Resolutions - Jersey City

BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
'Requied Pursuant To N.J.S.A. 19:44A-20.8
CITOF JERSEY CITY
Par I - Vendor Afrmation . . . GJ¡i.6CJs~.s ~
The underigned, beig authonzed and knowledgeable of the cicumstances, does hereby certify that the c:nome of rln-~t':J
"'hjiJÙ¡esJenti!y~has not made and w:i not makc any reportablc contrbutions puruant to NJ.S.A. 19:44A-l et seq. that, ¡.1
puruant to P.L. 2004, c. 19 would bar the award of ths contract in thc onc year period prccedig (dale of award fcberJi/ed 3 'i II
for approval of tbe contract/r the govmring botl) to any of the followig named candidate commttee, joint candidates .
commttee; or polii;cal party commttee representig the elected officials of the c:~lJif eff'!t;Jec~et:iil.~ as
defied puruantto N.T.SA 19:44A-3(p), (q) and (r). '.; 'i; S~. .
Friends of Peter Brennan Election Fund Gaughan Election Fund .
Friends of Kalimah H. Ahmad
The Election Fund of Steven Fulop
Election Fund ófRadames Velazquez Tr.
Friends of Viola Richardson for Ward F
Friends of Michael Sottolano
EFO David P. Donnelly J.C. Council
Friends of Nidi a R. Lopez
Part II - Ownership Disclosure Certification
2010 Healy for Mayor 2013
)8 I certify that the list below contais the names and home addrcsse~ of al owners holdig 10% ~I rJ0re of the
issued and outstandig stock of the undersigned. .
Check the box that represents the tye ofbusIness entity: .
DPartnership &orporation DSole Proprietorship DSubchapter S Corporation
DLiied Partnership DLited Liabilty Cor~oration .DLited Liabilty,Partnership
,. ri i
Name of Stock or Shareholder
(K.J! ri e-li: it ¡¿,'J ,1~
.
Home Address
-
~~.L'~l lJ c. ¡: 7 u
Part 3 - Signature and Attestation: .
The undersigned jsfuJ' awae that if! have misrepresented in whole OJ: part th affimation and certification, 1 andl or
the business entity, w: be IiPJ for é!n~naltyp~tted under l~ !J. '\ 'Í
Nune OfBUt'~' b-.- ClfU 0..1 "' r'"à I"" ~
Signed: ,. -c: 7 Title: C/
Prit Name: J,... C ~~ Date:.3 L
,
S~.crbed,ind sworn before me tls., ,any of
/,/ (/~/. /
ß'ávJt ,2111. /! . ,- ,.
My Co",';"" ~xp¡,~~~:'¿/,
MY COMMISSION EXPIRES JULY 16,201
V (Affiant).
IrL~ C~~p~ ~
(prit name & title of affiant) (CorporatE Seal)
.