City Clerk File No. Res.

10.X
Agenda No.

Approved:
TITLE:
RESOLUTION AUTHORIZING THE AWAR OF ~
CERTIFIED PRODUCTS FOR PARTS AND REP AIRS FOR R R.AT"- ~
MAINENANCE EQUIPMENT lURUANT TO STATE CONTRACT
FOR THE DIVSION OF AUTOMOTIV SERVICES

COUNCIL OFFERED AN MOVED

ADOPTION OF THE FOLLOWIG RESOLUTION:

WHREAS, pars and repairs for road maitenance equipment are needed to keep the
City of Jersey City's (City) vehicle fleet operational; and

WHEREAS, N.J.S.A 40A:ll-l2 of the Local Public Contracts Law authorizes

, municipalities to use a State contract and N.J.A.C. 5:34-7.29(c) requires City Council
authorization for contracts exceeding the public bid theshoÍd of $36,000.00; and

WHREAS, Certified Products Co., Inc., 400 Westside Avenue, Jersey City, New Jersey
073Ö5, being in possession of State contrct A 69708 submitted a proposal for par and repais
for various City Vehicles; and

WHEREAS, the contract term of the contract shall be for twelve (12) months and the
total cost of the contract shall not exceed one hundred and twenty thousand dollars
($120,000.00); and

WHREAS, fuds in the amount of twenty thousand dollars ($20,000.00) are available
in Account No. 11-01-201-26-315-310.

NOW, THEREFORE, BE IT RESOLVED by the Muncipal Council of the City of

Jersey City that:

1) A contract is awarded to Certified Products Co., Inc. for pars and repairs for
road maintenance equipm~ntfor varous City vehicles;

2) The contract term is for twelve (12) months effective as Januar 01, 2011, and
the maximum amount of the contract shall not exceed $120,000.00;

3) This contract is awarded pursuant to N.J.S.A. 40A:11-12;

4) Pursuat to N.J.A.C. 5:30-5.5(a), the continuation of the coiitract afer the

expenditue of fuds encumbered in the 2011 calendar year temporar budget
shall be subject to the availabilty and appropriation ,of suffcient iùds in the
2011 calendar year permanent budget;

5) Upon certification by an offcial or employee of the City authorized to receive

the material pursuat to the contract, that the same has been received and that
the requirements of the contract met; then, payment to the contrctor shall be
made in accordace with the provisions of the Local Affais Law, N.J.S.A.
40A:5-1~ g;; and

6) Ths contract award shall be subject to the condition that the vendor provides
satisfactory evidence of compliance with the Afrmative Action Amendments
to the Law Agait Discrimination, N.J.S.A. 1O:5-3l'~ g;.

(Continued on, page 2)

 Continuation of Resolution' Pg.# ~'
City Clerk File No. Res. 11-050
Agenda No. 1O.X

TITLE:

RESOLUTION AUTHORIZING THE AWAR OF CONTRACT TO

CERTIFIED PRODUCTS FOR PARTS, AND REP AI FOR ROAD
MAENANCE EQUIPMENT PURUAN TO STATE CONTRACT
FOR THE DIVISION OF AUTOMOTIV SERVICES
-.J~.

I, " Doima Mauer, Chief Financial Offcer, certfy tht

fuds in the amount of $20,000.00 are available in Account No. 11-01-201-26-315-310.

Requisition # Purchase Order # State Contract #

0153157 102175 A69708

RWHsb
Jan 03, 20ll

APPROVED: APPROVED AS TO LEGAL FORM

APPROVED:
Corporation Counsel,

Certifcation Required 0

Not Required

RECORD OF COUNCIL VOTE ON FINAL PASSAGE' 1/26/11

COUNCILPERSON ,AYE NAy N,V. ' :COUNCJLPERSON AYE NAY N,V. COUNCILPERSON AYE NAY N.V.
SOnOLANO GAUGHAN
VElAZQUEZ
DONNELLY FULOP FLOOD
LOPEZ RICHARDSON BRENNAN, PRES
.I Indicates Vote
N,V,.Not Voting (Abstain)

Adopted at a meeting of thè Municipal Council of the City of Jersey City N.j.

