camden PROPOSAL CHECKLIST.pdf

Request for Proposal

RFP #26-22

RISK MANAGEMENT CONSULTANT

SITE VISIT:

DATE AND TIME FOR RECEIPT OF PROPOSALS:

TUESDAY, OCTOBER 27, 2026 @ 11:00 AM

PROPOSALS WILL NOT BE ACCEPTED AFTER THE TIME SPECIFIED

Questions are due by 9:00 am on October 16, 2026

LOCATION:

CITY COUNCIL CHAMBERS

SECOND FLOOR, CITY HALL

520 MARKET STREET

CAMDEN, NEW JERSEY 08102

856-757-7159 PHONE/FAX

CITY OF CAMDEN

NOTICE TO PROPOSERS

Notice is hereby given that sealed proposals (“Proposal”) will be received by THE CITY OF CAMDEN from qualified Proposers for the following:

The Purchasing Agent is hereby authorized to receive electronic RFP Submissions on October 27, 2026 @ 11:00 a.m. via the City’s E-Procurement Portal, Bids&Tenders. Only electronic RFPs shall be accepted.

GUIDELINES may be obtained online at https://camden.bidsandtenders.net/Module/Tenders/en

The City will open the RFP at 11:00 am on October 27, 2026 in City Council Chambers, Second

Floor, City Hall, 520 Market Street, Camden, New Jersey 08102. Respondents can also log in to their registered account at this time for the RFP results.

The City encourages prospective respondents to submit their RFPs before the designated date and time of the opening via the City’s Bidding System.

No Respondent may submit more than one RFP. Any RFP received after 11:00 am shall not be accepted in the Bids&Tenders system.

The submitting person/agency must be qualified and experienced to conduct the services in the Proposal.

Those not providing written proof of required qualifications and experience will be disqualified.

If awarded a contract, your company/firm shall be required to comply with the requirements of N.J.S.A.

10:5-31 et seq. and N.J.A.C. 17:27 et seq.

This proposal is being solicited through a fair and open process in accordance with the N.J.S.A. 19:44a-

20.5 et seq.

Any questions concerning technical issues with the City’s Bids & Tenders electronic bidding system contact support@bidsandtenders.ca.

Lateefah Chandler

Purchasing Agent

856-757-7159

October 6, 2026

IN THE COUNTY OF CAMDEN, NEW JERSEY

1. INTRODUCTION

The City of Camden is currently seeking proposals from vendors to work with the Law

Department's Office of Risk Management to provide risk management consulting services including placement of property & casualty insurance coverage.

2. MINIMUM OUALFICATIONS

The vendor shall demonstrate:

a. consistent pattern (7 years) of providing risk management consulting services to

New Jersey public entities; and

b. knowledge of the City's operations and exposures; and

c. knowledge of the Municipal Excess Liability Joint Insurance Fund and any affiliated local JIF's Programs and Services; and

d. ability to access insurers that specialize in coverages & risk management services for

New Jersey municipalities

The vendor and all staff assigned to the City shall be a New Jersey licensed Property & Casualty

Producer.

Vendor to confirm Risk Management Consultant Fee set at six (6%) percent of the assessment by the

Camden County Municipal Joint Insurance Fund for the calendar year beginning January 1, 2027, through December 31, 2027. Vendor will receive payment directly from the Camden County

Municipal Joint Insurance Fund.

3. CITY'S RISK MANAGEMENT/INSURANCE PROGRAM

The City has 580 employees (full and part time). The City employs a full-time Risk Manager who is responsible for the internal oversight of the City's risk management/ safety/ insurance policies/procedures/programs.

The City is currently a member of the Camden County Municipal Joint Insurance Fund

(CCMJIF) / Municipal Excess Liability Fund (MELJIF). The Fund provides the following coverages: workers' compensation, auto & general liability, property including auto physical damage, public officials/employment practices liability, cyber liability, crime including statutory bonds and environmental impairment liability.

The City has 2 general liability policies for the City's Community Centers and a volunteer accident policy placed with commercial carriers.

The City's workers' compensation SIR is $500,000 per injury. The auto and general liability

SIR are $500,000 per occurrence. The property SIR is $100,000 per claim. All other deductibles/SIRs are determined by CCMJIF/MELJIF.

