24-26 RFP EAP Services.pdf

CITY OF CAPE MAY COUNTY OF CAPE MAY STATE

OF NEW JERSEY

PROFESSIONAL SERVICES SOLICITATION

RFP#24-26 EMPLOYEE ASSISTANCE PROGRAM

SERVICES

FAIR & OPEN PUBLIC SOLICITATION PROCESS PURSUANT

TO N.J.S.A. 19:44A-20.5 ET SEQ.

PUBLIC OPENING OF SUBMISSIONS: November 7, 2024 at 12:00P.M.

MAYOR & COUNCIL

Mayor Zachary Mullock

Deputy Mayor Lorraine M. Baldwin

Councilmember Shaine P. Meier

Councilmember Michael G. Yeager

Councilmember Maureen K. McDade

City Clerk Erin C. Burke

City Manager Paul E. Dietrich

CITY OF CAPE MAY, COUNTY OF CAPE MAY, STATE OF NEW JERSEY

PUBLIC NOTICE

FOR THE SOLICITATION OF PROFESSIONAL SERVICES CONTRACTS

Notice is hereby given by the City of Cape May that a invitation for public bid will be received by the City on

November 7, 2024 at 12:00P.M., prevailing time conducted on electronic platform, in accord with N.J.A.C.

5:34-1 et. Seq., on BIDNET at www.bidnetdirect.com//capemaycity

RFP#24-26 EMPLOYEE ASSISTANCE PROGRAM SERVICES

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 zoom contact and opening invitation please contact the Qualified Purchasing Agent at scanning@thecanninggroup.org

The City of Cape May will award this bid to the lowest responsible bidder in accord with N.J.S.A. 40A:11-

4A.

Date: October 22, 2024 Erin C. Burke

City Clerk http://www.bidnetdirect.com/capemaycity mailto:scanning@thecanninggroup.org

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

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 With Bid

Submission

X Experience and Background Questionnaire With Bid

Submission

X Insurance and Indemnification Certificate

Prior to

Contract

Award

X Disclosure of Investment Activities in Iran Form

Prior to

Contract

Award

X Certification of non-involvement in Prohibited Activities in

Russia or Belarus

Prior to

Award

Prevailing wage greater than 10% certification

Prior to

Contract

Award

Federal debarment Form

Prior to

Award

EEO/AA Form AA-201

After Notice of

Award, Prior to

Signing x

EEO/AA Form AA-302 or Letter of Federal Approval or

Certificate of Employee Information Report

After Notice of

Award, Prior to

Signing

Contract

X Bidder’s Checklist

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:

SCOPE OF WORK

It is the desire of the City of Cape May to solicit sealed proposals for Employee Assistance

Program Services. The goal is to obtain a price for both three (3) session and six (6) session options for assessment and counseling described below. The City will determine at time of award whether option one (1) and/or option two (2) will be awarded for the 2025 calendar year.

Pursuant to N.J.S.A. 40A:11-3(b), contracts for professional services pursuant to subparagraph (i) of paragraph (a) subsection (1) of section 5 of P.L. 1971, c. 198, N.J.S.A.

40A:11-5 may be awarded for a period not exceeding twelve (12) consecutive months.

PROGRAM SPECIFICATIONS:

Employee Assistance Program sessions are to include:

a) Assessment and counseling sessions for employees and immediate family members

b) Employee and supervisory orientations done on an as needed basis

c) Trainings and workshops on a quarterly basis (four (4) sessions a year)

d) DOT/SAP evaluations which include:

I. Consultation with supervisors

II. Compliance reports to City Manager’s Office

III.. Recommendation of placement for employees when necessary

IV. Recommendation of follow up testing schedule

V. Relevant policy and procedure review and development

e) Critical incident debriefing or crisis interventions with immediate response on an as needed basis

f) Supervisory consultations and mediation when appropriate

g) Employee promotional materials

h) Quarterly utilization reports

i) Twenty-four (24) hour phone line to handle routine appointments within seventy-two hours and emergent appointments immediately

j) Ability to request virtual/remote sessions.

THE STANDARDIZED SUBMISSION REQUIREMENTS SHALL INCLUDE:

1. Professional experience of the individual(s) to be assigned, including a listing of experience with the City of Cape May and/or experience with other municipalities.

