INVITATION TO SUBMIT PROPOSALS

FOR QUALIFYING SURVEYORS FOR THE YEAR 2027

WC2680FO

The Warren County Board of County Commissioners is soliciting proposals for

Qualifying Surveyors for 2027.

Proposals are being solicited through a fair and open process in accordance with

N.J.S.A. 19:44A-20.1, et seq.

Firms to provide Surveying Services will be selected by the Warren

County Board of County Commissioners or designee, based on an evaluation of the most advantageous technical proposal, price, and other factors considered.

Proposals will be evaluated on the basis of the following criteria:

1. Experience and reputation in the field.

2. Knowledge of the County of Warren and subject matter to be.

3. Knowledge of and compliance with the following:

a. State Agriculture Development Committee Farmland Preservation

Program Scope of Surveying Services and Standard Detail

Requirements Handbook for surveyors

b. the Uniform Standard of Professional Surveyor’s Practice

c. NJDEP Green Acres Program Regulations as they apply to Surveys

4. Other factors if demonstrated to be in the best interest of the County of

Warren.

SCOPE OF SERVICES

The County of Warren wishes to qualify surveyors for the use of the Warren

County Department of Land Preservation. Selection of a surveyor will be a two-step process. The Technical Evaluation Committee will review all complete “Qualification Statements” received and prepare a short list of selected surveyors to receive the “Request for Proposal”. The “Qualification

Statement” must contain the following information:

1. A statement that your firm is interested in performing the surveying work in accordance with the Agriculture Retention Program survey Handbook, Agricultural Retention Program Regulations, the Uniform Standard of

Professional Surveyor’s Practice and the NJDEP Green Acres Program

Regulations.

2. The address of the office where the work shall be performed.

3. Detail your experience in the field.

4. Detail your experience working with the County of Warren or its agents.

5. The Proposer will indemnify and hold the County of Warren harmless from any and all loss, damages, suits, penalties, costs, liabilities and expenses including, but not limited to, reasonable investigation and legal expenses arising out of, or under this Agreement. This indemnification includes, but is not limited to, responsibility covering liability for: 1) personal injury or property damage, 2) environmental liability, 3) damage for payment for the use of any patented or copy written material, process, article or devise that may enter into the manufacture or construction or form a part of the work covered by this Agreement, 4) for any statutory or administrative penalty for which the County may be held liable on account of the fault or default of the Proposer and 5) any and all damage or injury sustained on account of the default of the Proposer and costs and expenses in connection with remedying, repairing or completing the Proposer’s work.

Name of Firm

Name & Title (authorized person)

Signature

Address

The Warren County Board of County Commissioners reserves the right to reject any or all proposals and to waive immaterial formalities.

Sealed RFP responses must be received in the Offices of the Warren County

Purchasing Director no later than 1:30 p.m. on Friday, November 13, 2026 at which time they shall be publicly opened and read.

Proposals (one original and three copies) shall be submitted in a sealed envelope, marked as “SURVEYORS RFP RESPONSE” on the outside, to:

Director of Purchasing

Wayne Dumont Jr., Admin. Bldg.

165 Route 519 S.

Belvidere, NJ 07823

Respondents are expected to examine the RFP with care and observe all its requirements. All questions about the meaning or intent of this RFP, all interpretations and clarifications considered necessary by the Warren County Board of County Commissioners or their designee in response to such comments and questions will be issued by addenda delivered to all parties recorded as having received the RFP package. Only comments and questions responded to by formal written addenda will be binding. Oral interpretations, statements or clarifications are without legal effect.

Wherever the estimated quantities of work to be done are shown in any section of the RFP, they are given for use in comparing proposals. The owner especially reserves the right (except as herein otherwise specifically limited) to increase or diminish the quantities as may be deemed reasonably necessary or desirable by the owner to complete the work detailed by the contract. Such increase or diminution shall in no way violate this contract, nor shall any such increase or diminution give cause for claims or liability for damages.

LEGAL NOTICE – The Warren County Board of County Commissioners is soliciting proposals from Firms to provide Surveying Services for the Warren

County Board of County Commissioners Project WC2680FO. Deadline is

Friday, November 13, 2026, 1:30 p.m. Click here for more details. (Posted:

10/15/26)

PURCHASING DEPARTMENT

COUNTY OF WARREN

WAYNE DUMONT, JR. ADMINISTRATION BUILDING

165 COUNTY ROAD, 519 SOUTH

BELVIDERE, N.J. 07823-1949

MARIE S. WATTERS, QPA TELEPHONE: (908) 475-6573

DIRECTOR OF PURCHASING FAX: (908) 475-6555

TO: ALL VENDORS

FROM:

