Proposal for Garbage and Recycling Collection

Transcription

1 NOTICE TO BID NOTICE IS HEREBY GIVEN THAT sealed bids will be received by the Board of Education of the Township of Marlboro, in the County of Monmouth, until 10:00 A.M. prevailing time on Tuesday, July 10, 2018 in the Board of Education Administration Offices, 1980 Township Drive, Marlboro, New Jersey, 07746, for the following: Proposal for Garbage and Recycling Collection At that time the bids will be opened and read to the public. Previous bid submissions for this service which were received on June, 12, 2018 will be rejected by the Board at its June 19, 2018 Regular Meeting; therefore, this service is being re-bid. Specifications and bid forms may be obtained from the Marlboro Township Board of Education Administration Offices in person or by calling (732) x2025 Monday through Friday between 9:00 A.M. and 4:00 P.M. Specifications may also be obtained from the District s website at Bids must be delivered in sealed envelopes properly marked identifying bids. It is understood and agreed that any person in the Office of the Board of Education will be absolved from responsibility for premature opening of any proposal not properly identified. No bids will be received after the time specified above for opening, nor will any proposal allowed to be modified or withdrawn after the time set for the opening. The Marlboro Township Board of Education reserves the right to waive any informalities and to reject any or all bids. A bidder shall be required to deposit with their bid, security in the amount of not less than ten percent (10%) of the base bid, but not more than $20, in the form of certified check or bid bond. Bidders are required to comply with the requirements of P.L. 1975, c.127 (Affirmative Action) and N.J.S.A. 52: (Disclosure) and the Non-Collusion Affidavit. Bidding shall be in conformance with the applicable requirements of N.J.S.A. 18A:18A-1 et. seq. pertaining to the "Public School Contracts Law." BY ORDER OF: CINDY S. BARR-RAGUE SCHOOL BUSINESS ADMINISTRATOR/BOARD SECRETARY Marlboro Township Board of Education 1980 Township Drive Marlboro, New Jersey Page -1-

2 SPECIFICATIONS AND PROPOSAL FOR GARBAGE AND RECYCLING COLLECTION Sealed bids, plainly marked, PROPOSAL FOR GARBAGE AND RECYCLING COLLECTION will be received by the Board of Education of the Township of Marlboro in the County of Monmouth, New Jersey at the Board of Education Offices, 1980 Township Drive, Marlboro, New Jersey, until 10:00 A.M. prevailing time on Tuesday, July 10, 2018 at which time they will be publicly opened and read aloud. Previous bid submissions for this service which were received on June, 12, 2018 will be rejected by the Board at its June 19, 2018 Regular Meeting; therefore, this service is being re-bid. Specifications and bid forms may be obtained from the undersigned. Such bids may be delivered before the time, or at the time and place as specified above. It is understood and agreed that any person in the office of the Secretary/Business Administrator of the Board of Education will be absolved from responsibility for the premature opening of any proposal not properly identified. No bids will be received after the time specified for the opening, nor will any proposal be allowed to be modified or withdrawn after the time set for the opening. Sealed bids, properly executed on the forms attached hereto, may be delivered personally, or by mail and must be enclosed in opaque, sealed envelopes and addressed as follows: Cindy S. Barr-Rague School Business Administrator/Board Secretary Marlboro Township Board of Education 1980 Township Drive Marlboro, New Jersey The Marlboro Board of Education reserves the right to accept any bid meeting specifications regardless of price. The Board also reserves the right to accept any portion of the bid, waive any irregularities in bidding, and to proceed in any manner considered in its best interest. The right is reserved to reject any or all bids or to waive informality in the bidding if it is in the interest of the Board of Education to do so. Bidding shall be in conformance with the applicable requirements of N.J.S.A. 18A:18A-1 et seq., pertaining to the Public School Contracts Law. All Bidders are placed on notice that they are required to comply with the requirements of P.L.1975, C.127(N.J.A.C. 17:27). Interpretation and Approval: Should any dispute arise respecting the true construction and/or meaning of the specifications, the same shall be decided by the Board of Education. No bidder, representative of the firm or manufacturer of the concerned items to be bid, shall at any time prior to the date of the award of contract for said items be in personal contact with a member of the Marlboro Township Board of Education concerning any matter dealing with his proposal. Please conduct all business dealings with said bidding through the office of the Secretary/Business Administrator, 1980 Township Drive, Marlboro, New Jersey (732) Page -2-