Peter M. Brennan, President of Council Robert Byrne, City Clerk

 \".. T ur "i:t(~i: T \".. T
Requisition # Assigned PO #

0153157

Vendor
Requisition
Dept. Bil To
10')( K
CERTIFIED PRODUCTS CO INC AUTOMOTIVE Dept. Ship To
269 KEARNY AVENUE 575 ROUTE 440 575 ROUTE 440
JERSEY CITY NJ 07305 JERSEY CITY NJ 07305 JERSEY CITY NJ 07305

CE106100 Contact Info HECTOR ORTIZ, DIRECTOR

2015474423
Quantity UOM Description Account Unit Price Total
1.00 SC STATE CONTRACT RESO 01-201-26-315-310 20,000.00 20,000,00
PARTS AND REPAIRS FOR ROAD MANTENANCE EQUIPMENT ,:"

- STATE CONTRACT VENDOR --

SC#A69708, T# 2188

DURATION OF CONTRACT = 01/01/11 TO 12/31111

CONTRACT AMOUNT = $120,000.00

, TEMP, ENCUMBRANCY = $20,000,00

PARTIAL PAYMENT VOUCHERS

Req. Date: 01/07/2011

Requested By: BAIJNAUTHS Approved By:

Buyer Id:

This Is Not A Purchase Order

rurcna:t: ourt:au LoUIUrdCl ~t:arcl1 .£aö~.l V.l.J.

~ State of New Jery

~ Department of the Treasury .
Search All of NJ il
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I fAQs
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:Term Contract Search by TNumber

Click Here to search more Term Contract

T~Number I Title Vendor Contract #

T2i88 08-x- PART~ & REPAIRS FOR ROAD MAINTENANCE CERTIFIED 69708
36537 EOUI ¡MENT PRODUCTS CO
I TOl'
" ,,'

(l
!
Sløint I Ac Sta
~'_I....
~ Pùlcl_lI.!
Cania US I Prac Nace llé
81 ment

Purchase & Propert: Ho~e I News I Directions I Frequently Asked Questions i Contact DPP
Treasury: Home I Services i People I Businesses I Departents/Agencies I Forms I Contact Us
Statewide: NJ Home I Services A to Z I Departments/Agencies I FAQs
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This site is maintained by the Offce of Treasury Technology.

htt://ww.state.nj.us/cgi-bintreas/purchase/search.pl 1/72011
State ofNJ- Deparent of the Treasur - Division of Purchase & Propert Page 1 of1

Vendor Name &. Address: CERTIFIED PRODUCTS CO

400 WEST SIDE AVE
JERSEY CIT, NJ 07305
Contact Person: S.RAMDAT
Contact Phone: 201 -433-00J
Order Fax: 201 -4.33- 1482
Contract#: 69708 ,

Expiration Date: 06/30/11

Terms: 5% 10 NET 30
Delivery: 14 DAYS ARO
Small Business Enterprise: NO ,

Minority Business Enterprise: NO

Women Business Enterprise: NO
Cooperative Purchasing *: YES
,

htt://ww.state.nj.ustreasur /purchase/noalcontracts/t2188 ~08-x- 36537 .shtm 1/72011

This summary sheet is to be attched to the front of anyordinance, resolution, cooperation
agreement or contract that is submitted for Council consideration. Incomplete or sketchy
summary sheets wil be returned with the resolution or ordinance. The Departent, Division
or Agency responsible for the overall implementation of the proposed project or program
should provide a concise and accurate statement of facts.

1. Full title of ordinance/resolution/cooperative agreement:

State Contract Resolution authorizing a contract for the Department of Public Works, Division
of Automotive Maintenance.

2. Name and title of,person initiating ordinance/resolution, etc.:

Rodney W. Hadley, Director of the Departent of Public Works for the Division of Automotive
Maintenance.

3. Concise description of program, project or plan proposed in the ordinance/resolution:

SC resolution for parts and repairs for road maintenance equipment for the Department of
Public Works, Division of Automotive Services.

4. Reasons (need) for the proposed program, project, etc.:

For parts and repairs for road maintenance equipment for the Department of Public Works,
Division of Automotive Maintenance.

