esssex RFP_26-138_082923.pdf

NOTIFICATION

Every bid must be enclosed in a sealed envelope with the following information clearly written on the face of the envelope:

RFP Number:

Title of RFP:

Date of RFP:

and Opening Time of RFP.

The County of Essex disclaims any responsibility for bids forwarded by regular or overnight mail, or courier service. If the bid is sent by courier service, the designation above must also appear on the outside of the courier service company envelope or package. Bids received after the time of the scheduled opening will be returned unopened.

BIDDER MUST SUBMIT ONE (1)

ORIGINAL AND TWO (2) COPIES

PLEASE DO NOT SUBMIT DOUBLE-SIDED

BID COPIES

BIDS WILL BE OPENED IN THE OLD

CAFETERIA ACROSS FROM THE OFFICE

OF PURCHASING ROOM 335 IN THE

HALL OF RECORDS

COUNTY OF ESSEX, NEW JERSEY

O

F ESSEXCO

UN

TY

NEW JERSEY

REQUEST FOR PROPOSALS # 26-138

CONSTRUCTION ENGINEERING AND INSPECTION SERVICES FOR

BLOOMFIELD AVENUE IN NEWARK AND BELLEVILLE – 15

INTERSECTIONS – ESSEX COUNTY, FEDERAL PROJECT NUMBER

F00S(001), STATE JOB NUMBER 6114471

PROPOSAL DUE DATE AND TIME: July 31, 2026, at 11:00 AM

CONTACT PERSON: Julius N. Coltre

Office of Purchasing

Fax#: 973-621-5109

NOTE: All questions are to be submitted in writing to the Office of Purchasing

(via fax #973-621-5109 or email at procurequestions@admin.essexcountynj.org) no later than 4:30 PM at the end of business day, eight (8) business days prior to the proposal submission deadline (due date). The RFP number with the title must be in the email subject line. The specific page number and section each question refers to must be indicated. Only questions received by the Office of Purchasing will be answered and be considered official.

the Office of Purchasing will be answered and be considered official.

If the box contains a vendor submit the executed form. If a vendor must read.

RFP DOCUMENT CHECKLIST

Page

Π General Information

Σ Vendor Certification - sign 7

Σ Non-Collusion Affidavit Form - sign and notarize 8

Σ Statement of Ownership Disclosure - sign and notarize 9

Σ Hold Harmless Agreement 12

Σ Statement of Certain Political Contributions complete, sign and seal 13

Σ Applicant's Qualifications and Representations - complete 14

Σ Consent of Insurance Coverage - read and sign 20

X Applicant/Proposer's Affidavit - complete and sign 23

☑ Disclosure Statement

미 Mandatory Equal Employment Opportunity Language Exhibit A - read 25

Σ Affirmative Action Language Acknowledgement Form - sign 27

Σ Americans with Disabilities Act of 1990 Language - sign 29

Π Proof of Business Registration Certificate 30

Σ Vendor Information Sheet - Complete 32

Σ Iran Investment Activities- Complete and Sign 33

Σ Non-Involvement in Prohibited Russia-Belarus Activities

- Complete and Sign 34

Σ Authorization and Release- sign 35

Addenda Acknowledgement Form - sign

Specifications and Signature Page

Last

Pages

Essex County

- means read the item(s) Respondent Signature:

- means provide the required form(s)

Please initial each item below once executed

SUBJECT OF RFP:

GENERAL INFORMATION

REQUEST FOR PROPOSAL # 26-138

Construction Engineering and Inspection Services for 15 Traffic signals

REQUESTING AGENCY:

AGENCY CONTACТ:

Department of Public Works

Fax#: 973-621-5109

Office of Purchasing, Hall of Records, Room 335 465 Dr. Martin Luther King, Jr. Blvd.

