Year 2010 temporary budget to make available the ... - Jersey City

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Princeton Insurance Company COMMON POLICY DECLARATIONS: ENDORSEMENT EFFECTIVE 2/1/2009 If you have any questions about your policy. please contact your agent at (973) 383-21. POLICY NUMBER: PSOOO136 Named Insured NEIGHBORHOOD CLINIC, LLC and Mailng Address 559 WEST SIDE AVENUE JERSEY CITY, NJ 0730 . POLICY TYPE: OCCURRENCE PLUS Agent: THE WOODLAND SERVICES GROUP INC. DBA THE WOODLAND GROUP ~76RT.15 '. -- .- '-.-- STE20 . . -. ,.. '. , SPARTA, NJ 07871 Policy Period: 02/20 to 0211210 12:01 a.m. standard Time DELETE WAIVER OF CONSENT TO SETTLE FORM (PL0123) PROFESIONAL LIABILITY SCEDULE: Retroactie License Date Premium NEIGHBORHOOD CLINIC, LLC 088999 ENTITY: Shared Limits (no charge) Sharing Limits With: Solomon Owusu, MD Solomon Owusu, MD 080257 Internal Medicine-no surgery 11/01/1995 INCLUDED 25MA0598100 0210111994 $137.00 Limit of Liabilit: $ 1,00,00 Each Claim $ 3,000,000 Annual Aggregate THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS: Commercial Proper Coverage Part: Commercial General Liabilty Coverage Part: Terrorism Coverage (see Disclosure Notice): Professional Liabilit Coverage Part: NJ Proper & Liabilty Insurance Guaranty Assessment DUE DATE: ** TOTAL PREMIUM AMOUNT DUE: - Pleae refer to Invoice for actu due date. Invoi set und serae cover. .. The premium reflets the folloing PL discot Princon Elit Rate (45%) & SCheduled Credit - RM I APPLICABLE FORMS: Se Form AFOO04. CPDO101102 Novenber 13, 200 DATE $137.00 * $2.19 $139.19 ~rk AUTHORIZED REPmATIVE , Page 1 of1
Princeton Insurance Company COMMON POLICY DECLARATIONS: RENEWAL CERTIFICATE If you have any questions about your policy, please contact your agent at (973) 383-3421. POLICY NUMBER: PSOO013509 POLICY TYPE: OCCURRENCE PLUS Named Insured NEIGHBORHOOD CLINIC, LLC and Mailing Address 559 WEST SIDE AVENUE JERSEY CITY, NJ 07304 Agent: THE WOODLAND SERVICES GROUP INC. DBA THE WOODLAND GROUP 376 RT.15 STE 205 SPARTA, NJ 07871 Policy Period: 02/01/2010 to 02/01/2011 12:01 a.m. Standard Time PROFESSIONAL LIABILITY SCHEDULE: NEIGHBORHOOD CLINIC, LLC 088999 ENTITY: Shared Limits (no charge) Sharing Limits With: Solomon Owusu, MD Solomon Owusu, MD 080257 Internal Medicine-no surgery Retroactive License Date Premium 11/01/1995 INCLUDED 25MA05988100 02/01/1994 $ 13,700.00 Limit of Liabilty: $ 1,000,000 Each Claim $ 3,000,000 Annual Aggregate THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS: Commercial Property Coverage Part: Commercial General Liabilty Coverage Part: Terrorism Coverage (See Disclosure Notice): Professional Liability Coverage Part: NJ Property & Liabilty Insurance Guaranty Assessment DUE DATE: 02/01/2010 TOTAL PREMIUM AMOUNT DUE: * The premium reflects the following PL discount: Princeton Elite Rate (45%) & Scheduled Credit - RM I APPLICABLE FORMS: See Form AF0004. CPD0001 01/02 November 12, 2009 DATE NIA NIA NIA $ 13,700.00 * $123.30 $13,823.30 ~H- AUTHORIZED REP~TIVE Page 1 of1
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City Clerk File No. Agenda No. Appr
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Continuation of Resolution City Cle
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()- 00;1 EXHIBIT A JAN i 3 2010 BLO
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Block: 00763 Principal: 3,167.01 Ta
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N N N ~ -c N m 0 0 0 0 ;i 0 0 0 0 ;
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Memo to Brian O'Reiley, Business Ad
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Resolution of the City of Jersey Ci
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LEGISLATIVE FACT SHEET This summary
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of the Licensee or anyone employed
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14. Failure to adhere to the terms
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HOST CITY AGREEMENT THIS HOST CITY
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provided in writing by the Red Bull
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on the first business day following
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(1) Severabilty. If any provision o
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SCHEDULE A SERVICES The City shall
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.. November 16, 2009 Paragraph D -
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Aricle 26 November 16, 2009 Paragra
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Aricle 30 Insert New Paragraph H as
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Aricle 36 November 16,2009 Add new
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wil be $50 per 30-day supply, meani
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CERTIFICATION OF BRIAN O'REILLY IN
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. AFTI ACTION COMPLIACE NOTICE N.J.
