BOROUGH OF LINCOLN PARK BID PACKAGE 2018 CELL TOWER CO-LOCATOR. Bid Opening Date August 7, 2018 Time 10:00 AM

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1 Morris County New Jersey BID PACKAGE 2018 CELL TOWER CO-LOCATOR Bid Opening Date August 7, 2018 Time 10:00 AM BOROUGH OF LINCOLN PARK Dr. David Runfeldt, Mayor Louis Pepe, Council President Ann Thompson, Council Member Raymond Kerwin, Council Member James Wild, Council Member Gary Gemian, Council Member Ellen Ross, Council Member Dan Moeller, Council Member Submitted by:

2 TABLE OF CONTENTS PROJECT DESCRIPTION... 1 BID PROPOSAL FORM... 1 CHECK LIST OF REQUIRED DOCUMENTS... 1 ACKNOWLEDGEMENT OF ADDENDA... 3 AFFIRMATIVE ACTION CERTIFICATION... 4 EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS... 5 AMERICANS WITH DISABILITIES ACT... 9 STATEMENT OF OWNERSHIP OWNERSHIP DISCLOSURE PREVAILING WAGE CERTIFICATION OF COMPLIANCE SUBCONTRACTOR CERTIFICATION DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN RESPONSIBLE BIDDER CERTIFICATION AFFIDAVIT OF NON-COLLUSION RESPONSIBLE BIDDER S CHECKLIST EXPERIENCE, PERFORMANCE, AND FINANCIAL CAPABILITY QUESTIONS INSURANCE CERTIFICATION TAXPAYER IDENTIFICATION EQUIPMENT CERTIFICATION DEBARMENT CERTIFICATION RESPONSIBILITY ACKNOWLEDGEMENT INSTRUCTIONS FOR BIDDERS... 1 DEFINITIONS... 1 RESPONSIBLE BIDDER INFORMATION... 2 RECEIPT OF BID... 2 PROPOSAL FORM... 3 SIGNATURE ON PROPOSAL FORM... 3 BRAND NAMES, STANDARDS OF QUALITY, PATENTS... 3 CHALLENGES... 4 ADDENDA AND CLARIFICATIONS... 4 EQUAL OR TIE BIDS... 5 WITHDRAWING A BID... 5 REJECTION OF BIDS... 5 PROCEDURES ON AWARD OF CONTRACT... 5 NOTIFICATION OF AWARD... 5 ASSIGNING THE CONTRACT... 5 MULTI YEAR CONTRACTS... 5 TERMINATION OF CONTRACT... 5 i

3 PAYMENT... 6 THE LEASE... 6 PURCHASING AGENTS CONTROL... 7 FAMILIARITY WITH THE PROJECT AND SITE... 7 INSURANCE... 7 ACCIDENTS, INJURIES, DAMAGES... 9 INDEMNIFICATION... 9 LIENS AND CHATTEL MORTGAGES AUTHORITY AND DUTIES OF INSPECTORS PERMITS CONTRACTOR'S SUPERINTENDENT INTOXICATING BEVERAGES COMPLIANCE WITH LAWS NEW JERSEY PREVAILING WAGE ACT THE PUBLIC WORKS CONTRACTOR REGISTRATION ACT BUSINESS REGISTRATION CERTIFICATE AFFIDAVIT OF NON-COLLUSION NON-DISCRIMINATION REQUIRED AFFIRMATIVE ACTION EVIDENCE WORKER AND COMMUNITY RIGHT TO KNOW ACT ACQUISITIONS, MERGER, SALE AND/OR TRANSFER OF BUSINESS, ETC STATEMENT OF OWNERSHIP POLITICAL CONTRIBUTIONS PROHIBITED CONTRACT AWARDS DISPUTE RESOLUTION SCOPE OF WORK... 1 TS.1 SAMPLE LEASE... 2 WIRELESS TELECOMMUNICATIONS LEASE... 2 TS.2 EXISTING T-MOBILE AGREEMENT TS.3 SITE DRAWINGS TS.4 POLE AND FOUNDATION DRAWINGS... 1 TS.5 POLE DESIGN SPECIFICATIONS TS.6 POLE SHOP DRAWINGS... ERROR! BOOKMARK NOT DEFINED. ii

4 NOTICE TO BIDDERS NOTICE IS HEREBY GIVEN that sealed bids will be received by the Purchasing Agent of the Borough of Lincoln Park on August 7, :00 AM local prevailing time in the Meeting Room at Borough Hall, 34 Chapel Hill Road, Lincoln Park, NJ 07035, at which time and place bids will be opened and read in public for: CELL TOWER CO-LOCATOR PROJECT DESCRIPTION The Borough is accepting Bids for the lease of a co-location height on the cell tower located on Borough property, at the Department of Public Work Site, George Cobb Lane, Lincoln Park, New Jersey. Specifications and other Bid information may be reviewed and obtained at the Borough Administrator s Office during regular business hours 8:00 am to 4:00 pm. Bid documents are available free of charge for download, in a.pdf format, on the Borough s website or may be picked up at the Borough Administrator s office. Bid documents will not be ed. Any notices of addenda, cancellations or postponements may also be found at Questions shall ed to Borough Administrator Perry T. Mayers at pmayers@bolp.org. Bidders are required to comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-1 et seq. Bids must be submitted on the proposal forms contained in the Bid package. Bids must be in a sealed envelope, bearing the name and address of the Bidder and the name of the Project. This information must be clearly marked on the outside of the envelope and addressed to the Purchasing Agent in the following format: Bid #: Bid Title: Cell Tower Co-Locator If the Bid is sent by overnight or express mail, the above designation shall also be clearly marked on the outside of the courier company envelope. Any proposal received not complying with these requirements shall not be opened and shall be returned to sender marked Unresponsive. Perry T. Mayers, Borough Administrator and Q.P.A. Purchasing Agent Lease NTB-1

