'Garrubb'o 8L Capece, P.C. ATTORNEYS AT LAW 2204 MORRIS AVENUE SUITE 304 JOSEPH L. UNION. NEW JERSEY 07083 FRANK G. CAPECE LAURIE M. ESTEIIES . LISA DELLA PELLE (908)233-5575 CERTIFIED BY THE SUPREME- COURT OF NEW JERSEY AS FAX {903,2334994 A CIVIL TRIAL ATTORNEY - A MEMBER OF FL BATI attys@grrlawyers.com L50 November 16, 2018 Andrew J. Casals Borough Clerk Borough of Roselle Park 1 10 East West?eld Avenue, Roselle Park, NJ 07204 RE: Proposal for Labor Counsel Garrubbo Capece P.C. Enclosed please ?nd original and two copies proposal for Roselle Park Labor Counsel. Very truly yours, Frank G. Esq. FGC :ya Enclosure BOROUGH OF ROSELLE PARK SUBMISSION CHECKLIST THE FOLLOWING ITEMS, AS INDICATED BELOW E, SHALL BE PROVIDED Initial WITH THE RECEIPT OF SEALED SUBMISSIONS Here Completed RFP Checklist ,7 Completed Submission Form I Quali?cation Statement Statement of Ownership Disclosure Non-Collusion Af?davit I 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 W-9 of Vendor 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. Name of Vendor: a UV i0 (00 is (7-9 Peel? Date: 7 Signature: X. Print Name: Cliff-Q? Title: W61 (/Mf 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: See Attachment A 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: See Attachment A Page 9 of 26 ATTACHMENT A Summary of Quali?cations and Statement Municipal Counsel Berkeley Heights 1987, 1989 Clark Township 1992 1994 Win?eld Township 1985 2014 Perth Amboy 2003 2008 Plainfield Housing Authority 2005 2006 Union County Personnel Counsel 1989 201 1 Roselle Park Board of Education -- 1997 Roselle Park Labor Counsel- 2016 Kenilworth Labor Counsel 2018- Present Hillside Labor Counse1~ 2018- Present Special Counsel Secaucus City of Plain?eld Union City Township of Edison Township of Hillside Elizabeth Board of Education 2008-2016 BA New York University JD Delaware Law School Experience: Counsel to New Jersey Secretary of State Partner Waters, McPherson, McNeil Partner Garrubbo Capece P.C. Member Supreme Court Committee on Professional Corporations Member Corporation Law Revision Commission Member Hackensack Meadowlands Cultural Commission Member Union County Fee Arbitration Committee Reported Cases: Union County Democratic Committee V. Florio Corvelli V. Fonesca 323 NJ Super 342 1977 1982 1982 2002 2002 Present 1981 1978 1982 1981 2006 2011 Corzine V. 2005 Defense Base Closure and Realignment Commission, A Commission of the United States of America Created by an Act of Congress, et als (Represented U.S. Senator Jon. Corzine Case argued through 3rd Circuit Court of Appeals and Appeal US Supreme Court Todaro v. County of Union, 392 NJ Super 448 (App. Div. -- 2007). Supreme Court Committee on Professional Corporations State Bar Law Section Member Committee for U. S. Senator Frank Lautenberg on Military Academy Appointments. Recent Lectures NJ Municipal Association of Municipal Clerks on Administrative Law Rutgers University School of Journalism. Lecture on ABC Law and Enforcement- Rutgers University, Union County Municipal Clerks Association regarding ABC Enforcement Clerks Perspective. Author - NJ Law Journal on Corporate Name Selection and Legislative Apportionment Weekly Columnist? Worrall Newspapers Member of Corporation Law Revision Commission on Corporate Name Selection Member Transition Team Governor-elect James Florio Very truly yours ?w Frank G. Capece One original two copies SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND WRITE: 3. Description of ability to provide the services in a timely fashion (including staf?ng, familiarity and location of key staff): My of?ce is located within 5 minutes Of Roselle Park. My experience in labor law and arguing hefnre all levels: Of the ("hurt qutem in New Iereey and the Of?ce of Adminiqtmtive Law permit me in meet the neede m" the Borough Page 10 of 26 SUBMISSION FORM I 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: $135.00 per hour. My ?rm has never charged small municipalities such as Roselle Park for expenses not related to attorney services. CERTIFICATION OF PROPOSAL (Sign Below) Firm: 6E 170 Date: . Authorized Representative (Print): it,? 