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

Emmanuel Stuppard

CC# 25-15 Grants Writer Services

Through the Competitive Contracting Process

Due

November 19, 2025 at 11:00am

LEGAL NOTICE

Notice is hereby given by the Willingboro Municipal Utilities Authority that a Competitive Contract in accord with N.J.S.A.

40A:11- 4.1 will be received by the Authority on November 19, 2025 at 11:00am. 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

CC# 25-15 Grants Writer Services Competitive Contract

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., The Willingboro Municipal Utilities Authority will award this Competitive Contract in accord with Price and Other Factors as outlined within N.J.S.A 40A:11-4.1 et. Seq., and N.J.A.C. 5:34-4.1 et. Seq., Report of Competitive Contract:

In accord with N.J.S.A. 40A:11-4.4(d) the summary report will be posted on the WMUA procurement website at www.bidnetdirect.com//wmua at least 48 hours prior to the governing body taking action on award.

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

Emmanuel Stuppard October 22, 2025

Executive Director http://www.bidnetdirect.com/wmua

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

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

X Non-Collusion Affidavit Prior to Contract

Award

X Experience and Background Questionnaire With Bid

Submission

X Insurance and Indemnification Certificate Prior to Contract

Award

X Disclosure of Investment Activities in Russia Form Prior to Contract

Award

X Disclosure of Investment Activities in Iran Form Prior to Contract

Award

Federal debarment Form Prior to Contract

Award

EEO/AA Form AA-201

After Notice of

Award, Prior to

Signing Contract

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

Signing Contract

X Bidder’s Checklist Prior to Contract

Award x Fair Inclusion Questionnaire Prior to Contract

Award

X False Statement of Penalties Certification Prior to Contract

Award

X W9 Form

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. Please initial in the appropriate box.

Bidder Name: Date:

Authorized

Representative:

Signature:

Print Name &

Title:

ALL RESPONSES AND QUESTIONS ARE TO BE CONDUCTED ON THE WMUA’S E-PROCUREMENT

SITE AT

BIDNET at www.bidnetdirect.com//wmua

NO PHYSICAL OR EMAILED PROPOSAL RESPONSES SHALL BE ACCEPTED

Year 1 Monthly retainer fee ______________

Year 1 Hourly Grant Writing Services ______________

Year 1 Monthly/Annual Portal/Database fee ______________

Year 2 Monthly retainer fee ______________

Year 2 Hourly Grant Writing Services ______________

Year 2 Monthly/Annual Portal/Database fee ______________

Year 3 Monthly retainer fee ______________

Year 3 Hourly Grant Writing Services ______________

Year 3 Monthly/Annual Portal/Database fee ______________

Year 4 Monthly retainer fee ______________

Year 4 Hourly Grant Writing Services ______________

Year 4 Monthly/Annual Portal/Database fee ______________

Year 5 Monthly retainer fee ______________

Year 5 Hourly Grant Writing Services ______________

Year 5 Monthly/Annual Portal/Database fee ______________

Inclusive of all travel time and expenses as well as attendance at all designated meetings.

Company Name

Address

Type or Print Name

Telephone Number D a t e

Email Address

GRANT WRITING SERVICES

1.0 PURPOSE

1.1 It is the intent of the WMUA to solicit Qualification Statements from

Respondents that have expertise in the provision of the Services. Firms and/or persons responding to this RFP shall be able to demonstrate that they will have the continuing capabilities to perform these

Services. The Qualified Respondent awarded a contract will be responsible for identifying potential federal, state or local grant opportunities, prepare necessary applications for grant funding, meet with funding agencies, grant administrative services and follow through on the award and management of technical matters as required under the grants in order to assist the WMUA in providing essential municipal services that will enhance the quality of life for the citizens of Willingboro.

2.0 RESPONSES

2.1 All respondents must provide the following in order to be considered:

2.2 Documented past listing of references and successes at

obtaining grant funding in a municipal setting.

2.3 Evidence of capability, experience and skill:

2.4 Respondents shall provide a summary of the firm’s capability, experience and skill to provide the requested services.

