~~It V~e' - . 0, , - Jersey City

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AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5-31 and N.J.A.C. 17:27 GOODS AND SERVICES CONTRACTS (INCLUDING PROFESSIONAL SERVICES) This form is a summary of the successful bidder's requirement to comply with the requirements ofNJ.S.A. 10:5-31 and NJ.A.C. 17:27. The successful bidder shall submit to the public agency, after notification of award but prior to execution of this contract, one of the following three documents 'as forms of evidence: (a) A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned affinnative action program (good for one year from the date of the letter); OR (b) A photocopy of a Certificate of Employee Information Report approval, issued in accordance with NJ.A.C. 17:27-4; OR (c) A photocopy of an Employee Information Report (Form AA302) provided by the Division and distributed to the Pllblic agency to be completed by the contractor in accordance with NJ.A.C. 17:27-4. The successful vendor may obtain the Affrmative Action- Employee Information Report (AA302) from the contracting unit during normal business hours. The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and Equal Employment Opportnity in Public Contracts (Division). The Public Agency copy is submitted to the public agency, and the vendor copy is retained by the vendor. The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements ofNJ.S.A. 10:5-31 and NJ.A.C. 17:27 and agrees to furnsh the required forms of evidence. The undersigned vendor further understands that his/her bid shall be rejected as non-responsive if said contractor fails to comply T with Ithe requirements ofNJ.S.A. 10:5-31 and NJ.A.C. 17:27. COMPANY: ~(AIl-h 8ssef- ¡lesq.Cll.~ fl(4te () f JL SIGNATURE: ~ ~ DATE~Sk.V 16 PRIT NAME:UCuA- ¿ fJEoLw I~ TITLE: k1e.P~r AFFIRMTIVE ACTION COMPLIANCE (SAMPLE DOCUMENTS)
STATE OF NEW JERSEY Division of Public Contract Equal Employment Opportunity Compliance EMPLOYEE INFORMATION REPORT IMPORTANT- READ INSTRUCONS ON BACK OF FORM CAREFULLY BEFORE COMPLETING FORM. TYE OR PRINT IN SHARP BALLPOINT PEN. FAILURE TO PROPERlY COMPLE THE ENTRE FORM AND SUBMIT TME REQUIRE $1 50.0 NON-REFUNDABLE FEE MAY DELAY ISSUANCE OF YOUR CERTIICATE. DO NOT SUBMIT EEo-i REPORT FOR SEcnON B, ITM 11. Foilnstetlon, on completing the Form, go to: ww.stte.nj.us.ur/contr.et_compllance/pd/aaa02Ins.pd SECTION A - COMPANY IDEtmFICAnON 4.COMPANN~ I I r £ 1. FI. NO. OR SOCIA SECURTY 2. TYE OF BUSINS o i. MFG & 2, SERVICE 0 3. WHOLEALE o 4. REAl 0 S. all 3. TOTAL NO, EMLOYE IN TI EN COMPAN a (J/JlJU-4n i4ss~-:r tJullrö. J)(LìAn 6 Jc. S.STRT ' 7 CITY ~ CourJY STAlE ZI CODE 1 rJ fY L fL'"t.l:6 tLij.s~ (\3 673óY 6, NAM OF PAR OR AFfi1A TE COMPAN (IF NONE so INICAlE) CITY STAlE ZIP CODE 7. CHECK ONE: IS TI COMPAN: 'LSINGLEESTABUsIlEMLOYE CITY COUN Offdol Uø Only DAJE RECErv jAUGDAlE ASSIGN CERl1CATIQN NUMBER SECDON B - EMPLOYMENT DATA i i. Repon all peanent, tempor and pan-time employee ON YOUR OWN PAYROLL. Enter the approñlle figu on all line an i. all column,. Where ther are no employee, in a pacular caægoiy, enter a zeo. Include ALL employ.. lIjust thos in minoñty/non-minoñty caegori.. in coumns 1,2, & 3. DONOTSUBM" ANEEOi REPRT. iu EMPLOYE ~u 'in... JOB COL. I COL. 2 COL. 3 ......... MA¡:...................... ........ ...."..... ...................... CATlGOES TOTAL MA FEME , NON = ~ NON (COL..2&3) BLACK !HspANC ASIA MI. BLACK HISPANC INIA ASIA MI. OfcilS( Manage Presals Tednklas saleWor 0f" Cll Craftrb (SIled) O...ti.. (SeHlIed Labors (Unle Ser Woier TOTAL Toti..t Fr pnus ii-;IÌfanvl n_~ T..poar.. P.rt- The da below shal NOT be illluded in th figus for th appropriate categories abve. 12. HOW WAS INORMTION AS TO RACE OR E1C GROUP IN SECON B OBTAI 14. IS lHS TI FIT IS. IF NO, DATE LAST o i. Visu Surey 02. Employmet Rec 03. Oier (Spefy) Employee inonntion RERT SUBMJ Rep Submitt? ,¡'J II MO. rAYIYE 13. DA JES OF PAYROll PEOD USED To: i.~ 2,NOr Fro; Mit SECT C- SIGNATURE AND I~Tl 16. NAM OF PEON COMPLEllG FORM (Pm or TyP) SIGNAlU rr 17. ADDRESS NO." STT CIT 1 fJ ,In I k. "3eÆcj h i c. tha 1M Infarmtlon an this Fa Is tr.nd Cl COUN STAlE ZI CODE J.s¡ /I.; OlJ6¿ I DA:;O ¡DAYI YEAR PHONE (AR CODE, NO.,EXSION) 1.1 -7e.r. 5í'lG, , 1
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Resolution of the City of Jersey Ci
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Continuation of Resolution City Cle
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City Clerk File No. Res. 10-446 Age
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LICENSE AGREEMENT This AGREEMENT is
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City Clerk File No. Res. 10-448 Age
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This summary sheet is to be attache
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.E OF FET IIi 'JY ~ SA w is' . 71 N
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This summary sheet is to be attched
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City of, JERSEY CITY Office of Risk
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Central Avenue Special Improvement
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n.t:tJVli Vi ULL t:i;iUr ~ B.a Meet
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Keport ot Uirectors 8.f Meeting 07/
