Letter_of_Qualification_and_Letter_of_Intent__(17)_(Worker's_Comp)_(1).docx

APPENDIX A

LETTER OF QUALIFICATION

(Note: To be typed on Respondent’s Letterhead. No modifications may be made to this letter.)

Kenyatta K. Stewart, Corporation Counsel

Room 316 Newark, New Jersey 07102

Dear Mr. Stewart:

The undersigned have reviewed our Qualification Statement submitted in response to the Request for Qualifications (RFQ) issued by the City of Newark (“City”), dated Tuesday, October 21, 2025, in connection with the City’s need for Worker’s Compensation Counsel Services (Re-bid) for the City of Newark.

We affirm that the contents of our Qualification Statement (which Qualification Statement is incorporated herein by reference) are accurate, factual and complete to the best of our knowledge and belief, and that the Qualification Statement is submitted in good faith upon express understanding that any false statement may result in the disqualification of __________________.

(Name of Respondent)

(Respondent shall sign and complete the spaces provided below. If a joint venture, appropriate officers of each company sign.

(Signature of Chief Executive Officer) (Signature of Chief Financial Officer)

(Print Name and Title)

(Print Name and Title)

*If a joint venture, partnership or other formal organization is submitting a Qualification Statement, each participant shall execute this Letter of Qualification.

APPENDIX B

LETTER OF INTENT

(Note: To be typed on Respondent’s Letterhead. No modifications may be made to this Letter.)

Kenyatta K. Stewart, Corporation Counsel

Room 316 Newark, New Jersey 07102

Dear Mr. Stewart:

This undersigned as Respondent, has (have) submitted the attached Qualification Statement in response to a Request for Qualifications (RFQ) issued by the City of Newark (“City”), dated Tuesday, October 21, 2025, in connection with the City’s need for Worker’s Compensation Counsel Services (Re-bid).

(Name of Respondent) HEREBY STATES:

1. The Qualifications Statement contains accurate, factual and complete information.

2. (Name of Respondent) agrees (agree) to participate in good faith in the procurement process as described in the RFQ and to adhere to the City’s procurement schedule.

3. (Name of Respondent) acknowledges (acknowledge) that all costs incurred by it (them) in connection with the preparation and submission of the Qualification Statement and any proposal prepared and submitted in response to the (RFQ), or any negotiation which results therefrom shall be borne exclusively by the Respondent.

4. (Name of Respondent) hereby declares (declare) that the only persons participating in this Qualification Statement as Principals are named herein, and that no person other than those herein mentioned has any participation in the Qualification Statement or in any contract to be entered into with respect thereto. Additional persons may subsequently be included as participating Principals, but only if acceptable to the City. (Name of Respondent) declares that the Qualification Statement is made without connection with any other person, firm or parties who has submitted a Qualification Statement except as expressly set forth below and that it has been prepared and has been submitted in good faith and without collusion or fraud.

5. (Name of Respondent) acknowledges and agrees that the City may modify, amend, suspend and/or terminate the procurement process (in its sole judgment). In any case, the City shall not have any liability to the Respondent for any costs incurred by the Respondent with respect to the procurement activities described in this RFQ.

6. (Name of Respondent) acknowledges that any contract executed with respect to the provision of (insert service) must comply with all applicable affirmative and similar laws. Respondent hereby agrees to take such actions as are required in order to comply with such applicable laws.

7. (Respondent shall sign and complete the space provided below. If a joint venture, appropriate officers of each company shall sign).

(Signature of Chief Executive Officer)

(Print Name and Title)

(Print Name of Organization)

Date: _____________

(INSERT DATE)

*If a joint venture, partnership or other formal organization is submitting a Qualification Statement, each participant shall execute this Letter of Intent.