Newark, New Jersey 07102

SUBMISSION REQUIREMENTS:

PROPOSAL ACTIVITIES:

1. Timetable:

RFP Release:

Proposer's Conference:

One (1) original and two (2) copies shall be sent to:

Julius N. Coltre

Director of Purchasing

Office of Purchasing, Hall of Records, Room 335

465 Dr. Martin Luther King, Jr. Blvd.

Newark, New Jersey 07102

Submission Deadline for Receipt of Proposal:

2. Proposers' Conference

N/A

3. Submissions of Proposals

June 30, 2026

N/A

July 31, 2026

To facilitate the evaluation process, proposer is to submit one (1) original and two (2) copies of the proposal and any supporting documentation. Additional copies may be requested at a later date for the selected proposal.

Proposals must be received by 11:00 a.m. on the Submission Deadline for Receipt of

Proposal (found on Page 3 of this document). Proposer mailing their proposals should allow sufficient mail delivery time to ensure receipt of their proposals by the deadline.

Delivery is the sole responsibility of the proposer.

Proposals are to be delivered or sent to:

Julius N. Coltre

Director of Purchasing

Hall of Records, Room 335

465 Dr. Martin Luther King Jr. Blvd.

Newark, New Jersey 07102

NOTE: ALL PROPOSALS ARE TO BE SEALED and clearly marked on the outermost packaging or envelope with the project name and project/bid number (see cover page) and must be received by mail or other method of delivery by no later than the submission deadline date and time so stated on the cover of this document.

4. Restriction on Contact with County Employees

From the issue date of the RFP until a determination is made regarding the selection of a proposal, all contacts with county employees on this matter must be cleared by the Agency

Contact person. Proposer shall not approach County personnel with respect to employment during this period.

5. Security of Proposals

The content of each proposal will be held in strictest confidence and no details of any proposal will be discussed with other proposer or anyone other than those employees consultants of the County involved in the evaluation process.

6. Prime Contractor Responsibilities or orIn the event that a proposal includes the performance of work by another vendor organization, it shall be mandatory for the prime contractor (i.e., the successful Proposer) to assume full responsibility for such tasks specified in the Proposal.

The County will contract only with the successful Proposer. The County will consider the prime Contractor to be the sole contract with regard to all provisions of the proposal.

Payment of all charges resulting from the negotiated contract shall be the Prime Contractor only.

7. Incurring Costs

The County of Essex is not liable for any cost incurred by Proposer in the preparation of proposals or for any work performed prior to the approval of an executed contract.

8. Notification of Selection

After the successful proposal has been selected, all Proposers will be notified of the results.

The name of the successful Proposer will be disclosed. Upon selection, the successful

Proposer will be invited to negotiate a contract with the County. The contents of the selected proposal, subject to possible updating due to negotiations, together with this RFP and any formal questions and answers disseminated during the proposal process will be incorporated with and made a part of the final contract as developed by the County. Should negotiations fail to result in a signed contract within two weeks, the County reserves the right to terminate negotiations and select the next most responsive Proposer.

9. Тype of Contract Anticipated

The County expects to enter into a contract subject to the approval of the Essex County

Board of County Commissioners. The conduct of the work described in this RFP is to be on either a "fixed fee" or "time and materials, not to exceed" basis.

10. Performance Period

The Performance Period is: From Date of Award by the Essex County Board of

Chosen Commissioners to Project Completion.

Basis of Award

The award of a contract will be made to that proposer whose proposal is deemed to be most advantageous to the County, cost and other factors considered. Where circumstances and/or the needs of the County significantly change, or the contract is otherwise deemed no longer to be in the public interest, the County of Essex may modify quantities or terminate a contract entered into as a result of this RFP, upon no less than thirty (30) days' notice to the vendor.

11. Open Public Records Act

Respondents should be aware that responses to this [Bid/RFQ/RFP] will be available, upon request, for public inspection. The County, as an instrumentality of the State of New Jersey, is subject to the New Jersey Open Public Records Act (N.J.S.A. 47:1A-1) and New Jersey

Right-to-Know statutory law and relevant case law.

12. Appearance at Governing Body Meeting

Be advised that for award of bid your organization may need to attend Essex County

Board of County Commissioners' meeting, unless otherwise notified by the county.