364% Ca may: Signature: I Title: ?a (?lm Telephone No.: 5/0 3'33 ?177}! Fax No.: 70 3 133?? Page 11 of 26 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (P.L. 1977, 0.33, as amended by PL. 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 0R PROPOSAL. Name of Organization: Organization Address: Part 1 Check the box that represents the type of business organization: Sole Proprietorship (skip Parts 11 and execute certi?cation in Part IV) UNon-Pro?t Corporation (skip Parts II and execute certi?cation in Part IV) For-Pro?t Corporation (any type) Limited Liability Company (LLC) Partnership Limited Partnership Limited Liability Partnership (LLP) Other (be speci?c): Part ?1 The list 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 liability 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 26/1 {lg/VI "Yr (VA ?37a (gasp is, 2w ?rm-s can. Part DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II It' a bidder has a direct or indirect parent entity which is publicly 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 filing(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?cial interest in the publicly traded parent entity, along with the relevant page numbers of the ?ling(s) that contain the information on each such person. Attach additional sheets if more space is needed. Website containin the last annual SEC or to uivalent Pa 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/0r 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/Pa?ner/Member and Home Address (for Individuals) or Business Address Corresponding Entity Listed in Part II 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. I acknowledge: 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 Roseiie 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 certi?cation void and unenforceable. Full Name (Print): Frank G. Capece Title: Partner Signature: Date: 1 1-14-18 Page 14 of26 BOROUGH OF ROSELLE PARK AFFIDAVIT State of =?uv fin?, County of (.1er 55: 79? 24/2 Phi/1? glint-Qt? ?316%; UNI in the County of 64/ and State of full age, being duly sworn according to law on my oath depose and say that: 1am fact fy?wr? ofthe ?rm of 47 (??ecz (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 full knowledge 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 rr u? 4/ 7? a (name of contractor). Subscribed and sworn to before me this day of X. Signature {4/146 (101 09? 6.4 (Type or print name of af?ant under signature) Notary pl?JC/Of My Commission expires woman 8 meals, ?Eras WW Vii Jars-y at swig my BOROUGH OF ROSELLE PARK AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:53] 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 comply with the requirements of NJ .S.A. 1015-31 and N.J.A.C. 17:27~1 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. 17:27-4. . 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 certi?es that he/she is aware of the commitment to comply with the requirements of N.J.S.A. 10:5-31 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 10:5-31 and N.J.A.C. 17:27-1 et seq. COMPANY: Garrubbo &,Capecg, P.C, SIGNATURE: PRINT AME: Frank G. ngce TITLE: Partner DATE: 11-14-18 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 Of?cer 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 quali?ed 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 officer, 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. 10:5-3l 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 ofjob-related 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 agriis toyfeview all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such /71 are taken If Page 17 of 26 a' a we 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 (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 Af?rmative Action Plan Approval Certi?cate of Employee Information Report Employee Information Report Form AA302 (electronically 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 shall 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. .r Page 18 of 26 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 ll of the Americans with Disabilities Act of 1990 (the "Act") (42 U.S. C. $121 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, bene?t, 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 indemni?cation 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: Garrubbo 8: Capece. P.C. Signature: a Full Name (Print): Frank G. Capece Title: Partner Date 1144-18 Page 19 of26 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 perj ury, 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. PLE 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 af?liates is listed on the NJ. 