4. SCOPE OF SERVICES

The vendor must indicate in the proposal your agreement to the following statements:

• Assist the City in identifying its insurable exposures and recommend professional methods to reduce, assume or transfer the risk of loss.

• Assist the City in understanding and selecting the various types of coverage and limits available from the CCMJIF/MELJIF.

• Assist in preparing all applications, statements of value, and similar documents requested by insurers.

• Assist in reporting all changes in exposure to insurers throughout the year.

• Review with the City's Risk Manager any additional types of coverage that that

Consultant believes the City should purchase to protect its assets that are not available through CCMJIF/MELJIF. The Consultant will be responsible for soliciting proposals, presenting such to the City and, as authorized by the City, securing such coverages on the City's behalf.

• If applicable, prepare underwriting submissions, solicit proposals from insurers specializing in public entities and present findings (coverage/services/cost comparison) and recommendation to the City's Risk Manager at least 60 days prior to policy expiration.

• Assist the City in the preparation of its annual insurance budget.

• Review all loss control/engineering reports and assist the City in addressing recommendations.

• Attend and actively participate in the City's Safety Committee activities and meetings and shall present information to the Safety Committee on Safety related topics.

• Assist the City's Risk Manager in determining and facilitating the necessary training to meet the City's and/or its insurers' safety objectives.

• Assist the City's Risk Manager in determining the necessary training to comply with applicable governmental regulations.

• Review the City's loss data (recent losses, open claims, and loss trends) and provide recommendations on reducing such in the future.

• Assist the City's Risk Manager with ensuring certificates of insurance on behalf of the

City are issued.

• As requested by the City's Risk Manager, review certificates of insurance received by the

City.

• As requested by the City's Risk Manager, review indemnification and hold harmless language in proposed contracts between the City and organizations and contractors and advise if the City is assuming uninsured exposure.

• Assist the City on the risk management aspects of public events being staged or sponsored by the City.

• Review all coverage documents/policies to verify accuracy.

• Respond to all inquiries from authorized City Representatives.

• Prepare a written report outlining the City's risk management/insurance/safety program.

If requested, present to the Governing Body.

• Assist the City in understanding and utilizing all cost containment programs offered by the City's insurers.

• Perform services to ensure the City is meeting all requirements of its insurers.

• Assist with claim resolution when requested.

• Attend 90% of the City's insurer's Executive Committee Meetings.

• Perform any other services, i.e., claim review (including meeting attendance) to ensure the City is achieving its risk management goals and initiatives.

5. RFP SUBMISSION REQUIREMENTS

Technical

This section shall describe the vendor's approach and plans for accomplishing the work outlined in the Scope of Services along with vendor's agreement to the services listed in Section 4 "Scope of

Services". A summary of the problems that the vendor might reasonably expect when working with a urban municipality and a solution to those anticipated problems. Describe these plans and approaches in sufficient detail to permit fair evaluation, with a minimum possible misinterpretation.

Experience

This section shall contain all pertinent information relating to the vendor's organization, minimum qualifications, resumes of personnel assigned, and list of public entity clients.

6. TERM OF CONTRACT

The term of the contract shall be for one (1) year, effective 1/1/2027 to 1/1/2028

7. SELECTION PROCES

All proposals will be reviewed to determine responsiveness. The City may reject non-responsive proposals without evaluation but may waive minor non-compliance. An Evaluation Committee will evaluate responsive proposals. The Evaluation Committee will have a minimum of three members. The

Evaluation Committee may request interviews as part of the selection process. The City shall not be obligated to explain the results of the evaluation process to any Respondent.

The following evaluation criteria categories, separate or combined in some manner, and not necessarily listed in order of significance, will be used to evaluate proposals received in response to this RFP:

Qualifications -- The Total Score will be based on the following areas:

• Does the firm's proposal demonstrate an understanding of the scope of the work and related objectives?

• Does the firm have the expertise to undertake the work?

• Does the firm’s experience account for external factors such as demographic shifts, aging infrastructure and socioeconomic realities that uniquely influence a city’s risk profile?

• Does the firm have the resources to accomplish the work?

• Do the firm’s "key personnel" have sufficient education and experience to properly accomplish the work?

• Is the firm's approach clear and easily understandable and flexible enough to meet the City's needs?