5 BID PROPOSAL FORM This Bid is for the lease of a co-location height on the cell tower located on Borough property, Department of Public Works Site, George Cobb Lane, Lincoln Park, New Jersey. The Successful Bidder agrees to enter into a contract to lease a co-location site, as awarded, for a period of five years, with the option to renew for four successive periods of five years in accordance with the Wireless Telecommunications Lease, Item 7.e Terms, Options to Renew and the requirements of this entire Bid Document ( Bid Document ). The undersigned states that they have read and fully understands the Scope of Work, Wireless Telecommunications Site Lease, General Conditions, Information for Bidders, exhibits and all other requirements contained in this Bid Document The undersigned also agrees to provide agrees to furnish and deliver all materials and to perform all work in accordance with these Bid Documents. The undersigned therefor submits the following Bid Amount at no less than the minimum acceptable annual lease amount of $36,000 per year. Lump Sum Per Year Lease Amount in Words LS $ LS Lump Sum Per Year Lease Amount in Numbers The Borough of Lincoln Park has the right to accept bids or reject bids that are not in the best interest of the Borough. The undersigned also acknowledges that they shall comply with all state, federal and local laws and regulations as applicable to this Bid whether or not they are specified in this Bid Document. Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Federal I.D. # or Social Security # Address Telephone Number Fax Number address Lease P-1

6 CHECK LIST OF REQUIRED DOCUMENTS All items checked below shall be initialed as acknowledgement of inclusion in the Bid submission These are MANDATORY requirements of this Bid package. Failure to complete and include the following documents/pages, as checked, with your bid submission SHALL result in your Bid being disqualified: Bid Proposal Forms. Hard copy of Bid Proposal on the Proposal Forms contained in this Bid package with supporting documentation Checklist of Required Documents, signed below Initials Acknowledgement of Addenda (as applicable) Affirmative Action Certification Equal Employment Opportunity Americans With Disabilities Act Statement of Ownership Ownership Disclosure Prevailing Wage Certification of Compliance Contractor Listing (as applicable) Disclosure of Investment Activities in Iran Responsible Bidder Certification These items are REQUESTED of this bid package: Failure to complete and include the following documents/pages, as checked, with your bid submission MAY result in your bid being disqualified or a request for clarification issued. Affidavit of Non-Collusion Responsible Bidder Checklist Experience, Performance, and Financial Capability Questions Insurance Certification Taxpayer Identification (W-9) Completed Equipment Certification Debarment Certification Responsibility Acknowledgement Initials Q-1

7 All document checked below shall be initialed as acknowledgement of these additional document requirements. Prior to Award of the contract the following documents, as checked, shall be submitted: Public Works Contractor Certification(s) (contractors and subcontractors) Business Registration Certificate(s) (contractors and subcontractors) After Award of the contract the following documents, as checked, shall be submitted: Signed Contracts Security Deposit in the amount of 1 years lease Payment Bond Performance Bond (see exhibits) Affirmative Action Certificate, AA302 or letter of approval Initial Project Workforce Report (AA201) Contractor: Certificate of Insurance for the length of the Project naming the Borough of Lincoln Park as an additional insured for the Cell Tower Co-Locator Project Subcontractors: Certificate of Insurance for the length of the Project naming the Borough of Lincoln Park as an additional insured for the Cell Tower Co-Locator Project Prior to Final Approvals being made the following items, as checked, shall be submitted: Final List of Subcontractors Final Certified Payroll Maintenance Bond As Constructed Drawings Warrantees Any other documentation required under the Scope of Work Initials Initials Initials EACH REQUIRED ITEM CHECKED ABOVE MUST BE INITIALED IN THE SPACE PROVIDED AS ACKNOWLEDGEMENT OF THE DOCUMENTS THAT ARE INCLUDED AND THE DOCUMENTS TO BE PROVIDED BEFORE AND AFTER THE AWARD. THIS CHECKLIST MUST BE SIGNED AND SUBMITTED WITH THE BID PACKAGE. Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-2

8 ACKNOWLEDGEMENT OF ADDENDA Receipt of Changes to Bid Documents Form Pursuant to N.J.S.A. 40A: a, the undersigned hereby acknowledges receipt of the following notices, revisions, or addenda to the bid advertisement, specifications or bid documents. By indicating date of receipt, bidder acknowledges the submitted bid takes into account the provisions of the notice, revision or addendum. Note that the local unit s record of notice to bidders shall take precedence and that failure to include provisions of changes in a bid proposal may be subject for rejection of the bid. Note Clarifications issued in response to Q&A are NOT considered addenda as they do not substantially change the bid documents, and NOT required to be reported on this form. Addendum Number How Received ( , pick-up, etc.) Date Received Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-3