3 GARBAGE AND RECYCLING COLLECTION AND DISPOSAL GENERAL The garbage and recycling collection and disposal services must be furnished at the hereinafter listed locations for the period July 1, 2018 to June 30, 2019 and for alternate years of July 1, 2019 to June 30, 2020 and July 1, 2020 to June 30, WARRANTY The bidder herein warrants: 1. That they are bonafide dealers engaged in the business of garbage and refuse pick-up and disposal, and have complied with all applicable laws of the State of New Jersey and any applicable rules and regulations of the State of New Jersey. 2. That they have all the necessary equipment, personnel and disposal areas commonly used in transacting the business of garbage and refuse collection and removal, and have or will have procured all necessary state and local licenses and permits required in carrying out of said business. 3. That they have read the herein specifications and shall abide by each specification in every detail. FORM OF PROPOSAL A proposal must be made on the form furnished by the Board of Education and must be signed by the individual, partnership or corporation making the same. BOND Each proposal must be accompanied by a Bid or Proposal Bond executed by the bidder as principal and by a Surety Company licensed in the State of New Jersey. The Bid or Proposal Bond must be for a minimum of 10% of the base amount bid, or in lieu of said Bid or Proposal Bond, a certified check payable to the Board of Education, Township of Marlboro, in the amount not 10% of the total amount of the base bid, but in no event greater than $20, AGREEMENT OF SURETY The successful bidder will be required to furnish a satisfactory performance bond in the full amount of the contract price, executed by a surety company licensed to do business in the State of New Jersey, such bond to insure the fulfillment of all provisions of the contract, the prompt payment of all persons furnishing materials or labor or both required for the execution of the contract, defending settlements without annoyance to the owner, of liens, claims for personal injury or otherwise, or against other liabilities arising Page -3-

4 from execution of the contract. INSURANCE MARLBORO TOWNSHIP BOARD OF EDUCATION The successful bidder must furnish to the Secretary/Business Administrator of the Board of Education, prior to the beginning pick ups, certificates of insurance showing that the bidder has Contractors Public Liability, Property Damage, and Worker Compensation Insurance. It is the intent of this specification to relieve the Owner from all responsibility in the carrying of insurance except fire insurance, and extended coverage insurance. The payment of all Federal, State or other taxes, including social security, unemployment compensation insurance, etc., now in effect, shall be the responsibility of the contractor himself, his subcontractors, or the workers of any subcontractor. Public Liability Insurance shall be in the amount of $500,000.00; Property Insurance shall be in the amount of $1,000, and Worker Compensation Insurance shall be in the amount of $3,000, The Board of Education shall be named as additional insured. Said insurance certificate shall contain a clause stipulating that the policy will not be canceled or allowed to expire unless thirty (30) days written notice has been given the addressee of the certificate. All public liability and property damage insurance shall state that the Owner is HELD HARMLESS from all claims for damages because of bodily injury, including death to his employees and all others; and free from claims for damages to property, and/or all of which may arise out of or result from the contractor s operations under this contract, whether such operation be by himself or by any subcontractor or anyone directly or indirectly employed by either of them. The Board of Education shall require a written contract to be entered into for the furnishing of said services within (10) days after the award and notification thereof, and a performance bond in an amount equal to the estimated quantity at the unit price bid. Where bids are for the same amount the Board of Education may award in full to one contractor or award partial contracts, at their discretion. Chapters 127 and 33 of the Public Laws of 1977, deal with Affirmative Action matters and statement of names and addresses of stockholders respectively. Attached hereto and made a part of these specifications are the provisions that must be complied with under said acts. Page -4-