• How does the cost compare to other similarly scored proposals?

Statutory and Other Requirements

a. Acknowledgement of Receipt of Notices Revisions or Addenda to RFP Documents

Proposers shall acknowledge receipt of any addenda through the Bidding System by checking a box for each addenda and any applicable attachment.

It is the responsibility of the Bidder to have received all Addenda that are issued. Proposers should check online at https://camden.bidsandtenders.net prior to submitting their RFP and up until the RFP closing time and date in the event additional addendum are issued.

If a Proposer submits their RFP prior to the RFP closing time and date and an addenda have been issued, the Bidding System shall WITHDRAW the RFP submission and the RFP status will change to an INCOMPLETE STATUS and Withdraw the RFP. Proposers can view the status change in the “MY BIDS” section of the Bidding System.

The Proposer is solely responsible to:

• Make required adjustments to their RFP; and

• Acknowledge the addenda; and

• Ensure the re-submitted RFP is RECEIVED by the Bidding System no later than the stated RFP closing time and date.

b. Compliance with Laws

Any contract entered into between the contractor and the City must be in accordance with and subject to compliance by both parties with the New Jersey Local Public Contracts Law. The contractor must agree to comply with the non-discrimination provisions and all other laws and regulations applicable to the performance of services there under. The respondent shall sign and acknowledge such forms and certificates as may be required by this section.

c. Public Emergency

In the event of a Public Emergency declared at the Local, State or Federal Level, if the City opts to extend terms and conditions of this RFP, the contractor agrees to extend the terms and conditions of this RFP, whether existing, expiring or expired no longer than six months, for goods and/or services for the duration of the emergency. In the event the original contractor cannot meet this requirement, the City may solicit the goods and/or services from any respondent of this contract.

d. Non-Allocation of Funding Termination

Each calendar year payment obligation of the City is conditioned upon the availability of City funds appropriated or allocated for the payment of such an obligation. If funds are not allocated and available for the continuance of any services performed by the Contractor hereunder, whether in whole or in part, the City at the end of any particular fiscal year may terminate such services. The

City will notify the Contractor in writing immediately of any services that will be affected by a shortage of appropriated funds. This provision shall not be construed so as to permit the City to terminate this Agreement during the term, or any service hereunder, merely in order to acquire identical services from a third party contractor.

e. Mandatory EEO/Affirmative Action Compliance

No firm may be issued a contract unless it complies with the affirmative action regulations of N.J.S.A.

10:5-31 et seq. (P.L. 1975, c.127) and N.J.A.C. 17:27-1 et seq. as administered by the Division of

Purchase & Property Contract Compliance and Audit Unit (Division) and/or Department of Labor &

Workforce Development provided below. The form shall be properly executed and uploaded along with Certified Employee Information Report or form AA302. The contract will include the language included in this specification.

f. New Jersey Anti-Discrimination

The contract for this bid shall require that the contractor agrees not to discriminate in employment and agrees to abide by all anti-discrimination laws including but not limited to N.J.S.A. 10:2-1.

g. Americans with Disabilities Act of 1990

Discrimination on the basis of disability in contracting for the delivery of services is prohibited.

Respondents are required to read American with Disabilities language that is part of the documents attached hereto and agree that the provisions of Title II of the Act are made part of the contract. The contractor is obligated to comply with the Act and hold the City harmless.

h. Prompt Payment of Goods and Services Contracts

N.J.S.A. 40A:11-19.1 establishes a prompt payment requirement that applies to goods and services contracts a contracting unit awards to a “business concern” under the Local Public Contracts Law

(LPCL)

i. Statement of Ownership Disclosure

Pursuant to N.J.S.A. 52:25-24.2 provide that no business organization, regardless of form of ownership shall be awarded any contract for the performance of any work or the furnishing of any goods and services, unless, prior to the receipt of the bid or accompanying the bid of said business organization, bidders shall submit a statement setting forth the names and addresses of all persons and entities that own ten percent (10%) or more of its stock or interest of any type at all levels of ownership. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the ten percent ownership, has been listed.

The included Statement of Ownership shall be completed and uploaded into the e-procurement platform. This requirement applies to all forms of business organizations, including, but not limited to, corporations and partnerships, publicly-owned corporations, limited partnerships, limited liability corporations, limited liability partnerships, sole proprietorship, and Subchapter S corporations.

