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

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C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions ofN.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form. ~~ ignature Part II - Contribution Disclosure Soa. #a.rrìeS Printed Name e.tJ G'ec i l'l \Ie br'd2 Title Disclosure requirement: Pursuant to N.J.S.A. 19:44A-20.26 ths disclosure must include all reportble political contributions (more than $300 per election cycle) over the 12 months prior to submission to the committees of the governent entities listed on the form provided by the local unt. D Check here if disclosure is provided in electronic form. . o Check here if Contributor Name Recipient Name Date Dollar Amount . $ , ,I' kJ 1-'-\ . the information is continued on subsequent page(s) . .
Page of Vendor Name: o Check here if Continuation Page C. 271 POLIICAL CONTRIUTION DISCLOSUR FORM Required Pursuant To N.l.S.A. 19:44A-20.26 Contributor Name Recipient Name Date Dollar Amount $ . ..... ... .. .. -. ... ........-... ..... ..... - - . . the information is continued on subsequent page(s) . . . .
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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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-~_.._- ._----~_._-~.._----_._----~
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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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12/16/2009 18: ~1 9732435549 PAG 02
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: 12/1&/2009 17: 56 , ILl 19"'1111"
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: ::. _._'.- ::-: - - CERTiF1CA l"E
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12i'6/2E1E19 17: 56 9732435549 IL/1
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12/16/2009 18: 41 9732435549 PAGE 0
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12/1&/2009 18: 41 9732435549 PAGE 6
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i.~rl.~(~ElElê l!3: ~1. '" ~H~~4~S
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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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~ ~ '~ 10 * D . It ~ . D ~ I, j .,'
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, " .I~""IUI lt'~ IA I: (r¡1"~ 53t
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t '. " l ~. ~ON CO~LrlMON ~A~ STATE
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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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iLliiIL~~~ lL:LL Lin -~4 1-~23Ø LA
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...... oJ, r ...£~U LAW DEPT PAGE
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Page') of2 00491S4 II ,....... 8QVA
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12/11/2009 12:22 201-547-5230 LAW D
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LL(iiIL~~~ l¿:¿¿ :¿1:1-54 7 -52
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1¿/li/2ElEl9 12:22 201-547-52313 L
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City Clerk File No. Pg. #-- Agenda
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~i/~ii~~i~ 'l~:~~ ~~1-541-523Ø . .
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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(lS!20B9 11:52. 281-547-5230 lA D
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12/1B/20e9 11: 52 OI/~.I;OOB t1'~1
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12/18/2e09 11: 52 ~l/~4/~OØ9 '1;31
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12/18/2e~9 11~52 291-547-5238 LAW D
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12/19/2Ð09 11: 52 2ßl-547-5230 I.
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12/1ß/ze09 11 :52 201-547-5230 LA
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- ... '.'.. . . + 12/iB/28Ðti 11:5
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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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affixed the day, month and year abo
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Continuation of Resolution Pg. # 2
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cents ($1.50) per page; and (ii) ch
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pursuant to section 1 ofP.L.2001, c
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l:1/l:4/2E:l: 12: 10 201-547-5230 L
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~i/04/2010 12: 10 12/3ß/zÐÐ9 iø
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01/64/2610 J.:O ,jt;l :'I:ll:l': 12
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." ~l/~q/~~lØ l2~10 1~/3e/2009 18:
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~1/tlq/2~1~ 12: 113 12/36/2e~9 i~:
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~i,~q,~~i~ l~:l~ 2~1-547-5230 12/30
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~1/Ø4/2~1~ 12: 1~ 201-547-5230 i~i
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4""'& "".. r - .j'~U LHW Ui=r-, PAG
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.&¿.. .LV Lui -J"l t -;"L.::U:I -~
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~~, u~, ¿u¿u ¿¿~iD iLI ~~I ~~~~
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the preceding month. All statements
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complete or substantially complete
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Robert Byrne City Clerk Brian O'Rei
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Continuation of Resolution Pg. # Ci
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Requisition # 0148621 Vendor SOLOMO
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City of Jersey City Department of H
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VII. RECORDS AND FILES' All patient
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EXHIBIT A (Cont.) The contractor or
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.. ". \ .~ . ..' '::' . . . .~ . ,~
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MINORITY/wOMAN BUSINESS ENTERPRISE
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-d!.~tlN~Ni~y "i"" State' Of New Je
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Princeton Insurance Company COMMON
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. BUSINESS ENTITY DISCLOSUR CERTIFI
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Requisition # 0148192 . Vendor EDUC