5. Anticipated benefits to the community:

For parts and repairs for road maintenance equipment for the Department of Public Works,
Division of Automotive Maintenance.

6. Cost of proposed, program, project, etc. (Indicate the dollar amount of City, State and
Federal funds to be used, as well as match and in-kind contributions):

The cost of this contract is one hundred and twenty thousand dollars (120,000.00).

7. Date the proposed program, or project wil commence:

Upon adoption by The Jersey City Municipal CounciL.

8. Anticipated completion date:

December 31, 2011.

9. Person responsible for coordinating proposed program, project, etc.:

Hector Ortiz, Director~ Division of Automotive Maintenance, Department of Public Works.

10.Additional comments:
Resolution proposed at the recommendation of the Director of Automotive Maintenance.

Based on the information provided to me, i certify that all the facts presented herein are
accurate, to the best of my knowledge.
 CERTIFICATION OF RODNEY W. HALEY

I, Rodney W. Hadley, of ful age, hereby certifies as follows:

1. I am the Director of the Deparent of Public Works for the City of Jersey City.

2. The Deparent of Public Works, Division of Automotive Maintenance is

authorizing' a state contract resolution for par and repais for road maintenance
equipment for the Deparent of Public Works, Division of Automotive
Maitenance.

3. The tota fuds requested for this purose is $120,000.00.

4. The fuds are available in Account No. 11-01-201-26-315-310.

5.

the law. J
I certify that the foregoing statements are tre. I am aware that if any of the forgoing
statements made by me are willfuly false, I am subject to legal action to the fulest
extent of

Dated:
!~
, 'i, , . "" - ". o' ,.."" ':'~-;:

-4

CERTiICATION ÒFCOM:LIANCEWI'ITI CrrYÖFJERSEY CIT

,." ,
CONTRCTÒRPÄ,Y-TO-PLAYREFORM ORDINANCEOS-iiSAJOPTED ,
" ON SEPTEl\ER 3,2008

:PARtl~ VendorAf~n '

. . tieundm,' igne((b~ing, ~nz,' edan,dknOWledgeal~~rtheCir,',"'" ta,'" ,ces,dÖ~Sh,' erebY~er,'. tht
" :eøZ t:.. . ~ .. (nae, of busmess tity has not inde an~ reortle.
'contrbutions iI the **one-yea period 'precedg .' ø /~. ,/ I '(date City .Council '
, . ..' awardS contract) that would be dee~ed to pe'vIòlationsof ectioii OIie, of the City of Jersey.City's "
, ' Con~tor Pay-to-Play Refo~ Or~~~ 08-1~8 (~hed hereto) and.~at wo~d bar ~CA'Yard '
oftls. contrt. I fuer cert that dung the term -of the contrt e~~-: r A'~ ~
i28~ ;" " . . ,,' .'
, ,(name ofbuSIIess entity) will ,not make any reortblè contrbuti~ns in violati9D of OrQiance 08- "

P NlT 1I ~ Signe and,Attestátion:

.--Theuiderignedis,.fÝ aware thatifI:haveinepre~entedin'whole orpar ths afåtioiiaid '

.'
, 'cercation, I andlör lAe business entity, ,wi be liàbleforaiy penalty pertte4 under làw. . "

NaiòfBuSEntlty ~-/~~~s."'.
./1 q¿ed/ ~~. '
: . Sign~ . ' Title: ~;~ " ~"I .'
"'PrtNane.:sS~r( .~/ " 'Date:
.øæø~.
S~bscrQ~ and swo~before ine
ths Iff1l'dayof JA- N " 2~.llJ
" My ~oinssion expir~:.J. /()l/2iI.2 ,
~~O..,
~ (,A/"VlliJ 'k/A-~oJ
, (Pt rie & title of afant) ,(Corporate Sea)
, 't:ALVIN 'WATS,ON
NOTPUOfNE.J '
; c:&p111/112
"

" -'I,
r,

**Puuantto'Seetion 2 ofOrdiance08-1ZR, no eontrbutioiior solicitation'oÍ

, ."' " . .
'.

contrbutions IIade prior to the effective :dae 'Ordiançè 08- 128 (SePtember 23, 2008)
sh be deemed to be 'a violation of the Ordiaice~ , ' ,. '., ,',

:G:\wP~aytoPiI.P1a~il i9~'O 08Cl28:wp "

 -" .
---. --- ---
..l
-~---- ----~---- -------- -_.__._-~....._-:-.-.-._-_. .__:__._---.-----~.__.-.