Failure to submit a disclosure document shall result in rejection of the bid as it cannot be remedied after bids have been opened.

Not-for-profit entities should fill in their name, check the not-for-profit box, and certify the form. No other information is necessary.

The Respondent shall complete and upload the form of statement that is included in this RFP

j. Non-Collusion Affidavit

The Non-Collusion Affidavit, which is part of this RFP, shall be properly executed and submitted with the RFP response.

k. N.J. Business Registration Certificate

Certificate required pursuant to N.J.S.A. 52:32-44; failure to be registered by time of contract award may be cause for rejection. Entities or individuals are required to provide the certificate prior to contract award. The City recommends uploading this certificate via the City’s Bidding

System. Entities or individual that need to file for a certificate may do so on- line through the NJ

Division of Local Government Services at the following link:

http://www.state.nj.us/treasury/revenue/busregcert.shtml .

l. Disclosure of Investment Activities in Iran

Pursuant to N.J.S.A. 40A:11-2.1; N.J.S.A. 52:32-58 any person or entity that submits a bid or proposal 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 of its parents, subsidiaries, or affiliates, is identified on the Department of Treasury's Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found at:

http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Bidders must review this List prior to completing the below certification. Failure to complete the certification m a y render a bidder's proposal non-responsive. If the Director finds a person or entity to be in violation of law, s/he shall take 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.

m. Certification of Non-Involvement in Prohibited Activities in Russia or Belarus

Pursuant to N.J.S.A. 52:32-60.1, et seq. and N.J.S.A.40A:11-2.2 (L. 2022, c. 3) any person or entity

(hereinafter “Vendor”) that seeks to enter into or renew a contract with a local contracting unit subject to the Local Public Contracts Law 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.

n. Restrictions on Certain Contracts

The City operates under a Transitional Aid Memorandum of Understanding (“MOU”) with the State of New Jersey Department of Community Affairs, Division of Local Government Services, as approved in advance by the City Council of the City of Camden for the current State fiscal year.

Under the MOU, the City must obtain the written approval of the Director of the Division of Local

Government Services of certain contracts. The City must also obtain the Director’s written approval for the hiring of consultants and professionals, either directly or knowingly through a sub-contract, regardless of cost. Contract renewals must also be approved by the Director in writing.

Pursuant to the Municipal Rehabilitation and Economic Recovery Act, N.J.S.A. 52:27BBB-1 et seq., the State Commissioner of the Department of Community Affairs has authorization to veto any City resolution awarding, amending or renewing a City contract.

This document is not an offer to contract but is an RFP as defined herein, to satisfy specific user requirements of the City of Camden. Neither the issuance of the RFP, preparation and submission of a response, nor the subsequent receipt and evaluation of any response by the City of Camden, will commit the City to award a contract to any consultant even if all of the user requirements in the

RFP are met.

Only the execution of a written contract will obligate the City in accordance with the terms and conditions contained in such contract.

o. Discrepancies in RFPs

In the event that there is a discrepancy between the advertisement, as published or the City’s e-procurement platform and the City supplied RFP documents, the RFP documents shall govern. If the amount shown in words and its equivalent in figures do not agree, the written words shall be binding.

Ditto marks are not considered writing or printing and shall not be used.

p. Maintenance of Documents

Relevant records of private vendors or other persons entering into contracts with covered entities are subject to audit or review by OSC pursuant to N.J.S.A. 52:15C-14(d).

Pursuant to N.J.A.C. 19:70-1.6(b), the contractor/vendor to whom a contract has been awarded, shall maintain all documentation related to products, transactions or services under this contract for a period of five years from the date of final payment. Such records shall be made available to the

New Jersey Office of the State Comptroller upon request.

q. NJ Election Law Enforcement Commission (ELEC)

Contractors are advised of their responsibility to file an annual disclosure statement on political contributions with the New Jersey Election Law Enforcement Commission (“ELEC”) pursuant to

N.J.S.A. 19:44A-20.26-20.27 (P.L. 2005, c.271, s.3) if a Contractor receives contracts in excess of

