Project Manual 11-210C - Ramapo College of New Jersey

RAMAPO COLLEGE OF NEW JERSEY
STOCKHOLDER DISCLOSURE FORM
Firm Name
Address
City & State
__________________________
__________________________
__________________________
In the spaces provided, list the names and addresses of all owners, partners, directors, officers and
indirect owners owning 10% or more interest in the bidder's firm. If corporate owner, list in the space
provided stockholders or corporation whose ownership through the corporation is 10% or more of the
bidder. Complete affidavit at bottom of form. If this has already been submitted to Ramapo College, use
the form for any changes and complete the affidavit.
NAME
ADDRESS
(Street, City/Town, County, State, Zip)
President of the firm (Type or print name) ________________________ Phone _____________________
I certify that:
List of stockholders names and addresses has been submitted to Ramapo College
and it is current and correct to the best of my knowledge, with the
exceptions as listed above.
Signature of Authorized Representative
The list of stockholders above is current and correct to the best of my knowledge.
There are no stockholders holding 10% or more interest in this corporation or firm
to the best of my knowledge.
E-Wing Renovation for Teacher’s Education
RCNJ Project No. 11-210C
Form C105
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