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 l3 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 affiliates, 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: xii/Z?Al/C Ca :96 c0. Relationship to Bidder/Vendor: loot A Description of Activities: d; um (Tea Duration of Engagement: ??cr Anticipated Cessation Date: /fi Bidder/Vendor: A rmb?? Contact Name: F/l His/xi Cayuga Contact Phone Number: {0 9? :13 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 beIOereferenced 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): Frank G. Capece. Signature: Title: Partner Date 11?144 8 Bidder/Vendor: 63??be 8? capece: P.0- Page 21 of 26 BOROUGH OF ROSELLE PARK INSURANCE RE UIREMENTS 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: SIGNATURE: M4 215:? DATE: 11-144 8 Frank G. Capece- Partner (Printed Name Title) Page 22 of 26 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE OF NEW JERSEY COUNTY OF Comet-11a 0f the of I 4L I violoo 34- in the County of Czle and the State of New Jersey, of full age, being duly sworn SS. according to law on my oath depose and say that: I am the [pa 1'9le of the ?rm of Climb!? a ?m 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) dollars 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 of?ceholders, within one (1) calendar year immediately preceding the date of the contract or agreement. 1 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 child 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 percent or more of the equity in the corporation or business trust, partners, and of?cers 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. Subsc i ed and sworn to before mag, . dayof (Sigmof Professional) Name: f/Z?w/C CAVE Ce (Signatur of ary) (Af?x Title: {we 2 5 9:33;! 4:13.511 . .zi-w ?59 43:31: ?533} :u .'133- {?55 m9- 3311:1311: - . 55 . 1 $.21 55:51.3.) 3533:5?5?, ?5 51-5.. 5"?5 35' ?55.,5Id? -- :12? MI: '5 5193i}: 555* 5 5 5 I . 55933:? 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II . 41.91 ?t 5 1? - 5 .r?h?PI'ls? 5 c??'g??gngm . firl-L?k?gj 5., 515 g: 5:52;" 1,5 5. .l-s ?vgvm?f 5,5551!: ?39:5- {gaff $515? 5151*552195: .5 ?15555555551553? .. 45' 5:2: 55? $33512?? Adam: 8%?4?5 2? .595, min-$1. $595131:- 5551:3255: m? 7 get: my JPAI ?99 . '3 ?I?Ihli w. "f5 NJ. Department of Treasury Division ofRevelme, Oll-Line Inquiry Page 1 of 1 STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Taxpayer Name: GARRUBBO CAPECEI P.C. Trade Name: Address: 2204 MORRIS AVE UNION, NJ 07083 Certi?cate Number: 0074839 Effective Data. July 09, 2002 Date of Issuance: June 18! 2018 Fur Of?ce Use Only: 20180618163510933 .state.nj .usf - 6/ 1 8/201 8 am ?1?9 Request for Taxpayer Give Font-tome . be 2m . - requostor. Do not Identi?cation Number and Cortlfication seam ma m??omwsanla 1 Homo {as shown on yourmoomo mum}. Homo Iszoquirod on this line: do no! lam u?o 11m: blank. 2 un?t?; ?mummy-om {tom ohm Gambian 8: ac. a Ghodcoppropdotohox Iortodemunxolml?n?m mookomyono who I 4 op lo- 5 Origami: {flog?olorot ocupomlm Bacmmum Grumman a no umam g3 d; now-mam o-mo comma mo om: ?m A ?9 3 osngioomombuogmr. 9? pm a of economy} ?35 PD and aphorsuuo no.) Raquemmnanto and axiom: {optima} 2204 Morris Avenue, Suite 304 8 (my. two. code 0 5! Union, Now Jersey 07033 ?Mwoount numbodo} I1 oro (??own mu Taxpayer Idonti?oa?on Number - Eateryonr'l?m In tho appropnoio box. Thom! provided must much the name given on lino 1 to avoid So?alsucn?w number nadmp withholding. this Is genemily your social number (SEN). However. for mammalian. solo pmpdolor. or dlaroaardedenil .seotho Pan! Inshuouons on pages. Fortune: .. .. animus. It In your employer loonu?couon numbori If you do not how: oumborpage 5. or Hate. It lho mom than ono ma mountimstorlino 1 ondaho ohorton pago4 for . I: e. guldo?nosonwhosonum orlo [mm Certi?cation Undorptmaitloo of potlum I verify thou . 