PROJECT MANUAL

for

Bid #26-22

SLUDGE HAULING

Town of Newton, Sussex County

New Jersey

November 19, 2026, at 11:00am

FAIR & OPEN PUBLIC SOLICITATION PROCESS

PURSUANT TO N.J.S.A. 19:44A-20.5 ET SEQ.

TOWN OF NEWTON

39 TRINITY STREET

NEWTON, N.J. 07860

NOTICE TO

BIDDERS

Notice is hereby given that on November 19,2026 at 11:00am (Prevailing time), electronically sealed bids will be opened and conducted in electronic platform in accord with N.J.A.C. 5:34-1 et. Seq., on BidNet Direct at www.bidnetdirect.com//townofnewton at which time and place the sealed bids will be opened publicly and read for the following:

Bid # 26-22 SLUDGE HAULING RE-BID

Bids shall be electronically uploaded, no physical bids shall be received, opened or honored.

NOTE:

it is the bidder’s responsibility to ensure that the bid package is delivered 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.

Contract documents may be obtained from the bid platform, for zoom opening information contact the Qualified Purchasing Agent at:

Sean P. Canning, QPA scanning@TheCanningGroup.org

The Town of Newton does not release the project estimate.

Bidders are required to comply with the requirements of N.J.S.A.10:5-31 et seq.

and

N.J.A.C. 17:27.

Bid Tabulation:

Bid results will be posted on BidNet Direct at www.bidnetdirect.com//townofnewton within 24 hours of the bid opening.

October 16, 2026 Thomas S. Russo, Jr.

Town Manager

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

X Acknowledgment 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 Subcontractors

Prior to Award, but effective at time of bid

X Business Registration Certificate – Bidder and all Subcontractors

Prior to

Contract

Award

Non-Collusion Affidavit

Prior to

Contract

Award

X Experience and Qualifications

Prior to

Contract

Award

X Insurance and Indemnification Certificate

Prior to

Contract

Award

X Disclosure of Investment Activities in Russia Form

Prior to

Contract

Award

X Disclosure of Investment Activities in Iran Form

Prior to

Contract

Award

Federal Debarment Form

Prior to

Contract

Award

EEO/AA Form AA-201

After Notice of

Award, Prior to

Signing

Contract

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

Certificate of Employee Information Report

After Notice of

Award, Prior to

Signing

X Bidder’s Checklist Prior to

Award

This checklist is provided for bidder’s use in assuring compliance with required documentation; however, it does not include all specification 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:

TOWN OF NEWTON

BID PROPOSAL FORM

SLUDGE AND LIQUID CHEMICAL WASTE TRUCKING

Bid No.: __________________ Bidder legal name: __________________________________

1. Pricing Schedule

Enter a firm unit price per gallon for each contract year. Unit prices include all labor, trucks, pumps, equipment, loading, transportation, fuel, insurance and incidentals required by the specifications, but exclude disposal charges. Estimated quantities are for bid comparison only and do not guarantee purchases.

Item Hauling service

Year 1 $/gal Year 2 $/gal

1A Sludge:

Newton

WWTP to

Passaic Valley

Sewerage

Commission

1B ALTERNATE:

Sludge:

Newton

WWTP to

Parsippany–

Troy Hills

Incinerator

2 Liquid chemical waste: Morris

Lake WTP to

Newton

WWTP

Award shall be made to the lowest responsible and responsive bidder based on the Total Base Bid, subject to all requirements of the bid documents and applicable law. Arithmetic extensions are subject to verification using the stated unit prices.

3. Contract and Service Acknowledgments

The bidder acknowledges the initial two-year contract term and any extensions only as permitted by

N.J.S.A. 40A:11-15 and the final contract documents. The bidder has examined the sites and specifications and will furnish necessary personnel, vehicles, pumps, backup equipment, licenses and insurance. Sludge hauling is generally performed 8:00 a.m.–4:00 p.m. Monday–Friday; additional requested sludge must be removed within 48 hours of verbal notification.