9 AFFIRMATIVE ACTION CERTIFICATION This form is a summary of the successful bidder s requirement to comply with the requirements of N.J.S.A. 10:5-31 (P.L 1975, c.127) and N.J.A.C 17:27-1 et seq.. The successful Bidder 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 (b) A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4; OR (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 Bidder 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 certifies that they are aware of the commitment to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27 et seq. and agrees to furnish the required forms of evidence. The undersigned further understands that this bid shall be rejected as non-responsive if said Contractor fails to comply with these requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27 et seq.. Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-4

10 (REVISED 4/10) EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 CONSTRUCTION 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, up-grading, 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 or workers' representative of the contractor's commitments under this act 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. When hiring or scheduling workers in each construction trade, the contractor or subcontractor agrees to make good faith efforts to employ minority and women workers in each construction trade consistent with the targeted employment goal prescribed by N.J.A.C. l7:27-7.2; provided, however, that the Division may, in its discretion, exempt a contractor or subcontractor from compliance with the good faith procedures prescribed by the following provisions, A, B and C, as long as the Division is satisfied that the contractor or subcontractor is employing workers provided by a union which provides evidence, in accordance with standards prescribed by the Division, that its percentage of active "card carrying" members who are minority and women workers is equal to or greater than the targeted employment goal established in accordance with N.J.A.C. l7: The contractor or subcontractor agrees that a good faith effort shall include compliance with the following procedures: Q-5 INITIALS:

11 (A) If the contractor or subcontractor has a referral agreement or arrangement with a union for a construction trade, the contractor or subcontractor shall, within three business days of the contract award, seek assurances from the union that it will cooperate with the contractor or subcontractor as it fulfills its affirmative action obligations under this contract and in accordance with the rules promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et. seq., as supplemented and amended from time to time and the Americans with Disabilities Act. If the contractor or subcontractor is unable to obtain said assurances from the construction trade union at least five business days prior to the commencement of construction work, the contractor or subcontractor agrees to afford equal employment opportunities minority and women workers directly, consistent with this chapter. If the contractor's or subcontractor's prior experience with a construction trade union, regardless of whether the union has provided said assurances, indicates a significant possibility that the trade union will not refer sufficient minority and women workers consistent with affording equal employment opportunities as specified in this chapter, the contractor or subcontractor agrees to be prepared to provide such opportunities to minority and women workers directly, consistent with this chapter, by complying with the hiring or scheduling procedures prescribed under (B) below; and the contractor or subcontractor further agrees to take said action immediately if it determines that the union is not referring minority and women workers consistent with the equal employment opportunity goals set forth in this chapter. (B) If good faith efforts to meet targeted employment goals have not or cannot be met for each construction trade by adhering to the procedures of (A) above, or if the contractor does not have a referral agreement or arrangement with a union for a construction trade, the contractor or subcontractor agrees to take the following actions: (l) To notify the public agency compliance officer, the Division, and minority and women referral organizations listed by the Division pursuant to N.J.A.C. 17:27-5.3, of its workforce needs, and request referral of minority and women workers; (2) To notify any minority and women workers who have been listed with it as awaiting available vacancies; (3) Prior to commencement of work, to request that the local construction trade union refer minority and women workers to fill job openings, provided the contractor or subcontractor has a referral agreement or arrangement with a union for the construction trade; (4) To leave standing requests for additional referral to minority and women workers with the local construction trade union, provided the contractor or subcontractor has a referral agreement or arrangement with a union for the construction trade, the State Training and Employment Service and other approved referral sources in the area; (5) If it is necessary to lay off some of the workers in a given trade on the construction site, layoffs shall be conducted in compliance with the equal employment opportunity and non-discrimination standards set forth in this regulation, as well as with applicable Federal and State court decisions; (6) To adhere to the following procedure when minority and women workers apply or are referred to the contractor or subcontractor: (i) The contactor or subcontractor shall interview the referred minority or women worker. INITIALS: Q-6