$50,000 from public entities in a calendar year. It is a Contractor’s responsibility to determine if filing is necessary. Additional information on this requirement is available from ELEC at 888-313-

3532 or at www.elec.state.nj.us

r. Workplace Accountability in Labor List (WALL)

N.J.S.A. 34:1A-1.16(a)), any “person” in violation of State wage, benefit and tax laws, and with outstanding liabilities to NJDOL, may be named on the WALL. The law defines “person” as “any natural person, company corporate officer or principal, firm, association, corporation, contractor, subcontractor or other entity engaged in contracting.” The WALL is a list on NJDOL’s website of businesses that have been found in violation of New Jersey State wage, benefit and tax laws and have outstanding liabilities to NJDOL under a final order/judgment. Any business whose name appears on the WALL is prohibited from public contracting.

Ensure neither your company nor your subcontractors are on this list:

https://www.nj.gov/labor/ea/osec/wall.shtml

s. Termination of Contract

The Contract may be terminated for any of the following circumstances: failure of the Contractor to meet the performance requirements or any other terms or conditions stated herein or in the Contract.

If, through any cause, the Contractor shall fail to fulfill its obligations under the Contract, the City shall thereupon have the right to terminate the Contract by giving prior written notice to the

Contractor of such termination and specifying the effective date of termination.

The City may terminate the Contract at its convenience at any time by giving written notice to the

Contractor of such termination and specifying the effective date thereof at least thirty (30) days before the effective date of such termination.

In case of default by the Contractor, the City may procure the services from other sources and hold the Contractor responsible for any excess cost occasioned thereby.

Continuation of the terms of the Contract beyond the fiscal year is contingent on availability of funds in the following year's budget. In the event of unavailability of such funds, the City reserves the right to cancel the Contract.

If the City’s termination of the contract pursuant to this Section herein or a provision in the contract, is found by a court or other legal forum to be legally improper, the termination of the contract shall be treated as if it had been a termination for convenience in accordance with the above section governing terminations for convenience.

t. Open Public Records Act (OPRA)

All documents/information, except for OPRA’s Exemptions from Disclosure, submitted in response to this solicitation shall be available to the general public as required by the New Jersey Open

Public Records Act N.J.S.A. 47:1A-1 et seq.

u. Insurance and Indemnification

All insurance shall be maintained in force during the life of this contract by the bidder. Such coverage shall be with an insurance company authorized to do business in the State of New Jersey and shall name the City of Camden, all elected and appointed officials, employees, and volunteers as additional insured as an additional insured. It must be an insurer with a Best’s rating of no less than “A” indicated compliance with the required coverages. The bidder/vendor must notify the City of Camden immediately of any material change in insurance coverage such as changes in limits, coverages, status of policy, etc. The City of Camden reserves the right to require complete copies of insurance policies and/or change insurance limits at all times.

Certificates of the Required Insurance shall be submitted prior to or along with the contract as evidence covering Comprehensive General Liability, Comprehensive Automobile Liability, etc.

Certificates for Worker's Compensation and Employer's Liability Insurance shall also be submitted.

Self-insured contractors shall submit an affidavit attesting to their self-insured coverage and shall name the owner as additional insured. The workers compensation and employers’ liability can be waived if the vendor is a sole proprietorship.

Except as elsewhere provided herein, the SERVICE PROVIDER shall provide, at its own cost and expense, proof of the following insurance to the City of Camden:

A. General Liability: $1,000,000 occurrence $2,000,000 aggregate

B. Automobile Liability: $1,000,000

C. Workers’ Compensation**Statutory

D. Employer’s Liability: $1,000,000

E. Professional Liability: $1,000,000

F. Cyber Security & Privacy Liability: $1,000,000

Successful bidder will indemnify and hold harmless the City of Camden, all elected and appointed officials, employees, and volunteers from all claims, suits or actions and damages or costs of every name and description to which the City may be subjected or put by reason of injury to the person or property of another, or the property of the City, resulting from negligent acts or omissions on the part of the bidder, the bidder's agents, servants or subcontractors in the delivery of materials and supplies, or in the performance of the work under this agreement; the use of any copyrighted or copyrighted composition, valid trademark, secret process, patented or unpatented invention or article furnished or used in the performance of this contract

Upon execution of the contract, all policies of company shall contain the following provisions:

a. The insurance policy of the signed vendor shall be primary and non-contributory and must contain a waiver of subrogation against the City of Camden.