2.5 Resumes and history of all key personnel.

2.6 Evidence of adequate personnel to perform.

3.0 SCOPE OF SERVICES

3.1 The Grant Writer shall prepare grant applications and supporting documentation to ensure compliance with funding requirements.

3.2 The Grant Writer coordinates with WMUA staff to identify projects that are compatible with available funding sources.

3.3 The Grant Writer tracks the status of grant applications and provides additional information as required.

3.4 The Grant Writer works with appropriate personnel to expedite internal processing of grant proposals and maintains a positive, proactive relationship with community organizations, county and WMUA council persons, officials, non-profit agencies and other entities to assist in compliance and process efficiency.

3.5 Depending on the complexity of the data requirements for each grant application, the Grant Writer creates and distributes standard and special reports, studies, summaries and analyses as required by the grant application and the users.

4.0 Compensation response

4.1 In response vendors are asked to respond in one or all of the following manners for compensation per grant:

4.1.A Hour rate (minimum hours per project).

4.1.B Percentage of grant or funding achieved.

4.1.C Total project cost per grant or funding project.

4.1.D Monthly/Annual cost for grant portal/database access.

5.0 PROCUREMENT AND METHOD OF AWARD

5.0.1 This procurement is being conducted in accord with the laws governing competitive contracting at N.J.S.A40A:11-4.1 et.seq.,

5.0.2 Method of award shall be ratings upon responses of Price and

Other Factors more fully described within N.J.A.C. 5:34-4.3(d)

5.0.2.1 Managerial Weighted Percent %

5.0.2.2 Technical Weighted Percent %

5.0.2.3 Cost Weighted Percent %

6.0 TERM

6.1 The term of the contract shall be for a period of five (5) years.

7.0 CONTACTS/ QUESTIONS

6.0.1 All questions pertaining to process or technical questions shall be submitted through Bidnet Direct

NO EMAILED OR PHYSICAL SUBMITTALS WILL BE ACCEPTED

Technical criteria:

(Max Points) 1 Pt = Poor Response, 3 Points = Average Response, 5 Pts = Concise and Superior Response

Vendor Name:

Does the vendor's proposal demonstrate a clear understanding of the scope of work and related?

objectives?

(2) Is the vendor's proposal complete and responsive to the specific RFP requirements?

(3) Has the past performance of the vendor's proposed methodology been documented?

(4) Does the vendor's proposal use innovative technology and techniques?

Sub Total Technical 0 0 0

Management criteria:

(Max Points) 1 Pt = Poor Response, 3 Points = Average Response,

(1) Does the vendor document a record of reliability of timely delivery and on-time and on- budget implementation?

(2) Does the vendor document industry or program experience?

(3) Are the availability of in- house and contract resources documented?

Sub Total Managerial 0 0 0

Cost criteria:

(Max Points ) 1 Pt = Poor Response, 3 Points = Average Response, (1)Relative cost: How does the cost compare to other similarly scored proposals?

(2)Full explanation: Is the price and its component charges, fees, etc. adequately explained or documented?

(3) Does the proposal include quality control and assurance programs?

SUB TOTAL COST 0 0 0

Final Rater Score 0 0 0

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:

Date:

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.

☐ Yes ☐ No

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.

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

4. Training and Development

The Entity requires all employees to successfully complete diversity and/or equal employment opportunity training on at least an annual basis. considerations as part of its strategic plan for recruiting, hiring, retention, and promotion.

Taxpayer Identification

Affidavit Of Non-Collusion

The undersigned, being duly sworn according to law, deposes and says:

1. I reside at ____________________________________________________________

2. The name of the within applicant is _______________________________________

3. I execute the said RFP on behalf of the applicant with full authority to do so.

4. The applicant has not directly or indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint of fair and open process in connection with the contract.

5. All statements contained in the Qualification Statement and RFP and in this Affidavit are true and correct and were made with the full knowledge that the Willingboro Municipal Utilities Authority, Willingboro, County of Burlington, its officers and employees, rely on the truth of the statements therein made in awarding the above-named contract.

6. I further warrant that no person or selling agency has been employed or retained to solicit or service such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bonafide employees of or bonafide established commercial selling agencies maintained by the applicant.