12 (ii) If said individuals have never previously received any document or certification signifying a level of qualification lower than that required in order to perform the work of the construction trade, the contractor or subcontractor shall in good faith determine the qualifications of such individuals. The contractor or subcontractor shall hire or schedule those individuals who satisfy appropriate qualification standards in conformity with the equal employment opportunity and non-discrimination principles set forth in this chapter. However, a contractor or subcontractor shall determine that the individual at least possesses the requisite skills, and experience recognized by a union, apprentice program or a referral agency, provided the referral agency is acceptable to the Division. If necessary, the contractor or subcontractor shall hire or schedule minority and women workers who qualify as trainees pursuant to these rules. All of the requirements, however, are limited by the provisions of (C) below. (iii) The name of any interested women or minority individual shall be maintained on a waiting list, and shall be considered for employment as described in (i) above, whenever vacancies occur. At the request of the Division, the contractor or subcontractor shall provide evidence of its good faith efforts to employ women and minorities from the list to fill vacancies. (iv) If, for any reason, said contractor or subcontractor determines that a minority individual or a woman is not qualified or if the individual qualifies as an advanced trainee or apprentice, the contractor or subcontractor shall inform the individual in writing of the reasons for the determination, maintain a copy of the determination in its files, and send a copy to the public agency compliance officer and to the Division. (7) To keep a complete and accurate record of all requests made for the referral of workers in any trade covered by the contract, on forms made available by the Division and submitted promptly to the Division upon request. (C) The contractor or subcontractor agrees that nothing contained in (B) above shall preclude the contractor or subcontractor from complying with the union hiring hall or apprenticeship policies in any applicable collective bargaining agreement or union hiring hall arrangement, and, where required by custom or agreement, it shall send journeymen and trainees to the union for referral, or to the apprenticeship program for admission, pursuant to such agreement or arrangement. However, where the practices of a union or apprenticeship program will result in the exclusion of minorities and women or the failure to refer minorities and women consistent with the targeted county employment goal, the contractor or subcontractor shall consider for employment persons referred pursuant to (B) above without regard to such agreement or arrangement; provided further, however, that the contractor or subcontractor shall not be required to employ women and minority advanced trainees and trainees in numbers which result in the employment of advanced trainees and trainees as a percentage of the total workforce for the construction trade, which percentage significantly exceeds the apprentice to journey worker ratio specified in the applicable collective bargaining agreement, or in the absence of a collective bargaining agreement, exceeds the ratio established by practice in the area for said construction trade. Also, the contractor or subcontractor agrees that, in implementing the procedures of (B) above, it shall, where applicable, employ minority and women workers residing within the geographical jurisdiction of the union. After notification of award, but prior to signing a construction contract, the contractor shall submit to the public agency compliance officer and the Division an initial project workforce report (Form AA 201) electronically provided to the public agency by the Division, through its website, for distribution to and completion by the contractor, in accordance with N.J.A.C. 17:27-7. The contractor also agrees to submit a copy of the Monthly Project Workforce Report once a month thereafter for the duration of this contract to the Division and to the public agency compliance officer. INITIALS: Q-7

13 The contractor agrees to cooperate with the public agency in the payment of budgeted funds, as is necessary, for on-the-job and/or off-the-job programs for outreach and training of minorities and women. (D) 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 Division 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 l0 of the Administrative Code (N.J.A.C. 17:27). \ INITIALS: Q-8

14 AMERICANS WITH DISABILITIES ACT Equal Opportunity for Individuals with Disabilities The Contractor and the Borough of Lincoln Park do hereby agree that the provision of Title II of the Americans With Disabilities Act of 1990 (the ADA ) (42 U.S.C. Section 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 Borough pursuant to this contract, the Contractor agrees that the performance shall be in strict compliance with the ADA. In the event that the Contractor, its agents, servants, employees or subcontractors violate or are alleged to have violated the ADA during the performance of this contract, the Contractor shall defend the Borough in any action or administrative proceeding commenced pursuant to this ADA. The Contractor shall indemnify, protect and save harmless the Borough, 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 Borough grievance procedure, the Contractor agrees to abide by any decision of the Borough which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the Borough or if the Borough 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 Borough 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 Borough or any of its agents, servants, and employees, the Borough shall expeditiously forward or have forwarded to the Contractor every demand, complaint, notice, summons, pleading or other process received by the Borough or its representatives. It is expressly agreed and understood that any approval by the Borough of the services provided by the Contractor pursuant to this contract will not relieve the Contractor of the obligation to comply with the ADA and to defend, indemnify, protect, and save harmless the Borough pursuant to this paragraph. It is further agreed and understood that the Borough 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 Borough from taking any other actions available to it under any other provisions of this agreement or otherwise by law. INITIALS: Q-9

15 (REVISED 12/2016) STATEMENT OF OWNERSHIP N.J.S.A. 52: (P.L. 1977, c.33, as amended by P.L. 2016, c.43) This Statement Shall Be Included with All Bid and Proposal Submissions. N.J.S.A. 52: : Submission of statement required for bidding on public contracts. "No corporation, partnership, or limited liability company 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, unless prior to the receipt of the bid or proposal, or accompanying the bid or proposal of said corporation, said partnership, or said limited liability company there is submitted a statement setting forth 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. If one or more such stockholder or partner or member is itself a corporation or partnership or limited liability company, the stockholders holding 10 percent or more of that corporation s stock, or the individual partners owning 10 percent or greater interest in that partnership, or the members owning 10 percent or greater interest in that limited liability company, as the case may be, shall also be listed. 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 in this act, has been listed. To comply with this section, a bidder with any direct or indirect parent entity which is publicly traded may submit the name and address of each publicly traded entity and the name and address of each person that holds a 10 percent or greater beneficial interest in the publicly traded entity as of the last annual filing with the federal Securities and Exchange Commission or the foreign equivalent, and, if there is any person that holds a 10 percent or greater beneficial interest, also shall submit links to the websites containing the last annual filings with the federal Securities and Exchange Commission or the foreign equivalent and the relevant page numbers of the filings that contain the information on each person that holds a 10 percent (10%) or greater beneficial interest." Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Company Address Q-10