1. Tho number shown on this {mm Io my correct taxpayer I?onu?oouon numhnf (or! am walling fora. nu mbor to be issued In mo}: and 2. I om not outlook Io badwp barman: In} I am exempt {tom ortb) have not been nomad by Ihe Internal! Hovonuo Service (In Ihatl um wblect Io hookup wilhholdino use momtotofn?uw Io moon all mwrootor divldonds, or mum hos manned me than am no Iona-or su Ioul to backup and a. I am a v.3. citizen or other v.9. poison (de?ned below): and 4.1110 FATOA coasts] waxed on Ihls form (it any) Inolcothg that I om amp! 1mm MTGA to contact, common Inszrumlono?ou mustoross out item 2 above It you have? boonnolmod by tho IRS that carton?? subject to backup wilhholding becausoyou have failed to toponuu memo: and dividends on your onrelum. Formal coma Uanml ans. Ham 2 doos not apply. var mortgage Inwaat paJd. acquismon or abandonment o! sworn :1 property. common ordobt. canidhullons to an Individual rolls-mom arrangement [inn]. and generally. payments olhor U1 arm and dividends. you are requlmd to 31911 the comnoollon. but you must proviso your correct TIN. Seo lho Instructional mp 03. (W on,? 5 9? Signature of Here 8.8. Dotson Genaral a 1 non (homo mama Imorool}. 1098-2 (swoon: loan Inlnrosl}, Iona-1? II 0 Section talcum to tho Internal ?avonuo Coon woos nolod. . Form 1999.0 {macaw dcbI} Mm: dwolo menu. Infomlfo'n about dwelt: om moan Form w-s such - as arm on Mono It) Is atmv??mgov?wmm Form 1035M Incubation orobandormonl oI uncured property] Uso Fem on 590:: are a 11.3. pol-son {ndudmg a minim! who}. to Purpose of Form mo?doywroonocl i Inch-Ionarequired Io an Iolonnui' Irwudo no: Jerum Fom I0 919 moumorm'm a 7m you might ho subject Mum w?h m. msvgu?; obwn'gr??wngl wpoyorldontl?ullon numhor?'?} WP w?hhowing. 3m: What is bodwp mlhhofdhg? of! page 2. wringing} a? 1m $35391: By signing um Mod-nu! Ion-n, you: . a crow . . Idoo??oo?on mow (Elm. {gem-1 on on hformoilob ronn tho w??f?om to ?Esmw? the comet ow mm? 1: number you. or roporwblo . mum: homo. buwo Io. tho 1015mm: 2 . Om?rhal not abbot to backup mmdmo. or Form nomad our paid} 192%: wumggo??romwm??odgnh?dli?g It you no :59. mam 9mg? It i . . soon no a on .poroon oshuo Fum?lus? mm [mm mm urn-mun lands} mm Mm hum 03. um ?mums suhfudtotho fem woo-momma mm o! locum. p?ml. awards. atom: proceeds! 6511qu on [oroIQn pmmro? show a! aifco?volycormodod mom, and . Form 1039-3 (otockormuwa! fund on!? and 11th olhor annotation?? 4. con?rms: own: onlorod an no: form on [union cm on) balm} amp: tram mu FATDA moon on. I: oorrool. 8w ?53:17:91 Ego?ogogn - m1naosmmoosds?om tool motonmsoalons} 9'9? MW Pom moo-mmurcmm cm and {turd pony nah-mm uunsowom] cm. [19.1me Form (aw. 1mm) 'Garrubbo 8L: Capece, ATTORNEYS AT LAW l, JOSEPH L. FRANK G. CAPECE LAURIE M. LISA DELLA PELLE Andrew J. Casals Borough Clerk Borough of Roselle Park 110 East West?eld Avenue, Roselle Park, NJ 07204 RE: 2204 monms AVENUE SUITE 304 UNION, NEW JERSEY 07083 (seams-5575 FAX {90332334994 attys@grrlawvers.com I CERTIFIED BY THE SUPREME COURT OF NEW JERSEY A8 A CIVIL TRIAL ATTORNEY ALSO MEMBER OF FL BAH November 16, 2018 Proposal for Labor Counsel Garrubbo Capece P.C. Enclosed please ?nd original and two copies proposal for Roselle Park Labor Counsel. Enclosure Very truly yours, (my/"f lgrank G. Esq. BOROUGH OF ROSELLE PARK Name ofVendor: 4* ?Vb ?30 6/9 Peter? Signature: X. Ma'? Print Name: SUBMISSION CHECKLIST THE FOLLOWING ITEMS, AS INDICATED BELOW I, SHALL BE PROVIDED Initial WITH THE RECEIPT OF SEALED SUBMISSIONS Here Completed RFP Checklist ?Ks. Completed Submission Form Quali?cation Statement 1 - Statement of Ownership Disclosure Non-Collusion Af?davit I (?35:7 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 W-9 of Vendor Date: This checklist is provided for vendor?s use in assoring 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. 