BUSINSS ENITYDISCLOSURECERTIFICATION
FORNoN-FAIR~,OPEN CONTCl
Requied PusuatTo NJ.S.A.19:44A-20.,8
'C10F JERSRYCIT
Part I.., Vendor Afation
, ,The underig~ beig authoried ard IaowletIble of the cicutaces, does hereby'cer that t:e ~lI(Je oj ,
,bullesnllti!j~ ~iiot~de: and ~ not in~ any reporthlecontibuÏ:anS purt to NJ.S.A. 19:44A-let seq. that,
pi,uat toP.L '20, ~ i9 wouldbaidthe awa of th coi:tractin the one yeà perod pteq:di (date ojaward scheduled
forapprotlal oj the rontactby theg01ing bo4J) to any, of. the folloWig namec cadidate comttee, joint cadidates
comtte¡ or politica par comttee tep,reSenti the elecd offci of tie~nane ojeiti!J ojelecte.d o.çr~ as
"defied'putuant. to N.J.SA 19.:44A-3(p)~(q) and ,
(r).
'' GaU2han 'Ele~tionFund
"
Maio Ve2'a, Jr. Election Fund,
'Friends of Peter Brenan E.ec:ton l:lund The Elecion Fund of Steven Fulop, . . , ,

Cointtee to' Ele~t Wile Flood Friends of Viola Richardson for War P
of Michael Sottòlano
"
Friends

EFO David P. Donnell J.C. Council2010 Healy for Mayor 2009

,Friends'ofNidia R. Lopez ,

,...
, .
Part U~Owership Disc1o~ute Certfication , " " " " '
. ß:c~ that 1Ì~ lit below c~ntas 'the iies and home addreSseS'ofaU owners. hoidi lQO/~' or mò~¿ of the
issued and outstadi stocl of the Undersiged .' ,
. Check the box tbatrepresen~e!tyeofbùsiness" entiiy: "

dDP~etship ,,'~rp~tariOii' " ,DSo1 Ptoprietorshi~ o Subchpter S CÖrporatio1i' '

, OUmted' patetshipDJited 'Liabilty Cojpotarion ' "DLited Libilty Parership, '
Nam~ ,of ,Stock or Sharelloldet , H,ome Address
R7Ur""T./ /tJlllI -3~ ~..£'ê'r ~Úl/67
,.. :

CCJ~/.,' 1"0 g.
.. ,
-Ú/ ff/ .P/4fi 9'A'' d979d-/
,

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, ,
;

,,'
,

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" -'

"
,

Subscrbed and swom befote me th

JItUUAfY.-',iO.1l.:' '
My Cosi api= iila rlUJ i ~ '¿Jli,yIJ~bJ' ' .
, " '" (Ptitname ,c&tÍ~evi~~~~m~(~J:oi:teSC!J. "
NOTtJlYliJ8U(óf!'N~
. Ci~r(~1~L.:;sI~1 r1?!.r~~ 1 1(1 ()12
 "

BUSINSS ENTITY DISCLOSURE CERTIFICATioN

" , , FORNÖN~FAI:AbpEN CON-Çl , -
'ReqUied PttToN.J.S.A. 1?:44A-20~8
"1 OF CONJcrG AGENcY
, , The followi is statutoíy teX relted: to the t~ ~d citaonsused ~ the, BUSess Entity Disclosure
, "èecation - forr '
. .... . . . -..' . '.. . ' '. - .
"Lcál Unit Pay- To-Play Law" (P i. 2004; c.i9, ~s.amended by PoL. 2005, c.'51)

19:44A-20.6 ÇetÎ contrutions deemé~áS ê6ntrbuûoiis by-btIiness entity. , '