16 (Revised 02_2018 per DPP revision 06/19/2017) OWNERSHIP DISCLOSURE N.J.S.A. 52: (P.L. 1977, c.33, as amended by P.L. 2016, c.43) This statement shall be completed IN FULL, certified to, and included with all bid/proposal submissions. Failure to submit this required information is cause for automatic rejection of the bid/proposal. Company Name Company Address Part I (check yes or no for each 1-4): 1. Are there any individuals, corporations, partnerships, or limited liability companies owning a 10% or greater interest in the Vendor/Bidder? 2. Of those parties owning a 10% or greater interest in the Vendor/Bidder, are any of those parties individuals? 3. Of those parties owning a 10% or greater interest in the Vendor/Bidder, are any of those parties corporations, partnerships, or limited liability companies? 4. If your answer to Question 3 is YES, are there any parties owning a 10% or greater interest in the corporation, partnership, or limited liability company referenced in Question 3? Yes Yes Yes Yes No No No No If you answered Yes to question 1, continue to Part IV Certification, sign and notarize where indicated. If ANY of the answers to questions 2-4 are Yes, complete parts II and III, sign and notarize Part IV Certification where indicated. Part II: You must disclose identifying information related to the individuals, corporations, partnerships, and/or limited liability companies owning a 10% or greater interest in the Vendor/Bidder. Further, if one or more of these entities is itself a corporation, partnership, or limited liability company, you must also disclose all parties that own a 10% or greater interest in that corporation, partnership, or limited liability company. This information is required by statute. Name of Individual or Business Entity Home Address (for Individuals) or Business Address Continued on Additional Sheet (if necessary): Yes No Q-11

17 Continue to next page Part III: Disclosure of 10% or Greater Ownership in the Stockholders, Partners or LLC Members Listed in Part II To comply with the ownership disclosure requirement, a Bidder with any direct or indirect parent entity which is publicly traded may submit the name and address of each publicly traded entity and the name and address of each person that holds a 10% or greater beneficial interest in the publicly traded entity as of the last annual filing with the federal Securities and Exchange Commission or the foreign equivalent, and, if there is any person that holds a 10% or greater beneficial interest, also shall submit links to the websites containing the last annual filings with the federal Securities and Exchange Commission or the foreign equivalent and the relevant page numbers of the filings that contain the information on each person that holds a 10 percent or greater beneficial interest. Names/Companies Listed in Part II Website (URL) containing the last annual filing Page # s Continued on Additional Sheet (if necessary): Yes No Part IV: Certification I, the undersigned, certify that I am authorized to execute this Certification on behalf of the Bidder and that the foregoing information and any attachments hereto, to the best of my knowledge, are true and complete. I acknowledge that the Borough of Lincoln Park is relying on the information contained herein, and that the Bidder is under a continuing obligation from the date of this certification through the completion of any contract(s) with the Borough to notify the Purchasing Agent, 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 will be subject to criminal prosecution under the law, and that it will constitute a material breach of my agreement(s) with the Borough permitting them to declare any contract(s) resulting from this certification void and unenforceable. Printed Name of Authorized Agent Signature of Authorized Agent (Corporate Seal if a Corporation) Sworn and subscribed to before me on this day of, 20 Printed Name of Notary, ID# and Expiration Date Signature of Notary Q-12

18 I, the undersigned, certify that: PREVAILING WAGE CERTIFICATION OF COMPLIANCE 1. I am the duly authorized agent of the bidder/proposer and am authorized to make this Certification on their behalf. 2. I am compliant with the NJ State Prevailing Wage Act and Regulations N.J.S.A. 34: et seq., including, but not limited to, the following: N.J.S.A. 34: Record of wages paid by contractor and subcontractor. Every contractor and subcontractor shall keep an accurate record showing the name, craft or trade, and actual hourly rate of wages paid to each worker employed by him in connection with a public work and such records shall be preserved for two years from date of payment. The record shall be open at all reasonable hours to the inspection of the public body awarding the contract, to any other party to the lease or agreement to lease pursuant to which the public work is done, and to the commissioner. 3. All contractors and subcontractors performing public works construction projects must follow payroll reporting requirements in accordance with the NJ State Prevailing Wage Act and Regulations, including, but not limited to, the following: N.J.A.C. 12: Inspections: (c) The public works contractors and subcontractors shall submit to the public body or lessor which contracted for the public works project the following in a form satisfactory to the Commissioner. 1. A certified payroll record on each public works project. i. Such record shall be submitted each payroll period within 10 days of the payment of wages. ii. The public body shall receive, file, store and make available for inspection at its normal place of business and during normal business hours the certified payroll records. 4. I have read this statement and I know the contents of it and all other requirements of the NJ State Prevailing Wage Act and Regulations and know the same to be true to my own knowledge. 5. I have reviewed the prevailing wage rate located at: 6. I, therefore, certify that the bid submitted herewith is in compliance with the NJ State Prevailing Wage Act and Regulations. 7. I further certify that should the bid be less than the County Prevailing Wage rate found at, the certified payrolls shall reflect the current prevailing rate. Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-13

