REQUEST FOR PROPOSAL BOROUGH ENGINEER FOR THE BOROUGH OF ROSELLE PARK November 30, 2018 Prepared By: Victor E. Vinegra, PE, PP, PLS License No. 34460 Harbor Consultants, Inc. 320 North Avenue East Cranford, NJ 07016 908-276?27 1 5 908-709-1738 Victorv@hcicg.net BOROUGH OF ROSELLE PARK SUBMISSION CHECKLIST THE FOLLOWING ITEMS, AS INDICATED BELOW SHALL BE PROVIDED Initial WITH THE RECEIPT OF SEALED SUBMISSIONS Here Name of Vendor: Signature: X. 7 Print Name: Victor E. Vinegra Completed REP Checklist Completed Submission Form Qualification Statement Statement owanership Disclosure Non?Collusion Af?davit Required EEO/Af?rmative Action Evidence Signed Compliance Notice Acknowledgement of Americans with Disabilities Act Language of 1990 Disclosure of Investment Activities in Iran Insurance Requirement Acknowledgement Form Certi?cation Regarding Political Contributions New Jersey Business Registration Certi?cate of Vendor of Vendor Harbor Consultants inc Date: ?(aw/lg This checklist is provided for vendor?s use in assuring compliance with required documentation; however, it does not include all submission requirements and does not relieve the vendor of the need to read and comply with the RFP. i. Title: President Page 7 of 26 BOROUGH OF ROSELLE PARK SUBMISSION FORM QUALIFICATION STATEMENT (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 1. Names and roles of the individuals Who will perform the services and description of their education and experience with projects similar to the services contained herein: Victor E. Vinegra, P.E., P.P., P.L.S. Education: Bachelor of Science Degree in Civil Engineering, New Jersey institute of Technology, 1983 Professional Engineer State of New Jersey #34460 Professional Planner State of New Jersey #34460 Professional Engineer State of Delaware #8003 President, New Jersey Board of Professional Planners iVir. Vinegra is President of Harbor Consultants inc, and oversees the management and operation of firm, as well as providing engineering, planning and land surveying services for the past 25 years. His extensive experience includes the design and management of engineering projects, scheduling of project teams and professional testimony at public hearings. As a Professional Engineer, Land Surveyor and Planner, Mr. Vinegra specialized in the field of land use planning and value based engineering. He has completed advanced degrees in environmental engineering and advanced engineering practice in open and closed hydraulic systems. He has worked on a variety of jobs and projects such as sanitary sewage pumping faciilties, environmental cleanup and remedial design, roadway design, traffic analysis and feasibiity studies. He has created and implemented Master Plans for various townships, site plans and subdivision plans form initial concept design to total project build-out. He excels in the field of Construction Management, lnspectlon and Consulting. As a Professional Engineer, he has testified before numerous Planning and Zoning Boards of Adjusement throughout the State of New Jersey. Harbor Consuitants performs engineering and design services for construction projects which total over 100 million construction doiiars annually. Page 8 of 26 BOROUGH OF ROSELLE PARK SUBMISSION FORM QUALIFICATION STATEMENT (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 1. Names and roles of the individuais Who will perform the services and description of their education and experience with projects similar to the services contained herein: Anthony G. Galierano, P.E., PP. Education: Bachelor of Science Degree in Civii Engineering New Jersey Institute of Technology 1983 Professional Engineer State of New Jersey: Professional Engineer State of Professional Engineer State of New York: 6735709 Professional Planner State of New Jersey: lVlr. Gallerano is a principal engineer of Harbor Consultants, Inc, and provides engineering, professional planning, project management and design services for projects in both the public and private sectors. His experience is in the area of site development, subdivisions, municipal engineering, solid waste management, recreational facilities, public bidding and educational facilities. He has provided planning and engineering consulting for municipal planning boards and zoning board of adjustments including application review, expert engieering and planning testimony, zoning ordiance review, master plans and preparation of municipal ordiances. His experience includes site design. subdivision. stormwater management. water duality design. utilities design, ?oodplain managrnent, grading design, roadway improvements, iighting and landscaping plans, underground storage tank removal, spill presention plans, water system design, pumping stations, soil erosion and sediment control plans, landfill design and reguiatory compliance. Mr. Gallerano is a licensed Professional Engineer in the State of New Jersey, and New York and is a licensed Professional Planner in the State of New Jersey. Page 8 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 2. References and record of success of same or similar service: Borough of Garwood: Roadway and Drainage Improvements; Stormwater Management Design and Inspection