2. Statement concerning the ability of the firm/individual to perform tasks assigned by the City in a timely fashion.

3. Professional licenses held by the individual(s) to be assigned.

4. Educational background and experience of the individual(s) to be assigned.

5. Description of the support staff available to the individual(s) to be assigned.

6. Copy of a Certificate of Insurance, issued by an insurance carrier licensed in the State of New Jersey, for the firm/company showing the amount of the professional liability insurance and all other coverage in place as of 11/1/2024. Coverages appended to this

RFP.

7. List of professional references with addresses and telephone contact numbers for the past five (5) years.

8. Signed, completed copy of the enclosed RFP Document Checklist and documents required therein.

SELECTION CRITERIA

The selection criteria to be used in awarding a contract for the services described herein, in accordance with N.J.S. A. 19:44A-20.5 et seq. as a fair and open contract, shall include:

a. Qualifications of the individuals who will perform the services and their experience and familiarity of this service.

a. Experience in providing the services requested by the City and references related thereto.

b. Ability to perform the services in a timely fashion, including staffing and familiarity with the subject matter.

c. Location (distance) of primary office in relation to the City offices.

d. Thoroughness and completeness of the applicant's submittal.

e. Cost consideration including, but not limited to, standardized submission and compliance with proposal documents.

AWARD

The award of this contract shall be made to the vendor or vendors submitting the proposal which is deemed to be that which is most advantageous to the City, price and other factors considered.

Contract award will be for one (1) year commencing on January 1, 2025 and ending on

December 31, 2025. The City reserves the right to terminate contract, for good cause including claims of malpractice, immoral or unethical behavior.

SUBMITTAL AND QUESTIONS

All questions and submittal of proposal in response to this procurement shall be on bidnetdirect only at: www.bidnetdirect.com//capemaycity http://www.bidnetdirect.com/capemaycity

PROPOSAL

There are approximately 136 full-time employees and 260 part-time/seasonal employees. Proposal prices are to be based on the above information per full-time employee and part-time/seasonalemployees per month as indicated below. The City will determine at time of award whether Option One and/or Option Two will be awarded for the 2025 calendar year.

OPTION ONE: THREE (3) SESSIONS-ASSESSMENT AND CONSULTATIONS

Full-time Employees: $___________________per employee / per month x136

Part-time/Seasonal Employees: $ __________________ per employee/ per month x 260

OPTION TWO: SIX (6) SESSIONS-ASSESSMENT AND CONSULTATIONS

Full-time Employees: $ _________________ per employee / per month 136

Part-time/Seasonal Employees: $ _________________ per employee / per month x 260

DISTANCE OF FACILITY FROM CITY OF CAPE MAY:_________ Miles

Miles as measured by Google Maps

(City of Cape May, NJ, 643 Washington Street, Cape May, NJ 08204)

Company Name Federal ID # or Social Security #

Address

Signature of Authorized Agent Type or Print Name

Telephone Number Date

Fax Number E-mail address

EXHIBIT A

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE

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

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

GOODS, GENERAL SERVICES, AND PROFESSIONAL SERVICES

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 applicants 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 of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act.

The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals established in accordance with N.J.A.C. l7:27-5.2.

The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices.

The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions.

In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the

State of New Jersey, and applicable Federal law and applicable Federal court decisions.

The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents:

Letter of Federal Affirmative Action Plan

Approval; Certificate of Employee Information

Report; or

Employee Information Report Form AA-302 (electronically provided by the

Division and distributed to the public agency through the Division’s website at:

http:// www.state.nj.us/treasury/contract_compliance.

The contractor and its subcontractors shall furnish such reports or other documents to the

Division of Purchase & Property, CCAU, EEO Monitoring Program as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of

Purchase & Property, CCAU, EEO Monitoring Program for conducting a compliance investigation pursuant to N.J.A.C. 17:27-1.1 et seq http://www.state.nj.us/treasury/contract_compliance

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 City of Cape May (“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

Experience & Qualifications Questionnaire

This questionnaire must be filled out and submitted as a part of the Proposal. Failure to complete this form or to provide any of the requested information will be grounds for the rejection of the bid proposal. If additional space is required, the respondent shall add additional sheets, which identify the question being answered.

