

The report will include certain contributions and contract information for the current calendar year.

At a minimum, a list of all business entities that file an annual disclosure report will be listed on ELEC’s website at www.elec.state.nj.us.

If you have any questions please contact ELEC at:

1-888-313-ELEC (toll free in NJ) or

609-292-8700

An analyst from ELEC’s Special Programs Section will assist you.

http://www.elec.state.nj.us/

CERTIFICATION OF NON-DEBARMENT

FOR FEDERAL GOVERNMENT CONTRACTS

N.J.S.A. 52:32-44.1 (P.L. 2019, c.406)

This certification shall be completed, certified to, and submitted to the contracting unit prior to contract award, except for emergency contracts where submission is required prior to payment.

PART I: VENDOR INFORMATION

Individual or Organization Name

Address of Individual or Organization

DUNS Code (if applicable)

CAGE Code (if applicable)

Check the box that represents the type of business organization:

Sole Proprietorship (skip Parts III and IV) Non-Profit Corporation (skip Parts III and IV)

For-Profit Corporation (any type) Limited Liability Company (LLC) Partnership

Limited Partnership Limited Liability Partnership (LLP)

Other (be specific):

PART II – CERTIFICATION OF NON-DEBARMENT: Individual or Organization

I hereby certify that the individual or organization listed above in Part I is not debarred by the federal government from contracting with a federal agency. I further acknowledge: that I am authorized to execute this certification on behalf of the above-named organization; that the Willingboro Municipal Utilities Authority is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the date of contract award by Authority to notify the Authority 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 Authority permitting the Authority to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print):

Date:

PART III – CERTIFICATION OF NON-DEBARMENT: Individual or Entity Owning Greater than 50 Percent of Organization

Section A (Check the Box that applies)

Below is the name and address of the stockholder in the corporation who owns more than 50 percent of its voting stock, or of the partner in the partnership who owns more than 50 percent interest therein, or of the member of the limited liability company owning more than 50 percent interest therein, as the case may be.

Name of Individual or Organization

Home Address (for Individual) or Business Address

OR

No one stockholder in the corporation owns more than 50 percent of its voting stock, or no partner in the partnership owns more than 50 percent interest therein, or no member in the limited liability company owns more than 50 percent interest therein, as the case may be.

Section B (Skip if no Business entity is listed in Section A above)

Below is the name and address of the stockholder in the corporation who owns more than 50 percent of the voting stock of the organization’s parent entity, or of the partner in the partnership who owns more than 50 percent interest in the organization’s parent entity, or of the member of the limited liability company owning more than 50 percent interest in organization’s parent entity, as the case may be.

Stockholder/Partner/Member Owning Greater Than 50 Percent of Parent Entity

Home Address (for Individual) or Business Address

No one stockholder in the parent entity corporation owns more than 50 percent of its voting stock, no partner in the parent entity partnership owns more than 50 percent interest therein, or no member in the parent entity limited liability company owns more than 50 percent interest therein, as the case may be.

Section C – Part III Certification

I hereby certify that no individual or organization that is debarred by the federal government from contracting with a federal agency owns greater than 50 percent of the Organization listed above in Part I or, if applicable, owns greater than 50 percent of a parent entity of I further acknowledge: that I am authorized to execute this certification on behalf of the above-named organization; that the Willingboro Municipal Utilities Authority is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the date of contract award Authority to notify the Authority 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 Authority permitting the Authority to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print):

Part IV – CERTIFICATION OF NON-DEBARMENT: Contractor – Controlled Entities

Section A

Below is the name and address of the corporation(s) in which the Organization listed in Part I owns more than 50 percent of voting stock, or of the partnership(s) in which the Organization listed in Part I owns more than 50 percent interest therein, or of the limited liability company or companies in which the Organization listed above in Part I owns more than 50 percent interest therein, as the case may be.

Name of Business Entity Business Address

**Add additional sheets if necessary**

The Organization listed above in Part I does not own greater than 50 percent of the voting stock in any corporation and does not own greater than 50 percent interest in any partnership or any limited liability company.

Section B (skip if no business entities are listed in Section A of Part IV)

Below are the names and addresses of any entities in which an entity listed in Part III A owns greater than 50 percent of the voting stock (corporation) or owns greater than 50 percent interest (partnership or limited liability company).

Name of Business Entity Controlled by Entity Listed in Section A of Part IV

Business Address

**Add additional Sheets if necessary**

No entity listed in Part III A owns greater than 50 percent of the voting stock in any corporation or owns greater than 50 percent interest in any partnership or limited liability company.

Section C – Part IV Certification

I hereby certify that the does not own greater than 50 percent of any entity that that is debarred by the federal government from contracting with a federal agency and, if applicable, does not own greater than 50 percent of any entity that in turns owns greater than 50 percent of any entity debarred by the federal government from contracting with a federal agency. I further acknowledge: that I am authorized to execute this certification on behalf of the above-named organization; that the Willingboro Municipal Utilities Authority is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the date of contract award by Authority to notify the Authority 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 Authority permitting the Authority to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print):

Americans with Disabilities Act of 1990

The CONTRACTOR and the OWNER do hereby agree that the provisions of Title 11 of the Americans With

Disabilities Act of 1990 (the "ACT") (42 U.S.C~ S12101 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 thereunto, are made a part of this contract. In providing any act 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 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 must 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 frill and complete particulars of the claim. if any action or administrative proceedings 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.