0;?an Title: ?04 {ng Page 7 of 26 BOROUGH OF ROSELLE PARK SUBMISSION FORM UALIFICATION 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: See Attachment A Page 8 of 26 SUBMISSION UALIFICATI 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: See Attachment A Page 9 of 26 ATTACHMENT A Summary of Quali?cations and Statement Municipal Counsel Berkeley Heights 1987, 1989 Clark Township 1992 - 1994 Win?eld Township 1985 2014 Perth Amboy 2003 2008 Plain?eld Housing Authority 2005 2006 Union County Personnel Counsel 1989 2011 Roselle Park Board of Education 1997 Roselle Park Labor Counsel? 2016 Kenilworth Labor Counsel 2018- Present Hillside Labor Counsel- 2018? Present Special Counsel Secaucus City of Plain?eld Union City Township of Edison Township of Hillside Elizabeth Board of Education 2008-2016 BA New York University JD Delaware Law School Experience: Counsel to New Jersey Secretary of State Partner Waters, McPherson, McNeil Partner Garrubbo Capece P.C. Member Supreme Court Committee on Professional Corporations Member Corporation Law Revision Commission Member Hackensack Meadowlands Cultural Commission Member Union County Fee Arbitration Committee Reported Cases: Union County Democratic Committee v. lorio Corvelli v. Fonesca 323 NJ Super 342 1977 1982 1982 2002 2002 Present 1981 1978 1982 1981 2006 2011 Corzine V. 2005 Defense Base Closure and Realignment Commission, A Commission of the United States of America Created by an Act of Congress, et als (Represented U.S. Senator Jon. Corzine Case argued through 3rd Circuit Court of Appeals and Appeal US Supreme Court Todaro v. County of Union, 392 NJ Super 448 (App. Div. 2007). Supreme Court Committee on Professional Corporations State Bar Law Section Member Committee for U. S. Senator Frank Lautenberg on Military Academy Appointments. Recent Lectures - NJ Municipal Association of Municipal Clerks on Administrative Law - Rutgers University School of Journalism. Lecture on ABC Law and Enforcement- Rutgers University, Union County Municipal Clerks Association regarding ABC Enforcement Clerks Perspective. Author NJ Law Journal on Corporate Name Selection and Legislative Apportionment Weekly Columnist? Worrall Newspapers Member of Corporation Law Revision Commission on Corporate Name Selection Member Transition Team Governor-elect James Florio Very truly your Frank G. Capece One original two copies SUBMISSION FQRM I UALIFICATION 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): My of?ce is located within 5 minutes of Roselle Park. My experience in labor law and arguing 15 .111 irlat? . me in meet the needs of the Rnrnugh Page 10 of26 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 all expenses for any work that is not included in the primary duties: $135.00 per hour. My ?rm has never charged small municipalities such as Roselle Park for expenses not related to attorney services. CERTIFICATION OF PROPOSAL (Sign Below) Firm: 5:1? vb/ao 6/9538 Date: Authorized Representative (Print): FA 154% C24 may; Signature: I Title: fa Telephone No.: 40 333 Fax No.: ?70 '3 23"" (7/47? Page 11 of 26 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (EL. 1977, c.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: Organization Address: Part I Check the box that represents the type of business organization: Sole Proprietorship (skip Parts II and execute certi?cation in Part IV) DNon?Pro?t Corporation (skip Parts II and execute certi?cation in Part IV) For~Pro?t Corporation (any type) Limited Liability Company (LLC) Partnership Limited Partnership Limited Liability Partnership (LLP) Other (be speci?c): Part ?1 The list 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 liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART N) 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 Fa em (ems ?7 Mega 47? saga. 4,,?an 2w were A awe-?7" Part - DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS 0R LLC MEMBERS LISTED IN PART II If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater bene?cial interest in'the publicly traded parent entity as of the last annual federai 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?cial interest in the publicly traded parent entity, along with the relevant page numbers of the ?iing(s) that contain the information on each such person. Attach additional sheets if more space is needed. Website conta the last annual SEC or fo uivalent filin 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 3 