Number of years in business under present name & address:

If less than 5 years, list previous names and address:

Within the last 5 years has the business or any officer/partner failed to complete a contract awarded to them: . If yes, provide the details in on a separate page.

Have any liens and lawsuits been filed against the company in the past 5 years:

If yes, please provide details:

List similar services you are now providing for which you have signed contract, but not yet started work:

List all major subcontractors to be used to complete the service and the area of their responsibility:

Please provide at least 3 references below:

Name: Phone:

Address:

Equipment/Service Provided:

Contract Amount:

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)

OR

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 City 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 City to notify the City 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 City to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print):

Signature:

Date:

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.

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

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.

Disclosure of Investment Activities in Iran

Person or Entity

Part 1: Certification

COMPLETE PART 1 BY CHECKING EITHER BOX.

Pursuant to Public Law 2012, c. 25, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter into or renew a contract, must complete the certification below to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or affiliate is identified on the State Department of Treasury's

Chapter 25 list as a person or entity engaging in investment activities in Iran. The list is found on Treasury’s website at www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.

The Chapter 25 list must be reviewed prior to completing the below certification. If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may provided by law, rule or contract, including but not limited to imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party.

I certify, pursuant to Public Law 2012, c. 25, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate thereof is listed on the N.J. Department of the

Treasury’s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 List"). I further certify that I am the person listed above, or I am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. I will skip Part 2 and sign and complete the Certification below.

I am unable to certify as above because the person or entity and/or a parent entity, subsidiary, or affiliate thereof is listed on the N.J. Department of the Treasury’s Chapter

25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below sign and complete the Certification below.

http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf

Part 2: Additional Information

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN.

You must provide a detailed, accurate and precise description of the activities of the person or entity, or a parent entity, subsidiary, or affiliate thereof engaging in investment activates in Iran below and, if more space is needed, on additional sheets provided by you.

Part 3: Certification of True and Complete Information

I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments there to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person or entity.

I acknowledge that the City is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with the

City to notify the City in writing of any changes to the answers of information contained herein.

I acknowledge 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 recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the City and that the City at its option may declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print)

Title

Signature

Date

CERTIFICATION OF NON‐INVOLVEMENT IN PROHIBITED

ACTIVITIES IN RUSSIA OR BELARUS

Pursuant to N.J.S.A. 52:32-60.1, et seq. (L. 2022, c. 3) any person or entity (hereinafter “Vendori”) that seeks to enter into or renew a contract with a State agency for the provision of goods or services, or the purchase of bonds or other obligations, must complete the certification below indicating whether or not the Vendor is identified on the Office of Foreign Assets

Control (OFAC) Specially Designated Nationals and Blocked Persons list, available here:

https://sanctionssearch.ofac.treas.gov/. If the Department of the Treasury finds that a Vendor has made a certification in violation of the law, it shall take any action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party.

I, the undersigned, certify that I have read the definition of “Vendor” below, and have reviewed the Office of Foreign Assets

Control (OFAC) Specially Designated Nationals and Blocked Persons list, and having done so certify:

(Check the Appropriate Box)

A.

That the Vendor is not identified on the OFAC Specially Designated Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.

B. That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially Designated

Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.

C.

That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially Designated

Nationals and Blocked Persons list. However, the Vendor is engaged in activity related to Russia and/or Belarus consistent with federal law, regulation, license or exemption. A detailed description of how the Vendor’s activity related to Russia and/or Belarus is consistent with federal law is set forth below.

(Attach Additional Sheets If Necessary.)