5 AFFIRMATIVE ACTION: 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, SERVICES AND PROFESSIONAL SERVICES CONTRACTS During the performance of this contract, the Contractor or subcontractor 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 all 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 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. 10:5-31et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. Page -5-

6 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: 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-relate testing, as established by the statues 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 statues 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 AA302 (electronically provided by the Division and distributed to the public agency through the Division s website at: 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: et seq. The failure to submit such appropriate evidence will result in rescission of the contract. DISCLOSURE Pursuant to N.J.S.A. 52: , no corporation or partnership shall be awarded by any contract for the performance of work, the furnishing of materials or supplies to the State or any County Municipality or School District, etc. unless the bid is preceded or accompanied by a statement setting forth the names and addresses of all stockholders or partners whose interest in the corporation or partnership is 10% or greater. If N.J.S.A. 52: does not apply to the bidder (i.e. sole owner, no one stockholder holding 10% or Page -6-

7 more of stock, etc.) A written statement to this effect must accompany the bid. VALIDITY This bid will not be a valid bid and will not be read unless the following items are included with the bid documents: 1. Bid Bond or Certified Check in the amount of not less than ten percent (10%) of the Total Amount Bid, but not more than $20, Statement of Disclosure of Ownership. 3. Non-Collusion Affidavit. 4. A Certificate of Employee Information Report Approval, evidence of an existing federally approved or sanctioned Affirmative Action Program, or a completed Information Form (Form AA302). This form is available upon request from the Business Office of the Board of Education. 5. Affirmative Action Certification. 6. A New Jersey Business Registration Certificate. 7. Political Contribution Disclosure Affidavit and Form 8. Disclosure of Investment Activities in Iran Form CINDY S. BARR-RAGUE SCHOOL BUSINESS ADMINISTRATOR/BOARD SECRETARY Marlboro Township Board of Education 1980 Township Drive Marlboro, New Jersey Page -7-

8 SPECIFICATIONS Successful bidder is to furnish front end containers required: cubicle in shape, container must stand firmly on its bottom. No wheels or casters. Containers must be of front end loading type. These containers shall be in good condition and shall be subject to the approval of the Supervisor of Buildings and Grounds. Further, said containers shall be kept and maintained in satisfactory operating condition during the period of the contract. In order to present a neat appearance and eliminate hazards to personnel, all materials such as paper, cans or any foreign matter that should fall from the container while in the process of loading into the truck shall be picked up immediately. The following size containers shall be supplied and located in areas as designated by the Supervisor of Buildings and Grounds. Trash containers are to be picked up on Tuesday and Friday of each week, except for a holiday, which will mean that the contractor shall affect pickup the next work day. All recycling containers are to be picked up once a week. Pick up services for all containers are to run for twelve (12) months. Supply the listed containers at the following locations: Frank Defino/Central School, 175 State Highway 79, Marlboro, N.J Two (2) 8 cubic yard trash container 6 cubic yard single stream recycling container 3 cubic yard single stream recycling container Marlboro Elementary School, 100 School Road West, Marlboro, N.J Two (2) 8 cubic yard trash container 6 cubic yard single stream recycling container 3 cubic yard single stream recycling container Robertsville Elementary School, 36 Menzel Lane, Morganville, N.J Two (2) 8 cubic yard trash container 6 cubic yard single stream recycling container 3 cubic yard single stream recycling container Asher Holmes Elementary School, 48 Menzel Lane, Morganville, N.J Two (2) 8 cubic yard trash container 6 cubic yard single stream recycling container 3 cubic yard single stream recycling container Page -8-