member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25?242 has been listed. Attach additional sheets if more space is needed. StockholderlPartner/Member and Home Address (for Individuals) or Business Address Corresponding Entity Listed in Part II Page 13 of 26 STATEMENT OF OWNERSHIP DISCL SURE (Continued) Part IV Certi?cation I, being duly sworn upon my oath, herebylrepresent thatthe foregoing information and any attachments thereto . to the best of my knowledge are true and complete. I acknowledge: 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 a 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 criminal 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 certi?cation void and unenforceable. Full Name (Print): Frank G. Capece . Title: Partner Signature: Date: 11-14-18 Page 14 of 26 BOROUGH OF ROSELLE PARK NON-COLLUSION AFFIDAVIT State of w?w/ County of (/an 7e? g, agge oftheM 0A4. in the County of 0 NI 7/ and State of full age, being duly sworn according to law on my oath depose and say thatV'?i 4V0 67/6/4363 (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 affidavit are true and correct, and made with full knowledge 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 tide established commercial or selling agencies maintained by 5; rr v6 69619.5 (name of contractor). Subscribed and sworn to before me this Army of X. Signature 0a {04? at (Type or print name of af?ant under signature) Notary magic/of My Commission expires l/vQU ?4?94 8/ r26 935 WW Jamil Mr gi'I/ii': 1410/ BOROUGH OF ROSELLE PARK AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5?31 and N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS This form is a summary of the success?il bidder?s requirement to comply with the requirements of N.J.S.A. 10:5 ~31 and N.J.A.C. 17:27?1 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 0) 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. 17:27-4. - - The successful vendor may obtain the Af?rmative Action Employee Information Report (AA3 02) 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 certi?es that he/she is aware of the commitment to comply with the requirements of NJ .S.A. 10:5-31 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 10:5-31 and N.J.A.C. 17 :27-1 et seq. COMPANY: Garrubbo SIGNATURE: PRINT NAME: Frank apece TITLE: Partner DATE: 11-14-18 Page 16 of 26 BOROUGH OF ROSELLE PARK EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (EL. 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 affections! 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 quali?ed 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-related 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 a to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all su are taken Page 17 of 26 EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (EL. 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 Af?rmative Action Plan Approval Certi?cate of Employee information Report Employee Information Report Form AA302 (electronically 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 shall furnish such information as may be requested by the Division of i?urchase 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 of 26 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 (1.5. C. 8121 01 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, bene?t, 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 indemni?cation 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: Garrubbo 8t Qapece. P.C. Signature: Full Name (Print): Frank G. Capece Title: Partner Date 11?1443 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 perj ury, 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. PLE 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 af?liates is listed on the NJ. 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 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 THOROUGI-I ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, USE ADDITIONAL PAGES). Name: Ca ?96.61 Relationship to BidderNendor: Pa ('19th A Description of Activities: (lo 4; 64.. (7f) W1 Duration of Engagement: 'YZ?or Anticipated Cessation Date: f2. BidderNendor: ?x cam/?16m Contact Name: z! gr; Contact Phone Number: {9 17?? 