Att. 6 T1049 Sample Universal Title Form - Back.pdf
PDF 58 KB Posted
- Solicitation number
- 26DPP01318
- Issued by
- New Jersey
About this file
This is a sample universal title form document from the New Jersey Motor Vehicle Commission, specifically the back page of the NJMVC Form SS-1 Certificate of Ownership. The form is part of a printing bid solicitation (T1049) issued by the New Jersey Department of the Treasury, Division of Purchase and Property, for the procurement of Universal and Junk Title Forms. The solicitation requests bids for NJMVC Form SS-1 (Universal Title Forms) in six volume tiers ranging from 500,000 to 2,000,000 units and NJMVC Form SS-3 (Junk Title Forms) in five volume tiers ranging from 50,000 to 1,000,000 units. Quotes are due August 7, 2026 at 2:00 PM Eastern Time via the NJSTART eProcurement system, with an optional pre-quote conference scheduled for July 2, 2026 at 10:00 AM via Microsoft Teams and an electronic question-and-answer period closing July 9, 2026 at 2:00 PM. Delivery must occur within 4-6 weeks after proof approval to the NJMVC Forms Control Unit at 1600 North Olden Avenue, Trenton, New Jersey. The contract is estimated at $1.2 million over a three-year base term with optional extensions up to two additional years at the same terms.
The forms must meet AAMVA-defined security specifications and be printed on 25# green paper with specified pantone colors, security fibers, perforations, and bar coding/numbering in triplicate. Group 1 pricing requires firm, fixed, all-inclusive unit prices per thousand units, while Group 2 requires benchmark pricing per hundredweight for future paper cost adjustments after the first contract year. Performance security of $180,000 (15% of estimated contract value) is required within 30 days of award, and bidders must remit a 1% supplier convenience fee quarterly to Periscope Holdings, Inc. based on all purchases. Bidders must submit up to 25 sample units at no charge for testing and include technical quotes, security and quality management plans, organizational experience documentation, references from states supplied within the past three years, financial statements, and affirmative action certifications. No small business or disabled veteran-owned business set-asides apply to this solicitation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Att. 1 Combined State of New Jersey Standard Terms and Conditions 6.3.2025~1.pdf | ||
| T1049 Bid Solicitation 6.24.26~1.docx | DOCX document | |
| T1049 Revised Bid Solicitation 8.6.26.docx | DOCX document | |
| T1049 Bid Solicitation 6.24.26.docx | DOCX document | |
| Att. 4 Bidder Data Form~1.pdf | ||
| T1049 Bid Amendment 1 8.6.26~1.docx | DOCX document | |
| Att. 2 Checklist and Forms Packet~2.pdf | ||
| Att. 5 T1049 Sample Universal Title Form - Front.pdf | ||
| Att. 3 Bidder Quote Overview Form~1.pdf | ||
| T1049 State-Supplied Price Sheet 6.24.26~2.xlsx | XLSX spreadsheet | |
| Att. 6 T1049 Pre-Quote Conference PowerPoint.pptx | PPTX presentation | |
| Att. 7 - T1049 Sample Junk Title Form.pdf |
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ALTERATIONS OR ERASURES WILL VOID THIS CERTIFICATE
Buyer’s Signature X
Buyer’s Name (Hand Print)
Co-Buyer’s Signature X
Co-Buyer’s Name (Hand Print)
BUYER SIGN HERE
I/WE, the undersigned, hereby certify that the motor vehicle described on the reverse side of this Certificate of Ownership was purchased by me/us and I/We have compared the vehicle identification number shown on this certificate with that of the motor vehicle purchased and found that they agree in every particular.
NOTE: N.J.S.A. 39:10-11 requires that this certificate after assignment be presented to the MOTOR VEHICLE COMMISSION within ten days. Failure to do so will result in a penalty of $25 which will be in addition to the filing fee for a new Certificate of Ownership.
STATEMENT OF BUYER
Seller’s Signature X
Seller’s Name (Hand Print)
SELLER SIGN HERE
Date of Odometer Statement
Sales Tax Paid $
Net Sale $
Sale Price $
Date of Sale
Corpcode #
Corpcode #
Driver Lic. #
Seller’s Address
Seller’s Name
Lienholder’s Address
Lienholder’s Name
Co-Buyer’s Address
Co-Buyer’s Name
(Print)
(Print)
(Print)
Sales Tax Exemption #
Corpcode #
Driver Lic. #
Buyer’s Address
Buyer’s Name (Print)
I/We hereby assign this Certificate of Ownership of the vehicle described subject to the following liens or encumbrances, if any, and none other. I/We certify the accuracy of sale price, the mileage specified above, and that I/we am/are the owner(s) of the vehicle described on this Certificate of Ownership.
NOTE: New Jersey statute provides that anyone who knowingly or willfully misrepresents the description of a vehicle or makes a false statement in any title papers; forges, changes or counterfeits a part of title papers; or uses title papers on or for the wrong motor vehicle is guilty of a misdemeanor.