13. Stockholder Disclosure

Chapter 33 of the Public Laws of 1977 provides that no corporation or partnership shall be awarded any contract nor shall any agreement be entered into for the performance of any work or the furnishing of any materials or supplies, the cost of which is to be paid with or out of any public funds, by the State, or any county, municipality or school district, or any subsidiary or agency of the State, or of any county, municipality or school district, or by any authority, board, or commission which exercises governmental functions, unless prior to the receipt of the bid or accompanying the bid, of said corporation or said partnership, there is submitted a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own 10% or more of its stock, of any class or of all individual partners in the partnership who own a 10% or greater interest therein, as the case may be. If one or more such stockholder or partner is itself a corporation or partnership, the stockholders holding 10% or more of that corporation's stock, or the individual partners owning 10% or greater interest in that partnership, as the case may be, shall also be listed.

The disclosure shall be continued until names and addresses of every non-corporate stockholder, and individual partner, exceeding the 10% ownership criteria established this act, has been listed.

in

I, VENDOR CERTIFICATION

_, am duly authorized representative of

(Hereinafter referred to as "Vendor") who has submitted a proposal to provide the following services to the County of Essex (hereinafter referred to as "County").

NOTARY:

I have reviewed and I am aware of the representations made by the Vendor to the County in its proposal for said contract, dated

I am also aware that the County will rely upon said representations in the award of said contract and I certify that said representations made by the vendor are true and accurate.

Subscribed and sworn to before me this day of

Notary Public

My Commission expires:

(seal)

Vendor Signature

(Type or print name)

State of New Jersey

County of

NON-COLLUSION AFFIDAVIT

SS:

I, (name of affiant) municipality) residing in in the County of and State of being duly sworn according to law on my oath depose and say that:

(name of

_of full age, I am of the firm of

(title or position) the respondent entitled and that I executed the said Response with

(title of request)

(name of firm) full authority to do so that said respondent 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 Response and in this affidavit are true and correct, and made with full knowledge that the County of Essex relies upon the truth of the statements contained in said Response 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 feе, except bona fide employees or bona fide established commercial or selling agencies maintained by

Subscribed and sworn to before me this day of

Notary Public

My Commission expires:

(seal)

Signature

(Type or print name)

STATEMENT OF OWNERSHIP DISCLOSURE

N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, с.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 Il and III, execute certification in Part IV)

Non-Profit Corporation (skip Parts Il and III, execute certification in Part IV) For-Profit Corporation (any type)

Partnership Limited Partnership

Other (be specific):

Limited Liability Company (LLC)

Limited Liability Partnership (LLP)

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 Home Address (for Individuals) or Business 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 Il 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 Home Address (for Individuals) or Business 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 County of Essex 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 County of Essex to notify the County of Essex 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 County of Essex to declare any contract(s) resulting from this certification void and unenforceable.

Full Name

(Print):

Title:

Signature: Date:

Subscribed and sworn to before me this day of 20

Notary Public

My Commission expires

(seal)

HOLD HARMLESS AGREEMENT

BETWEEN: The County of Essex Hall of Records

465 Dr. Martin Luther King, Jr. Blvd.

Newark, NJ 07102

AND

Contractor's Name

Address - not a post office box

Telephone Number; Fax Number; & e-mail address

It is understood and agreed the Contractor is:

1. An independent Contractor and not an employee of the County of Essex.

2. The Contractor agrees to indemnify and hold harmless the County of Essex, the Essex

County Board of County Commissioners, and all of its respected elected officials, officers, agents and employees of and from and against any and all liability for damages for injury to person and property, including death, and from and against all suits and actions and all costs, damages and charges of whatsoever kind and nature, including attorneys' fees to which they or any of them may be put for, or on account of, any injury or alleged injury to person, including death, or property, resulting from the performance of the Contractor's operations under this contract, or by or in consequence of any neglect or omission on the part of the Contractor in the performance of operations under this contract, whether such operations, or the absence thereof, be by the Contractor or anyone directly or indirectly contracted with or employed by the Contractor.

