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

BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To N.J.S.A. 19:44A-20.8
CITY OF JERSEY CITY
Part I - Vendor Affrmation
The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that the -:name
of business entity:: has not made and wil not make any reportble contributions pursuant to N.l.S.A. 19:44A-l et
seq. that, pursuant to P.L. 2004, c. 19 would bar the award of
of award scheduledfor approval of
this contract in the one year period preceding (date
the contract by the governing body) to any of the following named candidate
committee, joint candidates committee; or political part committee representing the elected offcials of
of Jersey City as defined pursuant to N.l.S.A. 19:44A-3(p), (0) and (r).
Marano Vei:a, Jr. Election Fund
Gaughan Election Fund 2009
Friends of Peter Brennan Election Fund
Steven Fulop for Jersey City Inc.
Committee to Elect Wilie Flood
Friends of Michael Sottolano
Friends of Viola Richardson for Ward F
Friends of Philip J. Kenny for Council Healy for Mayor 2009
Friends of Nidia Lopez
Part II - Ownership Disclosure Certifcation
the City
ø I certify that the list below contains the names and home addresses of all owners holding 10% or more of the
._issued and outstag.sock of
the undersig.
Check the box that represents the type of business entity:
o Partnership o Corporation DSole Proprietorship DSubchapter S Corporation
DLimited Partnership tlLimited Liabilty Corporation DLimited Liabilty Partnership
Name of Stock or Shareholder
f A
f'J Pr
(
Home Address
Part 3 - Signature and Attestation:
The undersigned is fuly aware that if I have misrepresented in whole or par ths affrmation and
certification, I and/or the business entity, will be liable for any penalty permitted under law.
~\i~(" fwìS 'ItA M
Name of Businss Entit¡:
Sisnatue of Afant: &:Á1 =~, Title: E: "f.ct-U\i 'Vl: 1) \ Q.tZ:ít:i'R
Pnnted Name of Affant :0 M- \f)e: :rAtbol0'E Date: 'b 0: ó O¡ .
Subscribed and sworn before me ths & day
of OuoßW, ' 2 oeJr
My Commssion expires:
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(Witnesse _tedy)
(Seal)
tmARPlOFNEJE
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