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

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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.J.S.A. 19:44A-1 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 the City
of Jersey City as defined pursuant to N.J.S.A. 19:44A-3(p), (Q) and (r).
Mariano Vega, Jr. Election Fund
Gaughan Election Fund 2009
Friends of Peter Brennan Election Fund
Steven Fulop for Jersey City Inc.
Committee to Elect Wille Flood Friends of Viola Richardson for Ward F
Friends of Michael Sottolano
Friends of Philip J. Kenny for Council Healy for Mayor 2009
Friends of Nidia Lopez
Part II - Ownership Disclosure Certification
o I certify that the list below contains the names and home addresses of all owners holding 10% or more of the
iss_ued and ..utstading..tockofthe undersig.-
Check the box that repr~sents the type of business entity:
o Partnership o Corporation DSoie Proprietorship . DSubchapte~ S Corporation
DLimited Parnership DLimited Liabilty Corporation DLimited Liabilty Partnership
Name of Stock or Shareholder
Part 3 - Signature and Attestation:
.
Home Address
The undersigned is fully aware that if I have misrepresented in whole or par this afrmation and
certification, I and/or t e business entity, will be liable for any penalty permitted under law.
Name of Business En': e"" ~ rs~ C U", eN'l .
Signatue of Mfiant: Title: roO. t ß \'Coe r .
Printed Name of Affant: '" Date: 10 .ø1(, .CO
Subscribed å.d sworn before me this day
of lJ ~70 ~ , 2~. ",~"
My Commission expires: R0 IAOS LAVARO
_fD' 23771l'
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(2~ RAOS t.Rb
. (Witnessed or attested by)
(Seal)