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REQUEST FOR PROPOSAL
FOR STATE FISCAL YEAR 2012
ADOLESCENT PREGNANCY
PREVENTION INITIATIVE
CONTACT PERSON: Kathy Arrington, Director
Office of Budget & Purchasing
MAILING ADDRESS: Atlantic County Government
Division of Budget & Purchasing
6th Floor
1333 Atlantic Ave.
Atlantic City, NJ 08401
PROPOSAL DUE:
11:00 am APRIL 20, 2011
REQUEST FOR PROPOSALS
Public Notice is hereby given that SEALED PROPOSALS will be received by the
Purchasing Agent of the County of Atlantic, New Jersey at 11:00am prevailing time on
APRIL 20, 2011 in the Atlantic County Conference Room; 3rd Floor; 1333 Atlantic
Avenue; Atlantic City, New Jersey for :
RFP 201110.3
REQUEST FOR PROPOSALS FOR STATE FISCAL YEAR 2012
ADOLESCENT PREGNANCY PREVENTION INITIATIVE
Specifications and blank Bid Forms may be obtained online at the following web
address http://bids.aclink.org
Any questions concerning this specification must be directed to the Office of Budget &
Purchasing in writing by email to [email protected] or fax (609) 343-2193
Proposers are required to comply with requirements of NJSA 10:5-31 et seq. and
N.J.A.C. 17:27
Proposers must abide by the New Jersey Prevailing Wage Act, P.L. 1963, Chapter 150.
The Contractor must comply with the applicable special “Pay to Play” restrictions
adopted by the Board of Chosen Freeholders
The County of Atlantic reserves the right to reject any or all proposals
By order of the County Executive of the County of Atlantic
Kathy Arrington; Director,
Budget & Purchasing
County of Atlantic, New Jersey
REQUEST FOR PROPOSAL
TABLE OF CONTENTS
COVER PAGE
COPY OF LEGAL NOTICE
TABLE OF CONTENTS
GENERAL INFORMATION
DETAILED SCOPE OF SERVICES/SPECIFICATIONS
PROJECT PROPOSAL (to be submitted with the proposal)
Proposal
Political Contribution Form
Affirmative Action Requirements
Non-Collusion Affidavit
Recycling Compliance Affidavit
APPENDIX
Sample Contracts
Other Sample Forms (Grants etc)
Insurance Requirements
RFP CHECKLIST
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REQUEST FOR PROPOSALS
FOR STATE FISCAL YEAR 2012
ADOLESCENT PREGNANCY
PREVENTION INITIATIVE
PART I - INTRODUCTION
The County of Atlantic is requesting proposals for STATE FISCAL YEAR 2012 ADOLESCENT
PREGNANCY PREVENTION INITIATIVE
Proposals may be mailed and delivered to:
Kathy Arrington, Director of Budget & Purchasing
Atlantic County Government
1333 Atlantic Ave.; 6th Floor
Atlantic City, NJ 08401
Proposals must be submitted on or before APRIL 20, 2011 by 11:00 a.m. Late submissions will not
be entertained.
PART II - GENERAL CONDITIONS
A. Instructions
All questions must be answered. All forms and required certifications, which are located at
the end of the RFP, (Affirmative Action, Political Contribution Form, Non-Collusion Affidavit,
Recycling and Insurance Certificate) must be completed and submitted with your proposal.
Each proposal shall include a Letter of Transmittal which bears the original signature of an
authorized representative of the vendor and which also includes the name of individuals
authorized to negotiate with the County of Atlantic.
Each proposal shall include a full explanation of the services that will be provided.
Proposals shall be in sufficient detail to determine and evaluate the services provided.
One original and five (5) copies of the completed proposal must be delivered by APRIL 20,
2011 to the Atlantic County Office of Budget and Purchasing, 6th Floor - 1333 Atlantic
Avenue, Atlantic City, New Jersey 08401 by 11:00 a.m. EDT on that date. Late proposals
will not be eligible for review.
Each proposal must be submitted in a sealed envelope bearing on the outside the name
and address of the preparer and the name of the subject of the proposal.
Proposal prices are to remain firm for a period of not less than sixty (60) days to allow the
County to determine the best proposal that shall most economically serve the intentions of
this proposal.
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B. Proposer Qualifications
The proposal must include: the company history, a list of vendor credentials, and experience
statement to include but not limited to any experience with similar projects.
The preparer shall furnish to the County of Atlantic any and all such information,
documentation and data for this purpose, as the County of Atlantic may request.
The County of Atlantic reserves the right to reject any proposal should the information
submitted by or investigation of such vendor fail to satisfy the County of Atlantic.
Proposals must specify any deviations from the requirements.
The County reserves the right to reject any or all items covered in the proposal request, or
any portion(s) thereof, waive informalities, re-advertise and/or take such other actions
decreed necessary and in the best interest of the County of Atlantic.
Failure or inability to meet any of the requirements set forth in this RFP will be sufficient
reason to disqualify prepares.
The County of Atlantic reserves the right not to consider any proposal that is incomplete or
that does not meet the specification requirements.
C. Statutory Requirements
NEW JERSEY BUSINESS REGISTRATION CERTIFICATE
Section 1 of P.L. 2001,c.134 is amended to read as follows:
An act concerning business registration for providers of goods and services to the State,
State colleges and universities, county colleges, local contracting units, boards of
educations, water and wastewater contractors and casinos, supplementing Title 54 of the
revised Statues and amending P.L.1977,c.110.
All non governmental proposers SHOULD submit a copy of their Business
Registration Certificate with their proposal. No contract shall be entered into by any
contracting agency unless the contractor provides a copy of its business
registration.
All proposals must comply with the provisions mandated by applicable Federal Law and
New Jersey Statutes.
Any provisions in the RFP which may be in conflict with any New Jersey statute are
amended to conform to the minimum requirement of such statute.
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D. Terms
The contract will be for the term effective July 1, 2011 to June 30, 2012
E. Cancellation
Proposals are subject to :
1. Right of the County to cancel the contracts upon ninety (90) days written notice to the
contractor.
2. The County of Atlantic reserves the right to reject any and all proposals and any part
thereof and to waive any informalities, formalities, irregularities and errors in the proposals.
F. Questions
Please submit all questions in writing to :
Attn.: Kathy Arrington, Director of Budget & Purchasing
1333 Atlantic Ave.
Atlantic City, NJ 08401
or Fax to (609) 343-2193.
Responses will be forwarded to all vendors who have picked up RFP packages.
No firm intending to submit a proposal or any employee of any firm intending to submit a
proposal shall contact any County employee for any reason either directly or indirectly
related to this Request for Proposal. Any firm found violating this policy will be automatically
disqualified form submitting a proposal.
G. Contract
The Contractor will be required to signs the standard County Contract, a copy of which is
attached hereto as Attachment CT. If the contractor desires to make any modifications to
the County’s contract language, or has another contract form that he/she desired the
County to sign, in lieu of or in addition to the County Contract form, a sample copy of the
contractor’s proposed language modifications or contract form must be submitted with the
proposal, or it shall be assumed that the contract documents will consist exclusively of the
County’s form contract. Modifications or additions to the County’s form contract will not be
entertained after contract award. The County will not agree to sign a contract which
includes a provision for dispute resolution by arbitration.