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EXITA N.J.s.A. 10:5-31 aDd N.J.AC.
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APPENIX A AMRICANS WI DISABIL ACT O
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" Taxpayer Identifcation# 221~896.1
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0148637 CITY OF JERSEY CITY Requisi
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A summary of Aetna's proposal rates
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City of Jersey City Dental Program
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UL-\, .L C- C-UiiO .L-i- Jc: veL I
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CERTIFICATION OF BRIAN O'REILLY IN
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-,-~._'~_.,----_._.~.._--_.- -'-~--
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EXIT A N.J.s.A. 10:5-31 and N.J.AC.
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APPENDIX A AMRICANS WI DISABIL ACT
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Reqúisition # 0148636 Vendor DELTA
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. A sumary of Aetna's proposal rate
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Total Annual: Total Monthly: $158,0
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VcL-l¿-¿~~~ IJ;J¿ DEL TA DENTAL
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EXTRAORDINARY UNSPECIFIABLE SERVICE
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Requisition # 0148639 Vendor RELIAS
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EXIT A N.J.s.A.IG:5-3la.d N.J.A.C.
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APPENIX A AMRICANS WI DISABIL ACT O
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./ Resolution of the City of Jersey
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FULL TITLE OF RESOLUTION: RESOLUTIO
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61/64/2636 12: 62 9735860221 JAALE.
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01/04/2030 12: 02 9736800221 JAALEX
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. ..... ~_.... .., CITY OF JERSEY C
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":.'~" (l-~.. DEPAATUE1' OF 1'REASY
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EXHIT A 'MAATORY.EQUAL EMPLOYM OPPO
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C6r~ôn CERTIFICATE OF EMPLOYEE INF
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MioritylWoman BuSÎJess Enterprise
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.: i ..; ..' . TAXPAYER NAME: CHUKS
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AGREEMENT AGREEMENT made this _ day
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ARTICLE iv Compensation and Payment
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loss of life or property or in any
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executed by their duly authorized o
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EXBmIT A (Cant.) The contractor or
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Questionnaire for Bidders Jersey Ci
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" Treasurer ~: State Certification
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,"" -' CERTIFICATION IN SUPPORT OF
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Consulting Services Agreement For t
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A. The selected consultant shall pu
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The parties hereto reserve the righ
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A business organization that fails
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! . ¡', '" I.: " l~ . CERnFCATION
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This Agreei:ent dated the AGREEMENT
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approved in advance for any specifi
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et seq. 2. An Affirmative Action Em
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City Clerk File No. Pg. #-- Agenda
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. ; ii/12/20El9 10: ld 2131-547-523
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JRN-07-211111 15:34 trDm:2016536979
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month an affidavit of services spec
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The City does not agree to pay for
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administration of this contract. Al
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such as court reporters, investigat
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The City does not agree to pay for
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12/iS/2ee9 11: 52 281-547-5230 LAW
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AGREEMENT . Ths Agreement dated the
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Should the services of one or more
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Page 271 and 272: cents ($1.50) per page; and (ii) ch
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Page 295 and 296: Continuation of Resolution City Cle
Page 297 and 298: the preceding month. All statements
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Page 301 and 302: Robert Byrne City Clerk Brian O'Rei
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Page 305 and 306: Requisition # 0148621 Vendor SOLOMO
Page 307 and 308: City of Jersey City Department of H
Page 309 and 310: VII. RECORDS AND FILES' All patient
Page 311 and 312: EXHIBIT A (Cont.) The contractor or
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Page 315 and 316: MINORITY/wOMAN BUSINESS ENTERPRISE
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Page 321 and 322: . BUSINESS ENTITY DISCLOSUR CERTIFI
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Page 329 and 330: Continuation of Resolution City Cle
Page 331 and 332: Requisition # 0148192 . Vendor EDUC
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Page 346 and 347: List of Agencies with Elected Offic
Page 348 and 349: BUSINESS ENTITY DISCLOSURE CERTIFIC
Page 350 and 351: AGREEMENT THIS AGREEMENT entered in
Page 352 and 353: 6. Purchases C) The City may send a
Page 354 and 355: 12. Retention of Records Financial
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l'l.J. LlCIJWLllCHl VI llCè1:Sury
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C. 271 POLITICAL CONTRIBUTION DISCL
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Page_of Vendor Name: Continuation P
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BUSINESS ENTITY DISCLOSURE CERTIFIC