Services; Site Inspections; Planning Board Service and Review; Zoning Board of Adjusment Service and Review; Land Surveying Services Reference: Christina M. Arlemma, RMC Borough Clerk 908u789-0710 City of Elizabeth: Professional Planning Services; Planning Board reviews; Zoning Board of Adjustment reviews; Site Inspections; Roadway Improvements; Development Application Review; Master Plan Road Reconstruction Projects; Geographic Information System Deveiopment Reference: Eduardo Rodriguez, Director of Department of Pianning Community Development 908?820-4160 Township of Berkeley Heights: Township Planner, Redevelopment Studies; Zoning Board of Adjustment Reviews; Municipal Parking Lot Design; Roadway Improvements; Master Plan Reference: John Bussiculo, Borough of Keniiworth: Municipal Engineer; Stormwater Management Design and Inspection Services Preparation of Stormwater Management Ordinance; Preparation of Municipal Stormwater Mangement Plan; Master Plan; Roadway Improvements; Road Reconstruction Projects; Construction Observation Land Surveying Services; Roadway Resurfacing Projects Reference: Laura Reinertsen, Borough Clerk 908-276-9090 Page 9 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 3. Description of ability to provide the services in a timely fashion (including staf?ng, familiarity and location of key staff): Harbor Consultants, Inc. is a progressive engineering, planning and land surveying firm with over 30 years experience in New Jersey. Our Professionai staff provides a full range of consulting services to our clientele on a multitude of projects. Utilizing the latest advances in technoiogy, Harbor Consultants can expedite your project to meet the most stringent of time frames. provides diversity in the consulting field by servicing both the pubiic and private sectors. Completed projects range from mini mails to regional mega malls; plot plans to 300 unit subdivisions; roadway resurfacing to major highways; sewer force mains to submerged pipelines; GPS surveys to title surveys; underground tunnel surveying to aeriai digital orthro photography. MCI is presently the consuiting Pianner for the City of Elizabeth, the Township of Berkeiey Heights, the Township of Scotch Plains, Township of Craford, Borough of Englewood Cliffs, Township of Hillisde, the Borough of Kenilworth, the Borough of Garwood and the City of Hackensack. Harbor Consultants is also the Consulting Engineer for the City of Elizabeth and the Borough of Garwood. In addition is the Municipal Engineer for the Borough of Kenilworth. Harbor Consultants satisfies the requirements and is certified a Small Business Enterprise (SBE) in the State of New Jersey. HCI assists clients in meeting quotas on Set-Aside projects for the New Jersey Department of Transporation (NJDOT), New Jersey Transit, New York New Jersey Port Authority and the New Jersey Turnpike. l~iCl will furnish all equipment, office space and supplies to perform the work and field work necessary for the completion of the project within the time period alioted. The persons who wiil be assigned to perform the specified work are as follows: Victor E. Vinegra, PE, PLS, Anthony Gailerano, PE, Michael Mistretta, PP, Christian Cueto, PE, Jose Betances, PE, Katherine O'Kane, PP, All staff is located at: Harbor Consultants Inc, 320 North Avenue East, Cranford NJ 07016. Harbor Consultants, Inc., is a corporation in the State of New Jersey, in practive since May 1985. is a privately owned company that has been under the same managment since the creation of the firm. is fully compliant with all Affirmative Action local, state, and federal regulations with regard to Affirmative Page 10 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 3. Description of ability to provide the services in a timely fashion (including staf?ng, familiarity and location of key staff): Currently no individuals at Harbor Consultants are disbarred, suspended or prohibited from professional practice. Harbor Consultants has not been involved in any bankruptcy or reorganization proceedings. Currently no individuals at have any immediate relatives who are Authority employees or eEected officials. Professional Services provided, including but not limited to: Civil Engineering/Site Development; Construction Management Inspections; Ecological Services; Geotechnical Engineering; Grant and Funding Applications; Hydrographic Services; Land Surveying; Landscape Architecture; Municipai Engineering; Parks and Recreation Planning/Design; Professional Planning; Project Management; Regulatory Compliance; Stormwater Mangement; Structural and Buiiding Design; Traffic and Transporation Engineering; Water and Wastewater Engineering; Wetlands Studies; Urban Renewal/Development; Riparian Rights. Page 10 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 4. Cost details, including the annual fee for primary duties and the hourly rates of each of the individuals who will perform services, and all expenses for any work that is not included in the primary duties: Principal Engineer: $115 Professional Engineer/Board Review: $115 Design Engineer: $95 Junior Engineer: $75 Principal Planner: $115 Professional Planner/Board Review: $115 Project Manager: $115 