ࡱ> |z}` cmbjbj 8p%zzz  lll8| A~^!^!t!t!t!"*#T@@@@@@@$^BhD@u't!t!''@t!t!bAc*c*c*'^t!t!@c*'@c*c*[<K>t! Zgl(<>$xA0A=6TE(rTE,K>TEK>X~#d$c*%%'~#~#~#@@*^~#~#~#A'''' (D (  Request For A Waiver Of N.J.S.A. 19:44A-20.4 et seq. Pay-To Play Exigency Request Instructions The State Treasurer has required that a request for the exercise of a waiver pursuant to N.J.S.A. 19:44A-20.12 for a public exigency shall be initially filed with the Director of the Division of Local Government Services. The Director will review the request, and make a recommendation to the State Treasurer. The public agency shall not proceed with the execution of a waiver, until it has received written approval from the Treasurer. A Request for a Waiver is for a non-emergent public exigency where the public agency determined that the requirements of N.J.S.A. 19:44A-20.4 et seq. cannot be followed for goods or services that: Must be provided by a specific vendor; and, The timing or other circumstances of the procurement does not make compliance with the Chapter 19 fair and open procurement process (N.J.S.A. 19:44A-20.4) practical or possible; and, The procurement is otherwise consistent with the intentions of pay-to-play laws. A request for a waiver for a procurement that can be otherwise executed as through a non-fair and open process, save for a local policy that simply prohibits the use of all non-fair and open contracts, will not generally be a reason to authorize a waiver of the law. An example of an allowable exigency could be a contract that public policy warrants award to a specific vendor who has made a reportable contribution to an elected official serving in office within the last 12 months. A local policy that arbitrarily prohibits non-fair and open contracts as the reason for a wavier will not likely be considered as a sole justification for a waiver. Certain information is necessary to address a public agencys Request for a Waiver of the provisions of N.J.S.A. 19:44A-20.4 et seq. Use the enclosed form to submit a request. The form can be filled in using a MS Word file that can be downloaded from the Divisions Pay-to-Play website ( HYPERLINK "http://www.nj.gov/dca/lgs/p2p" www.nj.gov/dca/lgs/p2p). N.J. Division of Local Government Services REQUEST FOR A WAIVER OF THE PROVISIONS OF P.L. 2004, c.19 FOR A PUBLIC EXIGENCY This form is to be completed by the contracting agent of the public agency and filed with the Director of the Division of Local Government Services. Please provide the necessary information to satisfactorily complete the report. Refer to the Instructions accompanying this form and N.J.S.A. 19:44A-20.4 et seq. for additional information on the law. Name of Public Agency: FORMTEXT      County: FORMTEXT      Date of Request: FORMTEXT      Date contract must be awarded by: FORMTEXT      Name and title of the official requesting the contract:  FORMTEXT      Contact information of official:Phone: FORMTEXT      E-mail: FORMTEXT      Address: FORMTEXT      Name and title of agency contracting agent: FORMTEXT      Contact information of agent:Phone: FORMTEXT      E-mail: FORMTEXT      Address: FORMTEXT      Describe the condition or circumstance pertaining to the exigency request. Explain why the contract cannot be awarded without exigency approval. Please be specific as to the nature of the contract and provide full details concerning the circumstances. (attach additional sheets if necessary): FORMTEXT     Provide a complete and clear explanation on how the public