9 SPECIFICATIONS - Continued Frank J. Dugan Elementary School, 48 Topanemus Road, Marlboro, N.J Two (2) 8 cubic yard trash container 6 cubic yard single stream recycling container 3 cubic yard single stream recycling container Marlboro Middle School, 355 County Road 520, Marlboro, N.J Three (3) Three (3) 8 cubic yard trash containers 6 cubic yard single stream recycling containers Marlboro Board of Education, Transportation Garage, 1 Lotta Burke Way, Marlboro, N.J cubic yard trash container 6 cubic yard single stream recycling container Marlboro Early Learning Center, 171 Tennent Road, Morganville, N.J cubic yard trash container 6 cubic yard single stream recycling container Marlboro Memorial Middle School, 71 Nolan Road, Morganville, N.J Three (3) Three (3) 8 cubic yard trash containers 6 cubic yard cardboard container Page -9-

10 Bid Proposal for Garbage and Recycling Collection Cindy Barr Rague, School Business Administrator/Board Secretary Marlboro Township Board of Education 1980 Township Drive Marlboro, New Jersey Dear Mrs. Rague: Pursuant to and in compliance with your specifications to bidders and instructions to bidders relating thereto, the undersigned hereby proposes to furnish the work, materials or supplies set forth in the specifications applicable to garbage and recycling collection. In submitting this bid, it is understood that the right is reserved by the Board of Education to reject any and all bids, or to accept part of a bid and reject the remainder thereof, or to accept part from one bidder and the remainder from another bidder or bidders. Unless otherwise provided in any supplement to these instructions to bidders, no bidder shall modify, withdraw or cancel his/her bid or any part thereof after the time set for the opening. The undersigned agrees to perform and deliver the merchandise in accordance with the specifications. Attached hereto is: 1. Bid Bond or Certified Check in the amount of not less than Ten Percent (10%) of the base bid but more than $20, Disclosure Statement. 3. Non-Collusion Affidavit. 4. Affirmative Action Certification. 5. New Jersey Business Registration Certificate. 6. Political Contribution Disclosure Form. 7. Disclosure of Investment Activities in Iran Form. The undersigned has not entered into any collusion or fraud with any person in respect to this proposal or any other proposal, and the undersigned declared that no one other than the person named herein is interested in this proposal, and proposal is fair and that no member of the Board of Education is or shall become interested, directly or indirectly, in any portion or profit therefrom. Bidder must complete and sign the Non-collusion Affidavit in the presence of a Notary Public, whose signature and seal must be affixed. In witness whereof, the bidder has signed and sealed this bid on the date mentioned herein. Date Firm Name By: Signature of Authorized Agent Telephone Number Address of Firm or Individual Page -10-

11 A. STATEMENT OF DISCLOSURE OF OWNERSHIP In accordance with the requirements of N.J.S.A. 52: , the names and addresses of all (stockholders) (partners) who own (10% or more of the stock) (a 10% greater interest in) (NAME OF CORPORATION OR PARTNERSHIP) NAMES ADDRESSES (Use additional sheets if required) Name of Corporation or Partnership DATED: BY B. CERTIFICATION OF INAPPLICABILITY OF DISCLOSURE REQUIREMENTS The undersigned certified that he/she is familiar with the requirement of N.J. 52: and that said requirements are inapplicable to (Name of Company) DATED: (Name of Company) BY: NOTE: BIDDER MUST COMPLETE AND SIGN EITHER FORM A OR B AS APPLICABLE Page -11-

12 State of New Jersey ) )ss. County of ) NON-COLLUSION AFFIDAVIT I, In the County of City 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 for the above name project, and that I executed the said Proposal with full authority to do so that said bidder has not, directly or indirectly, entered into an 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 Marlboro Township Board of Education relies upon 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 established commercial or selling agencies mailed by (Name of contractor) Subscribed and sworn to before me this Day of, 20 Notary Public of My Commission expires, 20 (Also type or print name under signature) Page -12-