H. Insurance
Provider must supply with their proposals proof of insurance as detailed in Attachment INS
An insurance certificate must be submitted prior to contract execution.
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I. Recycling
The contractor must provide the County with information regarding their recycling program.
The County of Atlantic has, pursuant to P.L. 1987, CH 102, adopted the Atlantic County
Recycling Plan and Ordinance # 7 of 1988, which designates the following commercial and
institutional materials as recyclable and mandates the recycling thereof.
* Glass Food & Beverage containers: Clear, Amber, Green
* Newspapers
* Aluminum Beverage Cans
* Office Paper (White, Non-Colored)
* Computer Paper
The attached recycling affidavit will need to be completed and submitted with your proposal.
(Attachment R)
J. Affirmative Action
The Contractor will be required to comply with the requirements of PL 1975, C.127 (NJAC:
17:27 see Attachment AA
One of the following items must be submitted with each proposal:
1) A copy of he contractor's federal affirmative action plan approval letter for the
office of Federal Contract Compliance Programs.
2) A copy of the contractor’s certificate of employee information report.
3) Contractor’s initial affirmative Action employee information report (Form AA302)
K. Attachments
The provider must include all of the following with their proposal:
A. Non-Collusion Affidavit must be notarized
B. Political Contribution Form
C. Recycling Agreement must be notarized
D. Insurance Endorsement as described
E. Affirmative Action requirement
F. A Copy of their NJ Business Registration Certificate
L. Reservations
The County of Atlantic reserves the right to reject any and all proposals, and any part and to
waive any formalities, informalities, irregularities and errors in proposals.
A written request for the withdrawal of a proposal, or any party thereof, will be granted if the
request is received by the County Purchasing Agent prior to the specified time of the
proposal opening.
M. Interview
The County reserves the right to interview proposers, request clarification of proposals,
request additional information, request modification or proposals and negotiate contract
terms with the successful prepares.
Bidders may be asked to explain and/or clarify their proposal to a selection committee.
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N. Ordinance # 10 - 2007 Public Contracting (Pay -To - Play) Reform
Professional Business Entity - a “professional business entity” means an individual including
the individual’s spouse, if any, and child living at home ; person; firm , corporation;
professional corporation; partnership; organization; or association. The definition of a
professional business entity includes all principals who own 10% or more of the equity in
the corporation or business trust, partners, and officers in the aggregate employed by the
entity as well as any subsidiaries directly controlled by the professional business entity. This
definition excludes non-profit corporations under Internal Revenue Code (IRC), Section
501(c) (3) and their officers and board members.
Prohibits Atlantic County from entering into a agreement or otherwise contract to procure
professional , banking , insurance coverage services or any other consulting services
provided by a licensed professional , including those awarded pursuant to any process
including a fair and open process, if such professional business entity has solicited or made
any contribution of money or pledge of a contribution, including in-kind contributions to (i)
any campaign committee of any candidate for elective County Office or the current holders
of any elective County office, or (ii) to any Atlantic County party committees, (iii) to any
municipal party committee within Atlantic County , or (iv) to any candidate committee, state
or county political party or any Political Action Committee (PAC) that is engaged in the
financial or in kind support of candidates for elective Atlantic County offices, County
elections and/or Atlantic County political parties in excess of the annual maximum of $ 300
each or up to the amount of reportable contributions as may from time to time be
established by the Election Law Enforcement Commission (ELEC) for any purpose to any
candidate for elective County Office or current office holder, or $500 to any Atlantic County
party committee, or municipal party committee within Atlantic County , or to a single or joint
campaign account of a candidate committee, state or County political party or PAC.
Additionally, no business entity , which may include principals, partners, and officers of the
entity in the aggregate , may not annually contribute for any purpose in excess of $ 2500 to
all candidates for elective County offices and to office holders with the responsibility for the
award of the contract, who are the County Executive and the members of the County Board
of Freeholders. The Ordinance does not cover contributions made prior to October 22,
2007
The Proposer must complete a Political Contribution Form ,see attachment (PC), certifying
that it has not knowingly made a contribution in violation of the ordinance and has not made
or solicited contributions through intermediaries , third parties, immediate relatives, or
Political Action Committee (PAC) for the purpose of concealing the source of the
contribution. A Contractor that files an incorrect Political Disclosure Statement will have its
contract with the County declared null and void and will be disqualified from being awarded
any contract for a period of Four (4) years.
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SCOPE
OF
SERVICES
COUNTY OF ATLANTIC
REQUEST FOR PROPOSALS
FOR STATE FISCAL YEAR 2012
ADOLESCENT PREGNANCY
PREVENTION INITIATIVE
PURPOSE OF FUNDING:
The County of Atlantic is awarding grant funds for the Adolescent Pregnancy Prevention
Initiative. The program will target those populations most at-risk of adolescent
pregnancy and births, and will address the comprehensive needs of at-risk young
women and/or men.
CONTRACT PERIOD:
The contract period for this Request for Proposal will be July 1, 2011 through June 30,
2012, contingent upon the award of the grant funding from the State of New
Jersey.
PROGRAM DESCRIPTION:
Each Adolescent Pregnancy Prevention Initiative project will employ a Program
Coordinator who will provide counseling and service coordination services for a
minimum of 60 young women and/or men per site on an annual basis, who are
identified as at-risk for adolescent pregnancy. The counseling shall include individual,
group or family counseling; crisis counseling, referral and follow-up to other needed
services, and provide linkages with the educational, juvenile justice, and DYFS systems.
The coordinator will connect the participants to needed social services by providing
information, referrals, and follow-up services to outside agencies, including, but not
limited to substance abuse counseling, employment counseling, primary and
preventative health care, educational support services, and housing.
In addition to providing counseling and service coordination, the program coordinator
will facilitate the coordination of adolescent pregnancy prevention services to ensure
that the participants have access to teen-friendly, comprehensive family planning,
sexuality education, and social services.
These services may be provided by the
managing agency and/or through the collaboration with other local community based
organizations serving as partners in this grant initiative.
The sexuality education component should utilize an asset building approach,
promoting a balanced, comprehensive approach to risk reduction and prevention
strategies including sexual abstinence, monogamy, methods of contraception, an
understanding of sexual abuse, rape and date rape, and prevention education for HIV
and other sexually transmitted infections. Sexuality education should also include life
skills building and communication skills such as negotiation, refusal, and relationship
development.
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The program coordinator will ensure that the participants have access to the following
family planning services: reproductive health care, STD testing, pregnancy testing, and
sexuality education. [Note: Grant monies can not be used to pay for contraception or
abortion services.]
TARGET POPULATION:
Research shows that the characteristics of youth most at risk of pregnancy include
being in the lowest quarter of their school class, being overage for their grade level, and
showing the sexual characteristics of adults earlier than peers. They are likely to have a
home life that is sexually exploitive, neglectful, chaotic and/or poverty stricken and to
have siblings or parents who gave birth during their adolescent years. There is a high
correlation between the use of drugs and alcohol and adolescent pregnancy.