3. The Contractor shall hold the County of Essex harmless for damages to the Contractor's equipment utilized during the term of this contract.

S/

President, Vice President or Signature of Authorized Representative

Print Name Title

Date

STATEMENT OF

CERTAIN POLITICAL CONTRIBUTIONS

MADE AFTER JULY 11, 1986

(This statement is part of the proposal packet)

Ordinance Number 0-86-0007, as amended by Ordinance Number 0-95-0003, adopted by the Board of County Commissioners of the County of Essex, requires that all proposals for negotiated contracts submitted by individuals and/or business entities seeking to provide goods or to perform services for the County of Essex shall contain a statement setting forth each political contribution by them of $500.00 or more made within five years next preceding the date of said contract, either directly or indirectly, to any County elected political official, County political party and/or County official, political organization, or any State political party.

Set forth name of County elected official, County political party and/or County official, political organization, or State political party to whom a political contribution of $500.00 or more was made by proposers within five (5) years of the date hereof.

If none, write "none".

Name Amount

Proposer:

By:

(Signature)

Name of Signatory:

(Print or Type)

APPLICANT/PROPOSER'S QUALIFICATIONS AND REPRESENTATIONS

The Applicant/Proposer makes the following statements and representations as part of the Proposal:

1. Applicant/Proposer (firm name or individual):

2. Address:

3. Federal Employee Identification Number:

4. How long have you been in business?

5. How long at present address?

6. If incorporated, state date of incorporation and in what state incorporated in and designate whether you are a Not-For-Profit corporation or other classification. (If not a domestic corporation, attach a copy of the Certificate of Authority issued by the Secretary of State of New Jersey pursuant to the General

Corporation Law).

7. List below names and addresses of all officers of the Corporation (attach additional sheet(s) if necessary):

Name Address Title

7a. List below the names and addresses of all members of the Board of Directors.

Name Address Title

7b. Has any corporation, partnership, association or individual, other than the stockholders(s) herein set forth upon the Stock Holder Certificate, any beneficial interest, directly or indirectly in the stock held by said stockholders?

yes no

If answer is "yes", state the name and address of the corporation, partnership, association or individual having such beneficial interest and specify the nature of such interest. If such beneficial interest is held by a corporation, attach rider giving answer as required in questions 1 through 7b with respect to that corporation.

8.

Are you a partnership?

If so, list names and addresses of all partners (attach additional sheet(s) if necessary):

9. If you are doing business under a trade name, give state and county in which certificate if filed.

10. Average number of employees:

11. Have you ever submitted a proposal on County of Essex business under another name?

If the answer is yes, list below the name or names:

12. Have you any outstanding bids or proposals for contracts with the County of Essex?

answer is yes, list them.

Subject Requesting Agency

13. Have you any current contract awards from the County?

please list them including the amount of the award.

Subject

If the

If the answer is Yes, Amount Awarding Agency

14. Describe any other contracts for professional services which you have entered into within the past three

(3) years beginning with the most recent to least recent (include agency or department name, brief description of the department contact person's name and telephone number). Applicant need not provide more than five (5) such descriptions. Attach additional sheets(s) as required.

15. Bank references.

16. Submit a copy of your most recent reviewed financial statement.

17. That the Applicant/Proposer and each person signing on behalf of any Applicant/Proposer certifies, and in the case of a joint proposal, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his/her knowledge and belief:

(a) The prices in the proposal have been arrived at independently without collusion, consultation, communication, or agreement for the purpose of restricting competition as to any matter relating to such prices with any other proposer or with any competitor,

(b) Unless otherwise required by law, the prices which have been quoted in the proposal have not been knowingly disclosed by the Applicant/Proposer and will not knowingly be disclosed by the

Applicant/Proposer prior to opening, directly or indirectly, to any other Applicant/Proposer or to any competitor;

(c) No attempt has been made or will be made by the Applicant/Proposer to induce any other person, partnership or corporation to submit or not to submit a proposal for the purpose of restricting competition;