Certified Landscape Architect: $115 Environmental Planner: $115 Manager: $105 Senior CADD G18 Designer: $95 CADD Designer/GiS Technician: $80 Professional Land Surveyor: $115 Construction Manager: $115 Construction Observation: $105 Field Land Surveying Crew: $190?150 CERTIFICATION OF PROPOSAL (Sign Below) Firm: Harbor Consutlants Inc. Date: 1 1/26/18 Authorized Represe ta (Print): E. Vinegra Signature: Title: President Telephone No.: 908?276?271 5 Fax No: 908?709-1 738 Page 11 of26 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (PL. 1977, 0.33, as amended by P.L. 2016, c.43) THIS STATEMENT SHALL BE COMPLETED, CERTIFIED TO, AND INCLUDED WITH ALL BID AND PROPOSAL SUBMISSIONS. FAILURE TO SUBMIT THE REQUIRED INFORMATION IS CAUSE FOR AUTOMATIC REJECTION OF THE BID OR PROPOSAL. Name of Organization: Harbor Consultants Inc Organization Address: 320 North Avenue East, Cranford NJ 07016 Part I Check the box that represents the type of business organization: Sole Proprietorship (skip Parts II and execute certi?cation in Part IV) nNon?Pro?t Corporation (skip Parts II and execute certi?cation in Part IV) ForuPro?t Corporation (any type) ULimited Liability Company (LLC) Partnership El Limited Partnership ULimited Liability Partnership (LLP) Other (be speci?c): Part II The iist below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST ON THE NEXT PAGE IN THIS SECTION) OR No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited iiability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) Page 12 of 26 STATEMENT OF OWNERSHIP DISCLOSURE (Continued) (Please attach additional sheets if more space is needed): Name of Individual or Business Entity Home Address (for Individuals) or Business Address Victor E. Vinegra 425 Hazel Ave Garwood NJ 07027 Part DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II If a bidder has a direct or indirect parent entity which is pubiicly traded, and any person holds a 10 percent or greater bene?cial interest in the publicly traded parent entity as of the last annual federal Security and Exchange Commission (SEC) or foreign equivalent ?ling, ownership disclosure can be met by providing links to the website(s) containing the last annual ?ling(s) with the federal Securities and Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater bene?ciai interest in the publicly traded parent entity, along with the relevant page numbers of the tiling(s) that contain the information on each such person. Attach additional sheets if more space is needed. Website (URL) containing the last annual SEC (or foreign equivalent) ?ling Page Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part 11 other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 5225?242 has been listed. Attach additional sheets if more space is needed. Stockholder/Partner/Member and Home Address (for Individuals) or Business Address Corresponding Entity Listed in Part II Victor E. Vinegra 425 Hazet Ave Garwood NJ 07027 Page 13 of 26 STATEMENT OF OWNERSHIP DISCLOSURE (Continued) Part IV Certi?cation I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. 1 acknowiedge: that I am authorized to execute this certi?cation on behalf of the bidder/proposer; that the Borough of Roselle Park is relying on the information contained herein and that I am under a continuing obligation from the date of this certi?cation through the completion of any contracts with the Borough of Roselle Park to notify the Borough of Roselle Park in writing of any changes to the information contained herein; that i am aware that it is a criminal offense to make a false statement or misrepresentation in this certi?cationsubject to criminai prosecution under the law and that it will constitute a material breach of my agreement(s) with the, permitting the Borough of Roselle Park to declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print): Titie: Victor E. Vinegra President Signature: Date: 11/26/18 Ma'- Page 14 of26 BOROUGH OF ROSELLE PARK AFFIDAVIT State MW County of Union 1, Victor E. Vinegra Ofthe City of Garwood in the County of Union and State of New Jersey full age, being duly sworn according to iaw on my oath depose and say that: I am President of the ?rm of Harbor Consultants Inc (Title or Position) (Name of Firm) the bidder making this Proposal for the above named project, and that I executed the said proposal with full authority so to do; that said bidder has not, directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and in this af?davit are true and correct, and made with ?lli knowiedge that the Borough of Roselle Park relies upon the truth of the statements contained in said proposal and in the statements contained in this af?davit in awarding the contract for the said project. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee, except bona ?de employees or bona ?de employees or bona ?de established commercial or selling agencies maintained by Harbor Consultants Inc (name of contractor). Subscribed and sworn to before me this 26th _mday - x. of November 2018 5 Signature Victor E. Vinegra (Type or print name of af?ant under signature) (Nit/M Jilrgi?QQ/ Notary public of Nvew Jersey? My Commission expires May 2, 2020 ANNE VENTQLA ID ii 2250800 Page 15 of26 NOTAFRdEpiiljggigs EY STATE 0 My Commission Expires May 2. 