13 AFFIRMATIVE ACTION CERTIFICATION GOODS, SERVICES AND PROFESSIONAL SERVICES CONTRACTS As a condition to entering into a valid and binding contract with the Board of Education, the Vendor and all subcontractors shall execute this Certification and provide the Board with appropriate evidence that: 1. The Vendor has a federally approved or sanctioned Affirmative Action Plan approval. 2. The Vendor has a Certificate of Employee Information Report issued in accordance with to N.J.A.C. l7: The Vendor has an Employee Information Report (AA-302) provided by the Division to the Board of Education for distribution to and completion by the Vendor in accordance with N.J.A.C. l7:27-4. Complete the form and forward it to the Division, with the fee, for issuance of a Certificate of Employee Information Report. A copy shall be submitted to the board of education within seven (7) days of the notice of the intent to award the contract or the signing of the contract. The failure to submit such appropriate evidence will result in rescission of the contract. I certify that our Company has never before applied for a Certificate of Employee Information Report in accordance with the rules promulgated by the State Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and I agree to submit immediately a copy of the Employee Information Report (AA-302) to the Division of Public Contracts Equal Employment Opportunity Compliance, Department of Treasury, P.O. Box 209, Trenton, NJ I certify that the above information is correct to the best of my knowledge. SIGNATURE DATE NAME TITLE Page -13-

14 BID FORM GARBAGE AND RECYCLING COLLECTION AND DISPOSAL BASE BID: JULY 1, 2018 TO JUNE 30, 2019 $ OPTIONS: JULY 1, 2019 TO JUNE 30, 2020 $ JULY 1, 2020 TO JUNE 30, 2021 $ Signature Title Name of Firm Address Telephone Bid Surety (10% of base bid - not more than $20,000.00) Affirmative Action Certification Stockholders Statement Non-Collusion Affidavit New Jersey Business Registration Certificate Political Contribution Disclosure Affidavit and Form Disclosure of Investment Activities in Iran Form Page -14-

15 POLITICAL CONTRIBUTION DISCLOSURE AFFIDAVIT STATE OF ) COUNTY OF ) ss: I,, residing in the of in the County of and State of, of full age, being duly sworn according to law on my oath depose and say: I am of the firm of, the bidder making the proposal for the above named project. I am aware that: A. Pursuant to N.J.A.C. 6A:23A-6.3, no business entity which has made a reportable contribution (as defined in N.J.S.A. 19:44A-1 et seq.) to a member of the Board of Education during the preceding one (1) year shall be awarded a contract in excess of $17,500. B. Any business entity doing business with the School District is precluded from making any reportable contributions to any member of the Board of Education during the term of the Contract. C. When a business entity is a natural person, a contribution by that person s spouse or child that resides therewith shall be deemed to be a contribution by the business entity. Where a business entity is other than a natural person, a contribution by the person or other business entity having an interest therein shall be deemed to be a contribution by the business entity. D. A political contribution disclosure (hereinafter referred to as PCD ) form is required to be submitted for all contracts greater than $17,500. No contract award shall be made unless the completed PCD is submitted to the Board office prior to the award. Failure to submit the PCD shall result in the rejection of the bid. A Sample Form is included as part of the bidding documents and must be completed by the bidder. I aver that no reportable contributions have been made by the Bidder in violation of the provisions set forth in N.J.A.C. 6A:23A-6.3. If the Bidder is the lowest responsible bidder, a completed PCD form shall be submitted to the Board office ten (10) days prior to the contract award. Page -15-