AMOUNT OF AVAILABLE FUNDING:
Funding for this Request for Proposal will be available for State Fiscal Year 2011. A
total of $147,717 in grant funds is available for these projects. See program locations for
site amounts.
LOCATION OF SERVICES:
Please note that the resulting contract will be for one agency to provide services
to all locations described
For the contract period 7/1/11 through 6/30/12, services are to be provided at the
following locations:
Oakcrest High School, Hamilton Township NJ
Total amount of funds available: $62,777**
Buena Regional High School, Buena NJ
Total amount of funds available: $64,000*
Clearey Middle School, Buena Regional School District
Total amount of funds available: $20,940
**Program is funded through NJ APPI funds.
*Includes $25,000 from Buena School District
STAFFING:
The Adolescent Pregnancy Prevention Program Coordinator shall have the
following qualifications:
• MSW, MS, or MA or the equivalent in a social service related field (e.g. social
work, counseling, psychology, health education, etc.) for staff funded by State
APPI funding. Bachelor’s level staff may be approved on a case by case
basis for non State APPI funds.
• The ability to provide counseling and service coordination
• The ability to work with a community collaborative partnership
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•
•
•
•
•
•
Previous experience working with adolescents at-risk for pregnancy and other
factors
Full time twelve (12) month position*
A Licensed clinical social worker is required to provide clinical supervision of
the APPI Coordinator*
Will attend all statewide meetings and professional development trainings
provided by the Department of Children and Families*
Will attend a minimum of 2 professional development opportunities pertaining
to adolescent health and well being*
Agency agrees to participate with the APPI Management Information System
(MIS) which includes Internet access and the entry of data as required by the
State of New Jersey. In addition, the State of NJ may require additional
reporting requirements during the contract period*
*Requirements are for program staff hired with NJ APPI funds.
Roles:
• Serve as a liaison to the school and the local community based organizations
collaborating to serve students identified as at-risk for adolescent pregnancy
• To counsel program participants individually or in group, when appropriate
• To run programs such as pregnancy prevention, HIV prevention, decision
making, communication skills, negotiation and refusal skills, life skills, etc.
• To provide information to, and help maintain connections to already existing
school and community resources
• To maintain and expand the collaborative services provided to young women
and/or men, who are at-risk of adolescent pregnancy, ensuring that family
planning services are teen-friendly and comprehensive
• To provide referrals and follow-up when a teen needs the services of outside
agencies and/or collaborate with local School Based Youth Services
Program(s) when applicable.
ALLOWABLE USE OF FUNDS:
Funds may be used for:
•
Salaries/fringe for program staff;
•
Expanding services of existing programs;
•
Program materials, supplies and equipment;
•
Professional development activities (quotes from consultants, price list of
training materials, videos, staff release time, substitute costs, and travel);
and/or
•
Costs to the agency to support this grant (up to 10% of the grant amount)
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Funds may not be used for:
•
Purchase/construction of facilities, including additions and extensions, or for
the acquisition of land.
•
Purchase of vehicle(s).
REVIEW PROCESS:
A review panel composed of representatives of county government and private, not-forprofit agencies will review the applications. The committee will make recommendations
on the contract to provide the requested services based on the most advantageous
proposal. The award will be made to the most responsive proposer who, in the opinion
of the County, best meets all of the conditions and specifications contained in this RFP.
The grant applications will be rated on the basis of the criteria listed below.
APPLICATION SELECTION CRITERIA:
The applications will be evaluated and scored in accordance with the criteria listed
below, in the “Proposal Content Outline” section. The maximum score for all proposals
shall not exceed 100 points.
PROPOSAL CONTENT OUTLINE:
Proposals submitted for consideration must include all of the following sections in the
order stipulated and numbered in the same manner. Incomplete proposals will not be
considered.
One signed original and five (5) copies must be submitted.
A.
Narrative
1.
Organization Mission and Goals - Describe your agency’s
history, mission, and goals and how they relate to the
proposed program. If the agency is a private non profit,
please attach the most current listing of your Board of
Directors (5 points)
2.
Experience of the Agency/Organization - Describe your
agency’s administrative, management, and organizational
capacity to carry out the proposed program. (5 points)
3.
Goals and Objectives - Identify and describe your
organization’s goals and objectives concerning the proposed
program/services to be provided. (10 points)
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4.
Location of Services - Identify the specific location/address
where each of the various service components will be
provided. (5 points)
5.
Program Design (specify all services to be provided) Provide a detailed description of the total program design,
including the program/services to be provided by your
organization and the collaborative partners, and the specific
activities that program staff will employ to achieve the
program objectives. Outline the program objectives, the total
enrollment in the program, the targeted population to be
served, strategies to recruit and retain participants, and the
days/hours of operation. Include a 12 month detailed
timeline for the provisions of services. (30 points)
6.
Collaboration - As related to this program, identify by name
the community resources with which your organization will
be collaborating, the nature of the collaboration and previous
experiences with the partnerships, the program/services the
collaborating community organizations will be providing, the
days/hours/location of their operation and how the
collaborative program/services will be coordinated. (10
points)
7.
Evaluation – Describe the agency’s ability to evaluate the
proposed program. Describe the methodology your
organization will utilize to evaluate the effectiveness of the
program. For services at the Oakcrest High School APPI
funding), the following outcome measures must be
addressed: (20 points)
•
•
Goal: Youth will not become pregnant while enrolled in APPI
o Outcome: 97% of youth who complete the program will not
become pregnant prior to high school graduation.
o Objective: To assess sustainability of program goals over the
course of the participant’s high school career
o Activity: Each small group counseling participant will complete
the post survey prior to the end of each school year including the
year the participant graduates. There is a survey question that
asks if the participant is or has been pregnant.
Goal: Youth will demonstrate improved knowledge of safe sex practices.
o Outcome: 95% of youth who complete the program will
demonstrate improved knowledge of safe sex practices.
o Objective: To assess effectiveness of curriculum used and
information retained by participants
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o Activity: Each small group counseling participant will complete a
pre and post survey to assess for improvement between program
entry and program exit.
8.
D.
Staffing - Describe in detail the number, qualifications, and
skills of the program staff that will perform the service
activities.
Describe the management and supervision
methods that will be utilized in the operation of the program.
(5 points)
Budget Narrative (5 points)
Provide a narrative that explains the budget and shows a clear link between the
services and activities, the core components, and the proposed spending plan.
Provide a full description of the functional roles of all proposed program staff.
Locate and describe proposed program staff relative to their respective agency’s
staffing pattern or table of organization. On a separate sheet, describe the job
title, responsibilities, and qualifications for each program staff position.
E.
Budget Detail Summary (5 points)
A separate budget must be provided for each program location.
Provide an itemized summary of the budget detailing proposed expenditures.
The budget must be shown to be reasonable and practical within the context of
the program description and rationale, the goals and objectives, and the program
design, for the duration of the grant program. Funds must be allocated
appropriately across budget line items and the Budget Detail Summary must
support and justify the funds requested in this proposal.
