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n.J. Ui;paiulll;llt vi ill;~UlY - ulyl::lvll vi .lt:yt:llut:, Vll-Llllt: lllllwry rage 1 or 1 . -~ STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Taxpayer Name: P .R.S. CONSULTANTS, INC. Trade Name: Address: 6 TUSCANY CIRCLE MACHESTER, NJ 08759 Certifcate Number: 0576703 Effective Date: May 20,1991 Date of Issuance: October 26, 2009 . For Office Use Only: 20091026144454720 htts:llwwl.state.nj.us/TYTR_BRC/servlet!commonlRCLogin 10126/2009
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Public Agency Instructions This page provides guidance tO'public agencies entering into contracts with business entities that are required to fie Political Contribution Disclosure forms with the agency. It is not intended to be provided to contractors. What follows are instructions on the use of form local unts can provide to contractors that are required to disclose political contributions pursuant to N.l.S.A. 19:44A-20.26 (P.L. 2005, c. 271, s.2). Additional information on the process is available in Local Finance Notice 2006-1 (ww.nj.gov/dca/lgs/lfns/lfnenu.shtml). 1. The disclosure is required for all contracts in excess of$17,500 that are not awarded pursuant to a "fair and open" process (N.J.S.A. 19:44A-20.7). 2. Due to the potential length of some contractor submissions, the public agency should consider allowing data to be submitted in electronic form (i.e., spreadsheet, pdf fie, etc.). Submissions must be kept with the contract documents or in an appropriate computer file and be available for public access. The form is worded to accept this alternate submission. The text should be amended if electronic submission wil not be allowed. 3. The submission must be received from the contractor and on fie at least 10 days prior to award of the contract. Resolutions of award should reflect that the disclosure has been received and is on file. 4. The contractor must disclose contrbutions made to candidate and par committees covering a wide range of public agencies, including all public agencies that have elected offcials in the county of the public agency, state legislative positions, and various state entities. The Division of Local Government Services recommends that contractors be provided a list of the affected agencies. This will assist contractors in determining the campaign and political committees of officials and candidates affected by the disclosure. a. The Division has prepared model disclosure forms for each county. They can be downloaded from the "County PCD Forms" lin on the Pay-to-Play web site at ww.nj.gov/dca/lgs/p2p. They wil be updated from time-to-time as necessar. b. A public agency using these fonns should edit them to properly reflect the correct legislative district(s). As the fonns are county-based, they list alliegislaiive districts in each county. Districts that do not represent the public agency should be removed from the lists. c. Some contractors may find it easier to provide a single list that covers all contributions, regardless of the county. These submissions are appropriate and should be accepted. d. The form may be used "as-is", subject to edits as described herein. e. The "Contractor Instrctions" sheet is intended to be provided with the form. It is recommended that the Instrctions and the form be prited on the same piece of paper. The form notes that the Instructions are printed on the back of the form; where that is not the case, the textshould be edited accordingly. f. The form is a Word document and can be edited to meet local needs, and posted for download on web sites, used as an e-mail attchment, or provided as a printed document. 5. It is recommended that the contractor also complete a "Stockholder Disclosure Certification." This wil assist the local unit in its obligation to ensure that contractor did not make any prohibited contributions to the committees listed on the Business Entity Disclosure Certification . in the 12 months prior to the contract. (See Local Finance Notice 2006-7 for additional information on this obligation) A sample Certification form is par of this package and the instruction to complete it is included in the Contractor Instructions. NOTE: This section is not applicable to Boards of Education. the
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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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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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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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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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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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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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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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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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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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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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20. Political Activity Prohibited N
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DETERMINATION OF V ALUECERTIFICATIO
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EXHIBIT A MANDATORY EQUAL EMPLOYMEN
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APPENDIX A AMERICANS WITH DISABILIT
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P.L. 2004, c. 57 (N.J.S.A. 52:32-44
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C.271 POLITICAL CONTRIBUTION DISCLO
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List of Agencies with Elected Offic
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. ~ , BUSINESS ENTITY DISCLOSURE CE
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AGREEMENT TIDS AGREEMENT entered in
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6. Purchses C) The City may send a
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12. Retention of Records Financial
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Page 442 and 443: ATTACHEMENT A PROGRAM DESCRIPTION:
Page 444 and 445: AGREEMENT . THIS AGREEMENT entered
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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
Page 476 and 477: 12. Retention of Records Financial
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 492 and 493: C. 271 POLITICAL CONTRIBUTION DISCL
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
Page 514 and 515: '~""- " JON S. CORZINE Governor Dec
Page 516 and 517: WILLIAMR. GOBLE, P.E., CITY ENGINEE
Page 518 and 519: Grant Application for State Aid to
Page 520 and 521: Grant Application for State Aid to
Page 522 and 523: Scope of Work cant' d Grant Applica
Page 524 and 525: CITY OF JERSEY CITY o E PA R TM E N
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Page 536 and 537: Engineer's Estimate (12.03-2009) IT
Page 538 and 539: Project Classification (J Pedestria
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Name of Grantee: Jersey City Organi
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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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