16 Subscribed and sworn to before me this day of, 20. Notary Public of My Commission expires / /20. Page -16-

17 C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Contractor Instructions Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a fair and open process (defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of P.L. 2005, c. 271, s.2 (N.J.S.A. 19:44A-20.26). This law provides that 10 days prior to the award of such a contract, the contractor shall disclose contributions to: any State, county, or municipal committee of a political party any legislative leadership committee * any continuing political committee (a.k.a., political action committee) any candidate committee of a candidate for, or holder of, an elective office: o of the public entity awarding the contract o o o of that county in which that public entity is located of another public entity within that county or of a legislative district in which that public entity is located or, when the public entity is a county, of any legislative district which includes all or part of the county The disclosure must list reportable contributions to any of the committees that exceed $300 per election cycle that were made during the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8 and 19:44A-16 for more details on reportable contributions. N.J.S.A. 19:44A itemizes the parties from whom contributions must be disclosed when a business entity is not a natural person. This includes the following: individuals with an interest ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit all principals, partners, officers, or directors of the business entity or their spouses any subsidiaries directly or indirectly controlled by the business entity IRS Code Section 527 New Jersey based organizations, directly or indirectly controlled by the business entity and filing as continuing political committees, (PACs). When the business entity is a natural person, a contribution by that person s spouse or child, residing therewith, shall be deemed to be a contribution by the business entity. [N.J.S.A. 19:44A-20.26(b)] The contributor must be listed on the disclosure. Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed by ELEC in an amount to be determined by the Commission which may be based upon the amount that the business entity failed to report. Page -17-

18 The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official and/or candidate campaign committees are affected by the disclosure requirement. It is the contractor s responsibility to identify the specific committees to which contributions may have been made and need to be disclosed. The disclosed information may exceed the minimum requirement. The enclosed form, a content-consistent facsimile, or an electronic data file containing the required details (along with a signed cover sheet) may be used as the contractor s submission and is disclosable to the public under the Open Public Records Act. The contractor must also complete the attached Stockholder Disclosure Certification. This will assist the agency in meeting its obligations under the law. 1 N.J.S.A. 19:44A-3(s): The term "legislative leadership committee" means a committee established, authorized to be established, or designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the General Assembly or the Minority Leader of the General Assembly pursuant to section 16 of P.L.1993, c.65 (C.19:44A-10.1) for the purpose of receiving contributions and making expenditures. Page -18-

19 C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. Part I Vendor Information Vendor Name: Address: City: State: Zip: The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A and as represented by the Instructions accompanying this form. Signature Printed Name Title Part II Contribution Disclosure Disclosure requirement: Pursuant to N.J.S.A. 19:44A this disclosure must include all reportable political contributions (more than $300 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local unit. Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Dollar Amount $ Check here if the information is continued on subsequent page(s) Page -19-

20 I. Background MARLBORO TOWNSHIP BOARD OF EDUCATION DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN A. Certification Pursuant to N.J.S.A. 18A:18A-49.4, a board of education as defined in the Public Schools Contracts Law is required to implement and comply with the provisions of P.L. 2012, c. 25 (N.J.S.A , et. seq.), which require any person or entity ( bidder ) that submits a bid or proposal or otherwise enters into or renews a contract with a board of education to disclose if it is engaged in investment activities in Iran. In order to implement and comply with the provisions of P.L. 2012, c. 25, all bidders are required to complete a certification that attests that neither the bidder, nor any of its parents, subsidiaries and/or affiliates is listed on the list developed by the New Jersey Department of Treasury s List of Persons or Entities Engaging in Prohibited Investment Activities in Iran, pursuant to section 3 of P.L.2012, c. 25 (N.J.S.A. 52:32-57). The Department of Treasury List is available at A copy of the list is attached for informational purposes. All bidders are advised to refer to the most current version of the list to ensure compliance with P.L. 2012, c. 25. B. Unable to certify If the bidder is unable to certify compliance with the law, the bidder shall provide a detailed and precise description of such investment activities as described in N.J.S.A. 52:32-56(f). C. False certification If the board determines that a person or entity submits a false certification concerning its engagement in investment activities in Iran under section 4 of P.L.2012, c.25 (C.52:32-58), the board shall report to the New Jersey Attorney General the name of that person or entity. The Attorney General shall determine whether to bring a civil action against the person or entity to collect the penalty prescribed in paragraph (1) of subsection a. of section 5 of P.L.2012, c.25 (C.52:32-59). II. Instructions for Completing the Disclosure of Investment Activities in Iran Form A. Part 1: select and check the appropriate box. Top box: Select this box if the person or entity (bidder) filling out the form is able to certify that neither the person or entity nor any of the bidder s parents, subsidiaries, or affiliates is listed in the Department of Treasury s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012c, c. 25 (N.J.S.A , et. seq.). If you check the top box, skip part 2, fill in part 3 and return the form along with other required documentation in your bid or proposal. Bottom box: Select this bottom box if the person or entity (bidder) filling out the form is listed and/or one or more of its parents, subsidiaries, or affiliates is listed on the New Jersey Department of Treasury s list of entities determined to be engaged in prohibited activities in Iran. If you select this box, you must complete Page -20-

