Resolutions - Jersey City

BUSINSS ENTITY DISCLOSUR CERTIFICATION
FOR NON-FAmAN OPEN CONTCT
Requied Put To N.JS.A 19:44A-20.8
. CIo.F JERSEY CIT '
iart I - Vendor Afation
The underiged, beig authoried and knowledgeab' Of the cicutaces, does herebycer tht the -Cname of
b1tne¡ entil~ has not~de and wi not mae any reportble contrbutions puruat to N J.SA 19:44A-1 et seq. that,
puittò P.L 2004, c. 19 would bar the aw~d of ths contrCt in the one yea perod p.tecedi (dae of award .rcheduled
for approval of the contrar: ~ the governuzg botlJ to any of the followig naed cadidate commttee, joint cadidate .
commtte; or political patty co:Dttee represent:g the elected òffcials of the ':nameof enti ofeJected oJd.i.~ as
defied OU.suantto N.T.SA 19:44A-3(p); (q) and (r). . . . . .
.
Friends of Peter Brennan Electio~ Fund Gaue-han Election Fund
Friends ofKaahH..Aad The Election Fuid of Steven Fulop
Electon Fund óf Radames Velazquez Jr. . Friends of Viola Richardson for Ward F
Friends of Michael Sottolano
EFO David P. DonnellyJ.C. Counci!2010 . Heal for Mayor 2013
Friends of Nidi a R. Lopez
Part II - Ownership Disclosur~ Certcation '.' . . . .
in i certi that the lit below contas the names and home addi~~~' of al owners holdi 100/0- '~r m~.te of the.
issued and outstadig stock of the undersigned. .
Check the box that r~presents the tye orbusitess entity
. .DParei:ship " . '.. DCorporation o Sale Propritorshi DSubcliaptei S Corp~.rtion
D~ted Par~rship EKted Libilty CO~Qra1Ìon DLited Liabilty.Parerhip
Name of Stock or Shareholder
..
. .
Home Address
.f)lJÍ0 l-"q fl' 'for¡ . Jib íóWiJ(Af1 .e DtJv,lIt- fJl. d7r3 a
oJ
.
.'
.
. ,
, . . .
Part 3 - Signatue and Attestation: :
Theiidersigned is fuyawae that if I hae mis.tepresented in whole o.t p.att th afa1Ìon and certication r atd/ or
the business ~#ty, wi be li!e for any¡ penaltyyer1tedunder law. . -
Name ofBusiess Entity tic! M fl-r 11 ~tWV'G0 ,.
Si£ed:. TItle: p~S. .
Prit:Name: il?;'D0 kfëvv/1A n. i Date Czltïl11
~20t.\
Suf~~ed and swom before me th : .
daY9f
My Ci:mmsion~.ies: RONA GOLDENBERG'
NOTA~X:~VBUC OF NEW JERSÝ
,
.
.
..