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 Affrmatiori
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-l et
seq. that, pursuant to P.L. 2004, c. 19 would bar the award of
this contract in the one year period preceding (date
of award scheduled/or approval o/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 Jersev City as defined pursuant toN.I.S.A. 19:44A-3(
p), (q) and (r).
Marano Vega, 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 Viola Richardson for Ward F
Friends of Michael Sottolano
the City
Friends of Philip J. Kenny for Council
Healy for Mayor 2009
Friends of Nidia Lopez
Part II - Ownership Disclosure Certification
o lcertify that the list below contains the names and home addresses of all owners holding 10% or more of
jssiiedand _outstadin stock of-the.undersign.
Check the box that represents the type of business entity:
o Partnership ~Corporation DSole Proprietorship DSubchapterS Corporation
DLimited Partnership DLimited Liabilty Corporation DLimited Liabilty Partnership
Name of Stock or Shareholder
i f'
l\ \ I;.Ur"t
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.
Home Address
Part 3 - Signature and Attestation:
The undersigned is fully aware that if I have misrepresented in whole or par this affirmation and
certification. ' land/or the usiness entity, wil be liagle for any penalty ermitted under law.
Name of Business Enti : ~ f6 .s 1 W '0
Signatue of Afant: Title: &tWl¡''e. ì re.c.:fiC
Prited Name of A ant :
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Hø.rdfU
Date: IOJu" i~ , .
day
(Witnessed or attested by)
(Seal)
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