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CONTRACT
FORMS
PROPOSAL FORM
Date________________
The undersigned, having read the Notice to Proposers, Invitation to Submit Proposal, Instructions to
Proposers, and Scope of Services attached hereto and having thoroughly investigated all existing
conditions, equipment, material and labor required for PROVISION OF SERVICES AS OUTLINED
IN THESE SPECIFICATIONS in strict accordance with this Request for Proposal, hereby agrees to
complete said work, as follows:
LOCATION
FUNDS REQUESTED
Oakcrest High School, Hamilton Township NJ
**Program is funded through NJ APPI funds.
Buena Regional High School, Buena NJ
*Includes funds from Buena School District
Clearey Middle School, Buena Regional School District
Annual Cost for all Services
__________________________
Signature ________________________________________________
PROPOSER MUST COMPLETE AND SIGN ALL PF PAGES
PF-1
PROPOSAL FORM
Partnership
The undersigned is a Corporation under the laws of the State of______________________________
Individual
having Principal Offices at ___________________________________________________________
________________________________________________________________________________,
and is authorized to conduct business in the State of New Jersey.
NAME OF BIDDER
________________________________________________________________________________
Person
Firm/Corporation
BY:_____________________________________________________________________________
Signature
Print Name
________________________________________________________________________________
Street Address
________________________________________________________________________________
City/State
Zip code
___________________________________________________________________________
Telephone
Fax
Email _____________________________________________
PROPOSER MUST COMPLETE AND SIGN ALL PF PAGES
PF-1
ATLANTIC COUNTY ORDINANCE #10 POLITICAL CONTRIBUTION FORM
PART I: CERTIFICATION
I hereby certify as follows:
1. On or after October 22, 2007, the below-named person or entity has not solicited or made any
contribution of money, pledge of contribution, including in-kind contributions, company or organization
contributions, as set forth below that would bar the award of a contract to the "professional business
entity", pursuant to the terms (Pay-to-Play Reform Ordinance #10).
a) Within the 12 months immediately preceding the date of the contract or agreement (exclusive
of any contributions made prior to October 22, 2007), the below-named person or
organization has not made a contribution to:
(i) any campaign committee of any candidate for elective County office or to the
current holders of any elective County office, or
(ii) any Atlantic County party committee, or
(iii) any municipal party committee within Atlantic County, or
(iv) any candidate committee, state, or county political party or any Political Action
Committee (PAC) that is engaged in the financial or in kind support of candidates
for elective Atlantic County offices, County elections and/or Atlantic County
political parties, or
(v) any intermediary on the condition or with the agreement that it will be contributed
to a campaign committee for elective County office or to the current holders of any
elective County office.
(vi) any intermediary directly or indirectly, through or by any other person or means, do
any act which would subject that entity to the restrictions of the (Pay-to-Play
Reform Ordinance #10).
b) Between the time of first communication between that professional business entity and
Atlantic County regarding a specific professional services agreement or goods and
services agreement, as the case may be, and the latter of the termination of negotiations
or rejection of any proposal or the completion of the contract or agreement (exclusive of
any contributions made prior to October 22, 2007), the below-named person or
organization has not made a Contribution to:
(i)
any campaign committee or any candidate for elective County office or to the
current holders of any elective County office, or
(ii) any Atlantic County party committee, or
(iii) any municipal party committee within Atlantic County, or
(iv) any candidate committee, state, or county political party or any Political Action
Committee (PAC) that is engaged in the financial or in kind support of candidates
for elective Atlantic County offices, County elections and/or Atlantic County
political parties, or
(v) any intermediary on the condition or with the agreement that it will be contributed
to a campaign committee for elective County office or to the current holders of any
elective County office
(vi) any intermediary directly or indirectly, through or by any other person or means, do
any act which would subject that entity to the restrictions of the (Play-to-Pay
Reform Ordinance #10).
ATLANTIC COUNTY ORDINANCE #10 POLITICAL CONTRIBUTION FORM
2. If the “professional business entity” is awarded a contract pursuant to the solicitation for this
contract proposal, the below-named person or organization will , on a continuing basis,
continue to report any contributions it makes during the term of the contract, and any
extension(s) thereof.
____________________________________________________________________________________
CERTIFICATION ON BEHALF OF A COMPANY OR ORGANIZATION FOR A:
CORPORATION OR PARTNERSHIP
I certify as an officer or authorized representative of the company or organization identified below that, to
the best of my knowledge and belief, the foregoing statements by me are true. I am aware that if any of
the statements are willfully false, I am subject to punishment.
Name of Company or Organization : ______________________________________________
Print Name:_____________________________________ Title:_________________________
Signature: ______________________________________Date:_________________________
The above individual is signing on behalf of the company in the following capacity.
______ as Officer or Executive
______ Subsidiary
_____ Principal( more than 10% ownership or control )
________ Political Organization (PAC)
______________________________________________________________________________
CERTIFICATION BY SOLE PROPRIETORSHIP
I certify that , to the best of my knowledge and belief , that foregoing statements by me are true. I am
award that if any of the statements are willfully false, I am subject to punishment.
Print Name: ____________________________________________________________
Signature: _______________________________________Date: _______________________
______________________________________________________________________________
Note: “Professional Business Entity” means an individual including the individual’s spouse, if any and
any child living at home , person; firm, corporation; professional corporation; partnership; organization or
association. The definition of a professional business entity includes all principals who own 10% or more
of the equity in the corporation or business trust, partners, and officers in the aggregate employed by the
entity as well as any subsidiaries directly controlled by the professional business entity.
PC
POLITICAL CANDIDATE/COMMITTEE ACCOUNTS
February 4, 2010
(Two Year Period)
Current Holder of Elected Atlantic County Office and Campaign Committee for Elected Atlantic
County Office
Limit $300 per election cycle (primary and general) per Ord. No. 10 of 2007
Contributions over the limits on this page will
disqualify contributors from County contracts
Candidate
Election
Year
Office
Candidate/Committee
Name1
Balles, Frank
Carney, James
Cooper, Alisa
2008
2005
2008
Sheriff
Surrogate
Freeholder
Curcio, James
2009
Freeholder
Dase, Richard
2007
Freeholder
Foley, Jill
2007
Freeholder
Balles for Sheriff
Jim Carney for Surrogate
Friends of Alisa Cooper for
Freeholder
James Curcio
Finnerty Curcio and Russo
Freeholder
Friends of Rich Dase for
Freeholder
Friends of Jill Foley for
Freeholder
Formica, Frank
Garrett,
Charles
Giordano,
Frank
Levinson,
Dennis
McDevitt, Joe
McGettigan,
Edward
Russo,
Thomas
Sutton, Frank
2009
2007
Freeholder
Freeholder
2009
Freeholder
Candidate /Committee
Name 2
Charles Thomas Garrett
2007
Giordano, Falcone & Mason Friends of Frank Giordano
for Freeholder
for Freeholder
County Executive Levinson for Executive
Friends of Dennis Levinson
2007
2006
Freeholder
County Clerk
2006
Freeholder
Joe McDevitt 4 Freeholder
Ed McGettigan for County
Clerk
Thomas Russo
2008
Freeholder
Sutton for Freeholder
Any other candidate for any of the County offices listed above
…………………………………………………………………………….