: S.Wbei a busess entity is ana~ peion. a cootrution by tht peron's spousçor chd, residitherew~ , '
, slal be deeed to, be a
contrbution, by the,buSess entity._ When a fjuS~s,:entity is other'th a _naturalpersoo; a
,. ,contrbution by any peion or other buslies entit::havk, ~ interest therei shal be deeed to be a eonttòutic;n
by the b~iness entity.' , ,

19:44A-20."- Deftionsrelatie to cert campai contrbutions~

, 6.:As used in sections .2 though 12 óf,di act, ' , ,
, "busess entity" mèa, any natu or tCg person, busineSs corporation. piofessioii serces eOJ:potati(j~lited '
libilty eømJ:any~ pareiship. lited parerhi. 1Jusiress tit, assocition or any ótherlegcommerci entÏty, '
, orged under the la~s of th State or or any other state or fore jtic1ction;
c'itteest meas the oWneihi or control of more th 10% of the proRts or assets of a business ~tity or 10% of
the stock in thè cae-'ofab,¥iness entity thatjs a epi:oi:tion: fot profit" as approprite
Teinpora and Executing' , , any busess entity to perorm a'
, 12. Not:g eontaedii this actshalbe constred as afec the diilty of

, public eontictbeeausetht entityinde a contrution to any coiittee durg the one-yea perod imedtely "
prece the effe~e qate of th, act . ' ", , ': ' ' , - ,"
~~--~-~--------~-----
, 'seq.) , '
: TheNew Jersey Campai Contrbutiorl ani ExpeidiÏu ReportAci (N.J.S.A 19:44A-l et

'.," .~

16 ContrbutiÒn~~ 'eXpenditures" tepO~,requiements~, " " , ,

, çonibutns ' '. " "

19:44A.: . and

. :Whi 'the prvins of this .rectn ar too ex11 to "Pn(hereJ . the fOllWing it deemed to 'be the pertnentpaqffediig .aount. of

"The $300 1it~tablihed ~" th subsection shaI rem as stated in th subsection vithóut fuer ,adjustment by'
,the conusionin tie 1ner pr~cdbed by section 22 ofP.Ll993,.c.65 (C.l~:44& 1.2)- -' , -' -
 C~. 271 POLITICAL CONTRIBmON 'DISCLOSURE- FORM

Public Ag~ncy Ins,tructians

Th page provides "gudaice topublicagenci~s ènterig into contrcts withbuSInessentitiès tht '
file Poiitica Contrbution DisclosUr (onn~th ~e agency~ It is notiiteoded
,ai.'réqwred to

to be,provided to Coo..dors. What follows ,are .iItrctions ,on the use offori local unts ,èa
, 'provide to tÜntrtors tht ,are requied to disclose,
politica eoIitrbutol1 pUlt to 'j:l;J.S.A.
, 'i9:44A,.20~26(P.L. 2005, ç. 271, s.2). Additional UionIau()n ò~,the procss is available in
'LOå1 Ein~ae NotiCe 2006-1 (ww;nj.gov/dcaIgsleIiu.shÍr). " " '
not awarded puruani to
i., The disClosur is,reu¡red for alleOntrctinexcessofSJ 7,500 that ar

a "fair and oPen" process iN.l.S.A. i9:44A-20.7)., ',,',.- ,',.

2. " DUè to'the ~tenti~ lea.gt of some contrctor submissions the publicRgency should,consider
alloWig dafi to be submitt in electronic (onn (i.e.,' spreadsheet" Pdf Ï1e~ etc.). SubmisSions , ,
'iiustbe'kept with th~ contrctdocuients or man appropriate Computr fiedand be av.ailable for,
": public acès. The fonn is worded to aèceptthiSaitemate submision. 'The text should be
allowed ' -
ooff~
, ..
, 8Iendedif electronic sùbmission wil not be

3.11e submission must be receiv~ from thecontrcto~an,d ori fUe atlea io days
prior to award ' '
" 'of the contrct Resolutions of award should reflect-thatthedisClosue haS been reeived and.is

