ࡱ> acb#` bjbj sT-$%%%P&,H&-&&&&&&"'.' ,,,,,,,.h)1,-(&&((,&&,2v*v*v*(X&&,v*(,v*v*v*&& PL"%(v**,<-v*1)|1v*1v*8:'0j'"v*'':':':',,*p:':':'-((((    BUSINESS ENTITY DISCLOSURE CERTIFICATION FOR Non-fair and open Contracts Required Pursuant To N.J.S.A. 19:44A-20.8 Part I Vendor Affirmation The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that the has not made and will not make any reportable contributions pursuant to N.J.S.A. 19:44A-1 et seq. that, pursuant to P.L. 2004, c. 19 would bar the award of this contract in the one year period preceding (date of award scheduled for approval of the contract by the governing body) to any of the following named candidate committee, joint candidates committee; or political party committee representing the elected officials of the as defined pursuant to N.J.S.A. 19:44A-3(p), (q) and (r).  Part II Ownership Disclosure Certification ( I certify that the list below contains the names and home addresses of all owners holding 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business entity: (Partnership (Corporation (Sole Proprietorship (Subchapter S Corporation (Limited Partnership (Limited Liability Corporation (Limited Liability Partnership Name of Stock or ShareholderԹϺ Address Part 3 Signature and Attestation: The undersigned is fully aware that if I have misrepresented in whole or part this affirmation and certification, I and/or the business entity, will be liable for any penalty permitted under law. Name of Business Entity:___________________________________________ Signature of Affiant:________________________________ Title:_______________________________ Printed Name of Affiant :___________________________ Date:_______________________________ Subscribed and sworn before me this ___ day of ___________, 2___. My Commission expires:  _________________________________ (Witnessed or attested by) ________________________________ (Seal) BUSINESS ENTITY DISCLOSURE CERTIFICATION FOR Non-fair and open Contracts Required Pursuant To N.J.S.A. 19:44A-20.8 The following is statutory text related to the terms and citations used in the Business Entity Disclosure Certification form. Local Unit Pay-To-Play Law (P.L. 2004, c.19, as amended by P.L. 2005, c.51) 19:44A-20.6 Certain contributions deemed as contributions by business entity. 5. When a business entity is a natural person, a contribution by that person's spouse or child, residing therewith, shall be deemed to be a contribution by the business entity. When a business entity is other than a natural person, a contribution by any person or other business entity having an interest therein shall be deemed to be a contribution by the business entity. 19:44A-20.7 Definitions relative to certain campaign contributions. 6. As used in sections 2 through 12 of this act: business entity" means any natural or legal person, business corporation, professional services corporation, limited liability company, partnership, limited partnership, business trust, association or any other legal commercial entity organized under the laws of this State or of any other state or foreign jurisdiction; interest" means the ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit, as appropriate; Temporary and Executing 12.Nothing contained in this act shall be construed as affecting the eligibility of any business entity to perform a public contract because that entity made a contribution to any committee during the one-year period immediately preceding the effective date of this act. ~~~~~~~~~~~~~~~~~~~~~ The ԹϺ Campaign Contributions and Expenditures Reporting Act (N.J.S.A. 19:44A-1 et seq.) 19:44A-3 Definitions. In pertinent part p. The term "political party committee" means the State committee of a political party, as organized pursuant to R.S.19:5-4, any county committee of a political party, as organized pursuant to R.S.19:5-3, or any municipal committee of a political party, as organized pursuant to R.S.19:5-2. q. The term "candidate committee" means a committee established pursuant to subsection a. of section 9 of P.L.1973, c.83 (C.19:44A-9) for the purpose of receiving contributions and making expenditures. r. the term "joint candidates committee" means a committee established pursuant to subsection a. of section 9 of P.L.1973, c.83 (C.19:44A-9) by at least two candidates for the same elective public offices in the same election in a legislative district, county, municipality or school district, but not more candidates than the total number of the same elective public offices to be filled in that election, for the purpose of receiving contributions and making expenditures. For the purpose of this subsection: ; the offices of member of the board of chosen freeholders and county executive shall be deemed to be the same elective public offices in a county; and the offices of mayor and member of the municipal governing body shall be deemed to be the same elective public offices in a municipality. 