(2) WARNING - ODOMETER DISCREPANCY - I/We hereby certify that the odometer reading is NOT the actual mileage, and should not be relied upon for accuracy.
(1) I/We hereby certify that to the best of my/our knowledge the odometer has exceeded its mechanical limits and the reading started again at zero.
NOTE: FEDERAL LAW requires that you state the mileage upon transfer of ownership. Failure to complete this disclosure or providing false information may result in fines and/or imprisonment.
I/We state that the odometer now reads (do not show tenths of a mile) and to the best of my/our knowledge that reflects the actual mileage of the vehicle described on the reverse side of this Certificate of Ownership, unless one of the following statements is checked:
ODOMETER DISCLOSURE STATEMENT AND STATEMENT OF SELLER
NEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSI
NEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIN E
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Driver Lic. #
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
PLEASE RUB TO VERIFY
PURPLE TO COLORLESS INK_THERMOCHROMIC
L
O G
O L
IN
E
S
L O
G O
L
IN
E S
LOGOLINES
LOGOLINES
NJ
O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
SSI
OCEAN
BLUE
SSI
OCEAN
BLUE
SSP
KNTY GRN
L O
G O
L
IN
E S
LOGOLINES
LOGOLINES
ALTERATIONS OR ERASURES WILL VOID THIS CERTIFICATE
Buyer’s Signature X
Buyer’s Name (Hand Print)
Co-Buyer’s Signature X
Co-Buyer’s Name (Hand Print)
BUYER SIGN HERE
I/WE, the undersigned, hereby certify that the motor vehicle described on the reverse side of this Certificate of Ownership was purchased by me/us and I/We have compared the vehicle identification number shown on this certificate with that of the motor vehicle purchased and found that they agree in every particular.
NOTE: N.J.S.A. 39:10-11 requires that this certificate after assignment be presented to the MOTOR VEHICLE COMMISSION within ten days. Failure to do so will result in a penalty of $25 which will be in addition to the filing fee for a new Certificate of Ownership.
STATEMENT OF BUYER
Seller’s Signature X
Seller’s Name (Hand Print)
Co-Seller’s Signature X
Co-Seller’s Name (Hand Print)
SELLER SIGN HERE
Date of Odometer Statement
Sales Tax Paid $
Net Sale $
Sale Price $
Date of Sale
Corpcode #
Corpcode #
Driver Lic. #
Seller’s Address
Seller’s Name
Lienholder’s Address
Lienholder’s Name
Co-Buyer’s Address
Co-Buyer’s Name
(Print)
(Print)
(Print)
Sales Tax Exemption #
Corpcode #
Driver Lic. #
Buyer’s Address
Buyer’s Name (Print)
I/We hereby assign this Certificate of Ownership of the vehicle described subject to the following liens or encumbrances, if any, and none other. I/We certify the accuracy of sale price, the mileage specified above, and that I/we am/are the owner(s) of the vehicle described on this Certificate of Ownership.
NOTE: New Jersey statute provides that anyone who knowingly or willfully misrepresents the description of a vehicle or makes a false statement in any title papers; forges, changes or counterfeits a part of title papers; or uses title papers on or for the wrong motor vehicle is guilty of a misdemeanor.
(2) WARNING - ODOMETER DISCREPANCY - I/We hereby certify that the odometer reading is NOT the actual mileage, and should not be relied upon for accuracy.
(1) I/We hereby certify that to the best of my/our knowledge the odometer has exceeded its mechanical limits and the reading started again at zero.
NOTE: FEDERAL LAW requires that you state the mileage upon transfer of ownership. Failure to complete this disclosure or providing false information may result in fines and/or imprisonment.
I/We state that the odometer now reads (do not show tenths of a mile) and to the best of my/our knowledge that reflects the actual mileage of the vehicle described on the reverse side of this Certificate of Ownership, unless one of the following statements is checked:
NEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSIONNEWJERSEYMOTORVEHICLECOMMISSI
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Driver Lic. #
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
PLEASE RUB TO VERIFY
O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E
S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J S T A T E O F N J
NJ
B
A B
B
B
C
XXXXXXXX
CUSTOMER COPY
KEEP THIS COPY IN A SAFE PLACE, SEPARATE FROM THE TITLE,
SHOULD YOU REQUIRE THE INFORMATION THAT IS AVAILABLE ON
THIS FORM FOR FUTURE REFERENCE.
CUSTOMER COPY
KEEP THIS COPY IN A SAFE PLACE, SEPARATE FROM THE TITLE,
SHOULD YOU REQUIRE THE INFORMATION THAT IS AVAILABLE ON
THIS FORM FOR FUTURE REFERENCE.
XXXXXXXX
PURPLE TO COLORLESS INK_THERMOCHROMIC
ODOMETER DISCLOSURE STATEMENT AND STATEMENT OF SELLER
Auction Location
Auction Name
MVC Auction ID Auction Location
Auction Name
MVC Auction ID
Co-Seller’s Signature X
Co-Seller’s Name (Hand Print)
SSI
OCEAN
BLUE
SSP
KNTY GRN
SSI
OCEAN
BLUE
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