DocsuSign_Forms.pdf

SWEATSHOPS

Ordinance 6 PH S&FH 080499

Pursuant to Ordinance 6 PH S&FH 080499, the City of Newark shall not purchase, lease, rent or take on the consignment of goods or services produced under sweatshop conditions.

Compliance I, the undersigned, have read, understand and comply with all aspects of Ordinance 6 PH S&FH 080499. I agree that if either I or the company I represent am found to be in non-compliance with any aspect of this Ordinance, the immediate termination of any established contract will be reasonable and justified.

Authorized Representative Title Date

Information to be completed by the Division of Central Purchasing

VENDOR:

BID PROPOSAL: /BidID/

BID ADVERTISEMENT: /BidAdvertDate/

BID PROPOSAL DUE DATE: /BidPropDueDate/

Ord6phs Rev. 5/15/18

Docusign Envelope ID: A0136864-92B4-4F8C-9B67-C8BB26EE49AE

Hufsa Chaudry

STATE REQUIRED RECORD RETENTION

N.J.S.A. 52:15c-14(d) and N.J.A.C. 17:44-2.2

I, THE UNDERSIGNED HAVE READ, UNDERSTAND AND COMPLY WITH ALL ASPECTS OF N.J.S.A.

52:15C-14(d) and N.J.A.C. 17:44-2.2.

I 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. Refusal by the company, as named below, and/or any legal change to the name, to provide information upon request by the State Comptroller, or otherwise impede or fail to cooperate with any audit or performance review, the State Comptroller may recommend to the City of Newark that the person be subject to termination of their contract, or temporarily or permanently debarred from contracting with the City of Newark.

Company Name :

Company Address:

Bid Proposal Title: /BidID/____________________________ _____________

Bid Advertisement Date: /BidAdvertDate/_________________________________________

Bid Proposal Due Date: /BidPropDueDate/________________________________ _________

REPUBLIC OF SUDAN

Ordinance 6 PH S&F-b112007

Pursuant to Ordinance 6 PH S&F-b112007, the City of Newark shall not accept bids for any goods, materials, supplies and services required by the City of Newark from any business entity having investments, licenses or operations in the Republic of Sudan.

Compliance

I, the undersigned, have read, understand and comply with all aspects of Ordinance 6 PH S&F-b112007. I agree that if either I, or the company I represent is found to be in non-compliance with any aspect of this Ordinance, the immediate termination of any established contract will be reasonable and justified.

VENDOR: _______________________________________________________________________________

Bid Proposal: /BidID/____________________________ _____________

Ord6phs&F-b

DCP

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 subcontract, 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.

EXHIBIT A (Cont.)

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; and

Employee Information Report Form AA-302

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. 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 Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.

COMPANY NAME:____________________________________________

AUTHORIZED SIGNATURE____________________________________

PRINTED NAME:_____________________________________________

Prohibited Russia-Belarus Activities & Iran Investment Activities

Person or Entity

Part 1: Certification

COMPLETE PART 1 BY CHECKING ONE OF THE THREE BOXES BELOW

Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter into or renew a contract, for goods or services must complete the certification below prior to contract award to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as a person or entity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods or services can be amended or extended, a person or entity must certify that neither the person or entity, nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list. Both lists are found on Treasury’s website at the following web addresses:

https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.

As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the below certification.

A person or entity unable to make the certification must provide a detailed, accurate, and precise description of the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or investment activities in Iran. The person or entity must cease engaging in any prohibited activities and provide an updated certification before the contract can be entered into.

If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may be 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.

CONTRACT AWARDS AND RENEWALS

I certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022,

c. 3 or in investment activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25

List"). I further certify that I am the person listed above, or I am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. (Skip Part 2 and sign and complete the Certification below.)

Docusign Envelope ID: A0136864-92B4-4F8C-9B67-C8BB26EE49AE

Hufsa Chaudry https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf

Part 2: Additional Information

PLEASE PROVIDE FURTHER INFORMATION RELATED TO PROHIBITED ACTIVITIES IN

RUSSIA OR BELARUS AND/OR INVESTMENT ACTIVITIES IN IRAN.

You must provide a detailed, accurate, and precise description of the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or investment activities in Iran in the space below and, if needed, on additional sheets provided by you.

CONTRACT AMENDMENTS AND EXTENSIONS

I certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate is listed on the N.J. Department of the Treasury’s lists of entities determined to be engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c. 3. I further certify that I am the person listed above, or I am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. (Skip Part 2 and sign and complete the Certification below.)