Company Name

Address

Signature of Authorized Agent Type or Print Name

Telephone Number Date

Fax Number E-mail address

TECHNICAL SPECIFICATIONS

Sludge and Liquid Chemical Waste Trucking Services

1. General Requirements

1.1 Scope. The Contractor shall provide all qualified personnel, licensed vehicles, pumps, hoses, connections, backup equipment, supervision, fuel, transportation, and incident response necessary to load and transport wastewater sludge and water filtration plant liquid chemical waste between the facilities identified below. Services shall be furnished on an as-needed basis as directed by the Town.

1.2 Contract term. The intended initial term is two (2) years, with any extension only if permitted by N.J.S.A.

40A:11-15, the bid documents, and written Town authorization. No extension is automatic.

1.3 Regulatory compliance. Contractor shall obtain and maintain all permits, registrations, licenses, vehicle approvals, and facility authorizations applicable to the particular waste stream and transport operation. Contractor shall comply with applicable federal, State, county, municipal, transportation, environmental, safety, and receiving-facility requirements. The Town may request documentary evidence before commencement and throughout the contract.

1.4 Site inspection. Bidders are responsible for examining site access, loading arrangements, hose connections, receiving-facility restrictions, and equipment requirements. Submission of a bid confirms the bidder can perform the services specified.

1.5 Pricing. Unit prices shall be per gallon actually transported, inclusive of loading, labor, equipment, transportation, ordinary pumping and incidentals. Disposal or tipping fees are excluded from trucking unit prices unless the bid documents expressly state otherwise. The Town shall not pay for unperformed work or guaranteed minimum quantities. The pricing and award methodology shall be as set forth in the Proposal Form.

2. Wastewater Treatment Plant Sludge Trucking

2.1 Origin and material

Town of Newton Wastewater Treatment Plant, end of Townsend Street, Newton, Sussex County, New Jersey.

Liquid digested sludge is removed primarily from the digester using the existing sludge loading station. Historical sludge solids content averages approximately 2% to 8%.

2.2 Authorized destinations

Primary: Passaic Valley Sewerage Commission, 600 Wilson Avenue, Newark, New Jersey. Alternate: Parsippany–

Troy Hills Incinerator, 1001 Parsippany Boulevard, Parsippany, New Jersey 07054. The Parsippany destination may be used ONLY upon prior written approval of the Superintendent of Public Works or other duly authorized Town official. The Town reserves the right to direct all or part of the sludge to either approved destination, subject to facility acceptance and applicable requirements.

2.3 Scheduling and response

Normal sludge loading hours are 8:00 a.m. to 4:00 p.m., Monday through Friday, excluding recognized legal holidays. The Contractor shall coordinate truck arrivals and loading with the Wastewater Treatment Plant Operator.

When additional sludge removal is requested, the Contractor shall provide hauling service within forty-eight (48) hours after notification by the Operator, unless the Town approves another schedule in writing.

2.4 Estimated quantities

The original specification estimated 60,000 to 175,000 gallons per month. Historical annual quantities were

2,047,500 gallons (2023), 1,921,500 gallons (2024), and 2,135,700 gallons (2025). These figures are informational only and do not guarantee work or payment. The Town shall establish the bid-evaluation quantity in the Proposal

Form before advertisement.

2.5 Loading, equipment and ventilation

The Contractor shall furnish compatible, adequately sized trucks and pumps, including a discharge pump capable of at least twenty (20) feet of head lift, plus functional backup equipment. The Town will make a suitable water supply available without charge through an existing hydrant approximately fifty (50) feet from the digester, subject to plant rules. The Contractor shall provide a suitable adapter and quick disconnect at the truck ventilation or pump outlet and connect the Town-provided ventilation hose before transferring plant solids. Odorous ventilation gases shall not be vented directly to atmosphere during transfer. The Contractor shall disconnect and secure the hose after transfer.

