CC# 24-09 Mobile Beach Pass Competitive Contract.pdf

PROJECT MANUAL

for

CC# 24-09

COMPETITIVE CONTRACT

MOBILE BEACH PASS ACCESS SYSTEMS

City of Cape May, Cape May County, N.J.

April 18, 2024 at 11:00AM

MAYOR & COUNCIL

Mayor Zachary Mullock

Councilmember Lorraine Baldwin

Councilmember Shaine P. Meier

Councilmember Michael Yeager

Councilmember Maureen K. McDade

Erin C. Burke, RMC, City Clerk

Paul Dietrich, City Manager

Competitive Contract Request for Proposals

Notice is hereby given by the City of Cape May that a Competitive Contract in accord with N.J.S.A. 40A:11-4.1 will be received by the City on April 18, 2024 at 11:00AM prevailing time conducted on electronic platform, in accord with N.J.A.C. 5:34-1 et. Seq., on BIDNET at www.bidnetdirect.com//capemaycity

CC #24-09 Mobile Beach Pass Access System Competitive

Contract

NOTE:

It is the bidder’s responsibility to ensure that the bid package is uploaded onto the e-procurement site by the bid opening date and time. Any bid document received after the deadline established by the Department of Purchasing will not be accepted, regardless of the method of delivery.

Bidders must comply with the requirements of N.J.S.A. 10:5-31 et seq., and

N.J.A.C. 17:27 et. Seq., For zoom opening information, contact the Qualified Purchasing Agent at scanning@TheCanningGroup.org

The City of Cape May will award this Competitive Contract in accord with Price and

Other Factors as outlined within N.J.S.A 40A:11-4.1 et. Seq., and N.J.A.C. 5:34-4.1 et. Seq., Report of Competitive Contract:

In accord with N.J.S.A. 40A:11-4.4(d) the summary report will be posted on the City procurement website at www.bidnetdirect.com//capemaycity at least 48 hours prior to the governing body taking action on award.

This procurement has been advertised in accordance with the “Fair and Open Basis”

(N.J.S.A. 19:44A-20.5).

Ordered By: Erin C. Burke

City Clerk http://www.bidnetdirect.com/capemaycity mailto:scanning@TheCanningGroup.org

Applicable to Bid if marked “X”

DOCUMENTATION REQUIRED OR REVIEWED

Initials When Due

Bid Guarantee (Bid Bond or Certified/Cashier’s Check) (with

POA for full amount of Bid Bond)

With Bid

Submission

Consent of Surety (Certificate from Surety company)

Performance Bond and Labor and Material Payment Bond

(Required from the Awarded Contractor)

At signing of contract

Maintenance Bond in the Amount of 100 % for a period indicated in “General Conditions” Required from the Awarded

Contractor Upon Acceptance of Project

Upon

Acceptance of

Project

Acknowledgement of Receipt of Addenda (To be Completed if Addenda are Issued)

X Ownership Disclosure Form With Bid

Submission

Named Subcontractors in Bid for Listed Specialty Trades

Public Works Contractor Registration Certificate(s) for the

Bidder and all Sub Contractors

Prior to Award, but effective at time of bid

X Business Registration Certificate – Bidder and all Sub

Contractors

Prior to

Award

X Non-Collusion Affidavit With Bid

Submission

X Experience and Qualifications With Bid

Submission

X Insurance and Indemnification Certificate

Prior to

Contract

Award

X Disclosure of Investment Activities in Russa/ Iran Form

Prior to

Contract

Award

Federal debarment Form

Prior to

Contract

Award

Prevailing Wage Certification (PL 2021, C301)

Prior to

Contract

Award

Equipment Certification

EEO/AA Form AA-201

After Notice of

Award, Prior to

Signing

X EEO/AA Form AA-302 or Letter of Federal Approval or

Certificate of Employee Information Report

After Notice of

Award, Prior to

Signing

Contract

X Bidder’s Checklist

This checklist is provided for bidder’s use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications.

Bidder

Name:

Date:

Authorized

Representative:

Signature:

Print Name &

Title:

COMPETITIVE CONTRACT

CITYOF CAPE MAY

1.0 SCOPE AND PURPOSE

A. The City of Cape May intends on hiring a qualified firm to provide for electronic based mobile beach pass systems for the City’s beach access program. The City of Cape May intends to use the digital beach tags to supplement any physical beach tag sales.

B. Respondents shall propose a mobile application (“app”) that allows users to purchase and use digital beach passes directly from their mobile device. The app also allows users to purchase physical beach passes directly from their mobile device using a credit or debit card.

C. The City is conducting this procurement as a competitive contract concession in accord with N.J.S.A. 40A:11-4.1 et seq.

D. As such the vendor will be awarded based upon the most advantageous vendor price and other factors considered.

i. Technical _______%

ii. Manager________%

iii. Cost_____________%

iv. Weights will be announced at the time of opening.