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?cation, and ifI do so, I recognize 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 deciare any contract(s) resulting from this certi?cation void and unenforceable. FullName (Print): Frank G- 039398, Esq Signature: 0/ Title: Partner Date 11?14-18 Bidder/Vendor: Garrubbo Capece, P.C. Page 21 of 26 BOROUGH OF ROSELLE PARK INSURANCE RE UIREMENTS 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: SIGNATURE DATE: 11-14-1 8 Frank G. Capece- Partner (Printed Name Title) Page 22 of 26 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE or NEW JERSEY COUNTY OF I, (Liam of the of ?urvlolgg 1.- .C: ?ag. in the County of O?m/ and the State of New Jersey, of full age, being duly sworn SS. according to law on my oath depose and say that: 1 am the f?aram of the ?rm of (Siam/t, A. f. ?fm 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) dollars 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 of?ceholders, 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 child 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 percent or more of the equity in the corporation or business trust, partners, and of?cers 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. Subsc i ed and sworn to before map, 9 dayof ilk/t ,20_1i/ of Professional) (Signatur of ary) (Af?x Name: ?ew/C Title: ?04"fo l/ccui?: am deal @139? l/l/l/l?v/ c?L QIMH UL :5 er:- fa" . 'f5?5: . . g?g?l 5'11? . ?4 3' 1-4. Ls" sear-n .a?I $333 I . ?1 I. as." an.? We sag. 3?39?" Iggy tr; .Ejhlg?n?t a {Eat a 5.31? {Zhi' I- I ?"E'nfi I 'lv?I} 1M. ?a geesga Wag33.43am r. ,a?l a; -. 3' e' "1 1'23: 1e" .Tes?e'ess?fee?aa ahiasaeae: seaham? 213351.: ages. fs'mn 1. *u "is '55: $35.51*. {233914 Mi? v. W1 I?dvg?s?ggit?g. 1" main-q 333;? 132's! a? H.330: 59.5 243 {ft 51?3? Ell-O Eh 1??an 1 I n. ng?x?? 355.?- . . .. . . .. . . .. swam 32:1?; If?" "?iik?k-?sb . 05.12. v. 4 .r .53. . 3e, ?3.35 ?43. aga?aI??saaf is 1* a?uk?t, If)" 0111111433 2? K2 1 n- - 0 3n?? . a. 1?4: 342?: 3&0; a . . ?g?ifc? lo}! 1' 35:15:" sad gig? ring 911.1:- s- .- .t-a n? :33 .9 503?whiten; i bra-z. a 7? f' -. i?gg? 1' . 1-1? 3 . a s-Ma e. 55.014331 1 Effie?" {3a u?sv?seg?sae - . "win: - . 431:3: . 33m .9. . ?{Eig q. . 30?35i? "3124i: 921% deg; 5??9h.12. av.- a ?e iton? Re"? ?k I: . 71!: nuii?g my: K. . AIfgf?News; ., 1 .335: :a ??15 "z . 6- . LI "v70?. . if: . aa . It; "1?5 was sas. as egg?? a; gig . ??15331"? meg wit-?32 . . .. $191515. 'gk 5% . v. '??ikti- J3 we" ?I?lk ?fj? Stirgh-qu?i m; v.51: "Ii ?$3314? 1"?34 IV I: My?: ?4 u?nJ" hlfutfgawe? 1.1 ?h?gb I: @533? . 91%" ?V?I?fgii P. .f?lldiv?! f; ??tf?ftvh?. t?k? NJ. Department of Treasury -. Division of-Revenue,uOn-Line Inquiry Page i of STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Taxpayer Name: GARRUBBO CAPECE, RC. Trade Name: Address: I 2204 MORRIS AVE UNION, NJ 07033 Certificate Number: 007483 Effective iJatcz. 2002 Date of issuance: June 13,2018 For Of?ce Use Only: 20180618i63510938 - 8/201 8 Request for Taxpayer ?mm some . I - wall r. onu! Identi?cation Number and Gertr?oa?on mm .53 Mrnulnmuuwba . 1 trump: shown" on your Imam: tax roluijumn [smut-".113 11m Hunk- 2 3mm awardisrugardsd 11?!!th tram alum Gambian 8: Damon. ac. a box for mam! 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If I?a mount Is In more than one: mama. 111:: hakuullons tor line i and rha chart on page 4 for guidelines on whose number to emer. Socialsocurlwnunmr g. A. m" ?lumbar . 2.?n0036913 Part :1 Undarparraltlau or parlour. 1 vanity than 1. ?mn numhnr shown on this {mm in mymmazt taxpayenldorrti?muou marks: (or! am waiting fora number to be issued to rm): and 2. I am notsuh eot Io bacsmp wmrhowtng humus?: 1 Mb) I have not been normed by lheInlema! Hammer Sender: {In that I am sUbJem to Map wilhhol no Ionnur jam to backup withhurdiny: and o. I am a 11.3. amazon or other us. (de?ant: below}: and as a ?3th of afn?um to [upon an Interest crdeonds. or the ma has unlined me ?rst I am 4.1m FATGA code(3) cataract 9n this term (it any) Indicating that I am mum: from FATOA reporting I: correct. Instructionan'ou macros: outltam 2 above It you havs bean nolmud by 1110le that we wmliysuhjaot to backup wuhhaidhrg Because you have failed to report nil Interest and dividends on you: lax return. 