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EEO/ AFFIRMATIVE ACTION REQUIREMENT
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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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, .' C. 271 POLITICAL CONTRIBUTION
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C. 271 POUTICAL CONTRIBUTION DISCLO
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List of Agencies with Elected Offic
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BUSINESS ENTITY DISCLOSURE CERTIFIC
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AGREEMENT THIS AGREEMENT entered in
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6. Purchases 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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Requisition # 0148794 Vendor HORIZO
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EEOIAFFIRMATIVE ACTION --REQUIREMEN
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State Treasurer HORIZON HEALTH CENT
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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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CERTIFICATION OF COMPLIANCE WITH TH
Page 378 and 379: 3. Compliance with Approved Program
Page 380 and 381: B) Subgrantees that receive at leas
Page 382 and 383: comply with such additional conditi
Page 384 and 385: 20. Political Activity Prohibited N
Page 386 and 387: DETERMNATION OF VALUE CERTIFICATION
Page 388 and 389: EXHIBIT A MANDATORY EQUAL EMPLOYMEN
Page 390 and 391: APPENDIX A AMERICANS WITH DISABILIT
Page 392 and 393: Page L ot3 Public Contracts Equal E
Page 394 and 395: MINORITYIWOMAN BUSINESS ENTERPRISE
Page 396 and 397: P.L. 2004, c. 57 (N.J.S.A. 52:32~44
Page 398 and 399: N.J. uepartent of Treasury - Uivisi
Page 400 and 401: C. 271 POLITICAL CONTRIBUTION DISCL
Page 402 and 403: Page_of Vendor Name: o Check here i
Page 404 and 405: BUSINESS ENTITY DISCLOSURE CERTIFIC
Page 406 and 407: CERTIFICATION OF COMPLIANCE WITH TH
Page 408 and 409: 3. Compliance with Approved Program
Page 410 and 411: B) Subgrantees that receive at leas
Page 412 and 413: comply with such additional conditi
Page 414 and 415: 20. Political Activity Prohibited N
Page 416 and 417: DETERMINATION OF V ALUECERTIFICATIO
Page 418 and 419: EXHIBIT A MANDATORY EQUAL EMPLOYMEN
Page 420 and 421: APPENDIX A AMERICANS WITH DISABILIT
Page 422 and 423: MINORITYIWOMAN BUSINESS ENTERPRISE
Page 424 and 425: P.L. 2004, c. 57 (N.J.S.A. 52:32-44
Page 426 and 427: C.271 POLITICAL CONTRIBUTION DISCLO
Page 430 and 431: List of Agencies with Elected Offic
Page 432 and 433: . ~ , BUSINESS ENTITY DISCLOSURE CE
Page 434 and 435: AGREEMENT TIDS AGREEMENT entered in
Page 436 and 437: 6. Purchses C) The City may send a
Page 438 and 439: 12. Retention of Records Financial
Page 440 and 441: 17. Labor Standards All laborers an
Page 442 and 443: ATTACHEMENT A PROGRAM DESCRIPTION:
Page 444 and 445: AGREEMENT . THIS AGREEMENT entered
Page 446 and 447: 6. Purchses C) The City may send a
Page 450 and 451: 17. Labor Standards All laborers an
Page 452 and 453: ATTACHEMENT A PROGRAM DESCRIPTION:
Page 454 and 455: ~. Requisition # 0148802 Vendor PHI
Page 456 and 457: EEO/ AFFIRMATIVE _.._----_._."---.
Page 458 and 459: EXHIBIT A (Cont.) The contractor or
Page 460 and 461: Certification 778 CERTIFICATE OF EM
Page 462 and 463: MINORITYIWOMAN.BUSINESS ENTERPRISE
Page 464 and 465: l'l.J. UCPi:UIlCUl UL HCa:sury - Ui
Page 466 and 467: C. 271 POLITICAL CONTRIBUTION DISCL
Page 468 and 469: List of Agencies with Elected Offic
Page 470 and 471: BUSINESS ENTITY DISCLOSURE CERTIFIC
Page 472 and 473: AGREEMENT THIS AGREEMENT entered in
Page 474 and 475: C) The City may send a representati
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17. Labor Standards All laborers an
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Requisition # 0148804 Vendor . . PR
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EEO/ AFFIRMATIVE - --- - ----~- ---
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- --"- - - - -- - ----- - - - - - -
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n.J. Ui;paiulll;llt vi ill;~UlY - u
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C. 271 POLITICAL CONTRIBUTION DISCL
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Page ::of 2- Vendor Name: Continuat
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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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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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,..~J i. \. \.....,.. ...........-
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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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___________.....___.______._.__----
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09-206 34,736,189 ________-:_____._
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--,.-_...._-_...._......_...._...._
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SHEET 9 ----_....__...._------_.._-
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Click It or Ticket _.._.._-_.._---_
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_...._...._.._----------------_.._-
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. 1 ___....__......_..__.._...__~..
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-....--..---.-.--:.-.-------.~.....
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..____...._______..____.._______.._
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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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..------------------.--._--- 1 ..-.
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__.._._.____.______________________
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.___~___.__..~._..____.__________._
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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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I ___...____._-----....--..~---_---
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....__..--_.._--------_..-_..-.._-_
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____..____._...._.._.._.__.~__'____
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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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