Sworn and subscribed to before me on _______ this day of

_______________________, 20____

Signature

Print Name

Signature of Notary

Print Name

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. 17:27-1.1 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, affection- al 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, up- grading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprentice- ship. 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.

EXHIBIT A (Cont)

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 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 request- ed 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.

Affirmative Action Regulations P.L. 1975, C. 127 (N.J.A.C. 17:27)

If awarded a contract, all procurement and service contractors will be required to comply with the requirements of P.L. 1975, c. 127, (N.J.A.C. 17:27). Within seven (7) days after receipt of the notification of intent to award the contract or receipt of the contract, whichever is sooner, the contractor should present one of the following to the WMUA:

1. A letter from the U.S. Department of Labor that the contractor has an existing federally approved or sanctioned Affirmative

Action Program.

OR

2. A Certificate of Employee Information Report Approval.

OR

3. An Affirmative Action Employee Information Report (Form A.A. 302)

OR

4. All successful contractors must submit at signing of the contract an Initial Project Manning Report (AA201) for any contract award that meets or exceeds the Public Agency bidding threshold (available upon request). No bidder may be issued a contract unless they comply with the affirmative action regulations of P.L. 1975, c. 127.

The following questions must be answered by all bidders:

1. Do you have a federally approved or sanctioned Affirmative Action Program?

YES ____ NO ____

If yes, please submit an electronic copy of such approval.

2. Do you have a State Certificate of Employee Information Report Approval?

YES ____ NO ____

If yes, please submit an electronic copy of such certificate.

The undersigned contractor certifies that he is aware of the commitment to comply with the requirements of P.L. 1975, c. 127 and agrees to furnish the required documentation pursuant to the law.

Company: ________________________________

Signature: ________________________________

Title: ____________________________________

Note: A contractor must be rejected as non-responsive if a contractor fails to comply with requirements of P.L. 1975, c. 127, within the time frame.

Americans With Disabilities Act

Equal Opportunity for Individuals with Disabilities

The Contractor and the Willingboro Municipal Utilities Authority (“Authority”) do hereby agree that the provision of Title II of the

Americans With Disabilities Act of 1990 (the “ADA”) (42 U.S.C. Section 12101 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 aid, benefit or service on behalf of the Authority pursuant to this contract, the Contractor agrees that the performance shall be in strict compliance with the ADA. In the event that the Contractor, its agents, servants, employees or subcontractors violate or are alleged to have violated the ADA during the performance of this contract, the

Contractor shall defend the Authority in any action or administrative proceeding commenced pursuant to this ADA. The Contractor shall indemnify, protect and save harmless the Authority, 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 Authority grievance procedure, the Contractor agrees to abide by any decision of the Authority which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the Authority or if the Authority incurs any expense to cure a violation of the ADA that has been brought pursuant to its grievance procedure, the Contractor shall satisfy and discharge the same at its own expense.

The Authority shall, as soon as practicable after a claim has been made against it, give written notice thereof to the Contractor along with full and complete particulars of the claim. If any action or administrative proceeding is brought against the Authority or any of its agents, servants, and employees, the Authority shall expeditiously forward or have forwarded to the Contractor every demand, complaint, notice, summons, pleading or other process received by the Authority or its representatives.

It is expressly agreed and understood that any approval by the Authority of the services provided by the Contractor pursuant to this contract will not relieve the Contractor of the obligation to comply with the ADA and to defend, indemnify, protect, and save harmless the Authority pursuant to this paragraph.

It is further agreed and understood that the Authority 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

Authority from taking any other actions available to it under any other provisions of this agreement or otherwise by law.

Experience & Qualifications Questionnaire

4900-2950-4779.v1

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 public organizational references below:

Name: Phone:

Address:

Equipment/Service Provided:

Contract Amount:

New Jersey Business Registration Certification

Pursuant to N.J.S.A. 52:32-44, wmua ” 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/

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 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:

Part 2: Additional Information

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

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 WMUA 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 WMUA to notify the WMUA 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 WMUA and that the WMUA 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 (WMUA/State/Zip Code) Vendor’s Email Address 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 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/ common ownership or control with, any entity described in paragraph (1) or (2).