agency will be affected if the Request for a Waiver is denied. (A desire to have a reliable job performed is not acceptable.) FORMTEXT      The total (or estimated) cost for providing the goods or performing services is:$ FORMTEXT      List the name the contractor receiving the contract:  FORMTEXT      Has the contractor received other contracts from!56JRSTabzl s د{k[TMFM?M2MFjhA0J5U\ hA5\ h'%g5\ h p5\ h"x.5\h"x.h"x.5OJQJ\^Jh"x.h p5OJQJ\^J%hkhk5;OJQJ\^JaJhk5OJQJ\^JaJ"hkhk5OJQJ\^JaJ#h p5;CJOJQJ\^JaJ,h'%gh p5;>*CJOJQJ\^JaJ)h'%gh p5;CJOJQJ\^JaJ#h1+5;CJOJQJ\^JaJ6STab  q   & ' A$a$gd \ $da$gdA<gdA & F<gdAgdAdgdA$a$gdARW=mbms w     % & ) * X p q  / }   % ' Hchlpq0AF۷®h^|h"x.0Jjh"x.Ujh"x.U h p>*h \hhu"h"x.hAh ph__ h__5\ h'%g5\ h p5\DAI&'(),.0:<>LNrZ.jh \CJOJQJU^JaJmHnHu/jhxZh \CJOJQJU^JaJ#jh \CJOJQJU^JaJh \CJOJQJ^JaJ hbh \CJOJQJ^JaJh"x.hu" hNv $Ifgd $Ifgd p & F$Ifgd pgd \gd#h"x.h \5CJOJQJ^JaJ,jh"x.h \5CJOJQJU^JaJ h.Rh \CJOJQJ^JaJUh7jh"x.h5CJOJQJU^JaJmHnHu2jh"x.h p5CJOJQJU^JaJ#h"x.h5CJOJQJ^JaJ,jh"x.h5CJOJQJU^JaJhCJOJQJ^JaJ hm0hCJOJQJ^JaJh \NTvT~qh $Ifgd p & F$Ifgd pkd#$$Ifl0 (uv t0(62:44 la the local unit in the last 12 months? FORMTEXT      If the answer to question 9 is, Yes, please describe the nature of the contracts and cost: FORMTEXT      This report was completed by (print name and title): FORMTEXT      Signature: Date: FORMTEXT       Submit by mail or fax to: Director, Division of Local Government Services P.O. Box 803 Trenton, New Jersey 08625-0803 Fax: 609-633-6243  A wavier of the law in response to an emergency requires the filing of an  Emergency dTfThTrTtTvTxTTTTTU"U*U.U0U2UFUϳϡsssoXF#h"x.h5CJOJQJ^JaJ,jh"x.h5CJOJQJU^JaJhhu"CJOJQJ^JaJh pCJOJQJ^JaJhCJOJQJ^JaJh \#h"x.h \5CJOJQJ^JaJ7jh"x.h \5CJOJQJU^JaJmHnHu,jh"x.h \5CJOJQJU^JaJ2jh"x.h \5CJOJQJU^JaJvTxT.Upc & F$Ifgd pkd $$Ifl0"(l" t0(62:2:44 lap.U0UXU $Ifgd pwkd$$Ifl(( t0(62:244 lap FUHUJUTUVUXUZUUUUUUUUϳϡjX>j2jh"x.h \5CJOJQJU^JaJ#h"x.h \5CJOJQJ^JaJ,jh"x.h \5CJOJQJU^JaJhu"CJOJQJ^JaJh \CJOJQJ^JaJh#h"x.h5CJOJQJ^JaJ7jh"x.h5CJOJQJU^JaJmHnHu,jh"x.h5CJOJQJU^JaJ2j%h"x.h p5CJOJQJU^JaJ XUZUUU $Ifgd ppkd$$Ifl(( t0(644 lap UUUUUVV*V,V.V8V:VV@V,WPWRWTWXl"l#l̺~f]YUQGCAC9jhAUUhAjhA0JUh phٳV,;;;".".$$lı< !#( t0(644 lap(,WRWm@mAmCmDmFmGmIm`mambmcmѸѰh ph h"x.h"x.CJOJQJ^JaJjht\Uht\ hAhAh1+h^|hA0JjhAUjUhAUhA61h:p@> A Footnote TextCJaJ@&@@ AFootnote ReferenceH*6U@!6 A Hyperlink >*B*ph4@24 "x.Header  !4 @B4 "x.Footer  !ccp6STabq &'A^  ' ; < M a   " * > ? 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H \ ]   9 : M N  o';< d 3@||dtl ||(p c@TV@UnknownG: Times New Roman5Symbol3& : Arial"1h]/Ĥ&T|-|-!4d  2QHX ?'%g2REQUEST FOR A WAIVER OF N juliet perez Marc Pfeiffer,        Oh+'0  $0 P \ ht|REQUEST FOR A WAIVER OF Njuliet perez Normal.dotMarc Pfeiffer6Microsoft Office Word@ @j6<E@;g|-՜.+,D՜.+,L hp   State of NJ REQUEST FOR A WAIVER OF N Title, 8@ _PID_HLINKSA Ahttp://www.nj.gov/dca/lgs/p2p Ahttp://www.nj.gov/dca/lgs/p2p   !"#$%&'()*+,-./012345678:;<=>?@ABCEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefhijklmnpqrstuvyRoot Entry F[g{Data 941TableDEWordDocument8pSummaryInformation(gDocumentSummaryInformation8oCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89qRoot Entry FPij{Data 941TableDEWordDocument8p  !"#$%&'()*+,-./012345678:;<=>?@ABCEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefhijklmn՜.+,D՜.+,L hp   State of NJ REQUEST FOR A WAIVER OF N Title, 8@ _PID_HLINKSA Ahttp://www.nj.gov/dca/lgs/p2p Ahttp://www.nj.gov/dca/lgs/p2p SummaryInformation(gDocumentSummaryInformation8~CompObjq