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n.l:fJUll UI ULL t;l.lUI:S 8.r Meet
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8.q Meeting 07/14/10 CITY OF JERSEY
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ORDINANCEffSOLUTION FACT SHEET Date
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FULL TITLE OF RESOLUTION: RESOLUTIO
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EEO/AFFIRMATIVE ACTION REQUIREMENTS
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EXHfflT A (Cont) orientation, gende
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MinoritylWoman Business Enterprise
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P.L. 2004, c. 57 (N.J.S.A. 52:32-44
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.r~ER1~~1 Taxpaye. Identification#
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FULL TITLE OF RESOLUTION: RESOLUTIO
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... -.'t EXHIT A MAATORY EQUAL E!IL
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' '- CHS CHRlSTll C-overnar KI GUAD
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Continuatfon of Resolution City Cle
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~ .EEO/ AFFIRMATIVE ACTION REQUIREM
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EXHiBIT A (Cont) orientation, gende
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MinoritylWoman Business Enterprise
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Department of Labor and Workforce D
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REQUEST FOR' ,i'~d~ OFJERS.EYCITY .
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CITY OF JERSEY CIT RESOLUTION: ¡ V
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PUBLIC DISCLOSURE INFORMTION Chapte
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MAATORY EQUAL EMPLOYMENT OPPORTUNIT
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AMRICANS WITH DISABILITIES ACT OF 1
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MINORITYIWOM. BUSINESS ENTERPRISE (
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INSTRUCTIONS FOR COMPLETING THE EMP
Page 111 and 112: ITEM 16 .. Print or tye the name of
Page 113 and 114: , BUSINESS REGISTRATION LANGUAGE AN
Page 115 and 116: Page -' of -- Vendor Name: D Check
Page 117 and 118: Name of Business: STOCKHOLDER DISCL
Page 119 and 120: .,~jR Cl'Ty OF JERSEY'CITY DIVISION
Page 121 and 122: EXHIBIT A MANDATORY EQUAL EMPWYMENT
Page 123 and 124: APPENIX A AMCAN WI DISABIL ACf OF 1
Page 125 and 126: Resolution of the City òf Jersey C
Page 127 and 128: Continuation ofResolution City Cler
Page 129 and 130: Resolution of the City of Jersey Ci
Page 131 and 132: INTERDEPARTMENTAL MEMORANDUM OFFICE
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Page 135 and 136: Edward Toloza (/ To: Subject: Maure
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Page 139 and 140: INTERDEPARTMENTAL MEMORANDUM OFFICE
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Page 147 and 148: LEGISLATIVE FACT SHEET This summary
Page 149 and 150: Continuation of Resolution City Cle
Page 153 and 154: y . (J 'l/l/'d:J 11 ,.- ri1J~ r2UUV
Page 155 and 156: NON COLLUSION AFFIDAVIT STATE OF NE
Page 157 and 158: MANDA TORY EQUAL EMPLOYMENT OPPORTU
Page 159 and 160: AMERICANS WITH DISABILITIES ACT OF
Page 161: MINORITY/WOMAN BUSINESS ENTERPRISE
Page 165 and 166: THIS SHALL ONLY INCLUDE EMPLOYMENT
Page 167 and 168: Vendor must submit one of the follo
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Page 171 and 172: CERTIFICATION OF COMPLIANCE WITHTHE
Page 173 and 174: Page_of Vendor Name: 'Continuation
Page 175 and 176: LEGISLATIVE FACT SHEET This summary
Page 177 and 178: TITLE: Resolution of the City of Je
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Page 189 and 190: l" oo .. l"oo ~ Certification 32390
Page 191 and 192: EXHIBIT A (Cont). The contrctor or
Page 193 and 194: Jul 09 2010 5:26PM HP LASERJET FAX
Page 195 and 196: Continuation of Resolution , City C
Page 197 and 198: RESOLUTION FACT SHEET This summary
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Page 201 and 202: Ex;æß'ET .~'.' (ContJ ,. ""'~~~::
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Page 207 and 208: '. ,Form MtVs;.aContractor's;cômii
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Page 211 and 212: Stimulus Re.,orting Weare pleased t
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PROJECT: MUNICIPALITY: COUNTY: --t\
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'"'-':',' COUNTY: BIDDER: ;-vduon .
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DATE: J. 7 Ie, !to , ..Ó~" 01. ~~U
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NO. DATE SCHEDULE OF EMERGING SMAL
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---- .- T íliÐyer Identificat/on#
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07/08/2010 13: 57 FROM ; DRCOLi:N ~
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07/08/2010 13:57 Ci~ File No. O"J.
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07/138/213113 " 13:57 ~otClloi M.la
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87/08/2818 13:57 NO.891 ~øn ole/\
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07/08/2010 FROM : ORCOLAN ~ /,1 i:i
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