Any Atlantic County Party Committee or Atlantic County Municipal Committee
Limit $500 per calendar year per Ord. No. 10 of 2007
Atlantic County Democrat Committee
Atlantic County Republican Committee
Atlantic County Municipal Committee
Others Limited to $500 per calendar year per Ord. No. 10 of 2007
Any Candidate Committee; State Political Party; County Political Party; Any Political Action Committee (PAC)
that are involved in the financial or in-kind support of candidates for elective County office; County election
and/or Atlantic County political parties
Other Disclosable Contributions, but not limited by Ord. No. 10 of 2007
(these
these contributions do not disqualify
a professional business entity from having or seeking a contract with Atlantic County Government)
Election Office
Candidate
Candidate/Committee
Candidate/Committee
Year
Name 1
Name 2
Albano, Nelson 2009
Assembly
Van Drew, Albano for Van Drew, Albano & Milam
Assembly
for 1st District
Amodeo, John 2009
Assembly
Amodeo and Polistina for Amodeo for Assembly
Assembly
Connors,
2007
Senate/Assembly Connors,
Rumpf
and Connors and Rumpf
Christopher
VanPelt
Van Drew Albano and Milam for
Milam,
2009
Assembly
st
1 District
Matthew
Polistino,
2008
Assembly
Amodeo and Polistino for
Vince
Assembly
Rumpf, Brian
2009
Assembly
Election Fund of Connors Connors,
Rumpf
and
and Rumpf
VanPelt
Van Drew, Jeff 2007
Senate/Assembly Van Drew and Albano for Van Drew Albano & Milan
Assembly
for 1st District
Whelan,
2007
Senate
Friends of Whelan Kuehner Jim Whelan for Assembly
James
and Spellman
Burlington County Democrat Committee
Burlington County Republican Committee
Cape May County Democrat Committee
Cape May County Republican Committee
Cumberland County Democrat Committee
Cumberland County Republican Committee
Ocean County Democrat Committee
Ocean County Republican Committee
AFFIRMATIVE ACTION INFORMATION
Please complete the following:
Company Name __________________________________________________
1.
Our Company has a Federal Affirmative Action Plan Approval:
YES ______
NO _______
a. If yes, submit a photographic copy of the Approval
2.
Our Company has a New Jersey Certificate of Employee Information Report:
YES ______
NO _______
a. If yes, submit a Photographic copy of the Certificate
3.
Our Company has neither of the above, therefore send us Form AA-302 (Affirmative
Action Employee Information Report)
SEND AA-302 __________
(check if applicable)
I certify that the above information is correct to the best of my knowledge.
NAME: _________________________________________
SIGNATURE: ___________________________________
TITLE: _________________________________________
DATE: _________________________________________
AAI
NON-COLLUSION AFFIDAVIT
State of New Jersey )
) ss
County of __________________
I, _______________________ of __________________________ in the County of
_________________ and the State of ____________________________, of full age, being duly sworn
according to law on my oath, depose and say, that :
I am ___________________________ of the Firm of _____________________,
the bidder making the Proposal for the herein project, and that I executed the said Proposal with full authority to
do so, that said bidder has not directly or indirectly entered into any agreement, participated in any collusion, or
otherwise taken any action in restraint of free, competitive bidding in connection with the above named project,
and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full
knowledge that the County of Atlantic relies upon the truth of the statements contained in said Proposal and in
the statements contained in this affidavit in awarding the contract for the said project.
I warrant that no requirement or commitment was made in reference to any political contribution to any party,
person, or elected official and that no undisclosed benefits of any kind were promised to any one connected
with County government or any political party in reference hereto.
I further warrant that no person or selling agency has been employed or retained to solicit or secure such
contract upon agreement or understanding for a commission, percentage, brokerage or contingent fee, except
bona fide employees or bona fide established commercial or selling agencies maintained by
_______________________________________
NAME OF CONTRACTOR
I further warrant and represent that I have never been convicted of or acknowledge nor admitted to any payment
of kickbacks or unlawful gifts to any government official or employee for which conduct the County of Atlantic
deems me disqualified from doing business with County of Atlantic under such circumstances.
I also understand that the above disqualification does not apply to any vendor who cooperates with the
prosecution and gives supporting testimony on behalf of the prosecution in the course of a judicial inquiry.
SWORN AND SUBSCRIBED TO
BEFORE ME THE ________ DAY
OF _____________ 20____
____________________________
Signature of Notary Public
_______________________________
SIGNATURE OF AFFIANT
Notary Public of __________________
_______________________________
PRINT OR TYPE NAME OF AFFIANT
My Commission Expires _____________
NC
AFFIDAVIT OF COMPLIANCE ON CONTRACTOR'S RECYCLING PROGRAM
(CONTRACTOR MUST COMPLETE, SIGN AND NOTARIZE THIS FORM AND SUBMIT
WITH BID PACKAGE)
The County of Atlantic has pursuant to P.L. 1987, Chapter 102, adopted the Atlantic County Recycling
Plan and Ordinance #7 of 1988, which designates the following commercial and institutions materials as
recyclable and mandates the recycling thereof;
Glass, food and beverage containers: clear, amber, green
Newspapers
Aluminum beverage cans
corrugated cardboard
White office paper
Computer Paper
I. a. I hereby acknowledge that compliance with all applicable recycling laws is a material term and
condition of my contract with the County of Atlantic.
I. b. I hereby certify that _______________________________
Name of Company
(check as many as apply)
__________ currently is recycling.
__________ agrees to commence or continue recycling during the term of this contract with the
County.
II. The following recyclable waste generated during the performance of this contract, in accordance
with the requirements of the applicable N.J. Municipal Recycling Plan, or other applicable State or local
recycling law, shall be recycled:
_____ Aluminum Cans
_____ Glass
_____ Plastic
_____ Newspaper
_____ Office Paper
_____ Computer Paper
_____ Asphalt
_____ Concrete
_____ Other Please Specify ______________________________
Signed and sealed
before me on
_______________, 20____
________________________
NAME
________________________
TITLE
________________________
DATE
______________________
NOTARY
R
FORMS
SAMPLE CONTRACT
Law File #K.05.
AGREEMENT
THIS AGREEMENT made this
day of
COUNTY OF ATLANTIC hereinafter referred to as “COUNTY” and
to as “CONTRACTOR”.
, 2008, BETWEEN THE
hereinafter referred
WITNESSETH:
WHEREAS, the COUNTY desires to engage the services of the CONTRACTOR to perform
various services for the COUNTY as hereinafter provided, and
WHEREAS, the CONTRACTOR has represented that it is qualified by training and experience
to perform the required services in the manner and on the terms and conditions set forth herein.
NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein,
the parties hereto agree as follows:
ARTICLE I: SCOPE OF SERVICES AND CONTRACT DOCUMENTS
A. CONTRACTOR shall provide to the COUNTY the following services:
All services shall be provided in strict accordance with the requirements and or representations set forth
in one or more of the following applicable documents, as checked herein:
The Request for Proposals issued by the County (Exhibit A)
The CONTRACTOR’S proposal (Exhibit B)
Agreement Scope of Services statement (Exhibit C)
In the event of any inconsistencies between the documents the language of the Agreement shall prevail,
and the language of the other documents shall be deemed to have the following priority: Exhibit A,
Exhibit C, Exhibit B.
B. The Exhibits and Appendices to the Agreement listed below shall constitute integral parts of
this Agreement and are hereby incorporated herein in their entirety, unless any portions
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SAMPLE CONTRACT
thereof have been marked as deleted or modified. These documents collectively shall constitute the
Agreement between the parties.
Exhibit A (RFP)
Exhibit B (Proposal)
Exhibit C (Scope of Services Statement)
Appendix 1 (Affirmative Action)
Appendix 2 (Insurance)
ARTICLE II: PAYMENT
A. In accordance with the authorization granted by Resolution # ____________, adopted by the
Atlantic County Board of Chosen Freeholders on __________________ 2006, the CONTRACTOR
shall be compensated in an amount not to exceed $____________________in full consideration of all
services performed under this Agreement. The time, rate and manner of payment shall be as follows:
B. Any changes to the maximum compensation specified in Article II(A) shall only be effective
if such additional compensation is expressly authorized by an amendatory resolution duly adopted by the
Atlantic County Board of Chosen Freeholders. Even if the Agreement calls for the provision of services
on an hourly rate or other unit price basis or if the Agreement allows for payment of specified
reimbursable expenses, CONTRACTOR, understands that CONTRACTOR shall not be entitled to
payment for any level of services rendered in excess of the maximum compensation specified in Article
II(A) unless additional compensation is expressly authorized by resolution.
C. It is the exclusive right of the COUNTY to determine that services have been performed in a
proper and satisfactory manner in accordance with the terms and conditions set forth herein prior to
approval and payment of invoice submitted by CONTRACTOR.
D. Payment shall be made only upon submission by the CONTRACTOR of the required
executed standard County invoice, a bill on CONTRACTOR’S letterhead and any other documents
deemed necessary by the COUNTY.
E. CONTRACTOR agrees to maintain financial records, books and documents plus any
evidence necessary to reflect all direct and indirect costs incurred during this Agreement in an auditable
format. CONTRACTOR agrees to keep complete and accurate records with respect to the computation
of all billing, including receipts for any reimbursable expenses and time records for all persons billed on
an hourly rate basis. The CONTRACTOR also agrees to submit all documents and records necessary to
assure compliance and completion of this Agreement. CONTRACTOR agrees that all financial records
required to be kept be made available for inspection during normal business hours by representatives of
the COUNTY. Said records shall be kept for a minimum of three (3) years.
ARTICLE III: TERM
A. Upon its authorization and execution this Agreement shall be effective for the term
commencing _______________ and expiring on ___________________.
B. The CONTRACTOR shall complete the performance of services under this Agreement by
Click here to type Contract End Date and/or in accordance with any completion schedules set forth in
Exhibits A & B.
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SAMPLE CONTRACT
C. The County Executive or his designee may extend the time for completion specified by
Article III(B). Such extensions shall only be effective if in writing and shall not extend the Agreement
term beyond the term specified in the authorizing resolution. In the event that the time for completion is
extended, all of the original terms and conditions will remain in effect for the extended period.
D. The County Executive may terminate this Agreement at any time by giving written Notice of
Termination sent to the CONTRACTOR in the address set forth in Article IX. In the event of
termination of this Agreement, the CONTRACTOR shall furnish to the COUNTY such reports or
documents that the COUNTY may require based upon work completed under the provisions of this
Agreement. The CONTRACTOR shall be compensated in the amount determined by the County
Executive to be commensurate with the work performed at the time of termination and upon acceptance
of said payment CONTRACTOR shall have no further rights against the County.
E. Any of the following events shall constitute a breach of this Agreement and shall make this
Agreement voidable at COUNTY’S sole option, upon which event CONTRACTOR shall be entitled to
compensation only for work performed to the date of termination: a) Bankruptcy or insolvency, whether
liquidating or non-liquidating, of contractor; b) Conviction of any principal of CONTRACTOR of any
crime under the laws of the State of New Jersey which, if committed by a public official, would
disqualify that person from public employment; c) Breach of any term of the Agreement; d)
Abandonment of the work by CONTRACTOR without the express written permission of County; e)
failure of CONTRACTOR to pay its subcontractors and/or suppliers.
ARTICLE IV: GENERAL PROVISIONS
A. The CONTRACTOR’S status shall be that of an independent principal and not as agent or
employee of the COUNTY.
B. The CONTRACTOR agrees not to assign this Agreement or any monies due hereunder
without the prior written approval of the COUNTY.
C. The CONTRACTOR agrees that in the performance of this Agreement he will obey, and
comply with applicable Federal, State and Municipal laws and regulations.
D. This Agreement shall be governed and construed and the rights and obligations of the parties
hereto shall be determined in accordance with the laws of the State of New Jersey, and any litigation
brought by the parties arising out of this Agreement shall be brought only in the Superior Court, and
venued in Atlantic County and the CONTRACTOR hereby voluntarily submits to the jurisdiction of said
court.
E. All materials, information, reports, drawings, plans or other documents which have been paid
for by the COUNTY remain the property of the COUNTY and may be utilized for any County purpose.
CONTRACTOR waives and relinquishes all patent, copyright, or other intellectual property rights,
whether statutory or common law, in said reports or work products.
F. This Agreement may not be altered, modified or rescinded orally, but any changes agreed
upon and executed by both parties may be incorporated into this Agreement.
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SAMPLE CONTRACT
G. The CONTRACTOR agrees not to sub-contract any of the services described herein without
the written prior approval of the COUNTY.
H. In any contract requiring submission of reports or work products to appropriate officials of
the COUNTY, it is agreed that all work products prepared pursuant to said Agreement are the property
of the COUNTY and shall include a statement that such reports were prepared under Agreement with
the COUNTY.
I. The failure to enforce any of the terms and conditions of this Agreement by either of the
parties hereto shall not be deemed a waiver of any other right or privilege under this Agreement or a
waiver of the right to thereafter claim damages for any deficiencies resulting from any
misrepresentation, breach of warranty, or non-fulfillment of any obligation of any other party hereto. In
order for there to be a waiver of any term or condition of this Agreement, such waiver must be in writing
and signed by the party making the waiver.
J. Should any provision to this Agreement be held invalid or unenforceable by any court of
competent jurisdiction, the remaining provisions shall remain in full force and effect.
K. If the CONTRACTOR shall fail to comply with any of the terms, conditions, provisions or
stipulations of this Agreement, according to the true intent and meaning thereof, then the COUNTY may
make use of any or all remedies provided in his behalf in the Agreement or at law and shall have the
right and power to proceed in accordance with the provisions thereof.