NEW JERSEY BUSINESS REGISTRATION

REQUIREMENTS – NON-CONSTRUCTION

Pursuant to N.J.S.A. 52:32-44, The City of Camden 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. Direct any questions in this regard to the Division of Taxation at

(609)292-6400.

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.

A sample Business Registration Certificate is attached. Other forms, such as a Certificate of

Authority to collect Sales and Use Taxes or a Certificate of Employee Information Report Approval, are not acceptable.

Any questions in this regard can be directed to the Division of Revenue & Enterprise Services at https://www.state.nj.us/treasury/revenue/revgencode.shtml. Form NJ-REG can be filed online at:

http://www.state.nj.us/treasury/revenue/busregcert.shtml

THESE ARE SAMPLES OF THE ONLY ACCEPTABLE

BUSINESS REGISTRATION CERTIFICATES

STATE OF NEW JERSEY

BUSINESS REGISTRATION CERTIFICATE

Taxpayer Name: TAX REG TEST ACCOUNT

Trade Name:

Address: 847 ROEBLING AVE

TRENTON, NJ 08611

Certificate Number: 1093907

Date of Issuance: October 14, 2004

For Office Use Only:

20041014113823533 ti

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)

PartnershipLimited 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 or proposer 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.

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 City of Camden 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 City of Camden to notify the

City of Camden 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 City of Camden, permitting the City of Camden to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print): Title:

Signature: Date:

Stockholder/Partner/Member and Corresponding Entity Listed in Part II

Address

NON-COLLUSION AFFIDAVIT

(N.J.S.A. 52-34-15)

STATE OF ________________________ )

ss:

COUNTY OF ______________________ )

RE: RFP#_____________________________

I, _______________________________________________of full age, being duly sworn (Name of Affiant) according to law, on my oath depose and say: I am the _________________________________ (Title of Position) of ________________________________________,the vendor for the above named project, and (Name of Vendor/Firm) that I executed the said proposal with full authority so to do; that said vendor has not, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive proposal in connection with the above named project; and that all statements contained in the proposal and in this affidavit are true and correct, and made with full knowledge that the City of Camden relies upon the truth of the statements contained in the proposal and in the statements contained in this affidavit in awarding a contract for the said project.

I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or sell agencies maintained by my firm for the purpose of securing business.

Signed: X

Business Name:

Tax ID #:

*provide a fully completed W9 form Subscribed and sworn to before me this _________day of ________________,20______.

Notary Public of

My commission expires , 20 .

ADDITIONAL STATUTORY REQUIREMENTS

EXHIBIT A

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE

N.J.S.A. 10:5-31 et seq. (P.L.1975, c.127) and N.J.A.C. 17:27 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, affectional 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, upgrading, demotion, or transfer;

recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. 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.

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 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 requested 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.

AFFIRMATIVE ACTION COMPLIANCE NOTICE

N.J.S.A. 10:5-31 and N.J.A.C. 17:27

GOODS AND SERVICES CONTRACTS

(INCLUDING PROFESSIONAL SERVICES)

This form is a summary of the successful proposer/bidder’s requirement to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27-1 et seq.

The successful bidder/proposer shall submit to the public agency, after notification of award but prior to execution of this contract, one of the following three documents as forms of evidence:

(a) A photocopy of a valid letter that the contractor is operating under an existing

Federally approved or sanctioned affirmative action program (good for one year from the date of the letter);

OR

(b) A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4;

(c) A photocopy of an Employee Information Report (Form AA302) provided by the Division and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4.

The successful vendor may obtain the Affirmative Action Employee Information Report (AA302) from the contracting unit during normal business hours.

The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract

Compliance and Equal Employment Opportunity in Public Contracts (Division). The Public

Agency copy is submitted to the public agency, and the vendor copy is retained by the vendor.

The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27.1 et seq. and agrees to furnish the required forms of evidence.

The undersigned vendor further understands that his/her bid/proposal shall be rejected as non-responsive if said contractor fails to comply with the requirements of N.J.S.A. 10:5-31 and

N.J.A.C. 17:27-1 et seq.