Signature of Vendor’s Authorized Representative Date

Print Name and Title of Vendor’s Authorized Representative Vendor’s FEIN

Vendor’s Name Vendor’s Phone Number

Vendor’s Address (Street Address) Vendor’s Fax Number

Vendor’s Address (City/State/Zip Code) Vendor’s Email Address https://pub.njleg.state.nj.us/Bills/2022/PL22/3_.PDF https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ i Vendor means: (1) A natural person, corporation, company, limited partnership, limited liability partnership, limited liability company, business association, sole proprietorship, joint venture, partnership, society, trust, or any other nongovernmental entity, organization, or group; (2) Any governmental entity or instrumentality of a government, including a multilateral development institution, as defined in Section 1701(c)(3) of the

International Financial Institutions Act, 22 U.S.C. 262r(c)(3); or (3) Any parent, successor, subunit, direct or indirect subsidiary, or any entity under common ownership or control with, any entity described in paragraph (1) or (2).

NJ Rev. 1.22.2024

Certificate of Insurance Guidelines 2024

CHAPTER 4

PROFESSIONALS/CONSULTANTS

Professional Service Providers (i.e., Solicitor, Labor Attorney, Auditor, Engineer, Municipal Risk Management Consultant (RMC), specified medical practitioners, etc.)

MINIMUM REQUIREMENTS

General Liability:

A. Commercial General Liability with a $1,000,000, and Si ,000,000 Aggregate per occurrence for Bodily Injury. Personal and Advertising Injury and Property Damage.

B. Contractor’s insurance to be primary and non—contributory.

C. Waiver of subrogation

D. 30-day notice of intent to cancel, non-renew, or make material change in coverage.

E. 10-day non-payment of premium cancellation notice

F. Municipality to be named as “Additional Insured.”

G. Executed Indemnity and Hold Harmless Agreement or substantially similar provisions should be included in the bid specifications or contract.

II. Automobile Liability:

A. Sl,000.000 Combined Single Limit of Liability for Bodily Injun and Pi’opeiiy Damage per accident.

B. Coverage to include “Owned. Non-Owned. and Hired” automobiles.

C. 30-day notice of intent to cancel, non-renew, or make material change in coverage.

D. 10 day non payment of preniluTi cancellation notice

III. Professional Liability: (Solicitor, Labor Attorney, Auditor, Engineer, RMC, etc.)

A. $1,000,000 Errors & Omissions Insurance or Professional Liability.

B. 30-day notice of intent to cancel, non-renew or make material change in coverage.

C. 10-day nonpayment of premium cancellation notice

D. Executed Indemnity and Hold I larmless Agreement or similar provision should be included

Ceftificate of Insurance Guidelines 2024

NOTE: Indemnity Agreement for architects, engineers and landscape design (Design Professional) is subject to state law. Legal counsel should review your indemnity agreements. “Additional Insured” is not required.

W. Cyber Security and Privacy Liability Insurance. jContracts with Consultants/Contractors with access to Confidential or Personally Identifiable Information (P11)]

A. $1,000,000 per occurrence or claim

B. 30-day notice of intent to cancel, non-renew or make material change in coverage

C. 10-day nonpayment of premium cancellation notice

D. Executed Indemnity and Hold Harmless Agreement (see Appendix H) or similar provision should be included in the Service Contract.

Sample Contract Language: Consultant/Contractor shall procure and maintain insurance which shall contain the following coverage:

a. Liability arising from the thefl, dissemination and/or use of confidential infomation, including but not limited to, personally identifiable information (P11), protected health infomation (PHI), security codes, access codes, passwords, security codes or personal identification numbers (PINS);

b. Notification costs, credit monitoring and other expert services, regulatory fines and defense costs;

c. Network security liability arising from unauthorized access to, use of, or tampering with computer systems, including hacker attacks;

d. Liability arising from the introduction of a computer virus into, or otherwise causing damagc to vendor (first party) or customer’s (third party) computer, computer system, network or similarly related property and the data, software and programs thereon;

e. Liability arising from professional misconduct or lack of the requisite skill required for the performances of services defined in the contract or agreement.

V. Technology Errors and Omissions Insurance. (Contracts with IT Consultants, Systems

Analysts, Web Designers, Online Services and Content Providers, Programmers, Cloud-based Providers, Payroll Companies, System Installation and Software Personnel)

A. $1,000,000 per occurrence or claim

B. 30-day notice of intent to cancel, non-renew or make material change in coverage

C. 10 day nonpayment of premium cancellation notice

Executed Indemnity and Hold Harmless Agreement (see Appendix H) or similar provision should be included in the Service Contract.