ARTICLE V: WARRANTIES
A. The undersigned does hereby warrant and represent that this Agreement has not been
solicited or secured, directly or indirectly, in a manner contrary to the laws of the State of New Jersey
and that said laws have not been violated and shall not be violated as they relate to the procurement or
the performance of this Agreement by any conduct, including the paying or giving of any fee,
commission, compensation, gift, gratuity or consideration of any kind, directly or indirectly, to any
COUNTY, employee, officer or officials.
B. The CONTRACTOR does hereby warrant and represent that he is qualified by training and
experience to perform the required services in the manner and on the terms and conditions set forth
herein.
C. The CONTRACTOR does hereby represent that he is ready, willing and able to perform all
services in the timeframe and as required by this Agreement, and that he and/or his subcontractors
performing the work presently hold in good standing any and all necessary licenses for the lawful
performance of said services within the State of New Jersey.
ARTICLE VI: INDEMNIFICATION
A. CONTRACTOR agrees to protect, defend, indemnify and save harmless the COUNTY, its
officers, agents and servants from any and all losses, claims, actions, costs, expenses, judgment,
subrogations or other expenses by reason of any real or alleged injury or damage to the person or
property of others arising out of or incidental to the performance of the terms of this contract.
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SAMPLE CONTRACT
B. If it becomes necessary for the CONTRACTOR, either as principal or by agent or employee,
to enter upon the premises or property of the COUNTY, in order to construct, erect, inspect, make
delivery or remove property hereunder, the CONTRACTOR hereby covenants and agrees to take, use,
provide and make all proper, necessary and sufficient precautions, safeguards and protections against the
occurrence of happenings of any accidents, injuries, damages or hurt to any person or property during
the progress of the work herein covered, and to be responsible for, and to the indemnify and save
harmless the COUNTY from the payment of all sums of money by reason of all, or any, such accidents,
injuries damages or hurt that may happen or occur upon or about such work and all fines, penalties and
loss incurred for or by reason of the violation of any municipal or COUNTY ordinance, regulations, or
the laws of the State, or the United States, while the said work is in progress. If the COUNTY requires,
the CONTRACTOR will carry insurance to indemnify the COUNTY against any claim for loss, damage
or injury to property or persons arising out of the services covered by the Agreement and the use, misuse
or failure of any equipment used by the CONTRACTOR or his employees or agents, and shall provide
certificates of such insurance to the COUNTY.
C. The CONTRACTOR shall indemnify and save harmless the COUNTY against any and all
claims for royalty, patent infringements or suits for information thereon which may be involved in the
manufacture or use of the item to be furnished herein.
ARTICLE VII. INSURANCE
A. CONTRACTOR shall purchase and maintain during the entire period of this Agreement
insurance coverage either:
as specified in the insurance requirements set
forth in the Request for Proposal (Exhibit A), or
as specified in Appendix 2 which is hereby
incorporated into this agreement.
no insurance is required for this Agreement.
B. CONTRACTOR must provide the COUNTY with a certificate of insurance in accordance
with the requirements of either Exhibit A or Appendix 2 prior to the COUNTY’S execution of this
Agreement and payment of invoices for services rendered under this Agreement.
ARTICLE VIII: REGULATORY REQUIREMENTS
A.
Affirmative Action and Non-Discrimination
CONTRACTOR agrees to comply with the requirements of PL 1975 c.127
(N.J.A.C. 17:27), which requirements are set forth in Appendix 1 which
is attached hereto and incorporated herein.
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SAMPLE CONTRACT
B.
Prevailing Wage
The New Jersey Prevailing Wage Act, N.J.S.A. 34:11-56.25 (P.L. 19630, Chapter 150), is
hereby made a part of every Agreement entered into by the COUNTY OF ATLANTIC,
except those Agreements which are not within the scope of the Act. The successful
CONTRACTOR and any of its subcontractors shall be obligated to pay the prevailing
wage, to submit certified payrolls and documentation of compliance, and to permit onsite monitoring, including interviews with employees and review of subcontracts, by
COUNTY representatives. The CONTRACTOR’S signature on this Agreement is his
guarantee that neither he nor any subcontractors he might employ to perform the work
covered by this bid are listed or are on record in the office of the Commissioner of the
New Jersey State Department of Labor as one who has failed to pay prevailing wages in
accordance with the provisions of this act. Every CONTRACTOR and subcontractor
shall keep an accurate payroll record, showing the name, craft or trade, job title or
classification, actual hourly rate of wages paid, hours worked, and total wages paid to
each workman employed by him in connection with a public work. The prevailing wage
as published by the Department of Labor shall be noted on the payroll journal next to the
actual wage rate paid.
Payroll records shall be presented for a period of two years from the date of payment.
C.
Non-Discrimination
The parties to this Agreement do hereby agree that the provisions of N.J.S.A. 10:2-1
through 10:2-4, dealing with discrimination in employment on public contracts, and the
Rules and Regulations promulgated pursuant thereunto, are hereby made a part of this
Agreement and are binding upon them.
ARTICLE IX: ADDRESS FOR NOTICE
The address given below shall be the address of the representatives parties to which all notices
and reports required by this Agreement shall be sent by mail:
County of Atlantic
County Executive
1333 Atlantic Avenue
County Office Building
8th Floor
Atlantic City, NJ 08401
Copy to County Counsel
1333 Atlantic Avenue
County Office Building
8th Floor
Atlantic City, NJ 08401
Any notice or statement by any party shall be deemed to be sufficiently given when sent by prepaid
certified mail return receipt requested, to any party at its address set forth hereinabove. This address
shall remain in effect unless another address is substituted by written notice.
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SAMPLE CONTRACT
IN WITNESS WHEREOF, the parties hereto have duly signed and sealed this Agreement.
ATTEST:
COUNTY OF ATLANTIC:
Sonya Harris , Clerk
Board of Chosen Freeholders
Dennis Levinson
County Executive
ATTEST
CONTRACTOR:
Affix Corporate Seal, if
applicable
APPROVED AS TO FORM:
James F. Ferguson
County Counsel
prof svcs contract & App 1
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SAMPLE CONTRACT
(REVISED 4/10)
EXHIBIT A
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)
N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or
applicant for employment because of age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with
respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure
that equal employment opportunity is afforded to such applicants in recruitment and employment, and
that employees are treated during employment, without regard to their age, race, creed, color, national
origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability,
nationality or sex. Such equal employment opportunity shall include, but not be limited to the following:
employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection for training, including
apprenticeship. The contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the Public Agency Compliance Officer setting
forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for
employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital
status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor will send to each labor union, with which it has a collective
bargaining agreement, a notice, to be provided by the agency contracting officer, advising the labor
union of the contractor's commitments under this chapter and shall post copies of the notice in
conspicuous places available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated
by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time
and the Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to meet targeted county
employment goals established in accordance with N.J.A.C. l7:27-5.2.
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SAMPLE CONTRACT
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies
including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor
unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry,
marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or
sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect
discriminatory practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to
assure that all personnel testing conforms with the principles of job-related testing, as established by
the statutes and court decisions of the State of New Jersey and as established by applicable Federal
law and applicable Federal court decisions.
In conforming with the targeted employment goals, the contractor or subcontractor agrees to
review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such
actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent
with the statutes and court decisions of the State of New Jersey, and applicable Federal law and
applicable Federal court decisions.