COMPANY: ____________________________ SIGNATURE: __________________________

PRINT NAME:_____________________________ TITLE: _____________________________

DATE: __________________

AMERICANS WITH DISABILITIES ACT OF 1990 - P.L 101-336

Equal Opportunity for Individuals with Disability

The contractor must comply with all provisions of the Americans with Disabilities Act (ADA), P.L 101-336, in accordance with 42 U.S.C. § 12101 et seq. Thus, pursuant to P.L 101-336 (42

U.S.C. § 12101 et seq. if awarded a contract, the proposer agrees that:

The PROPOSER and the OWNER do hereby agree that the provisions of Title II of the

Americans with Disabilities Act of 1990 P.L 101-336 (the "Act") (42 U.S.C. S12101 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 OWNER pursuant to this contract, the PROPOSER agrees that the performance shall be in strict compliance with the Act. In the event that the Proposer, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the PROPOSER shall defend the OWNER in any action or administrative proceeding commenced pursuant to this Act. The Proposer shall indemnify, protect, and save harmless the OWNER, it 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 PROPOSER shall at its own expense, appear, defend any 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 OWNER'S grievance procedure, the PROPOSER agrees to abide by any decision of the OWNER which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the OWNER or if the OWNER incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the PROPOSER shall satisfy and discharge the same at its grievance procedure, the PROPOSER shall satisfy and discharge the same at its own expense.

The OWNER shall, as soon as practicable after a claim has been made against it, give written notice thereof to the PROPOSER along with full and complete particulars of the claim. If any action or administrative proceedings is brought against the OWNER or any of its agents, servants, and employees, the OWNER shall expeditiously forward or have forwarded to the

PROPOSER every demand, complaint, notice, summons, pleading or other process received by the OWNER or its representatives.

It is expressly agreed and understood that any approval by the OWNER of the services provided by the PROPOSER pursuant to this contract will not relieve the PROPOSER of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the

OWNER pursuant to this paragraph.

It is further agreed and understood that the OWNER assumes no obligation to indemnify or save harmless the PROPOSER, its agents, servants, employees, and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the PROPOSER expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the Proposer's obligations assumed in this Agreement, nor shall they be construed to relieve the PROPOSER from any liability, nor preclude the OWNER from taking any other actions available to it under any other provisions of the Agreement or otherwise at law.

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 proposer 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 proposer, nor any person acting on behalf of such proposer 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 proposer, 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 proposer 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 proposer from the contracting public agency of any prior violation of this section of the contract.

CITY OF CAMDEN – EQUAL EMPLOYMENT OPPORTUNITY QUESTIONNAIRE

The following information is necessary for the City of Camden to evaluate its hiring/RFP practices and to prepare reports required by law for the State and Federal Government. This form will not accompany the application. The information contained will be confidential and will NOT be used to make a decision about your employment.

POSITION/RFP APPLIED FOR:

CHECK GENDER: MALE FEMALE:

CHECK ETHNIC GROUP: WHITE BLACK HISPANIC

AMERICAN INDIAN/ALASKAN NATIVE ASIAN/PACIFIC

ISLANDER

MINORITY STATUS: MBE WMBE

The City of Camden is an Equal Opportunity Employer, does not discriminate on the basis of disabilities and is committed to providing reasonable accommodations.

PLEASE INDICATE ANY DISABILTIES YOU MAY HAVE:

Physical (Specify)

Mental (Specify)

If you have a disability requiring reasonable accommodation during the selection process, please inform Personnel (Employment) at (856) 757-7414 Purchasing Bureau (RFP’s/Bids) at (856) 757-7159 at the time you are invited for an interview or bid opening.

HOW DID YOU LEARN OF THIS OPPORTUNITY?

Friend Personal Inquiry Courier Post Star Ledger Referral Service (Specify)

Dodge Report Posted Bulletin (Where) Internet (Specify Website)

Other (Specify) Professional Publication (Specify)

VETERAN’S PREFERENCE PROGRAM

This program provides that in the event that a veteran has qualifications identical to those possessed by another applicant, based upon the veteran’s and the other applicant’s examinations, interviews, experience, education, training and work history, at the time of appointment, the City shall grant preference to the veteran.

The City of Camden defines Veteran using Government Code section 18973.

A Veteran means…