Sample Contract Language: Consultant/Conti-actor shall procure and maintain insurance which shall contain the following coverage:

a. Liability arising from the theft, dissemination and/or use of confidential or personally identifiable information; including credit monitoring and regulatory fines arising from such theft, dissemination or use of the confidential information.

b. Network security liabilit arising from the unauthorized use of, access to, or tampering with computer systems.

c. Liability arising from the failure of technology products (software) required under the contract for Consultant to properly perform the services intended.

d. Electronic Media Liability arising from personal injuiy, plagiarism or misappropriation of ideas, domain name infringement or improper deep-linking or framing, and infringement or violation of intellectual property rights.

e. Liability arising from the failure to render professional services

VI. Medical Malpractice: (physicians, dentists, psychologists)

A. $1,000,000 Medical Malpractice Insurance.

B. 30-day notice of intent to cancel, non-renew or make material change in coverage.

a. Executed Indemnity and Hold Harmless Agreement or similar provisions should be included in the service contract.

b. Additional Insured Agreement is not required.

c. In certain circumstances the following applies: General Liability and Automobile Liability with Limits of Liability of $1.000.000 each.

VII, Workers’ Compensation/Employer’s Liability:

A. Certificate of Insurance indicating “statutory” limits.

B. 30-day notice of intent to cancel, non-renew, or make material change in coverage.

C. 10 day nonpayment of premium cancellation notice

0. Employer’s Liability, $1,000,000 per accident and per employee.

VIII. * Sexual Abuse or Molestation:

A. S3.000.000 Sexual Abuse Injury Limit of Insurance

B. All other requirements as provided under GeneraI Liability (b through ef above.

* Applicable when consultants are working with minors.

MENIMUM SCOPE OF INSURANCE

Coverage shall beat least as broad as*:

I. Insurance Services Office Commercial General Liability coverage (occunence Form CG 0001).

Insurance Services Office Form covering Automobile Liability, Code 1 (any auto)

2. Workers’ Compensation insurance as required by State law and Emplover’s Liability Insurance.

3. Professional Liability insurance appropriale to the consullanis profession. Architects’ and Engineers coverage is to be endorsed to include contractual liability.

*Your Risk Management Consultant can assist you in evaluating coverage adequacy.

MINIMUM LIMITS OF INSURANCE

C.omractor shall maintain limits no less than:

1. General Liability:

(Including products and completed operations)

S1,000,000/Sl ,000,000

2. Automobile Liability:

3a. Workers’ Compensation:

3b. Employer’s Liability:

4. Cyber Security/Privacy

5. Cyber (Technology E&O)

6. Professional Liability or Medical Malpractice:

(Based on profession)

Note - Sexual Abuse or Molestation: Exceptions for consultants who do not have access to children on municipal premises

$1,000,000

$1,000,000

SI ,000,000

$1,000,000

$1,000,000

$1,000,000

Per accident for bodily injury and property damage.

As required by State law.

Per accident for bodily injury or disease.

Per occurrence or claim.

Per occurrence or claim.

Per occurrence.

Sexual Abuse or Injury Limit Insurance.

DEDUCTIBLES AND SELF-INSURED RETENTIONS

Per occurrence/aggregate for bodily injury, personal and advertising injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit as seen above.

Any deductibles or self-insured retentions must be declared to and approved by the Municipality. At the option of the Municipality, either: the insurer shall reduce or eliminate such deductibles or self- insured retentions as respects the Municipality, its officers, officials, employees and volunteers; or the Consultant shall provide a financial guarantee satisfactory to the Municipality guaranteeing payment of losses and related investigations, claim administration and defense expenses.

OTHER INSURANCE PROVISIONS

I. The commercial General Liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions:

a. To the fullest extent permitted by law, the Municipality, its officers, officials, employees and volunteers are to he covered as insureds as respects: liability arising out of work or operations performed by or on behalf of the Professional/Consultant; or automobiles owned, leased, hired or borrowed by the Consultant.

b. For any claims related to this project. the Professional’s/Consultant’s insurance coverage shall be primary insurance as respects the Municipality, its officers, officials, employees and volunteers.