19 SUBCONTRACTOR CERTIFICATION N.J.S.A. 40A:11-16, N.J.S.A. 40A: , N.J.S.A. 34: No contractor shall bid on any contract for public work as defined in section 2 of P.L.1963, c. 150 (C.34: ) unless the contractor is registered pursuant to this act. No contractor shall list a subcontractor in a bid proposal for the contract unless the subcontractor is registered pursuant to P.L.1999, c.238 (C.34: et seq.) at the time the bid is made. No contractor or subcontractor, including a subcontractor not listed in the bid proposal, shall engage in the performance of any public work subject to the contract, unless the contractor or subcontractor is registered pursuant to that act. Per N.J.S.A. 40A:11-16.b. Whenever a bid sets forth more than one subcontractor for any of the categories (1) through (4) in paragraph 1 of subsection a. of this section, the bidder shall submit to the contracting unit a certificate signed by the bidder listing each subcontractor named in the bid for that category. The certificate shall set forth the scope of work, goods and services for which the subcontractor has submitted a price quote and which the bidder has agreed to award to each subcontractor should the bidder be awarded the contract. The certificate shall be submitted to the contracting unit simultaneously with the list of the subcontractors. The certificate may take the form of a single certificate listing all subcontractors or, alternatively, a separate certificate may be submitted for each subcontractor. If a bidder does not submit a certificate or certificates to the contracting unit, the contracting unit shall award the contract to the next lowest responsible bidder. Per N.J.S.A. 40A:11-16.a.(1) (1) The plumbing and gas fitting and all kindred work; (2) Steam power plants, steam and hot water heating and ventilating and refrigeration apparatus and all kindred work; (3) Electrical work, including any electrical power plants, tele-data, fire alarm, or security system; (4) Structural steel and ornamental iron work; and (5) General construction, which shall include all other work required for the completion of the Project. Named Sub-Contractors must be used for the duration of the project unless otherwise approved, in writing, by the Borough. Failure to submit this information is cause for automatic rejection. Prime Subcontractors 1. Plumbing Contractor Company Name, Address, Phone, & Fax Number 2. Electrical Contractor 3. Steel Contractor 4. HVAC Contractor 5. General Contractor Continued to next page Q-14

20 List Type of additional subcontractors Company Name, Address, Phone, & Fax Number I, the undersigned, certify that I am authorized to execute this certification on behalf of the Bidder, that the foregoing information and any attachments hereto, to the best of my knowledge are true and complete. I further certify that this Subcontractor Listing is being submitted in good faith and that each subcontractor has been notified that it has been listed and that each subcontractor has consented, in writing, to its name being submitted for this contract. Additionally, I certify that I shall notify each subcontractor listed, in writing, if the award is granted to my firm, and I shall make all documentation available to the Owner upon request. I acknowledge that the Owner is relying on the information contained herein, and that the Bidder is under a continuing obligation from the date of this certification through the completion of any contract(s) with the Owner to notify the Owner, 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 Owner, permitting the Owner to declare any contract(s) resulting from this Certification void and unenforceable. Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-15

21 Updated DPP Rev 06/19/2017 DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN N.J.S.A. 52:32-57 FAILURE TO CHECK ONE OF THE BOXES IN PART 1 WILL RENDER THE BID/RFP SUBMISSION NON-RESPONSIVE AND IS CAUSE FOR AUTOMATIC REJECTION. PART 1 Pursuant to Public Law 2012, c. 25 any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certification below to attest, under penalty of perjury, that neither the person or entity, nor any of its parents, subsidiaries, or affiliates (any parent, successor, subunit, direct or indirect subsidiary, or any entity under common ownership or control with, any entity), is identified \ Vendor/Bidder nbvcxzon 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 State of New Jersey, Department of Treasury, Division of Purchase and Property website at Bidders must review this list prior to completing the below certification. Failure to complete the certification will render a bidder's proposal non-responsive. If the Borough 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. PLEASE CHECK THE APPROPRIATE BOX: A. I certify, pursuant to Public Law 2012, c. 25, that neither the Vendor/Bidder listed below nor any of its parents, subsidiaries, or affiliates is listed on the N.J. Department of the Treasury s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 ( Chapter 25 List ). Disregard Part 2 and complete and sign the Certification below. OR B. 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 in Part 2 below and sign and complete the Certification below. Failure to provide such information will result in the proposal being rendered as nonresponsive and appropriate penalties, fines and/or sanctions will be assessed as provided by law. PART 2: PLEASE PROVIDE ADDITIONAL INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN IF YOU CHECKED BOX B ABOVE, provide a detailed, accurate and precise description of the activities of the Vendor/Bidder, or one of its parents, subsidiaries or affiliates, engaged in the investment activities in Iran by completing the boxes below. Name: Description of Activities: Duration of Engagement: Vendor/Bidder Contact Name: Relationship to Vendor/Bidder: Anticipated Cessation Date: Vendor/Bidder Phone Number: CERTIFICATION I, the undersigned, certify that I am authorized to execute this certification on behalf of the Vendor/Bidder, that the foregoing information and any attachments hereto, to the best of my knowledge are true and complete. I acknowledge that the Borough is relying on the information contained herein, and that the Vendor/Bidder is under a continuing obligation from the date of this Certification through the completion of any contract(s) with the Borough to notify the Borough 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 will be subject to criminal prosecution under the law, and it will constitute a material breach of my agreement(s) with the Borough, permitting the Borough to declare any contract(s) resulting from this certification void and unenforceable. Printed Name of Authorized Agent Title Signature of Authorized Agent Date Company Name Q-16