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.

Lowest Responsible Bidder by 10% or More

Certification of Prevailing Wage Rates and

Acknowledgement of Penalties Form

P.L.2021, c.301

I, of the bidding organization/firm of

, located in the Municipality of

, County of , State of

; and being of full age, do hereby certify and affirm that:

I am a Bidder and/or authorized representative of same submitting a bid for labor/materials/services on the [Project]. I hereby certify that, should [organization/firm] be deemed the lowest responsible bidder for the Project, and should [organization/firm’s] bid amount be ten percent (10%) or more lower than the next lowest bid for the contract, that the prevailing wage rates required by the New

Jersey Prevailing Wage Act, P.L.1963, c.150 (C.34:11-56.25 et seq.) shall be paid.

Furthermore, I hereby certify and acknowledge, that I understand that if [organization/firm] does not provide this Certification prior to the award of contract, the Project Owner shall award the contract to the next lowest responsible and responsive bid, pursuant to P.L.2021, c.301.

Name of Authorized Agent

Signature

Title

Date

STATEMENT OF OWNERSHIP DISCLOSURE

N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)

This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure to submit the required information is cause for automatic rejection of the bid or proposal.

Name of Organization:_________________________________________________________________

Organization Address:_________________________________________________________________

Part I Check the box that represents the type of business organization:

Sole Proprietorship (skip Parts II and III, execute certification in Part IV)

Non-Profit Corporation (skip Parts II and III, execute certification in Part IV)

For-Profit Corporation (any type) Limited Liability Company (LLC)

Partnership Limited Partnership Limited Liability Partnership (LLP)

Other (be specific): ______________________________________________

Part II

The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE

THE LIST BELOW IN THIS SECTION)

No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV)

(Please attach additional sheets if more space is needed):

Name of Individual or Business Entity Address

Part III DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS

LISTED IN PART II

If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annual federal

Security and Exchange Commission (SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s) containing the last annual filing(s) with the federal Securities and

Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filing(s) that contain the information on each such person. Attach additional sheets if more space is needed.

Website (URL) containing the last annual SEC (or foreign equivalent) filing Page #’s

Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part II other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed.

Stockholder/Partner/Member and

Corresponding Entity Listed in Part II

Address

Part IV 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/proposer; that the Authority is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the completion of any contracts with Authority to notify the Authority 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, permitting the Authority to declare any contract(s) resulting from this certification void and unenforceable.

Full Name

(Print):

Signature: Date:

WMUA Tracking Questionnaire Regarding Good-Faith Efforts to Ensure

Fair Inclusion of Women and Minorities in the Workforce

Name of Organization:

Contact Email Address:

Contact Name:

Contact Phone Number:

Contact Title:

The Willingboro Municipal Utilities Authority ("WMUA") recognizes diversity and inclusion as a core value that strengthens our ability to deliver a premier service. We believe that an analysis of the participation and roles of certain groups that have historically been underrepresented in professional services is of particular importance to the WMUA. To that end, we are asking the private bidders/business entities (“Entity”) to complete this survey so that we may benchmark and track information about diversity and inclusion.

Please check the box that accurately describes the policies, procedures, or practices in place at your organization at the time of the completion of this questionnaire.

1. Organizational Commitment to Diversity and Inclusion

The Entity has a diversity and inclusion strategy or includes diversity and inclusion considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity’s senior leadership has expressed public support for its diversity and inclusion efforts.

☐ Yes ☐ No

The Entity has highlighted on its website, in social media, and in marketing materials that it is an equal opportunity employer and values diversity.

☐ Yes ☐ No

The Entity has an equal employment opportunity policy and grievance process to address discrimination concerns.

☐ Yes ☐ No

The Entity has a senior-level official, preferably with knowledge of and experience in diversity and inclusion policies and practices, who oversees and directs the Entity’s diversity and inclusion efforts.

☐ Yes ☐ No

2. Recruitment Practices

The Entity utilizes a diverse panel of interviewers when meeting with candidates. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity recruits at historically black colleges and universities, Hispanic-serving institutions, women’s colleges, military colleges, and/or colleges that typically serve a majority-minority population. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

The Entity posts or advertises employment opportunities in media and publications focused on minorities and women. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity ensures that women and minorities are made aware of job opportunities within the organization by posting all open positions. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity uses staffing agencies that target women and minorities for experienced hire needs. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity utilizes relationships with relevant diverse professional associations to assist with recruitment efforts. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity participates in conferences, workshops, and other events to attract women and minorities and to inform them of employment and promotion opportunities. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity’s recruiting materials reflect staff diversity. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity leverages employees from different backgrounds to assist in recruitment efforts through their professional and educational networks. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

3. Retention Strategies

The Entity has established mentoring and sponsorship programs to enhance career development opportunities and retention of employees. Such relationships include providing informal guidance and feedback to employees to help guide them and serve as a resource. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity partners with diversity-focused professional business organizations to support the professional and leadership development of women and minorities within the Entity. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity maintains policies and procedures to ensure the inclusion of women and minorities in all business activities, including management. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity supports employee resource groups to facilitate employee engagement, networking, and personal development.

considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity supports career/work life balance with flexible work schedules, telework, wellness programs, etc. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

☐ Yes ☐ No

The Entity assesses employee contributions to diversity and inclusion through…