4-6r - NJ Debarred Affidavit.pdf
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- Attached to
- BID #2026-045-TWP STAFFORD TOWNSHIP DREDGING & POPULAR POINT RESTORATION PROJECT-PHASE 2
- Solicitation number
- BID #2026-045
- Issued by
- Ocean County, New Jersey
About this file
This is a Debarred List Affidavit required by the Township of Stafford, New Jersey, for the Dredging & Popular Point Restoration Project-Phase 2 (Bid #2026-045). The affidavit is a sworn statement that must be completed and notarized by an authorized representative of any bidding firm. The document certifies that the bidder is not currently listed on the State of New Jersey State Treasurer's List of Debarred, Suspended and Disqualified Bidders at the time of proposal submission. The affiant must confirm that all statements contained in the proposal are true and correct, and acknowledge that the Township of Stafford relies on this certification in making its contract award decision.
The affidavit includes a warranty requiring the bidder to immediately notify the Township of Stafford if the firm's name appears on the debarred list at any point prior to or during the contract term, including any guarantee period. Bidders are further advised that contractors are subject to disbarment, suspension, and disqualification from contracting with the State of New Jersey if they commit any acts enumerated in N.J.A.C. 7:15.2, as determined according to applicable law and regulations. The completed affidavit must be signed by the contractor's authorized representative, printed with the contractor's name and address, and notarized before submission with the bid proposal.
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Text version
TOWNSHIP OF STAFFORD
STATE OF NEW JERSEY DEBARRED LIST AFFIDAVIT
State of New Jersey County of ______________ SS: _______________________
I, _________________________________, of the __________________________________________ (name of affiant) (name of municipality)
In the County of _______________________________ and State of ___________________________ of full age, being duly sworn according to law on my oath depose and say that:
I am _______________________________ of the firm of ______________________________________ (title of position) (name of firm)
______________________________________________ the Bidder making this Proposal for the bid entitled __________________________________, and that I executed the said Proposal with full authority to do so; that said Bidder at the time of making this Bid is not included on the State of New Jersey, State Treasurer’s List of Debarred, Suspended and Disqualified Bidders: and that all statements contained in said
Proposal and in this affidavit are true and correct, and made with the full knowledge that the Township of Stafford, as
Owner, relies upon the truth of statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said project.
The undersigned further warrants that should the name of the firm making this Bid appear on the State Treasurer’s
List of Debarred, Suspended and Disqualified Bidders at any time prior to, and during the life of this Contract, including Guarantee Period, that the Township of Stafford shall be immediately notified by the signatory of this
Eligibility Affidavit.
The undersigned understand that the firm making the bid as Contractor is subject to disbarment, suspensions and/or disqualification in contracting with the State of New Jersey, if the Contractor, pursuant to N.J.A.C. 7:15.2, commits any of the acts listed therein, and as determined according to applicable law and regulations.
(Type or print name and address of Contractor)
Subscribed and sworn before me this ______ day of ___________, 2 ________.
(Notary Public)
My Commission expires:
(Seal)
(Affiant)
(Print name & title of affiant)
(Corporate Seal)
| County of: |
| SS: |
| I: |
| of the: |
| In the County of: |
| and State of: |
| I am: |
| of the firm of: |
| the Bidder making this Proposal for the bid: |
| entitled: |
| Type or print name and address of Contractor: |
| Subscribed and sworn before me this 1: |
| Subscribed and sworn before me this 2: |
| 2: |
| Affiant: |
| Print name title of affiant: |
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