Resolutions - Jersey City

ITEM 16 _ Print or type the name oftheperson completing the form. Include the signature, titleand date.ITEM i 7 _ Enter the physicalZip Code and Phone Number.TYE OR PRINT IN SHARP BALL POINT PENlocation where the form is being completed. Include City, State,The vendor is to complete the employee information repoit form (AA302) and retain copy forthe vendor's own fies. The vendor is to submit a copy to the public agency awarding thecontract and forward a copy to:NJ Department of the TreasuryDivision of Contract Compliance & Equal Employment OppurtunityP.O. Box 209Trenton, New Jersey 08625-0209 Telephone No. (609) 292-5475df, Note that the sample form shown on the following page is for illustrative pUllloses only andshould not be submitted, Use the state website links above to obtain the actual f0111.