3. Water Filtration Plant Liquid Chemical Waste Trucking

3.1 Origin, material and destination

Origin: Town of Newton Water Filtration Plant, 60 Morris Lake Road, Sparta, New Jersey. Material is liquid chemical waste from the plant’s 10,000-gallon holding tank and loading station, with reported average solids content below 2%. Authorized destination: Town of Newton Wastewater Treatment Plant, end of Townsend Street, Newton, New Jersey. The Contractor shall not redirect the material to another destination without written Town authorization and required approvals.

3.2 Scheduling

Normal liquid chemical waste trucking operations shall occur between 9:00 a.m. and 4:00 p.m., Monday through

Friday, excluding recognized legal holidays. Site access is generally available between 8:00 a.m. and 4:00 p.m. The

Contractor shall coordinate loading and delivery with both facility operators.

3.3 Quantities

The prior specifications estimated 30,000 to 45,000 gallons per year, but reported historical quantities of 91,700 gallons (2019), 147,800 gallons (2020), and 151,700 gallons (2021). The Town must reconcile these figures and insert a single estimated annual evaluation quantity into the Proposal Form before advertisement. No quantity is guaranteed.

3.4 Equipment and handling

The Contractor shall provide appropriate vacuum or pumping equipment, hoses, fittings, leakproof transport vehicles, and backup equipment suitable for the material and tank configuration. A pump capable of at least twenty

(20) feet of head lift shall be available if required by the loading or discharge arrangement. Any hydrant or utility water use must be authorized by plant personnel. Where the plant requires vapor capture, the Contractor shall furnish a compatible adapter and quick disconnect and connect Town-provided ventilation hose before transfer; no uncontrolled venting shall be permitted.

4. Requirements Applicable to Both Services

4.1 Contractor responsibilities

The Contractor is responsible for safe filling, loading, containment, transportation, unloading, and lawful delivery of all material accepted for transport. Loads shall not exceed lawful vehicle weight or tank capacity. Vehicles shall be inspected and maintained to prevent leaks and discharge. The Contractor shall comply with receiving-facility procedures and promptly advise the Town of any rejection, delay, mechanical failure, or service interruption.

4.2 Spills, releases and cleanup

The Contractor shall immediately secure the area, stop and contain any release where safe, notify appropriate authorities and the Town, and undertake prompt cleanup and restoration in compliance with applicable law. The

Contractor shall bear costs of cleanup, remediation, restoration, fines, claims, and damages to the extent attributable to its operations, acts, or omissions. No material may be discharged into storm drains, soil, surface water, or other unauthorized locations.

4.3 Protection of property

The Contractor shall protect Town equipment, structures, pavement, piping, utilities, loading stations, and adjacent property. Damage caused by the Contractor, its personnel, vehicles, or subcontractors shall be promptly repaired or reimbursed at the Contractor’s expense, subject to applicable law.

4.4 Documentation and invoicing

For each load, the Contractor shall provide a dated ticket identifying the origin, destination, vehicle, material, measured gallons, and receiving-facility acknowledgment where available. Invoices shall itemize each load, applicable bid item, unit price, gallons, and extended amount. Payment shall be based on documented gallons actually transported and accepted, subject to Town verification. The Contractor shall retain records and provide them on request.

4.5 Insurance and indemnification

Before commencing work, the Contractor shall provide certificates and endorsements evidencing workers’ compensation as required by law, commercial general liability, automobile liability, and any owner’s protective liability coverage expressly required by the final bid package. The prior specifications called for personal injury liability limits of $1,000,000 per occurrence / $2,000,000 aggregate and property damage limits of $500,000 per occurrence / $1,000,000 aggregate. The Town and its counsel/risk manager shall confirm final coverage types, limits, additional-insured requirements, pollution coverage, and indemnification language before issuance. The

Contractor shall indemnify the Town to the extent set forth in the final General Conditions and permitted by law.

4.6 No exclusivity or minimum guarantee

All volumes are estimates. The Town may vary hauling schedules and quantities based on operational requirements.

The Contractor is entitled only to compensation for authorized, satisfactorily completed services.

