8-File S- Federal Debarment.pdf

This is a Federal Debarment Certification form for the Township of Stafford, New Jersey, related to BID #2026-049A-W/S for the Ocean Acres Booster Pump Replacement Phase 2 and Well No. 5 Redevelopment project. The form requires certification of nondebarment status and documentation of ownership information for the bidding contractor. The project involves furnishing all labor, materials, equipment, tools, and supervision required to rehabilitate existing Well No. 5 and replace two existing high service booster pumps with associated motor rehabilitation. The high service pumps are located at 327 Golfview Drive, Manahawkin, New Jersey, and the existing Well No. 5 is located at 181 Stafford Avenue, Manahawkin, New Jersey. All well rehabilitation work must be performed under the direct supervision of a New Jersey Licensed Master Well Driller in accordance with pertinent State of New Jersey Department of Environmental Protection requirements.

The debarment certification form requires contractors to identify principal owners holding more than 50 percent interest in the organization, including stockholders, partners, or members of limited liability companies, as well as owners of parent entities. Contractors must also list all controlled business entities and certify that neither the prime contractor nor any controlled entities are debarred, suspended, proposed for debarment, or otherwise ineligible to receive federal or state contracts. The form includes signature blocks for authorized representatives and requires complete disclosure of organizational structure and ownership information to establish eligibility for the state and local contract opportunity.