Any insurance or self-insurance maintained by the Municipality, its officers, officials, employees or volunteers shall be excess of the Consultant’s insurance and shall not contribute with it.

c. Coverage required under this Agreement shall not be canceled or non-renewed without 30 days prior written notice from contractor to the Municipality, except where cancellation is for non payment of premium. then 10 days’ prior notice shall be given.

d. Optional: A copy- of the claims reporting requirements must be submitted to the Municipality for review.

2. If Professional Liability. andior En-ors & Omissions coverages are written on a claims-made form:

a. The retroactive date must be shown, and must be before the date of the contract or the beginning of contract work

b. Insurance must be maintained and evidence of insurance must he provided for at least five (5) yeats after completion of the contract of work.

c. If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, the Contractor must purchase an extended period coverage for a minimum of five (5) yeats after completion of contract work.

d. A copy of the claims reporting requirements must be submitted to the Municipality for review.

ACCEPTABILITY OF INSURERS

Insurance is to be placed with insurers with a current AM. Best’s rating of no less than A— VII and admitted to do business in the state in which the services are to be performed , or accepted by the Surplus

Lines Association to do business in the state. A Non-admitted company should have an AM. Best’s rating of A- X or higher

VERIFICATION OF COVERAGE

Professional/Consultant shall furnish the Municipality with original certificates and amendatory endorsements effecting coverage required by this clause. The endorsements should be on forms provided by the Municipality or on other than the Municipality’s forms provided those endorsements conform to

Municipality requirements. All certificates and endorsements are to be received and approved by the

Municipality before work commences. However, failure to do so shall not operate as a waiver of these insurance requirements. The Municipality reserves the right to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications at any time.

WAIVER OF SUBROGATION

Consultant hereby grants to Municipality a waiver of any right to subrogation which any insurer or contractor may acquire from vendor by virtue of the payment of any loss. Professional/Consultant agrees to obtain any endorsement that may be necessaty to effect this waiver of subrogation.

The Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of the

Municipality for all work performed by the consultant, its employees, agents and subcontractors.

SUBCONTRACTORS

Professional/Consultant shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein.

Insurance Matrix (Recommended Minimum Amounts)

Trade Contractors: Painters, Plumbers, Landscapers. etc.

$1,000,000

$1,000,000

Statutory

$1,000,000

General Liability

Automobile Liability

Workers’ Compensation

Employer’s Liability

$1 .000,000

$1,000,000

Statutory

S 1,000,000

$1,000,000 (occu ne rice);

$2,000,000 (aggregate)

Consultants/Professional Service Providers: Solicitor. Labor Attorney, Auditor, Engineer, Risk Management Consultant, Specified Medical Practitioners, etc.

General Liability 51.000,000

Automobile Liability $1,000,000

Professional Liability (other than physicians) SI .000.000 Medical Malpractice (doctors, dentists, psychologists) $1,000,000

Workers’ Compensation

Employer’s Liability

Sexual Abuse or Molestation

Cyber Security and Privacy Liability

Technology Errors and Omissions

*Waiver of Subrogation Required

Building Contractors

General Liability

Automobile Liability

Workers’ Compensation

Employer’s Liability

Professional Liability

Ccrtificatc Add’lChapter Description Pg of Insurance Insured

$5,000,000

$1,000,000

Statutory

$1,000,000

S 1.000,000 xx x x

Included x x x x included x

Environmental Contractors or Consultants I I

General Liability

Automobile Liability

Workers’ Compensation

Employer’s Liability

Pollution Liability and/•or Asbestos Pollution Liability and’or Professional Liability xx x x

Included x x x x x x x

Included x x x

Statutory

$1,000,000

$3,000,000

$1 ,000,000

$1,000,000 x x x xl’

Certificate Add’lChap Description Pg of Insurance Insured

General Liability $1,000,000 X X

Automobile Liability $1,000,000 X

Workers’ Compensation Statutory X *

Cyber Security and Privacy Liability $1,000,000 X X Replacement

Property Insurance X Value

Use of Facilities: Private Citizens, 30Organizations or Non-business Groups, etc.

General Liability $1,000,000 X X

Suppliers and/or Vendors 22

I *waivei. of Subrogation Required