The contractor shall submit to the public agency, after notification of award but prior to execution
of a goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval
Certificate of Employee Information Report
Employee Information Report Form AA302 (electronically provided by the Division and distributed
to the public agency through the Division’s website at www.state.nj.us/treasury/contract_compliance)
The contractor and its subcontractors shall furnish such reports or other documents to the
Division of Public Contracts Equal Employment Opportunity Compliance as may be requested by the
office from time to time in order to carry out the purposes of these regulations, and public agencies
shall furnish such information as may be requested by the Division of Public Contracts Equal
Employment Opportunity Compliance for conducting a compliance investigation pursuant to
Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.
CT-9
CONTRACTORS INSURANCE REQUIREMENTS
A/. GENERAL REQUIREMENTS
1/ The Contractor(s) shall provide and pay for insurance coverage of such type and in such amounts
as will completely protect the Contractor and the County, its elected officials, officers, agents, servants
employees and assigns against any and all risks of loss (including costs of defense) or liability arising
out of this contract.
2/ The insurance should be furnished by insurance companies with and "A- (Excellent) VII" or
better or better rating as published in the most recent editions of Best Insurance Key Rating and shall be
authorized to conduct business in the State of New Jersey.
3/ It is recognized that in some instances that insurance may be acceptable which is underwritten by
an insurance company that is not reported in the BEST GUIDE , or the coverage is extended under a
self insured program. This insurance, or self insurance, must be in conformity with the rules and
regulations of the Commissioner of Insurance of the State of New Jersey. Any insurance or self
insurance of this type is subject to the review and acceptance by the County Risk Manager or the County
Counsel. Furthermore written proof of acceptability by the Office of the Commissioner of Insurance
may be necessary.
4/ The Contractor(s) shall furnish the County with Certificates of Insurance, as shown under “B”
Specific Coverage Requirements, policies for General Liability must be endorsed to include the County
of Atlantic as an Additional Insured, a copy of ISO Endorsements CG 20 10 is required along
with the certificate. The Certificates of Insurance shall set out the types of coverage, the limits of
liability, describe the operation by reference to this contract and provide for (30 days) written notice to
the County of cancellation and/or non-renewal. All of the Contractors. Deductibles or Retention's
shall be the sole responsibility of the contractor, those in excess of $10,000 are to be disclosed and are
subject to approval by the County. If requested actual policy copies or incurred loss information may be
required.
5/ The policies and specified limits of coverage must be effective prior to the commencement of
work and must remain in force until final acceptance of the work under the contract. Contracts that
involve construction, installation, or maintenance repair must maintain completed operations
insurance, endorsing the County as an additional insured for a term of two (2) years beginning on
the date of the final acceptance. They also must include a copy of I.S O. Endorsement CG 2037 , or
its equivalent.
6/ The Contractor(s) shall obtain, and furnish the County, certificates of insurance from their
subcontractor(s) or sub sub contractor(s) showing polices in force with coverage and limits as described
under these insurance requirements.
INS-1
7/ The Certificate of Insurance with a A COPY OF THE ADDITIONAL INSURED
ENDORSEMENTS , are to be signed by a person authorized by the insuring company(s) to bind
coverage on it's behalf. Neither approval by the County nor failure to disapprove Certificates of
Insurance/ furnished by the Contractor shall release the Contractor from full responsibility for all
liability including costs of defense. Insurance is required as a measure of protection and the Contractor's
liability is not limited thereby.
8/ The Certificates of Insurance, must be submitted to the County and shall be subject to the
review and approval of the County Counsel or Risk Manager.
9/ If at any time during the term of this contract or any extension thereof, if any of the required
policies of insurance should expire, change or be canceled, it will be the responsibility of the
Contractor, prior to the expiration, change or cancellation, to furnish to the County a Certificate of
Insurance indicating renewal or an
acceptable replacement of the policy so that there will be no lapse
in any coverage. In the event of interruption of any coverage for any reason, all payments and work
under the contract shall cease and not be resumed until coverage has been restored and a current
Certificate of Insurance received and approved.
10/ Any policy of insurance that is written on a claims made basis shall, under the terms of this
contract, be renewed or the coverage extended for a period of not less than three years and shall provide
coverage for the period operations were performed by the contractor. Proof of such extension shall
annually be presented to the Risk Manager for the County of Atlantic and indicate the retroactive date of
coverage or indicate that all prior acts coverage is provided.
11/ Insurance or Risk Funding maintained by the County shall be considered as Excess over
Contractors Insurance. Insurance or Risk Funding Maintained by the County of Atlantic does not
provide protection for Contractors liability.
12/ Certificates of Insurance and Evidence of Property Forms shall show the Certificate Holder
as follows:
COUNTY OF ATLANTIC
COUNTY OFFICE BUILDING
1333 ATLANTIC AVENUE
ATLANTIC CITY, NEW JERSEY 08401
ATTN.: ROBERT GRIST, RISK MANAGER
Certificates of Insurance not reading as above will not be acceptable and will delay contract signature
and/or payment.
13/ Questions regarding these insurance requirements may be directed to Robert Grist at (609)345-6700 Ext. 2495. Certificates for approval may be preliminarily submitted to Robert Grist via fax to
(609)-343-2164, or to (609)-343-2373.
INS-2
B./ SPECIFIC COVERAGE REQUIREMENTS
1/ The following checked items are the minimum mandatory types of insurance coverage to be
carried under the preceding requirements:
------X--------(a) Workers Compensation-Statutory Limits , Employers Liability - with minimum
limits of - $1,000,000/1,000,000/1,000,000.
-----X----------(b) General Liability in a comprehensive form, with minimum limits as follows:
1/ Each Occurrence
$1,000,000
2/ Damage to Rented or Leased Properties
$ 100,000
3/ Medical Expense
$
5,000
4/ Personal & Adv. Injury
$1,000,000
5/ General Aggregate
$2,000,000
6/ Products-Completed Operations Aggregate $2,000,000
-----X---------(c) Motor Vehicle Liability Insurance in a comprehensive form, endorsed to
include pollution coverage, with minimum limits of $1,000,0000 CSL
1/ Owned Vehicles
2/ Hired/Leased Vehicles
3/ Non-Owned Vehicles
----X-------(d) Excess/Umbrella liability with minimum limits of $1,000.000
January , 2010
INS-3
REQUEST FOR PROPOSAL
CHECKLIST
1. Complete and Sign Proposal /Pricing Pages
Include 1 Signed Original and five (5) copies of all Proposals
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2. Political Contribution Page
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3. Provide a copy of your New Jersey Business Registration Certificate
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4. Non-Collusion Affidavit properly signed and notarized.
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5. Affirmative Action Page Properly signed and completed
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6. Affidavit of Compliance on Contractor's Recycling Program.
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The undersigned hereby acknowledges the above listed requirements:
NAME OF BIDDER:
_____________________________
Person, Firm or Corporation
_____________________________
Signature
Title
ATTENTION:
Bidder's can not submit their own form of non-collusion affidavit. Use
only the forms supplied.