22 RESPONSIBLE BIDDER CERTIFICATION A copy of this Certification must be included with the submission and must be fully completed, signed by at least one general partner, owner, or officer authorized to legally obligate the Bidder and notarized. The Bidder recognizes that the information submitted in the questionnaire herein is for the express purpose of inducing the Borough to award a contract to the Bidder. The Bidder acknowledges that they have read and understand the requirements of this Bid and has read and understands the instructions for completing the Bid. The Bidder acknowledges that they are duly authorized to provide the information contained in this Bid and that answering the questions in this Bid is entirely within their control. DECLARATION I hereby certify that I am a general partner, owner, or officer and as such authorized to legally obligate the Bidder and am authorized to make this Certification on their behalf. I further certify that I have read and understood the questions contained in this Bid, and that to the best of my knowledge and belief all information contained herein and submitted concurrently or in supplemental documents with this Bid is complete, current, and true. I further acknowledge that any false, deceptive or fraudulent statements or documents submitted with this Bid may result in non-award of contract. I hereby authorize the Borough to contact any entity named herein, or any other internal or outside resource, for the purpose of verifying information provided in the questionnaire or this Bid to develop other information deemed relevant by the Borough. Printed Name of Authorized Agent Signature of Authorized Agent Sworn and subscribed to before me on this day of, 20 Printed Name of Notary, ID# and Expiration Date Signature of Notary Q-17

23 AFFIDAVIT OF NON-COLLUSION The undersigned, being duly sworn according to law, deposes and says: I (print name) am the/a (title) for the within named Bidder. I reside at County of State of 1. I execute the said Bid on behalf of the Bidder with full authority to do so. 2. The 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 contract. 3. All statements contained in and submitted with the Bid Documents and in this Affidavit are true and correct and were made with the full knowledge that the Borough of Lincoln Park, County of Somerset, its officers and employees, relies upon the truth of the statements therein made in awarding the contract. 4. I further warrant that no person or selling agency has been employed or retained to solicit or service such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bonafide employees of or bonafide established commercial selling agencies maintained by the Bidder. Therefor I hereby affirm under the penalties for perjury that the facts and information contained in and submitted with the Bid are true and correct. Printed Name of Authorized Agent Signature of Authorized Agent Sworn and subscribed to before me on this day of, 20 Printed Name of Notary, ID# and Expiration Date Signature of Notary Q-18

24 RESPONSIBLE BIDDER S CHECKLIST The following are screening statements which shall be used to determine whether or not a prospective applicant is responsible to enter into a contract with the Borough of Lincoln Park. Refusal to answer or omission of response to any question on this form shall be considered a Fatal Flaw and shall result in disqualification of the Bidder. PART 1 1. I am bidding as the prime contractor. Yes No 2. I am appropriately licensed and bondable. Yes No 3. I have completed at least three (3) public works construction projects within the last five (5) years as a Prime Contractor. ( Public Works Construction Projects is defined as projects for government agencies including Public Schools, County, Community College s, Municipalities, Special Districts, county, state and federal agencies requiring prevailing wages rates paid to workers.) 4. I am eligible to bid on a Public Works contract as per New Jersey Prevailing Wage Act, N.J.S.A. 34: et. seq. 5. I meet the minimum safety requirements specified by the Borough s Safety Program as follows: a. No willful violations of any occupational safety or health standard. b. All violations corrected prior to reinspection. IF ANY of the answers to these questions is No, please provide a detailed explanation: Yes Yes Yes No No No Attach additional pages if necessary Continued to next page Q-19

25 PART 2 1. In the last five (5) years, has your firm or any person in your firm or any person or entity listed on this form or its attachments ever been arrested, charged, indicted, or convicted in a criminal or disorderly persons matter by the State of New Jersey (or political subdivision thereof), or by any other state or the U.S. Government? 2. In the last five (5) years, has your firm or any person in your firm or any person or entity listed on this form, been defaulted or terminated by an owner (other than for convenience of the owner) or has your insurance had a claim placed against it? 3. In the last five (5) years, has any person or entity listed on this form or its attachments ever been suspended, debarred or otherwise declared ineligible by any government agency from bidding or contracting to provide services, labor, materials or supplies? 4. At the time of submitting this bid form, is your firm or any person in your firm or any person or entity listed on this form or its attachments, ineligible to bid on or be awarded any public contract, or perform as a sub-contractor on a public contract? 5. Has your firm, any person in your firm or any person or entity listed on this form or its attachments, ever been found guilty in a criminal action, for making any false claim or material misrepresentation to any public agency or entity? 6. In the last ten (10) years, has your firm, or any key Person in your firm, ever been convicted of a crime involving any federal, state or local contracts or been held as a defendant by a government entity for failure to perform services? 7. Are there currently any pending criminal matters or debarment proceedings in which the firm and/or its officers and/or managers are involved? 8. Has any person or entity listed on this form or its attachments been denied any license, permit or similar authorization required to engage in the work applied for herein, or has any such license, permit or similar authorization been revoked by any agency of federal, state or local government? Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No IF ANY of the answers to these questions is yes, please provide the requested information in Part 3. IF ALL of the answers to the questions are no, no further action is needed; please sign and date the Certification in Part 4. PART 3 If you answered YES any of the questions above, you must provide a detailed description of any investigation or litigation, including but not limited to administrative complaints or other administrative proceedings, involving public sector clients during the past five (5) years. The description must include the nature and status of the investigation, and for any litigation, the caption of the action, a brief description of the action, the date of inception, current status, and if applicable, disposition. Continued to next page Q-20