Marie S. Watters,QPA

Director of Purchasing

RE: Professional Service Contracts

When issuing Professional Service Contracts through resolutions, the following forms must be issued and/or provided by the contractor and all necessary forms completed, signed and/or provided and returned to

Warren

County:

-Non-Collusion Affidavit

-Statement of Ownership Disclosure

-Affirmative Action Exhibit A

-Required Evidence Affirmative Action Regulations

-New Jersey Business Registration Requirements

-Contract

-Certificate Employee Information Report

-Business Registration Certificate

-Liability Insurance Certificate

-Disclosure of Investment Activities with Iran

Certification of Non-Involvement in Prohibited Activities in Russia or Belarus

-Acknowledgement Receipt of Addenda (only if issued)

“NEW JERSEY BUSINESS REGISTRATION

REQUIREMENTS”

The contractor shall provide written notice to its subcontractors of the responsibility to submit proof of business registration to the contractor.

Before final payment on the contract is made by the contracting agency, the contractor shall submit an accurate list and the proof of business registration of each subcontractor or supplier used in the fulfillment of the contract, or shall attest that no subcontractors were used.

For the term of the contract, the contractor and each of its affiliates and a subcontractor and each of its affiliates [N.J.S.A. 52:32-44(g)(3)] shall collect and remit to the Director, New Jersey Division of

Taxation, the use tax due pursuant to the Sales and

Use Tax Act on all sales of tangible personal property is intended for a contract with a contracting agency.

A business organization that fails to provide a copy of a business registration as required pursuant to section 1 of P.L.2001,c.134(C.52:32-44 et al.) or subsection e. or f. of section 92 of P.L.1977, c.110(C.5:12-92), or that provides false business registration information under the requirements of either of those sections, shall be liable for a penalty of $25 for each day of violation, not to exceed $50,000 for each business registration copy not properly provided under a contract with a contracting agency.

STATEMENT OF OWNERSHIP DISCLOSURE

N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)

This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure to submit the required information is cause for automatic rejection of the bid or proposal.

Name of Organization:_________________________________________________________________

Organization Address:_________________________________________________________________

Part I Check the box that represents the type of business organization:

Sole Proprietorship (skip Parts II and III, execute certification in Part IV)

Non-Profit Corporation (skip Parts II and III, execute certification in Part IV)

For-Profit Corporation (any type) Limited Liability Company (LLC)

Partnership Limited Partnership Limited Liability Partnership (LLP)

Other (be specific): ______________________________________________

Part II

The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION)

OR

No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP

TO PART IV)

(Please attach additional sheets if more space is needed):

Name of Individual or Business Entity Address

Part III DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS

LISTED IN PART II

If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annual federal Security and Exchange

Commission (SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s) containing the last annual filing(s) with the federal Securities and Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filing(s) that contain the information on each such person. Attach additional sheets if more space is needed.

Website (URL) containing the last annual SEC (or foreign equivalent) filing Page #’s

Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part II other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed.

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

Address

Part IV Certification

I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to execute this certification on behalf of the bidder/proposer; that the <name of contracting unit> 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 <type of contracting unit> to notify the <type of contracting unit> 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 <type of contracting unit> to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print): Title:

Signature: Date:

NON-COLLUSION AFFIDAVIT

STATE OF NEW

JERSEY

ss:

COUNTY

I, _______________________________, of the city of in the county of __________________ and the state of of full age, being duly sworn according to law on my oath depose and say that: I am _______________ of the firm of

________________ the bidder making the Proposal of the above named project, and that I executed the said Proposal with full authority so to do; 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 in this affidavit are true and correct, and made with full knowledge that the County of Warren relies upon the truth of the statements contained in said Proposal 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 maintained by ________________________________

(N.J.S.A.52:34-15).

(name of contractor)

Subscribed and sworn to before me this _____ day

(also type or print name of affiant under signature) of ____________ 20 _____ notary public of

My commission expires __________ 20 __

SF3

(REVISED 4/10)

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

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. 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

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.

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN FORM (COUNTY OF WARREN)

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.

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

State of New Jersey 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 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. 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 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.

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

REQUIRED EVIDENCE

AFFIRMATIVE ACTION REGULATIONS P.L. 1975, c. 127 (N.J.A.C.

17:27)

If awarded a contract, all procurement and service contractors will be required to comply with the requirements of P.L. 1975, c. 127, (N.J.A.C.

17:27). Within seven (7) days after receipt of the notification of intent to award the contract or receipt of the contract, whichever is sooner, the contractor should present one of the following to the

Purchasing Agent:

1. A letter from the U.S. Department of Labor that the contractor has an existing,federally approved or sanctioned Affirmative

Action Program. OR

A Certificate of Employee Information Report Approval.