4~' 'TIe coiitrctor must disclose, contrbutions 'Inade to candidate andpiu committeeeoverig a
'wide rage 'of publiaagencies, including all public agencies 'that have electe' offCials in the
, ,county of the public agency,sttelegis~ative positi.ons, ànd varous stteenqties. The J)ivisipn'.of '
Loc3'Goverment Services reCOmmends thàt contrtors be provided' a lis of the afecte "
,agencies. This wiUassis.contrctors in determining the çapaign and pOlitical conimitees of the,
, , offci~lsand cadidates affected by the disclosure.' '
a.' , 'The Division has' prepared'model disclo~e fomi for each co~ty~' They can be
doWioaded from the "County PCD Forms"Jink on the Pay-to-PIaywebsiteat
" ,..'
.wW.ni.gov/d~lgsp2p. They wil be updted from ~e-to.time as'necssa., " '
b. A public agency 'using,thèse forms šhould '~d.t the~topropèrly reflect the corl"
leglatie district(s). As the foms are eOunty-baSed, they li all legilative diScts in
do not represent the public ageiicyshoul~be renioved '
from theJists. ',' '.' '
each county~ Districts that

,c. Some contrctors may fid it eaier to provide a siigle list that cove.r aU contrbutons,.
-' ';, regardless of the CO\IIity. These. submissionS ar appropriate andshould be àccpte.
d. The form may be used "as-is", subjectto eØitsas described hei:ein. ' ,
è. 'The "Contrctor Instrctions" sheet is iltended to :b~ provided ~ith the fomi. It is ~
, recollerided tJiat the Inctions aId the folm be prited on the samê pi~ ,of
pape.' ' : '
The for notes thát the Instctions are,printed,on the back'ofthe form; where that is not'
, th,e case, the teXt shouid be edite aecordmgly. ", '
t' The f~rmis a \Void 4ouri~niand can be editedto meet iocai'nee, and posted for ' '.
" ' 'dowiioadon web sites, used'as an e-mail attclmeIit, or'provi4~aS a prit~ d~umeiit.
, ... It js~ecommeIided '"that the contrctor 'also ~mplete a '"Stockholder DiSclosure 'certficaion~" ,
Th wiI asist tIe loC unit in it obligation to ensur.thatcOntrctòr'didiiot make any
prohibited ,contnõutions to the èommittees listed on the Business
Entity Disclosur Ceitificition
'jlÚhè 12 m~)ßths 'prior to t1é CQ~trCL '(See. LoaI Finance Notice 2006-_ Îor addjtonal '
",infomåtion on this obligátion) ASåple Certcatioilfònn'ispar ófthis pac~ge and,the ,,-
.. 'ineao~ to .complete it is included in, the Contr~tor ~ctions~ '. ¡ ~, '
 ,
; C. 27-1 POLliìcAL CONTRIBUTION' DISCLOSURE' fORM '
. .
Contractorlnstructioñs
~ Busines ertiti~ (contrctors) reiving çontrcts frm a public 8gencythat are NOT awar(led pursuant to
a '~fair an~ open" procss (defined at NJ.S;A~ 19:44A-20.7) arsubjectto tleprovisions ofP.L. 2005, c.
f71, s.2(NJ.S.A.'19:44A":20.26).' This law provides that 10 day~ prior,to the award of
such a cOnnet die
.contrctor shall disclòs contibutio~to: ,: " '" ' '
· ~y State, county, 'or niuncipal Commttee of ~ politca par
.anylegislmve leadersip coinittee. "
. .any contiuing poIi~ committee (a.k.a., politi~ acton commi) ,
· ,any cadidatecoUuttee of a cadidate for, or'holderof, an elective offce: - "
_ 0 of the public entityawaringthe contrct
, 0 'òftht county in which that public en.tity is 100t~
o ' of another public enti within'that couity ,
, . 0 'or of a legilative distct'in whicli that public enti is locate or, when the
_ public enti is a county, of any legilative disct which inCludes, all or par
, oftIe county , " . . .
cycle tJat were

: '. .
TÌ~ disclosnre must Jist reportble contrbutions to 'any of.the COInittees that ex~d $300 per electon
made during the 12 months pñor.toawarofthe;~ntrct. See'N.J.S.A. 19:44A-8 and:' ,
1 9:44A- i 6 for more detals on reportble contributons. '