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CERTIFICATION OF COMPLIANCE WITH TH
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3. Compliance with Approved Program
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B) Subgrantees that receive at leas
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comply with such additional conditi
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20. Political Activity Prohibited N
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DETERMNATION OF VALUE CERTIFICATION
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EXHIBIT A MANDATORY EQUAL EMPLOYMEN
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APPENDIX A AMERICANS WITH DISABILIT
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Page L ot3 Public Contracts Equal E
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MINORITYIWOMAN BUSINESS ENTERPRISE
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P.L. 2004, c. 57 (N.J.S.A. 52:32~44
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N.J. uepartent of Treasury - Uivisi
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Page_of Vendor Name: o Check here i
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DETERMINATION OF V ALUECERTIFICATIO
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EXHIBIT A MANDATORY EQUAL EMPLOYMEN
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APPENDIX A AMERICANS WITH DISABILIT
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P.L. 2004, c. 57 (N.J.S.A. 52:32-44
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C.271 POLITICAL CONTRIBUTION DISCLO
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List of Agencies with Elected Offic
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. ~ , BUSINESS ENTITY DISCLOSURE CE
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AGREEMENT TIDS AGREEMENT entered in
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6. Purchses C) The City may send a
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12. Retention of Records Financial
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17. Labor Standards All laborers an
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ATTACHEMENT A PROGRAM DESCRIPTION:
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AGREEMENT . THIS AGREEMENT entered
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6. Purchses C) The City may send a
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ATTACHEMENT A PROGRAM DESCRIPTION:
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~. Requisition # 0148802 Vendor PHI
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EEO/ AFFIRMATIVE _.._----_._."---.
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EXHIBIT A (Cont.) The contractor or
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Certification 778 CERTIFICATE OF EM
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MINORITYIWOMAN.BUSINESS ENTERPRISE
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l'l.J. UCPi:UIlCUl UL HCa:sury - Ui
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List of Agencies with Elected Offic
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AGREEMENT THIS AGREEMENT entered in
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C) The City may send a representati
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Requisition # 0148804 Vendor . . PR
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EEO/ AFFIRMATIVE - --- - ----~- ---
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EXHIBIT A (Cont.) The contractor or
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n.J. Ui;paiulll;llt vi ill;~UlY - u
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Page ::of 2- Vendor Name: Continuat
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City Clerk File No. Pg.#~ Agenda No
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Date Submitted ORDINANCEIRSOLUTION
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'~""- " JON S. CORZINE Governor Dec
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WILLIAMR. GOBLE, P.E., CITY ENGINEE
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Grant Application for State Aid to
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Grant Application for State Aid to
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Scope of Work cant' d Grant Applica
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CITY OF JERSEY CITY o E PA R TM E N
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Engineer's Estimate (12.03-2009) IT
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Project Classification (J Pedestria
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Name of Grantee: Jersey City Organi
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;:t:dn udlldynt:.. - Un:in¡; "'t:~
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LEGISLATIVE FACT SHEET This summary
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10. Any equipment installed or used
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Cit Clerk File No. Agenda No. 10.Z.
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and fully cooperate with the Direct
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7. Plan for collection ofuutstandin
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Dated: ~ SHEET 1 Dated: Director of
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Sheet 2 RECORDED VOTE- Ayes: SO-rOL
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SHEET3A ,. SEE BUDGET APPROPRIATION
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SHEET3B_1 PRIORYEAR.'S LOCAL MUNICI
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SHEET3C Totals days 265,942 $73,979
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09-206 34,736,189 ________-:_____._
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01/12/10 SHEET 15A _________.._____
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01/12/10 SHEET 18A I I I 13,711 I T
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I 01/12/10 SHEET 240 I I I I , ----
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TÖTALCAPITAL IMPROVEMENTS FROM "CA
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(Tis appendix must be Included in a
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Sheet 40b C-3 TOT ALS- ALL PROJECTS
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TOTALS. ALL PROJECTS 33-399 210,155
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Sheet 44 JAN 1 3 2010 Date If you h
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Year 2010 temporary budget to make available the ... - Jersey City

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