26 Person/Entity Involved: Contact Name: Contact Number: Case Caption: Current Status: Date of Inception: Summary of Investigation: Attached additional sheets if necessary PART 4 CERTIFICATION I, the undersigned, certify that I am authorized to execute this certification on behalf of the Applicant, that the foregoing information and any attachments hereto, to the best of my knowledge are true and complete. I acknowledge that the Borough is relying on the information contained herein, and that the Applicant is under a continuing obligation from the date of this certification through the completion of any contract(s) with the Borough to notify the Borough 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 will be subject to criminal prosecution under the law and it will constitute a material breach of my agreement(s) with the Borough, permitting the Borough to declare any contract(s) resulting from this certification void and unenforceable. Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-21

27 EXPERIENCE, PERFORMANCE, AND FINANCIAL CAPABILITY QUESTIONS Refusal to answer or omission of response to any question on this form shall be considered a Fatal Flaw and shall result in disqualification of the Bidder; and Any answer not answered to the satisfaction of the Borough shall also be considered a Fatal Flaw. Question How many years has your organization been in business in New Jersey as a contractor under your present business name and license number? List any other names under which the bidder, its partners or officers have conducted business in the past five years. Response Years Lic. No. None Company official shall initial all statements initial initial How many years' experience does your firm have as a licensed contractor? Is your firm in good standing with the Department of Labor, or have they ever licenses suspended, put on probation, or revoked? (Check One) How many years has your firm performed construction work to public agencies under the New Jersey Department of Labor prevailing wage rules and regulations? How many projects with construction costs over $250,000 has your firm completed as a Prime Contractor for municipalities or other government entities in the past five (5) years? How many times in the last five (5) years has your company received Non-responsive Notices on public works contracts? Within the last five (5) years, how many lawsuits brought by suppliers, subcontractors, prime contractors, or owners have been defended in court by your firm and preceded to judgment against your firm and/or any individual key Person from your firm? Years Never Suspended or on Probation Suspended Probation Revoked Years Projects Notices Lawsuits initial initial initial initial initial initial Q-22

28 Question Response Company official shall initial all statements Continued to next page Within the last five (5) years, how many times has your company been awarded a public works contract in which you failed to execute a contract? Note: Failure to Execute is any of the following: (1) Refusal to pick up, sign, and/or return contract documents; (2) Inability Times initial to obtain insurance and/or bond requirements; or (3) Failure to submit required agreement forms such as a Public Works Contractor Registration, Business Registration Certificate, or Certificates of Insurance. Has your firm been assessed liquidated damages on any project within the past five (5) Yes No initial years? Has an owner ever made a demand on your performance bond? Yes No initial Has your firm ever had insurance terminated by a carrier in the past five (5) years due to an excessive claims history and/or nonpayment of Yes No initial premium? Within the past five (5) years, have any of your employees or another entity (including an Owner) filed a complaint against your firm Yes No initial with the New Jersey Department of Labor? If Complaints yes, how many complaints were filed? Has your firm or any related affiliate ever filed bankruptcy or re-organization under the bankruptcy laws? Yes No initial What size projects is your company currently contracted for?: Largest Single job: $ Total Work in Progress: $ Continued to next page Q-23

29 List the two (2) largest, in terms of value, public works and new construction contracts completed in the State of New Jersey in the past five (5) years and provide the requested information for each project listed: Contracting Agency Contact & Phone # Project Name Contract $ Year Completed Project A Project B Original contract value: Change orders total value: Owner-initiated change orders - % of total: Change orders due to differing site conditions - % of total: Other change orders - % of total: Final contract value: Original contract duration - calendar days: Final contract duration - calendar days: Original contract completion date: Actual contract completion date: Time extensions voluntarily resolved with owner - calendar days: Time extensions involuntarily resolved by mediation, arbitration, or litigation - calendar days: Project A Project B List all projects current and or completed for Public Entities including School Districts, in the last five (5) years not listed in A or B above: (Attach separate sheet(s) as needed.) Governing Agency Contact & Phone Inspector & Phone Job Description Contract $ Year Completed Continued to next page Q-24

30 List two (2) current Trade Suppliers that you principally work with: Company Material or Service Provided Contact Phone # List three (3) current Trade Subcontractors that you principally work with: Company Material or Service Provided Contact Phone # Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-25

31 INSURANCE CERTIFICATION I have a liability insurance policy with a policy limit of at least $1,000,000 per occurrence and $3,000,000 aggregate. I have a workers compensation insurance policy as required by the New Jersey Department of Labor. Yes Yes No No Please provide a Current Certificate of Insurance as verification copy attached Or provide the following: Amount of Insurance $ Years with Ins. Co.: Insurance Company Name: Address: Contact Name: Contact Phone Contact Fax: Printed Name of Authorized Agent Signature of Authorized Agent Title Date Company Name Q-26

32 TAXPAYER IDENTIFICATION Q-27