21 part 2 of the certification. MARLBORO TOWNSHIP BOARD OF EDUCATION B. Part 2: Complete this part only if you selected the bottom box in Part 2. If you must complete this part, make sure that you provide a detailed, accurate and precise description of the activities. In so doing, please make sure that you complete all fields. With regards to the Bidder contact information, please provide phone numbers and/or the most effective way to reach the person filling out the form. Add additional activities as attachments, following the format under Part 2. List the number of attachments on the form and affix the attachments to the form. C. Part 3: Certification Complete this section as required, including printing the name, signing, dating the document, providing the title of the person who is filling the form and the bidder/vendor contact information. The bidder/contact information should be the most effective way to reach the person filling out the form. Page -21-

22 Bidder Name: Contract Name: DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN Contract/Renewal Date: Pursuant to Public Law 2012, c.25 (N.J.S.A :55 et. seq.), any person or entity (bidder) 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, is identified on the Department of Treasury s Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found on the Division s website at Bidders must review this list prior to completing the below certification. Failure to complete the certification will render a bidder s proposal nonresponsive. If the board determines that a bidder submits a false certification, the board shall report the name of the bidder to the New Jersey Attorney General, whom shall determine whether to bring a civil action against the person or entity to collect the penalty described in section 5 of P.L. 2012, c (N.J.S.A. 52:32-59). PART 1. PLEASE CHECK APPROPRIATE BOX I certify, pursuant to Public Law 2012, c. 25, that neither the bidder listed above nor any of the bidder s parents, subsidiaries, or affiliates is listed on the New Jersey Department of Treasury s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 ( Chapter 25 List ). I further certify that I am the person listed above, or am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. I am unable to certify as indicated above because the bidder and/or one or more of its parents, subsidiaries, or affiliates is listed on the New Jersey Department of Treasury s list of entities determined to be engaged in prohibited activities in Iran. 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 the information required in Part 2 will result in the proposal being rendered as non-responsive and appropriate penalties, fines and/or sanctions will be assessed as provided by law. PART 2. INVESTMENT ACTIVITIES IN IRAN (Complete only if you checked the second box in Part 1) Please provide further information related to investment activities in Iran. You must provide a detailed, accurate and precise description of the activities of the bidder, the bidder s parents, subsidiaries and/or affiliates that are engaged in investment activities as described in N.J.S.A 52:32-56(f). 1. Name and Address: 2. Relationship to Bidder: 3. Duration of Engagement: Page -22-

23 4. Cessation of Activity: 5. Bidder Contact Name: 6. Bidder Contact Phone Number ADDITIONAL ACTIVITIES/CONTINUATION SHEETS (Check this box if you are including additional activities): If there are additional activities that require disclosure, please provide the description as attachments to this form, following the same format under part 2 above. Please number each attachment and affix to this form. Number of Attachments: PART 3. CERTIFICATION I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the below-referenced person or entity. I acknowledge that (fill in the name of the SFA or LEA) is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of the contract to notify the school in writing of any changes to the answers of information contained herein. I acknowledge 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 recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the school and that the school, at its option, may declare any existing contract(s) resulting from this certification void and unenforceable. 1. Full Name (Print): 2. Date: 3. Signature: 4. Title: 5. Bidder/Vendor: 6. Bidder/Vendor Phone Number and/or Contact Information: Page -23-