5-File R- STATE ON NJ DEBAR.pdf
PDF 209 KB Posted
- Attached to
- BID #2026-049A-W/S OCEAN ACRES BOOSTER PUMP REPLACEMENT PHASE 2 AND WELL NO. 5 REDEVELOPMENT
- Solicitation number
- BID #2026-049A-W/S
- Issued by
- Ocean County, New Jersey
About this file
This is a State Debarred List Affidavit required by the Township of Stafford, New Jersey, for Bid #2026-049A addressing the Ocean Acres Booster Pump Replacement Phase 2 and Well No. 5 Redevelopment project. The affidavit serves as a sworn declaration by authorized representatives of bidding firms confirming that neither the bidder nor the firm is currently listed on the State of New Jersey State Treasurer's List of Debarred, Suspended, and Disqualified Bidders. The document certifies that all statements contained in the proposal are true and correct and acknowledges that the Township of Stafford relies on the truthfulness of these representations in making contract award decisions. Bidders must also warrant that they will immediately notify the Township should the firm's name appear on the debarment list at any point prior to or during the contract term, including any guarantee period.
The affidavit further establishes that bidding contractors understand their potential liability for disbarment, suspension, or disqualification from state contracting with New Jersey if they commit acts enumerated under N.J.A.C. 7:15.2 as determined by applicable law and regulations. The form requires completion by an authorized officer or representative of the bidding firm, notarization by a notary public, and inclusion of the firm's corporate seal. This document is a mandatory compliance requirement for all bid submissions and serves as a protective mechanism for the Township to ensure contract awards are made only to eligible, qualified contractors in good standing with the State of New Jersey.
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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: |
| name of affiant: |
| name of municipality: |
| full age being duly sworn according to law on my oath depose and say that: |
| and State of: |
| title of position: |
| name of firm: |
| the Bidder making this Proposal for the bid: |
| and that I executed the said Proposal with: |
| Type or print name and address of Contractor: |
| Subscribed and sworn before me this: |
| 2: |
| undefined: |
| Affiant: |
| Print name title of affiant: |
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