(d) That no commissioner or other officer or employee or person whose salary is payable in whole or in part from the County Treasury is directly or indirectly interested in the proposal, or in the supplies, materials, equipment, work, or labor to which it relates, or in any of the profits thereof;

(e) That said Applicant/Proposer is not in arrears to the County of Essex upon any debt or contract, and is not a defaulter, as to surety or otherwise, upon any obligation to the County of Essex, and has not been declared not responsible, or disqualified, by an agency of the County of Essex or State of New

Jersey. Nor is there any proceeding pending relating to the responsibility or qualification of the Applicant/Proposer to receive public contracts except: (if none, Applicant/Proposer will insert "none").

18. That the Applicant/Proposer, if an individual, is of lawful age; that the Applicant/Proposer is the only one interested in this proposal; and that no person, firm or corporation other than that named has any interest in the proposal, or in the contract proposed to be taken.

19. That the Applicant/Proposer fully understands and submits its proposal with the specific knowledge that:

(a) All proposals must be approved by the County of Essex.

(b) In the event Applicant/Proposers proposal is accepted and receives all necessary approvals, the proposal will be incorporated into a contract containing provisions provided by the County of Essex, and that the resultant contract must be approved as to form by the County Counsel of the County of

Essex, and approved by the Board of County Commissioners of the County of Essex (if in an amount of $21,000.00 or more)

APPLICANT/PROPOSER'S 'QUALIFICATIONS AND REPRESENTATION

20. That the Applicant/Proposer certifies that it is duly licensed to do business in the State of New Jersey and will provide with the proposal all licenses necessary to perform their duties in the State of New

Jersey and to obtain necessary insurance coverage as directed by the County of Essex.

21. That the Applicant/Proposer will not alter the personnel assignments shown in the proposal without written consent of the County.

STANDARD PROFESSIONAL SERVICES AGREEMENT INSURANCE REQUIREMENTs

OUNTY OF ESSE

NEW JERSEY

Consultant, please promptly give this to your broker

These requirements constitute the Contract Insurance requirements

Throughout the life of this Contract, the Consultant shall pay for and maintain in full force and effect with an insurance company(s) (Company) admitted by the New Jersey Department of Banking & Insurance to do business in the State of New Jersey and rated not less than “A- VIII” in Best Insurance Key Rating Guide, the following policies of insurance:

REQUIRED COVERAGES - the following may be provided through a combination of primary and excess policies in order to meet the minimum limits set forth below:

1. Workers' Compensation and Employer's Liability:

Provided in the State of New Jersey and elsewhere as may be required and shall include:

a) Workers' Compensation Coverage:

b) Employers Liability Limits not less than:

Bodily Injury by Accident:

Bodily Injury by Disease:

Bodily Injury by Disease:

Statutory Requirements

$1,000,000 Each Accident

$1,000,000 Each Employee $1,000,000 Policy Limit

2. Commercial General Liability:

Occurrence Form with the following limits:

(1) Each Occurrence: $1,000,000

(2) General Aggregate: $2,000,000

Products/Completed Operations

a) Each Occurrence: $1,000,000

b) General Aggregate: $2,000,000

(3) Personal and Advertising Injury: $1,000,000

3. Professional Liability:

Claims Made Form with the following limits:

a. Per Occurrence/Claim: $1,000,000

b. General Aggregate: $2,000,000 Three (3) year tail coverage for Claims Made policies is required

4. Automobile Liability:

When autos are used in conjunction with contracts/agreements with Essex County entities coverage must include All Owned, Hired and Non-Owned vehicles.

a) Per Accident Combined Single Limit $1,000,000

5. Privacy Liability:

Provider of Professional Services shall maintain coverage for third party liability arising out of breach of privacy, inclusive of confidential and proprietary business information, HIPAA violations and other breaches of personally identifiable information and/or protected health information that may arise from their work with this contract. Minimum Limits of Liability:

a. Per Claim:

b. Aggregate:

6. Indemnification:

$1,000,000

$1,000,000

Provider of Goods and Services shall indemnify and hold harmless, the County, and the County's respective members, elected officials, employees, agents and representatives from and against claims, damages, losses, demands, suits, actions, recoveries, judgments, and costs and expenses, arising out of or resulting from performance of work, provided that such claim, damage, loss, or expense is attributable to bodily injury, sickness, disease, or death, or injury to or destruction of tangible property but only to the extent caused by the negligent acts or omissions of the Provider of Goods and Services, anyone directly or indirectly employed by them or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss, expense, is caused in part by any Indemnified Parties

7. Deductibles/Self-Insured Retentions:

Deductibles and Self-Insured Retentions must be declared. Provider of Goods and Services shall not have a Deductible or Self Insured Retention (SIR) on any policy greater than $25,000. Higher values must be approved by the County Risk Manager.

8. Additional Insurance Requirements:

a.

b.

C.

Each insurance policy required by this clause shall be endorsed to state that coverage shall not be cancelled by either party, except that after thirty (30) days' prior to written notice by certified mail, return receipt requested, has been given to the County. The Insurer shall provide the County with notification of any cancellation, non-renewal, major change, modification or reduction in coverage.

Regardless of these contract minimum insurance requirements, the Provider of Goods and Service's and its insurer shall agree to commit the Provider of Goods and Service's full policy limits and these minimum requirements shall not restrict the Provider of Goods and Service's liability or coverage limit obligations.

The Provider of Goods and Services shall furnish the County of Essex with the Insurance

Certificates and applicable Endorsements for all required insurance, prior to the County's execution of the Agreement and start of work. Proper Address for Certificates, Endorsements and Notices shall be:

County of Essex

Risk Management Department Hall of Records/Room 510

465 Dr. Martin Luther King Blvd.

Newark, NJ 07102

d. Provider of Goods and Services shall waive all rights of recovery against the County and all the additional insureds for loss or damage covered by any of the insurance maintained by the Provider of Goods and Services, where applicable by law.

Sworn to and subscribed before me on this day of 20

NOTARY PUBLIC

PRINCIPAL:

(Respondent's Company Name)

(Authorized Signature on Behalf of the Principal)

(Print Name)

INSURER:

(Insurer's Company Name)

(Authorized Signature on behalf of the Insurer)

APPLICANT/PROPOSER'S AFFIDAVIT

The following affidavit must be subscribed and sworn to before a Notary Public or Commissioner of Deeds.

(If the applicant is an individual he must be the subscriber; if applicant is a partnership, one of the partners must be the subscriber; if applicant is a corporation, the affidavit must be subscribed by an officer of the corporation who must state what office he holds).

STATE OF NEW JERSEY

COUNTY OF

SS:

AFFIDAVIT

The undersigned hereby certifies to the truth and accuracy of all statements, answers and data contained in this proposal and application, and hereby authorizes the County of Essex to make any necessary examination or inquiry in order to make a determination as to his qualifications and responsibility. The undersigned has examined all parts of the Request for Proposal and understands that it is completely discretionary with the County officials whether to accept, reject, or negotiate its proposal submitted pursuant thereto.

Signature of Applicant

Print/Type Name

Title

Sworn to before me this day of 20

Notary Public or Commissioner of Deeds

DISCLOSURE STATEMENT

The attention of prospective vendors is drawn to the provisions of the Local Government Ethics Law (N.J.S.A. 40A:9-22-1, et seq.)

which prohibits a County Officer or employee or member of his/her immediate family from having an interest in a business organization or engaging in any business transaction, or professional activity which is in substantial conflict with the proper discharge of his/her duties in the public interest.

In furtherance thereof, every vendor must disclose below, being an Essex County officer or employee or whether an immediate family member is an Essex County officer or employee. If the vendor is a business organization, then disclosure shall be made with respect to anyone having an interest in the business and their immediate family members.

Please answer the following:

Is the vendor or a member of the vendor's immediate family, or anyone having an interest in the vendor's business organization including their immediate family members, an officer or employee of Essex County?