E. Term of contract in accord with N.J.S.A. 40A:11-4.1 et. Seq. shall be for a period not to exceed five (5) years.

2.0 SUBMITTALS AND QUESTIONS

A. All responses shall be made on the procurement platform for the City at:

www.bidnetdirect.com//capemaycity

B. All questions shall be through the e-procurement portal.

C. No physical or emailed responses will be honored or received.

http://www.bidnetdirect.com/capemaycity

3.0 INTRODUCTION AND OVERVIEW

A. The City of Cape May, N.J. (City) intends to modernize the operations of its beach tag and access systems. Currently the City experiences $3 million beach tag sales per year, with an annual gross revenue for beach access as follows (Physical Beach Tag

Experience) :

i. 2023- $3,034,179

ii. 2022- $3,015,104

iii. 2021- $2,952,664

B. Following the specifications outlined in this document and deliverable services related to implementation must include solutions that will meet the functional and technical requirements as defined in the RFP.

C. The successful vendor(s) will also be required to develop and implement such system(s) to the extent described, and provide the access, integrations to system operating and management platforms and sites and provide information and analytical reports as described in this RFP. All costs for these products, services, and warranties must be provided in the manner specified and presented herein.

D. The app allows the purchase and use of beach passes in a fully digital format. The app displays the digital beach pass as a self-authenticating animated QR code; the animation allows the passes to be visually authenticated, without scanning. The QR code screen also displays the date and beach for which the pass is valid, and as an additional layer of visual verification and fraud protection, the pass animation color changes if tapped.

E. The users’ passes can only be accessed on their mobile device while the pass is valid.

Once the pass has expired, the pass is removed from the users’ profile. Only while the pass is valid do users have access to the animated QR code screen. The QR code cannot be accessed by users until the date(s) for which the pass is valid.

F. Optionally, the QR code can be scanned by a beach pass checker, also running the application. When scanned, the user’s mobile device performing the scanning will query a back-end database, which will display a notification as to whether the pass is valid. This provides an additional layer of protection to ensure that the pass is valid on the date in question.

G. Users can purchase and store multiple passes per account. Passes can be swiped through for authentication. The app will recognize each mobile phone’s IMEI, which is a unique identification code specific to each device; this ensures log-in credentials cannot be shared.

H. Once a pass is purchased, the vendor must provide a system capable of providing transactional ledgers through a dashboard. The data is shown in Universal Coordinated

Time. The data provided includes transaction history and revenue.

I. The app also must be capable of facilitating the purchase of physical passes, via credit or debit card payment. These passes will be available for pick-up at a location. The user purchasing a physical pass will receive a confirmation email with information on where to pick-up their passes at a physical location. The municipality will also receive a confirmation email when physical passes are purchased.

4.0 Background

A. With a permanent population of 3,800 residents, Cape May plays host to 45,000 vacationers during the summer weekends without compromising its tranquil, slow-paced, and relaxing atmosphere. In addition, based upon seasonally warm weather in the spring and fall, the City has evolved into a town for all seasons with a presentation of a comprehensive selection of themed festivals and diversified events reflecting the embracing of the arts, culture, and history into our fabric.

5.0 Vendor response

A. All equipment, devices, systems, and software platforms associated with the provision of hardware, software and services, to be provided by responding vendors, shall be capable of being appropriately connected and integrated as required.

B. All vendors shall be obligated to work with and provide the same systems and levels of connectivity and integration, at no charge to the City.

C. The selected vendors shall be required to work with the city and other vendors, as appropriate, to deliver, operationalize and provide on-going service and support to achieve a seamless multi-faceted solution to the City of Cape May.

D. The successful vendor(s) must present their capabilities and qualifications to provide all materials, labor, equipment, on-going service/support, warranties, and training necessary to install and operationalize these sought-after procurement elements as described below:

E. The VENDOR MUST AS PART OF ITS PROPOSAL, retain and charge their charge per beach pass cost and remit to the City the fees associated with beach pass sales.

F. In other words, the charges for the vendor services must be applied and be payable by the end user, the net impact of which being the City receiving 100% of the applicable rate.

G. At no point in the proposal shall a vendor propose the city to remit the recompense portion of the beach pass service from the city.

H. Such a proposal will render the proposal as non-responsive to this procurement.

I. Prior to award, each vendor must give a presentation to the recommendation committee. The recommended vendor must be available to give a presentation at the designated City Council meeting.

Technical criteria: RATER NAME:

(Max Points _) 1 Pt = Poor Response, 3 Points = Average Response, 5 Pts =

Concise and Superior Response

Vendor Name:

(1) Does the vendor's proposal demonstrate a clear understanding of the scope as listed in the minimum qualifications?

(2) Is the vendor's proposal complete and responsive to the specific requirements for service as requested?

(3) Has the past performance of the vendor's experience and qualifications been documented and proposed?

(4) Does the vendor's proposal use innovative technology and techniques that set them apart from other proposals?

Sub Total Technical 0

Management criteria:

(Max Points __) 1 Pt = Poor Response, 3 Points = Average Response, 5 Pts =

Concise and Superior Response

Vendor Name:

(1)How well does the proposed scheduling timeline meet the contracting unit's needs?