19:44A-8 and 16 Contributions, expenditures, reports, requirements. While the provisions of this section are too extensive to reprint here, the following is deemed to be the pertinent part affecting amounts of contributions: The $300 limit established in this subsection shall remain as stated in this subsection without further adjustment by the commission in the manner prescribed by section 22 of P.L.1993, c.65 (C.19:44A-7.2)     )->IMnrs - D E  ; < N O }  ¹xm^RhCJOJQJaJ johCJ"OJQJaJh:gh5>*\hWhCJhh6CJaJhCJaJh 'h6CJaJh 'hCJaJh:gh5>*CJh[bhCJ he]h56;\h 'h;\ h\h 'h\ h;\h>%;\5;\)< = > ? @ A k}kd$$Ifl0@( t0644 layt $Ifgdgd$a$gd A B C D xx $Ifgd}kdW$$Ifl0@( t0644 laytD E F G xx $Ifgd}kd$$Ifl0@( t0644 laytG H I J xx $Ifgd}kd$$Ifl0@( t0644 laytJ K L M xx $Ifgd}kd\$$Ifl0@( t0644 laytM N O } @ H *}|sjYYjL 7$8$H$]gd07$8$H$^`0gd 7$8$H$gd gdgd}kd$$Ifl0@( t0644 layt  < > @ F H )*+>?@A^_}~ȿȧțȧȧȧzhYhYhT h>*h5CJOJQJ^JaJ#he]h5CJOJQJ^JaJh(chCJ ^JaJhCJ^JaJhCJ^JaJhCJ,OJQJaJ johCJ"OJQJaJh5CJ\hWhCJ hCJhe]hCJaJh(chCJOJQJaJh(chCJaJh(chCJ^JaJ }~h__ $Ifgd}kd $$Ifl0|)0 t0)644 layt $$Ifa$gd 7$8$H$]gdxx $Ifgd}kdo$$Ifl0|)0 t0)644 laytxx $Ifgd}kd$$Ifl0|)0 t0)644 laytxx $Ifgd}kd9$$Ifl0|)0 t0)644 laytxx $Ifgd}kd$$Ifl0|)0 t0)644 laytxx $Ifgd}kd$$Ifl0|)0 t0)644 laytxx $Ifgd}kdh$$Ifl0|)0 t0)644 laytxx $Ifgd}kd$$Ifl0|)0 t0)644 laytxx $Ifgd}kd2$$Ifl0|)0 t0)644 laytxx $Ifgd}kd$$Ifl0|)0 t0)644 laytxxssssd[[ $Ifgd { $Ifgdgd 7$8$H$gd}kd$$Ifl0|)0 t0)644 layt IOPUW\z)Demnoٺٱzszkfk\h 'h;\ h\h 'h\ h;\h>%h;\h5;\h5CJ OJQJ\^J hCJhhCJaJ h5h[bhCJh[bhCJhD hSdhD hSdhSdhSdhhLVh5>*hLVh5>*\hWh5>*CJ \")Demno_R \$gdoa$vkda$$Ifl{0*0+4 layt$ $Ifa$gd$ $Ifa$gd $Ifgdo~5F\ A $[$a$gd $\$a$gdxgdgd$a$gdOw  MN5CDF[\  reh5B* CJ\ph#hkCh5@B* CJ\ph h5@hjh5@hkChCJhkCh5CJ hCJhkChCJ hjhCJhjh5CJ\ h5hvh5h5CJ\ h\hNXh\hhe]h56;\&Ahy[ h}JPhy[@<CJOJQJaJhzjhzUhhhjhCJ hCJ h6CJhjh6CJhjh6CJ\hkCh5CJ\gdgd90&PP:p/ =!`"`#$@% 6&P1h:p/ =!"#$% U$$If!vh55#v:Vl t65ytU$$If!vh55#v:Vl t65ytU$$If!vh55#v:Vl t65ytU$$If!vh55#v:Vl t65ytU$$If!vh55#v:Vl t65ytU$$If!vh55#v:Vl t65ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505ytc$$If!vh505#v0#v:Vl t)6505yt$$If!vh55#v:V l{0+54ytH@H Normal CJOJQJ_HaJmH sH tH DAD Default Paragraph FontRi@R  Table Normal4 l4a (k(No ListB^@B  Normal (Web)dd[$\$4@4 Header  !j@j  Table Grid7:V0H"H Sd Balloon TextCJOJQJ^JaJ=T;TABDEGHJKMN&')*,-/0235689;<>?,>07184'@$0091:'@$00;1<(@$00=1>)@$00?1@T)@$00A1 B)@$0 0C1 D)@$0 0E1 F)@$0 0G1 H4*@$0 0I1 Jl*@$0 0K1 L*@$0 0M1 N*@$0 0O1 P+@$0 0Q1 RL+@$0 0S1 T+@$0 0U1 V+@$0 0A1B)@$0@0b@0b)Is<=>?"&'()*+,-./0123456789:;<=>?@ABCDEFj.r()kl6`}~K L   ;<hUyz],-0369:;>@0@0@0@0@0@0@0@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0@0@0@0@0@0@0@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0@0@0@0@0@0@0@0@0 @0@0@0@0@0 @0 @0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0b00000000@0@000t)Is<=>?"&'()*+,-./0123456789:;<=>?@ABCDEFj.r)kl6`}~K L   ;<hUyz],-:>@0@0@0@0@0@0@0@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0@0@0@0@0@0@0@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0@0@0@0@0@0@0@0 @0@0@0@0@0 @0 @0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0b@0 0,  $'(A D G J M }o !"#%&){8F23}{8F16}R>x*>J NTK OcL lY>^>>*urn:schemas-microsoft-com:office:smarttags PersonName9*urn:schemas-microsoft-com:office:smarttagsplace9*urn:schemas-microsoft-com:office:smarttagsState --//00235689;>EGW `  + DQUg--//00235689;>3333333'(,>'()--//00235689>V<=>?&'()*+,-./0123456789:;<=>?@ABCDE)>@(~~=@ @Unknown Marc PfeifferG: Times New Roman5Symbol3& : Arial;Wingdings?& Arial Black9Garamond5& zaTahoma"1h <5D <O (O (!`4""2QHX ?2(BUSINESS ENTITY DISCLOSURE CERTIFICATIONdzipin Marc PfeifferOh+'0 4@ ` l x ,BUSINESS ENTITY DISCLOSURE CERTIFICATIONdzipin Normal.dotMarc Pfeiffer4Microsoft Office Word@G@( @@F?@O՜.+,0 hp   State of NJ( " )BUSINESS ENTITY DISCLOSURE CERTIFICATION Title  !"#$%&'()*,-./012456789:;<=>?@ABCDEFGHIJKMNOPQRSUVWXYZ[^Root Entry FPde"`Data +1Table31WordDocumentsTSummaryInformation(LDocumentSummaryInformation8TCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89qRoot Entry F cf@Data +1Table31WordDocumentsT  !"#$%&'()*,-./012456789:;<=>?@ABCDEFGHIJKMNOPQRSed SummaryInformation(LDocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q՜.+,D՜.+,\ hp   State of NJ( " )BUSINESS ENTITY DISCLOSURE CERTIFICATION Title4 $,