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

SAMPLE CERTIFICATE OF EMPLOYEE INFORMATION REPORT

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.

New Jersey Business Registration Certification

Pursuant to N.J.S.A. 52:32-44, Town of Newton (“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.

Non-Collusion Affidavit

STATE OF NEW JERSEY

TOWN OF NEWTON:

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 Town of Newton 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 , Print Name of

Affiant:

Notary Public of

My commission expires

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

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.

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:

Please provide at least 3 references below:

Name: Phone:

Address:

Equipment/Service Provided:

Contract Amount:

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN

FORM

STATE OF NEW JERSEY

DEPARTMENT OF THE TREASURY - DIVISION OF PURCHASE AND

PROPERTY 33 WEST STATE STREET, P.O. BOX 230 TRENTON, NEW

JERSEY 08625-0230

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 nor entity, nor any of its parents, subsidiaries, or affiliates, is identified on the New Jersey Department of the Treasury’s Chapter

25 List as a person or entity engaged in investment activities in Iran. The Chapter 25 list is found on the Division’s website at https://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.

Vendors/Bidders must review this list prior to completing the below certification. If the Director of the Division of Purchase and Property finds a person or entity to be in violation of the 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.

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 its parents, subsidiaries, or affiliates is listed on the New Jersey 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 New Jersey Department of the Treasury’s Chapter 25 List. I will provide a detailed, accurate and precise description of the activities of the Vendor/Bidder, or one of its parents, subsidiaries or affiliates, has engaged in regarding investment activities in Iran by completing the information requested below.

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 State of New Jersey is relying on the information contained

Entity Engaged in Investment Activities Relationship to Vendor/ Bidder

Description of Activities

Duration of Engagement Anticipated Cessation Date

*Attach Additional Sheets If Necessary.

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

Signature Date

Print Name and Title

DPP Rev. 12.13.2021

CERTIFICATION OF NON‐INVOLVEMENT IN PROHIBITED

ACTIVITIES IN RUSSIA OR BELARUS

Pursuant to N.J.S.A. 52:32-60.1, et seq. (L. 2022, c. 3) any person or entity (hereinafter “Vendori”) that seeks to enter into or renew a contract with a State agency for the provision of goods or services, or the purchase of bonds or other obligations, must complete the certification below indicating whether or not the Vendor is identified on the

Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, available here:

https://sanctionssearch.ofac.treas.gov/. If the Department of the Treasury finds that a Vendor has made a certification in violation of the law, it shall take any action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party.

I, the undersigned, certify that I have read the definition of “Vendor” below, and have reviewed the Office of Foreign

Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, and having done so certify:

(Check the Appropriate Box)

A.

That the Vendor is not identified on the OFAC Specially Designated Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.

OR

B. That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially Designated

Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.

C.

That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially Designated

Nationals and Blocked Persons list. However, the Vendor is engaged in activity related to Russia and/or Belarus consistent with federal law, regulation, license or exemption. A detailed description of how the Vendor’s activity related to Russia and/or Belarus is consistent with federal law is set forth below.

(Attach Additional Sheets If Necessary.)

Signature of Vendor’s Authorized Representative Date

Print Name and Title of Vendor’s Authorized Representative Vendor’s FEIN

Vendor’s Name Vendor’s Phone Number

Vendor’s Address (Street Address) Vendor’s Fax Number

Vendor’s Address (City/State/Zip Code) Vendor’s Email Address i Vendor means: (1) A natural person, corporation, company, limited partnership, limited liability partnership, limited liability company, business association, sole proprietorship, joint venture, partnership, society, trust, or any other nongovernmental entity, organization, or group;

(2) Any governmental entity or instrumentality of a government, including a multilateral development institution, as defined in Section

1701(c)(3) of the International Financial Institutions Act, 22 U.S.C. 262r(c)(3); or (3) Any parent, successor, subunit, direct or indirect subsidiary, or any entity under common ownership or control with, any entity described in paragraph (1) or (2).

NJ Rev. 1.22.2024

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)

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

Full Name

(Print):

Signature: Date: