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

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Name Monthly Premium Delta Dental Plan of New Jersey $70.35 $71.94 (POBAlPSOAl1066/1064) Aetna $77.51 $101.81 (POBAlPSOAl1066/1064) 5) I have reviewed the rules of the Division of Local government services as contained in N.JAC. 5:34-2.1 et seq. and certify that the proposed contract may be considered as extraordinary unspecifiable service in accordance with the requirements thereof. Respectfully, Name: Brian O'Reily Title: Business Administrator
. AFTI ACTION COMPLIACE NOTICE N.J.S.Al0:5-31 and N.J.AC.17:27 GOODS AN SERVICES CONTCTS (ICLUDING PROFESSIONAL SERVICES) Th form is a su of the sucsfu bidde's requient to comply with the requiements ofN.J.S.A. 10:5-31 and N.J.A.C.17:27. The successfu bidd shall submt to th public agen, af noticaon of award but prior to exection of ths contIt, one of the followi th doents as form of evidee: (a) A photopy of a vald lett th th contrr is ope un an existg Federay approved or sactioned afve acon progr (goo for one yea frm the da of the lettr); OR (b) A photopy of a Cercate of Employee Inomition Rep apprva, issued in acordae with N.J.A.C. 17:27-4; OR (c) A photopy of an Employee Informon Reprt (Form AA02) provided by the Division an distbute to the public agency to be colete by the contrtor in acrdåce with N.J.A.C. 17:27-4. . The sucesfu vendor may obta th Afve Acton Emloyee Inormon Reprt (AA02) from the contrg unt dung norm busies hour. The succssfu vendoi(s) must sumit the copies of the AA02 Reprt to the Diviion of Contrt Compli an Equa Employment Oppoty in Pulic Cont (Division). The Pulic Agency coy is submitt to the public agency, and the vendr copy is retd by the vendor. . The underigned vendor cefies th he/she is awar of the cotmt to comply with th reuient ofN.J.S.A. 10:5-31 and N.l.A.C. 17:27 and ag to fuh the re form of evdence. The unign vendr fuer undeds th bisler bid sh be rejecte as non-respnsive if sad contrctor fals to comply with th reuiements ofN .J.S.A. 10:5-31 and NJ.A.C. 17:27. COMPAN: j)~n Jl4J'f~ np ¡(9' SIGNATU: sømJ!~ 7 . -: ¡; e- ( -- ú'G DATE: Ir/r/61 PRI NAM: t/i~ $CJlfll¿.\ .TI: AOMI,vljtUTOJC, JJIl~JJ /lOC)I..c./' AFIRTI ACTION COMPLICE (SAMLE DOUM
Page 1 and 2: City Clerk File No. Agenda No. Appr
Page 3 and 4: Continuation of Resolution City Cle
Page 5 and 6: ()- 00;1 EXHIBIT A JAN i 3 2010 BLO
Page 7 and 8: Block: 00763 Principal: 3,167.01 Ta
Page 9 and 10: N N N ~ -c N m 0 0 0 0 ;i 0 0 0 0 ;
Page 11 and 12: Memo to Brian O'Reiley, Business Ad
Page 15 and 16: Resolution of the City of Jersey Ci
Page 17 and 18: LEGISLATIVE FACT SHEET This summary
Page 21 and 22: of the Licensee or anyone employed
Page 23 and 24: 14. Failure to adhere to the terms
Page 25 and 26: HOST CITY AGREEMENT THIS HOST CITY
Page 27 and 28: provided in writing by the Red Bull
Page 29 and 30: on the first business day following
Page 31 and 32: (1) Severabilty. If any provision o
Page 33 and 34: SCHEDULE A SERVICES The City shall
Page 37 and 38: .. November 16, 2009 Paragraph D -
Page 39 and 40: Aricle 26 November 16, 2009 Paragra
Page 41 and 42: Aricle 30 Insert New Paragraph H as
Page 43 and 44: Aricle 36 November 16,2009 Add new
Page 45 and 46: wil be $50 per 30-day supply, meani
Page 49: CERTIFICATION OF BRIAN O'REILLY IN
Page 53 and 54: EXITA N.J.s.A. 10:5-31 aDd N.J.AC.
Page 55 and 56: APPENIX A AMRICANS WI DISABIL ACT O
Page 57 and 58: " Taxpayer Identifcation# 221~896.1
Page 59 and 60: 0148637 CITY OF JERSEY CITY Requisi
Page 61 and 62: A summary of Aetna's proposal rates
Page 63 and 64: City of Jersey City Dental Program
Page 65 and 66: UL-\, .L C- C-UiiO .L-i- Jc: veL I
Page 69 and 70: CERTIFICATION OF BRIAN O'REILLY IN
Page 71 and 72: -,-~._'~_.,----_._.~.._--_.- -'-~--
Page 73 and 74: EXIT A N.J.s.A. 10:5-31 and N.J.AC.
Page 75 and 76: APPENDIX A AMRICANS WI DISABIL ACT
Page 77 and 78: -~_.._- ._----~_._-~.._----_._----~
Page 79 and 80: Reqúisition # 0148636 Vendor DELTA
Page 81 and 82: . A sumary of Aetna's proposal rate
Page 83 and 84: Total Annual: Total Monthly: $158,0
Page 85 and 86: VcL-l¿-¿~~~ IJ;J¿ DEL TA DENTAL
Page 89 and 90: EXTRAORDINARY UNSPECIFIABLE SERVICE
Page 92: Requisition # 0148639 Vendor RELIAS
Page 95 and 96: EXIT A N.J.s.A.IG:5-3la.d N.J.A.C.
Page 97 and 98: APPENIX A AMRICANS WI DISABIL ACT O
Page 99 and 100: ./ Resolution of the City of Jersey
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Resolution of the City of Jersey Ci
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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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Continuation of Resolution City Cle
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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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12/16/2009 18: 41 9732435549 PAGE 0
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12/1&/2009 18: 41 9732435549 PAGE 6
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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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City Clerk File No. Agenda No. Appr
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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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iLliiIL~~~ lL:LL Lin -~4 1-~23Ø LA
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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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12/18/2e09 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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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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Page_of Vendor Name: o Check here i
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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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. ~ , 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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ATTACHEMENT A PROGRAM DESCRIPTION:
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AGREEMENT . THIS AGREEMENT entered
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6. Purchses C) The City may send a
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ATTACHEMENT A PROGRAM DESCRIPTION:
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~. Requisition # 0148802 Vendor PHI
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EEO/ AFFIRMATIVE _.._----_._."---.
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Certification 778 CERTIFICATE OF EM
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MINORITYIWOMAN.BUSINESS ENTERPRISE
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l'l.J. UCPi:UIlCUl UL HCa:sury - Ui
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AGREEMENT THIS AGREEMENT entered in
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C) The City may send a representati
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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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Page ::of 2- Vendor Name: Continuat
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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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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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SHEET 9 ----_....__...._------_.._-
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Click It or Ticket _.._.._-_.._---_
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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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