NO

S

YES

* President, Vice President or Signature of

Authorized Representative

Print Name

Title

If yes, provide the name of the individual and identify the position held, below, and notify in writing the Office of County Counsel, Hall of Records, 465 Dr. Martin Luther King, Jr. Blvd., Room 535, Newark, NJ 07102. (Attach a copy of the correspondence to this form).

NOTE: All terms used herein are to be construed in accordance with their meaning under the Local Government Ethics Law, cited above.

EXHIBIT A

(revised 4/10)

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE

N.J.S.A. 10:5-31 et seq. (P.L. 1975, С. 127) N.J.A.C. 17:27

GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE 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. 17:27-5.2.

it

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 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

Employee Information Report Form AA302 (electronically provided by the Division and distributed to the public agency through the Division's website at www.state.nj.us/treasury/contract~compliance)

The contractor and its subcontractors shall furnish such reports or other documents to the Division of Public

Contracts Equal Employment Opportunity Compliance 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 Public Contracts Equal Employment Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C.

17:27.

AFFIRMATIVE ACTION COMPLIANCE NOTICE

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

GOODS AND SERVICES CONTRACTS

(INCLUDING PROFESSIONAL SERVICES)

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

The successful respondent 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 Sample of Certificate

YEE INFORMATION

(b) A photocopy of a Certificate of Employee Information

Report approval, issued in accordance with N.J.A.C. 17:27-4;

OR

JORGENSEN

VAYHE, NJ 07 bahbtreon L elpmes only

(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 et seq. and N.J.A.C.17:27 and agrees to furnish the required forms of evidence.

The undersigned vendor further understands that his/her response shall be rejected as non-responsive if said contractor fails to comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C.17:27.

COMPANY:

PRINT NAME:

DATE:

SIGNATURE:

TITLE:

PLACE HERE

A COPY OF THE

CERTIFICATE OF

EMPLOYEE INFORMATION

REPORT

Certification 9666

CERTIFICATE OF EMPLOYEE INFORMATIÓNION REPORT

RENEWALHE

This is to certify that the contractop listed below has submitfed an Employee Information Report pursuant to N.J.A.C. 17:27-1.1 et seq. and traState Trensurer has approved said report. This approval witl remain in offect for the period of 5-FEB 2004 1015-FEE-2007

JORGENSEN

10 SHERLOCK

WAYNE NJ 07470

L sample onl

F H E

C R E

S E

State Treasurer

AMERICANS WITH DISABILITIES ACТ

EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABILITIES

The contractor and the County of Essex, (hereafter "Owner") do hereby agree that the provisions of Title 11 of the

Americans With Disabilities Act of 1990 (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 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 contractor agrees that the performance shall be in strict compliance with the Act. In the event 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'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 Owner 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 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 relieve the contractor from any liability, nor preclude the Owner from taking any other actions available to it under any other provisions of this Agreement or otherwise at law.

to

S/

President, Vice President or Signature of Authorized Representative

Print Name

Title Date

PROOF OF BUSINESS REGISTRATION (Revised)

Pursuant to PL 2004, Chapter 57, each respondent (contractor) is required to be registered at or before time of response award.

Proof of registration shall be a copy of the respondent's Business Registration Certificate (BRC), which must be submitted by or before award of contract. A BRC is obtained from the New Jersey Division of Revenue.

A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed $50,000 for each business registration not properly provided or maintained under a contract with a contracting agency. The NJ State website address for getting registered is as follows: www.nj.gov/treasury/revenue/busregcert.shtml contact the state by phone at (609) 292-1730.

N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly provide goods or perform services for a contractor fulfilling this contract:

1) The contractor shall provide written notice to its subcontractors and suppliers to submit proof of business registration to the contractor;

2) Prior to receipt of final payment from a contracting agency, a contractor must submit to the contacting agency an accurate list of all subcontractors or attest that none was used;

3) During the term of this contract, the contractor and its affiliates shall collect and remit, and shall notify all subcontractors and their affiliates that they must collect and remit to the Director, New Jersey Division of Taxation, 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 this State.

