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l'l.J. UCPi:UIlCUl UL HCa:sury - Uivisiun or K.evenue, Un-LIne inquiry .page 1 ot 1 . Taxpayer Name: Trade Name: Address: Certifcate Number: Effective Date: Date of Issuance: For Office Use Only: 20091026165515341 STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE PHILIPPINE AMERICAN FRIENDSHIP COMMTTEE INC 176 MALLORY AVENUE ÆRSEY CITY, NJ 07304 0580771 April 19, 1995 October 26, 2009 htts:llww1.state.nj.us/TYTR_BRClservleticommonIRCLogin 10126/2009
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Contractor Instructions Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a "fair and open" process (defined at N.J.S.A. 19:44A-20.7) are subject tothe provisions of P.L. 2005, c. 271, s.2 æ.J.S.A. 19:44A-20.26). This law provides that 10 days prior to the award of such a contract, the contractor shall disclose contributions to: · any State, county, or municipal committee of a political par · any legislative leadership committee. · any continuing political committee (a.k.a., political action committee) · any candidate committee ofa candidate for, or holder of, an elective office: o . of the public entity awarding the contract o of that county in which that public entity is located o of another public entity within that county o or of a legislative district in which that public entity is located or, when the public entity is a county, of any legislative district which includes all or par of the county The disclosure must list reportble contributions to any of the committees that exceed $300 per election cycle that were made during the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8 and l9:44A~ 16 for rnoredetailson reportblecontributions.-- N.J.S.A. 19:44A-20.26 itemÍzes the paries from whom contributions must be disclosed when a business entity is not a'natural person. This includes the following: · individuals with an "interest" ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit · all principals, parners, offcers, or directors of the business entity or their spouses · any subsidiaries directly or indirectly controlled by the business entity · IRS Code Section 527 New Jersey based organiztions, directly or indirectly controlled by the business entity and filing as continuing political committees, (PACs). When the business entity is a natural person, "a contribution by that person's spouse or child, residing therewith, shall be deemed to be a contrbution by the business entity." (N.J.S.A. 19:44A-20.26(b)) The contributor must be listed on the disclosure. Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed by ELEC in an amount to be determined by the Commission which may be based upon the amount the business entity failed to report. The enclosed list of agencies is provided to assist the contrctor in identifying those public agencies whose elected offcial and/or candidate campaign committees are affected by the disclosure requirment. It is the contractor's responsibilty to identify the specific committees to which contributions may have been made and need to be disclosed. The disclosed information may exceed the minimum requirement. The enclosed form, a content-consistent facsimile, or an electronic data fie containing the required details (along with a signed cover sheet) may be used as the contractor's submission and is disclosable to the public under the Open Public Records Act. The contractor must also complete the attched Stockholder Disclosure Certification. This wil assist the agency in meeting its obligations under the law. NOTE: This section does not apply to Board of Education contracts. . N.J.S.A. i 9:44A-3(s): "The term "legislative leadership committee" means a committee established, authorized to be established, or designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the General Assembly or the Minority Leader of the General Assembly pursuant to section 16 ofP.L. 1993, c.65 (C. 1 9:44A- 1 O. 1) for the purose of receiving contrbutions and makipg expenditures." that
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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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":.'~" (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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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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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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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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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
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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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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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C. 271 POLITICAL CONTRIBUTION DISCL
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Page_of Vendor Name: o Check here i
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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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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 428 and 429: C. 271 POLITICAL CONTRIBUTION DISCL
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 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 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
Page 480 and 481: Requisition # 0148804 Vendor . . PR
Page 482 and 483: EEO/ AFFIRMATIVE - --- - ----~- ---
Page 484 and 485: EXHIBIT A (Cont.) The contractor or
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Page 488 and 489: MINORITYIWOMAN BUSINESS ENTERPRISE
Page 490 and 491: n.J. Ui;paiulll;llt vi ill;~UlY - u
Page 494 and 495: Page ::of 2- Vendor Name: Continuat
Page 496 and 497: BUSINESS ENTITY DISCLOSURE CERTIFIC
Page 498 and 499: CERTIFICATION OF COMPLIANCE WITH TH
Page 500 and 501: 3. Compliance with Approved Program
Page 502 and 503: B) Subgrantees that receive at leas
Page 504 and 505: comply with such additional conditi
Page 506 and 507: 20. Political Activity Prohibited N
Page 508 and 509: City Clerk File No. Pg.#~ Agenda No
Page 510 and 511: Date Submitted ORDINANCEIRSOLUTION
Page 512 and 513: Continuation of Resolution City Cle
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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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