IF UNABLE TO CERTIFY

I am unable to certify as above because the person or entity and/or a parent entity, subsidiary, or affiliate is listed on the Department's Russia-Belarus list and/or

Chapter 25 Iran list. I will provide a detailed, accurate, and precise description of the activities as directed in Part 2 below, and sign and complete the Certification below. Failure to provide such will prevent the award of the contract to the person or entity, and appropriate penalties, fines, and/or sanctions will be assessed as provided by law.

Part 3: Certification of True and Complete Information

I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments there, to the best of my knowledge, are true and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person or entity.

I acknowledge that the City of Newark is relying on the information contained herein and hereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with the City of Newark to notify the City of Newark in writing of any changes to the answers of information contained herein.

I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification. If I do so, I recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the City of Newark and that the City of Newark at its option may declare any contract(s) resulting from this certification void and unenforceable.

Full Name

(Print)

Title

Signature Date

ATTACHMENT C

AMERICANS WITH DISABILITIES ACT OF 1996

Equal Opportunity for Individuals with Disability

The contractor and the owner do hereby agree that the provisions of Title 11 of the Americans with Disabilities Act of 199 (the "Act") (42 U.S.C. S121 01 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 there unto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the City of Newark 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 City of Newark in any action or administrative proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the City, 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’s 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 incurs 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 City of Newark shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim, if any action or administrative proceeding is brought against the City of Newark or any of its agents, servants, and employees, the City of Newark 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 City of Newark 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 City of Newark pursuant to this paragraph.

It is further agreed and understood that the City of Newark 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 City of Newark from taking any other actions available to it under any other provisions of the Agreement or otherwise at law.

Date Signature

REQUEST FOR CONSENT TO HOLD PRICES

Pursuant to N.J.S.A. 40A:11-24, The City of Newark and/or its Central Purchasing Division is requesting consent to hold prices from each Respondent/bidder submitting a Bid response package, in the event the contracting unit is unable to award a contract within sixty (60) days.

I, the undersigned, understand that this is a request from The City of Newark and/or its Central Purchasing Division for my company/business, submitting this Bid response package, to consent to hold prices in the event that there are any delays with the awarding of this contract and the City of Newark is unable to award the contract within sixty (60 days.

I consent/agree that the City of Newark and/or its Central Purchasing Division may hold my bid proposal for consideration until such time as an award is made, or until ____________ (Date consent expires). If no date is entered, my consent to hold prices is valid until an award is made and contract is executed.

VENDOR: ____________________________________________________________________

Bid Proposal: /BidID/____________________________ _____________ orm P-2ved 3/2/15

CITY OF NEWARK

POLITICAL CONTRIBUTION DISCLOSURE FORM

Required Pursuant To Newark Contractor Pay-to-Play Ordinance 6PSF-d (s) 06/22/2021

This form or its permitted facsimile must be submitted to the City of Newark no later than ten (10) days prior to the award of the contract.

Part I – Vendor/Business Entity (BE) Information

Vendor/BE

Name:

Address:

City: State: Zip:

The undersigned being authorized to certify, hereby certifies, under penalty of perjury, that the submission provided herein represents compliance with the provisions of Newark Contractor Pay-to-Play Ordinance 6PSF-d (s)

06/22/2021 as represented by the Ordinance accompanying this form. The Ordinance has been read and the

Vendor/BE is hereby in compliance.

Signature Printed Name Title & Date

Part II – Contribution Disclosure

Disclosure requirement: Pursuant to Newark Contractor Pay-to-Play Ordinance 6PSF-d (s) 06/22/2021 this disclosure must include political contributions reportable by the recipient under P.L.1973, c.83 (C.19:44A-1 et seq.).

If you have no contributions to disclose, you must write “None” in the Contributor Name column.

Contributor Name Recipient Name Date Dollar Amount

(If no contributors, please write-in

“NONE”)

Check here if additional information is continued on separate pages. All Information should be provided in the form set forth therein.

This is an official standardized form of the City of Newark.

This form may be photocopied, but reproducing, re-formatting, revising, and similar alterations are prohibited and will not be accepted.

City Form P-2

Rev. 8.6.2021

Continuation Page

CITY OF NEWARK

POLITICAL CONTRIBUTION DISCLOSURE FORM

Required Pursuant To Newark Contractor Pay-to-Play Ordinance 6PSF-d (s) 06/22/2021

Page ___ of ______

Vendor/BE Name: ___________________________________________

Contributor Name Recipient Name Date Dollar Amount

(If no contributors, please write-in ‘NONE’) $

Check here if the information is continued on subsequent page(s)

This is an official standardized form of the City of Newark.

This form may be photocopied, but reproducing, re-formatting, revising, and similar alterations are prohibited and will not be accepted.

City Form P-2

Rev. 8.6.2021

Compliance