2020 BOROUGH OF ROSELLE PARK AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 105.31 and N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS This form is a summary of the successful bidder?s requirement to compiy with the requirements of N.J.S.A. 1025~31 and N.J.A.C. 1727?] et seq. The successful bidder shall submit to the public agency, after noti?cation of award but prior to execution of this contract, one of the following three documents as forms of evidence: a) A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned af?rmative action program (good for one year from the date of the letter); OR b) A photocopy of a Certi?cate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27?4; OR o) A photocopy of an Employee Information Report (Form AA302) provided by the Division and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 1727-4. The successful vendor may obtain the Af?rmative Action Employee Information Report (AA302) from the contracting unit during normal business hours. The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public agency, and the vendor copy is retained by the vendor. The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements 1025-31 and N.J.A.C. 17:27.1 et seq. and agrees to furnish the required forms of evidence. The undersigned vendor further understands that his/her bid shall be rejected as non?responsive if said contractor fails to comply with the requirements of NJ .S.A. 1025-31 and N.J.A.C. 17 :27~1 et seq. COMPANY: Harbor Consultants hag/n (f SIGNATURE: PRINT AME: Victor E. Vinegra TITLE: President DATE: 11/26/18 Page 16 of 26 BOROUGH OF ROSELLE PARK EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5~31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a notice, to be provided by the agency contracting of?cer, advising the labor union of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to meet targeted Borough employment goals established in accordance with N.J.A.C. 17:27?52. The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of ob?reiated testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. In conforming with the targeted employment goals, the contractor or subcontractor agrees to review ali procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken Page 17 of 26 EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5~31 et seq. (PL. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS (Continued) Without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after noti?cation of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Affirmative Action Plan Approval Certi?cate of Employee Information Report Employee Information Report Form AA302 (electronicaiiy provided by the Division and distributed to the public agency through the Division?s website at The contractor and its subcontractors shall furnish such reports or other documents to the Division of Purchase Property, CCAU, EEO Monitoring Program as may be requested by the of?ce from time to time in order to carry out the purposes of these regulations, and public agencies shail furnish such information as may be requested by the Division of Purchase Property, CCAU, EEO Monitoring Program for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27. Page 18 on6 BOROUGH OF ROSELLE PARK AMERICANS WITH DISABILITIES ACT OF 1990 Equal Opportunity for Individuals with Disability The Contractor and the Owner, do hereby agree that the provisions of Title 11 of the Americans with Disabilities Act of 1990 (the "Act") (42 US. C. 0] et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs, and activities provided or made available by public entities, and the rules and regulations promulgated pursuant there unto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the owner pursuant to this contract, the contractor agrees that the performance shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall defend the owner in any action or administrative proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the owner, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages, of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the owner?s grievance procedure, the contractor agrees to abide by any decision of the owner which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the owner, or if the owner incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense. The owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim, If any action or administrative proceeding is brought against the owner or any of its agents, servants, and employees, the owner shall expeditiously forward or have forwarded to the contractor every demand, complaint, notice, summons, pleading, or other process received by the owner or its representatives. It is expressly agreed and understood that any approval by the owner of the services provided by the contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the owner pursuant to this paragraph. It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the contractor?s obligations assumed in this Agreement, nor shall they be construed to relieve the contractor from any liability, nor preclude the owner from taking any other actions available to it under any other provisions of the Agreement or otherwise at law. The undersigned vendor consents to the full understanding of the forgoing Americans with Disabilities Act Language of 1990: Bidder/Vendor: ,lalarbor Consultants kw Signature: Full Name (Print): E. Vinegra Title: President Date 11/26/18 Page 19 of 26 BOROUGH OF ROSELLE PARK DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN PART 1: CERTIFICATION BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX. Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certi?cation below to attest, under penalty of perjury, that neither the person or entity, nor any of its parents, subsidiaries, or af?liates, is identi?ed on the Department of Treasury?s Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found on the Division?s website at Bidders must review this list prior to completing the below certi?cation. Failure to complete the certi?cation will render a bidder?s proposal non?responsive. PLEASE CHECK EITHER BOX: I certify, pursuant to Public Law 2012, c. 25, that neither the person/entity listed above nor any of the entity?s parents, subsidiaries, or affiliates is listed on the Department of the Treasury?s list of entities determined to be engaged in prohibited activities in Iran pursuant to FL. 2012, c. 25 (?Chapter 25 List?). I further certify that I am the person listed above, or I am an of?cer or representative of the entity listed above and am authorized to make this certi?cation on its behalf. I will skip Part 2 and sign and complete the Certi?cation below. OR El I am unable to certify as above because I or the bidding entity and/or one or more of its parents, subsidiaries, or af?liates is listed on the Department?s Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below and sign and complete the Certi?cation below. Failure to provide such will result in the proposal being rendered as non-responsive and appropriate penalties, ?nes and/or sanctions will be assessed as provided by law. PART 2 PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or af?liates, engaging in the investment activities in Iran outlined above by completing the form below. (PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, USE ADDITIONAL PAGES). Name: Relationship to Bidder/Vendor: Description of Activities: Duration of Engagement: Anticipated Cessation Date: Bidder/ Vendor: Contact Name: Contact Phone Number: Page 20 of 26 DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN (Continued) CERTIFICATION I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that i am authorized to execute this certi?cation on behalf of the below-referenced person or entity. I acknowledge that the Borough of Roselle Park is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certi?cation through the completion of contracts with the Borough of Roselle Park to notify the Borough of Roselle Park in writing of any changes to the answers or information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certi?cationrecognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreements(s) with the Borough of Roselle Park and that the Borough of Roselle Park at its option may declare any contract(s) resulting from this certi?cation void and unenforceable. Full Name (Print): Victor E- Vinegra Signature: Title: President Date 11/26/18 Bidder/Vendor; Harbor Consultants Inc Page 21 of 26 BOROUGH OF ROSELLE PARK INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM Certi?cate(s) of Insurance shall be ?led with the Borough Clerk's Of?ce upon award of contract by the governing body The minimum amount of insurance to be carried by the Professional Service Entity shall be as follows: PROFESSIONAL LIABILITY INSURANCE Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy period. Acknowledgement of Insurance Requirement: DATE: 11/26/18 Victor E. Vinegra, President (Printed Name Title) Page 22 of 26 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE OF NEW JERSEY SS. COUNTY OF Union 1, Victor E. Vinegra President of the Firm of Harbor Consuitants in the County of Union and the State of New Jersey, of full age, being duly sworn according to law on my oath depose and say that: I am the President of the ?rm of Harbor Consultants Inc the Professional Service Entity making the submissions for the above named Service, and that I executed the said submission with full authority to do so; that said Professional Service Entity acknowledges that it is aware that the Borough of Roselle Park pursuant to Section 2-4 of the Borough Code prohibits the awarding of any public contract to any Professional Service Entity that has contributed in excess of two hundred ($200.00) doliars to a campaign committee of any Borough of Roselle Park candidate or holder of the public of?ce having ultimate responsibility for the award of the contract, or to any Borough of Roselle Park or Union County Party Committee, or to any political action committee (PAC) that is organized for the primary purpose of promoting or supporting Borough of Roselle Park municipal candidates or municipal officeholders, within one (1) calendar year immediately preceding the date of the contract or agreement. I further warrant that pursuant to Roselle Park Borough Section 2?4, a ?professional service provider? seeking a public contract means: an individual, including the individual?s spouse, if any, and any chiid living at home; person; ?rm; corporation; professional corporation; partnership; organization; or association. The de?nition of a service provider includes all principals who own one (i percent or more of the equity in the corporation or business trust, partners, and officers in the aggregate employed by the provider as well as any subsidiaries directly controlled by the service provider. I further warrant that I have reviewed Borough Code Section 2?4. I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment for contempt of Court. Subscribed and sworn to before me 7M this 26th day of November 20_18 (Signafdre of Professional) l. 4 i Name: Victor E. Vinegra Title: President (Signature of Nota ?lm's tt?l variants NOTARY PUBLIC STATE OF NEW JERSEY My Commission Expires May 2. 2020 Page 23 of 26 . - 10125I01 Taxpayer Identi?cation# 222-673-191I000 Dear Business Representative: Congratulations! You are now registered with the New Jersey Division of Revenue. Use the Taxpayer Identi?cation Number listed above on all correspondence with the Divisions of Revenue and Taxation. as well as with the Department of Labor (if the business is subject to unemployment withholdings). Your tax returns and payments will be ?led under this number. and you will be able to access Information about your account by referencing It. Additionally. please note that State law (Public Law 2001. c.134) requires all contractors and subcontractors with State. county and municipal agencies to provide proof of their registration with the Division of Revenue. The law also amended Section 92 of the Casino Control Act. which deals with the casino service industry. We have attached a Proof of Registration Certi?cate for your use. To comply with the law. if you are currently under contract or entering into a contract with a State. county or municipal agency. you must provide a copy of the certi?cate to the contracting agency. if you have any questions or require more information, feel free to call our Registration Hotline at (609) 292?1730. I wish you continued success In your business endeavors. Sincerely. QM 4% Patricia A. Chiacchio Director. Division of Revenue :5 3 STATE OF NEW JERSEY 5 0? E: BUSINESS REGISTRATION CERTIFICATE DEPARTMENT OF DIVISION or REVENUE g; FOR STATE AGENCY AND CASINO SERVICE CONTRACTORS =3 PO BOX 252 giving?? 7?:qu TAXPAYER NAME: TRADE NAME: HARBOR CONSULTANTS. INC. TAXPAYER CONTRACTOR 222-673-191I000 0105464 ADDRESS ISSUANCE DATE: 320 NORTH AVE 10125,? CRANFORD NJ 01016 EFFECTIVE DATE: . 4 g. 10l03185 Director. Division of Revenue FORM-BRO 08-01 . It mu -- eggn?splcuggsy m- -- ,0 clung? . 1:44". Hi 9n as 214:1: . 8 ruff?) I Id - ., I7 HIGHERHEUEQ Illujilpl? "Ulil a? n? 2? :j up .- g?mugm mu 5; ?Il? ?1 fl?. -4 4 1 If}; r. . lit/I; will): Form w-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service Harbor Consultants Inc 2 Business name/disregarded entity name, if different from above Request for Taxpayer Identification Number and Certification Go to for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Give Form to the requester. Do not send to the IRS. following seven boxes. Individual/sole proprietor or Corporation single?member LLC Print or type. Other (see instructions) Corporation I: Limited liability company. Enter the tax classification corporation, corporation, P=Partnership) Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single?member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single?member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. 3 Check appropriate box for federal tax classification ofthe person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Partnership El Trust/estate Exempt payee code (if any) code (if any) (Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. 320 North Avenue East See Specific Instructions on page 3. Requester?s name and address (optional) 6 City, state, and ZIP code Cranford NJ 07016 7 List account number(s) here (optional) Iatn Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. I Social security number or Employer identification number I 22-2673191 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: I am exempt from backup withholding, or I have not been notified by the Internal RevenUe Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. 8'9" Signature of Here U.S. person ?7 General Instructions Section references are to the Internal Revenue Code unless othenNise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to Purpose of Form An individual or entity (Form requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. Form 1099-INT (interest earned or paid) Dateb - Form 1099-DIV (dividends, including those from stocks or mutual funds) 0 Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) 0 Form 1099-8 (stock or mutual fund sates and certain other transactions by brokers) - Form 1099?8 (proceeds from real estate transactions) 0 Form 1 (merchant card and third party network transactions) 0 Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) 0 Form 1099-0 (canceled debt) Form (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018)