(2)Is there a project management plan?

(3)Does the vendor document the qualifications of its personnel to a greater degree of expertise than other proposals?

Sub Total Managerial 0

Cost criteria:

(Max Points __) 1 Pt = Poor Response, 3 Points = Average Response, 5 Pts =

Concise and Superior Response

Vendor Name:

(1)How well does the proposed scheduling timeline meet the contracting unit's needs?

(2)Is there a project management plan?

(3)Does the vendor document the qualifications of its personnel to a greater degree of expertise than other proposals?

(4) Yearly maintenance cost of software & data storage

SUB TOTAL COST 0

Final Rater Score 0

EXHIBIT A

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE

N.J.S.A. 10:5-31 et seq. (P.L.1975, c.127)

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 and distributed to the public agency through the Division’s website 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 http://www.state.nj.us/treasury/contract_compliance

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

SAMPLE CERTIFICATE OF EMPLOYEE INFORMATION REPORT

New Jersey Business Registration Certification

Pursuant to N.J.S.A. 52:32-44, The City of Cape May (“Contracting

Agency”) 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. Any questions in this regard can be directed to the Division of

Taxation at (609)292-6400. Form NJ-REG can be filed online at http://www.state.nj.us/treasury/revenue/busregcert.shtml.

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.

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

SAMPLE BUSINESS REGISTRATION CERTIFICATE

FormAA302 Rev. 11/11

PAY TO PLAY ADVISORY

Disclosure Requirement

P.L. 2005, Chapter 271, Section 3 Reporting

(N.J.S.A. 19:44A – 20.27)

Any business entity that has received $50,000 or more in contracts from government entities in a calendar year will be required to file an annual disclosure report with ELEC.

The report will include certain contributions and contract information for the current calendar year.

At a minimum, a list of all business entities that file an annual disclosure report will be listed on ELEC’s website at www.elec.state.nj.us.

If you have any questions please contact ELEC at:

1-888-313-ELEC (toll free in NJ) or

609-292-8700

An analyst from ELEC’s Special Programs Section will assist you.

Initials http://www.elec.state.nj.us/

Experience & Qualifications Questionnaire

This questionnaire must be filled out and submitted as a part of the Proposal.

Failure to complete this form or to provide any of the requested information will be grounds for the rejection of the bid proposal. If additional space is required, the respondent shall add additional sheets, which identify the question being answered.

Number of years in business under present name & address:

If less than 5 years, list previous names and address:

Within the last 5 years has the business or any officer/partner failed to complete a contract awarded to them: . If yes, provide the details in on a separate page.

Have any liens and lawsuits been filed against the company in the past 5 years:

If yes, please provide details:

List similar services you are now providing for which you have signed contract, but not yet started work:

List all major subcontractors to be used to complete the service and the area of their responsibility:

Experience & Qualifications Questionnaire

Please provide at least 3 references below:

Name: Phone:

Address:

Equipment/Service Provided:

Contract Amount:

Americans with Disabilities Act of 1990

The CONTRACTOR and the OWNER do hereby agree that the provisions of Title 11 of the Americans With

Disabilities Act of 1990 (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 act benefit, or service on behalf of the OWNER pursuant to this contract, the CONTRACTOR agrees that the performance shall be in strict compliance with the Act. In the event that the Contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the CONTRACTOR shall defend the OWNER in any action or administrative proceeding commenced pursuant to this Act. The Contractor shall indemnify, protect, and save harmless the OWNER, its 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 CONTRACTOR shall, at its own expense, appear, defend, and 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 grievance procedure, the CONTRACTOR 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 must any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the CONTRACTOR 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 CONTRACTOR along with frill 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 CONTRACTOR 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

CONTRACTOR pursuant to this contract will not relieve the CONTRACTOR 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 CONTRACTOR, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the CONTRACTOR expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the CONTRACTOR'S obligations assumed in this Agreement, nor shall they be construed to relieve the CONTRACTOR 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.

Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the contractor’s obligations assumed in this Agreement, nor shall they be construed to relieve the contractor 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.

Business Name (Print):

Representative’s Name (Print):

Representative’s Title:

Representative’s Signature:

Phone: Date:

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)

Partnership Limited 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 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.

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

Address

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

Full Name (Print):

Title:

Signature:

Date:

STATE OF NEW JERSEY

City of Cape May

I certify that I am _______________________________________________________________ of the firm of __________________________________________________________________ the Respondent making this Proposal for the bid or proposal for the above named project, that I executed the said proposal with full authority to do so; that said bidder has not, directly or indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and this affidavit are true, correct, and made with full knowledge that the City of Cape May relies upon the truth of the statements contained in said Proposals and in the statements contained in this affidavit in awarding the 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 selling agencies.

Signature of Representative:

Subscribed and sworn to before me this_________ day of ___________________, 20_______

Print Name of Affiant:___________________________________________________________

Notary Public of ____________________________

My commission expires_______________________

*This form MUST be completed, notarized and submitted with the bid document*

Non Collusion Affidavit