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

BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAlAND OPEN CONTRCTS
Requied pursuant To N.J.S.A. 19:44A-20.8
CIT OF JERSEX Cl1
lart i - :Vendor Afnnation
The undersigned, beig authoried and knowledgeable of the ~oistances, does hereby certify that the -(nami of
burineu entirj;; has not made and wi not make any l"eportble contrbutions pursuant to N.J .S.A. 19:44A-l et seq. tha.t,
pursuant to P.L. 200, c. 19 would bar the awar of ths contract in the one yeai perod precedig (datr of o1Vard ¡çlidl/led
Jor apval oj ¡hi contr./ by th61,ovd'inl, botl) to any of the followg named candidate commttee, joint candidates
commttee; or politica pa commttee tepresentig the dected offcials of the ~name of intil) of elutd ofdals'? as
defied puruant to N.J.SA. i9:44A-3(p). (q) and (x).
Gauirhan Election Fund 2005
Marano Ve2a. Tr. Election Fund
Steven Fulop fol' Jersey City Inc.
Friends of Peter Brennan Election Fund
Friends of Viola Richardson for.Waid F
Coøujttee to Elect WíIe Flood
Friends of Michaef Sottolano
Healy ror Mayor 2009
Friends of Mai Spinell for Council
Friends of Steve Lipslò
Par I1- Owership Disclosure Cerficati.o
o i cettfy that the list below contais the names and home addresses of ~ii owneis holdig 10% or more of the
issued and outstadig stock of the undersigned.
Check the 'bo:i that represents the tye of business entity: gi NO)\ - PfOh-\
OPare:ship DCotporation OSole Proprie.torshi DSubchaptet S Corporation
OLited Parership DLimted Liabilty Corpo:ition DLited Liabilty Partership
Name of Stock or Shareholder
Par 3 - Signtue and Attstation:
7/1 L J 1'./
Y'I-/ -; /1
/ (/ 7 J:
I / '/
( 'i /
Home Address
The undersigned is fuy awae that if I have misrepresented in whole or par ths affiation and certcation, I and/or
the business entity, -w be lible for ~y penalty pe.tted under l~. - r 1-
~ame ofBu.iness Entity: Cbmd\ON!\ ø-set f~~~d- or c.
Signed: ~ ~ Tide; e..
PritN~t4 t6ø.. Date; ? hfy /0 .
..¡~
(M6ant)
(prit name & title of affant) (Corporate Sea)