A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed $50,000 for each business registration not properly provided or maintained under a contract with a contracting agency. Information on the law and its requirements is available by calling (609) 292-9292.

PLEASE NOTE: NON-PROFIT ORGANIZATIONS ARE EXEMPT-HOWEVER, NON-PROFIT

ORGANIZATIONS MUST PROVIDE A COPY OF THEIR 501C STATUS OR EQUIVALENT

TAX REG ACCOUNT CLIENT REGISTRATIO

970-097-382/50 0107

JANC

TRESTON NGA 07/14/04

Jul s Tuth

0 00 22

STATE OF NEW JERSEY

BUSINESS REGISTRATION CERTIFICATE

Taxpayer Name: TAX REG TEST ACCOUNT

Trade Name:

Address:

Certificate Number

Date of Issuance:

847 ROEBLING AVE

TRENTON, NJ 08911

1093907

October 14, 2004

For Office Use Only:

20041014112823533

AS A PROFESSIONAL

COURTESY,

PLEASE PLACE HERE

A PHOTOCOPY OF

YOUR NJ BRC

VENDOR'S INFORMATION SHEET

Please fill in the following information and submit with your Response:

COMPANY/RESPONDENTS NAME:

ADDRESS:

PHONE NUMBER:

FAX NUMBER:

FEDERAL I.D. NUMBER:

NAME OF PERSON PREPARING RESPONSE:

REMITTANCE NAME:

REMITTANCE ADDRESS

REMITTANCE ADDRESS:

REMITTANCE PHONE: PERSON TO CONTACТ:

FAX NUMBER:

PROJECT MANAGER/POINT OF CONTACТ

COMPANY NAME:

ADDRESS:

PHONE NUMBER:

CELL PHONE NUMBER:

PAGER NUMBER:

FAX NUMBER:

PERSON TO CONTACT:

EMAIL ADDRESS:

EMPLOYER I.D. # or S.S. #:

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN FORM

BID SOLICITATION # AND TITLE:

VENDOR NAME:

Pursuant to N.J.S.A. 52:32-57, et seq. (P.L. 2012, c.25 and P.L.2021, c.4) any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must certify 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 on the Division's website at www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Vendors/Bidders must review this list prior to completing the below certification. 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

Π

CHECK THE APPROPRIATE BOX

I certify, pursuant to N.J.S.A. 52:32-57, et seq. (P.L. 2012, c.25 and P.L.2021, c.4) that neither the Vendor/Bidder listed above nor any of the bidder's parents, subsidiaries, or affiliates is listed on the N.J. Department of the Treasury's Chapter 25 List of entities determined to be engaged in prohibited activities in Iran.

OR

I am unable to certify as above because the Vendor/Bidder and/or one or more of its parents, subsidiaries, or affiliates

☐ is listed on the Department's Chapter 25 list. I will provide a detailed, accurate and precise description of the activities of the Vendor/Bidder, or one of it's parents, subsidiaries or affiliates, has engaged in regarding investment activities in

Iran by completing the information requested below.

Entity Engaged in Investment Activities

Relationship to Vendor/Bidder

Description of Activities

Duration of Engagement

Anticipated Cessation Date

*Attach Additional Sheets if Necessary

CERTIFICATION

I, the undersigned, certify that I am authorized to execute this certification on behalf of the Vendor, that the foregoing information and any attachments hereto, to the best of my knowledge are true and complete.

I acknowledge that the County of Essex is relying on the information contained herein, and that the Vendor is under a continuing obligation from the date of this certification through the completion of any contract(s) with the County of Essex to notify the County of Essex in writing of any changes to the answers of information contained herein; 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 may be subject to criminal prosecution under the law, and it will constitute a material breach of my contract(s) with the County of Essex, permitting the County of Essex to declare any contract(s) resulting from this certification void and unenforceable.

Signature Date

Print Name and Title

Updated 10/21/22

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…