, NJ~S.A52:34-25(b)itemiZs the'pares frm whom contributioiis must be disclosed'when a business

entity is not a natl person. This incluaes ~e followig: ' " ,',
control of more.thai 10% oftJe profits or'assets

profit . ' ,
, · mdividUaswit an "interest" oWnership or

ofa businesentity or 10% of the stock in the cae- of a business entity that is a corporation
for

,. all pñncîpals, parers, offCers, or: dirorS oft1e business entity or their spouses
· any subsidiares dieètIy orindir~tly ~ontrolled bythë b~iness eIititY . -', ,
· "IR Code SecaÏi 527 New Jerseybascil orgaii;tions,' diretly or indireetlyconirlled by
,. the business entin, ard filing asconanuiIg politica oonIîtts, (l ACs). '
" , , Wlen the'buSiiess enti is a natural person, "acontrbution by that person's spouse or child, residing
therewith; sha be deemed to be a contrbution by the busniess entity." tN.J.S.A. 19:4:A-20.26(b)) The .
contrbutor must be list on the disclosure.' , . ',. --

. 1'. . /. '..
, ,." ,,:Ay business 'enti ,that fails to comply with the disclosure provisions shallbe subjec to a fie 'impo~
, .by ELC in anamoUil to be deteinéd 'by the Còmiission wJich maybe based upOn the amountth!n
, , the buslnes~entity failed to report. ,', " , ,
~e enclo~ list of'agenciesis provided toassîst the' contrçW¡' in ìdentifynigtlose public 'agencies whose
elec~ offcial and/or cadic;e capaign committs are afeced by1he dislosur'reuiement ltIs the,
contrctor's responsibilty to identify the speific colnittsto .which contrbutions may haýebeniDe ' ,
and neë to be'disêlose.' The dislosed information may ex~ U1e niimii reqment ' ',' .
Th enclose fo~ 'acontent-consistent fa~imi1e, or aielec~iÍ~ da~dfile contalig the requiredetIs
'a, signed cover-sheet) may be use as the contrctor's sûbmisîonand, is diSclosåble tqthe. ' ,
Open Public Recrds'Act. " , ,
(along with " '
publiciinder the

The còiiiictor irust alsoconiplete the' attched Stockholder Disclosu~C? C~rtcaon. This wiUassistthe
, agenèyII meeting its obligatons under the law.' ',' " :','. ' " ' ' ,

. . , ' .. Nj.SA. 'l9:44A.,3(s): "1b~' term ~legisI.ative leaderhi committeè m~ aCOmnitteeesIished aUtri to
, .,', -- :.' be' ëSõliñ~ofcdesìgialëdb!the Preident 9fthe Seïie, the MiöntyLeaer óÎtI~fseñate; tl Speaerof1le '
'" GeiieralAssembIy Or the MiIoñty Leder of the GeiieraAssembly puruantto, secon 16 of PL. I 993, c:65 ' '
, (C. I 9:44A-IO.1) fordiepwpose of recivig cOntributons andmalg expndifues." .
.0 ¡

, C* 271'POLIICAl CONTIB,UTION DISCLOSURE FORM .

, Requi Pursuat To NJ.S.A. 19:44A-20.26 '

This 'form or itS permit facsimiie must be submitted to thelocal'unit'

, ,.' no .later than 10 days ,prior to the awatiofthe contrct.. "
)

:r .'
¿J73-ò..-
, The underigned being'authoifd,to cert, heI"~byceites that the submission provided heréfu rep~esnts , ,

,form. ,',. . . ' , " ,

, cOmpliance'with the pro . iotis ofN.J.S.A.,'19:44A-20.26 and as representedbytle Instctions accmpanying tlii$

~'?/'-r,R:~~r ',y~'
. P'ited Na,e Title
,Paitll-Contñbution Discíosure.

Disclosu requiement:Puruat to,N.J.S.A. 19:44A-20.26 ths diclosure mustiiicludeall reportble

, politica contIòutioDS (niore th $300 per' elecon cycle lover,the 12 lIonthprior to' submission to the
cOintt 'of the, governent entities'liste onÜ1e form provided by the lo~ tit., ' . " ,

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'.Contiriuation Page

. ,. .
C.271,OUnCAL CONTBUnøNDlSCOSURE FOM
" Requied Puuat To N.J:S.A. 19:44A-20.26

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