OR

2. An Affirmative Action Employee Information Report (Form AA302)

OR

3. All successful contractors must submit at signing of the contract, an Initial Project Manning Report (AA201), for any contract award that meets or exceeds the Public Agency bidding threshold (available upon request). NO FIRM MAY BE ISSUED A

CONTRACT UNLESS THEY COMPLY WITH THE

AFFIRMATIVE ACTION REGULATIONS OF P.L. 1975, c.127.

The following questions must be answered by all bidders:

1. Do you have a federally approved or sanctioned Affirmative

Action Program?

YES__________ NO__________

If yes, please submit a photostatic copy of such approval.

2. Do you have a State Certificate of Employee Information

Report Approval?

YES__________ NO__________

If yes, please submit a photostatic copy of such certificate.

THE UNDERSIGNED CONTRACTOR CERTIFIES THAT HE IS AWARE OF THE COMMITMENT TO

COMPLY WITH THE REQUIREMENTS OF P.L. 1975, c. 127 AND AGREES TO

FURNISH THE REQUIRED DOCUMENTATION PURSUANT TO THE LAW.

COMPANY

SIGNATURE

TITLE

NOTE: A CONTRACTOR’S BID MUST BE REJECTED AS NON-RESPONSIVE IF A

CONTRACTOR FAILS TO COMPLY WITH REQUIREMENTS OF P.L. 1975, c. 127, WITHIN

THE TIME FRAME.

WC 2680FO

COUNTY OF WARREN

CONTRACT AGREEMENT

THIS AGREEMENT made between the BOARD OF COUNTY

COMMISSIONERS of the COUNTY OF WARREN of BELVIDERE, NEW

JERSEY, party of the first part, and party of the second part.

WITNESSETH, that said party of the second part, for and in consideration of the payments hereinafter specified and agreed to be made by the party of the first part, hereby covenants and agrees to furnish and deliver all materials, goods or services in strict conformity with the contract documents hereto annexed, duly approved by said Board of

County Commissioners, adopted the day of ____________, which said contract documents are hereby made part of this Agreement as fully and with the same effect as if the same has been set forth in the body of this agreement.

THE PARTY of the first part agrees to make payment of all proper charges for materials and/or labor required in the aforementioned work as detailed in the bid of the party of the second part and the specifications of the party of the first part; the party of the second part agrees to indemnify, save, defend and hold harmless the party of the first part, its officers, agents and servants, and each and every one of them, against and from all suits, claims and costs of every kind and description and from all damages to which said party of the first part or any of its officers, agents or servants may be put, by reason of injury to the person or property of others resulting from the negligence in the performance of said work or through the negligence of said party of the second part or any of its officers, agents or servants or through any improper or defective machinery, implements, goods, materials or appliances negligently used or supplied by the party of the second part in the aforesaid work or through any negligent act or omission on the part of the said party of the second part or any of its officers, agents or servants.

IN CONSIDERATION OF these promises, the party of the first part hereby agrees to pay the party of the second part for said work when completed in accordance with the said specifications and within the time stated for the actual authorized work done under each item scheduled in the proposal at the respective prices bid therefore by the party of the second part, which payment, according to the services, _______________ per proposal.

All contracts are subject to the availability and appropriation of funds for the current year.

Additional funds may be certified upon adoption of the temporary and/or permanent budgets for the next fiscal year.

THIS AGREEMENT represents the full and complete understanding of the parties hereto and said parties warrant that there are no other representations or understandings between same regarding the subject matter hereof.

THIS CONTRACT is to be binding upon the party of the first part, its successors or assigns and upon the party of the second part and its successors or assigns.

IN WITNESS WHEREOF, the undersigned parties have caused this instrument to be executed this _______ day of _______________, _______ in accordance with the approved

Contract Documents and the resolution approving the award date _________. Either party may terminate this agreement, without cause, at any time upon thirty (30) days prior written notice to the other party.

BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WARREN

165 COUNTY ROUTE 519 SOUTH

BELVIDERE, NJ 07823-1949

ATTEST: ___________________________ BY: _____________________

Alex J. Lazorisak, Administrator/Clerk Lori Ciesla, Director

DATE: _______________________

(contractor)

(address)

ATTEST: BY:

(signature)

Print or type Name and Title Print or Type Name and Title

(CORPORATE SEAL)

COUNTY OF WARREN, NEW JERSEY

ACKNOWLEDGMENT OF RECEIPT OF ADDENDA

The undersigned Bidder hereby acknowledges receipt of the following Addenda:

ADDENDUM# DATE ACKNOWLEDGE RECEIPT

(Initial)

Acknowledged for: __________________________________

(Name of Bidder)

By:____________________________________

(Signature of Authorized Representative)

Name:__________________________________

(Print or Type)

Title:___________________________________

Date:____________________________________

FORM NOT REQUIRED IF NO ADDENDA ISSUED