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Purpose Form Minahrlduax oran?lr (Farm We mum?rcr) who Is re War! to {in an lures-ma?a? return with I ms must obtain r?13m on??ution nun-burg? kl; 311m pro?doywrcorroct men do not :3 va?f which may ?0:1;de WW ndivldual lupawrfd ?who! a an we multicadonnumber ?employer rami?cation rumba! {?th tamper: an an mo mural mid In you. grail-mammal report-um on an Exampluat warmth? mum Memo. but 3:6 notllnilod to; tho - Farm 1w3vmrt?almu me}! or paid} - Fem: Ind-radars than from storm ornmun lunch} gm prizes. awards, orgroawmuds) Fem: 1039-3 (stock err-mutual runs an!? and curtain brake?!) Hemp! tram Urn FA - Pom mas-s m! a pom 1osa-Ktmurclumcard am! third party named: uunrann?? apart an. . Farm deb!) Faun 1039-5. {acquls?rdon arahandmm n! at ?cured property} Usu Form an a U3. person maudlng a mldonl ultra}. to . uremia: 71 Mb Inbackupsw'lhh ?u for: ?y winning U16 mica-out {tumJ you: tho'?? you are gMno I: comet {of wt: an wailing for a drum: yau misubiacl. In bicku? or a. backup withholding mm swim up plume. maul also ?Wu that as a US. much. so 0! .. mm or business I: no! snhfucl to the mamwwipfm mo from a ding!? on (mun pm Mers? Shara a! a1 {may commend In: um, and 4. 013! M'l??wot ontorod unit-rarer": {an mum om unto no.1: current. can w?m?gam main?? car. Henmrx rm (Row, 1mm) ?Garrubb?o 85 Capece, ATTORNEYS AT LAW JOSEPH L. FRANK o. CAPECE LAURIE M. ESTEVES LISA DELLA PELLE Andrew J. Casals Borough Clerk Borough of Roselle Park 110 East West?eld Avenue, Roselle Park, NJ 07204 RE: 2204 Home AVENUE suns 304 UNION. new JERSEY 07033 {98312335576 FAX (903)233-4994 attys?grrlawyers.com CERTIFIED BY THE SUPREME COURT OF NEW JERSEY AS A CIVIL TRIAL RTTOFINEY ALSO MEMBER OF FL BAR November 16, 2018 Proposal for Labor Counsel Garrubbo Capece P.C. Enclosed please ?nd original and two copies proposal for Roselle Park Labor Counsel. Enclosure Very truly yours, If. Erank G. Capece, Esq. BOROUGH OF ROSELLE PARK SUBMISSION CHECKLIST THE FOLLOWING ITEMS, AS INDICATED BELOW I, SHALL BE PROVIDED WITH THE RECEIPT OF SEALED SUBMISSIONS Initial Completed RFP Checklist Completed Submission Form Quali?cation Statement Statement of Ownership Disclosure Non-Collusion Af?davit Required EEO/Af?rmative Action Evidence Signed Compliance Notice I 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 v: fl I ll 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. Name of Vendor: a [0 b0 1? 6/9 roe-'59 Date: Signature: X. w" Print Title: Name: (:2?ch ?at {ng Page 7 of 26 BOROUGH OF ROSELLE PARK SUBMISSION FORM I 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: See Attachment A 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: See Attachment A Page 9 of 26 ATTACHMENT A Summary of Quali?cations and Statement Municipal Counsel Berkeley Heights 1987, 1989 Clark Township 1992 1994 Win?eld Township 1985 2014 Perth Amboy 2003 2008 Plain?eld Housing Authority 2005 2006 Union County Personnel Counsel 1989 2011 Roselle Park Board of Education 1997 Roselle Park Labor Counsel- 2016 Kenilworth Labor Counsel 2018- Present Hillside Labor Counsel- 2018? Present Special Counsel Secaucus City of Plain?eld Union City Township of Edison Township of Hillside Elizabeth Board of Education 2008-2016 BA New York University JD Delaware Law School Experience: Counsel to New Jersey Secretary of State Partner Waters, McPherson, McNeil Partner Garrubbo Capece P.C. Member Supreme Court Committee on Professional Corporations Member Corporation Law Revision Commission Member - Hackensack Meadowlands Cultural Commission Member Union County Fee Arbitration Committee Reported Cases: Union County Democratic Committee V. Florio Corvelli v. Fonesca 323 NJ Super 342 1977 1982 1982 2002 2002 Present 1981 1978 1982 1981 2006 - 2011 Corzine V. 2005 Defense Base Closure and Realignment Commission, A Commission of the United States of America Created by an Act of Congress, et als (Represented US. Senator Jon. Corzine Case argued through 3rd Circuit Court of Appeals and Appeal US Supreme Court Todaro v. County of Union, 392 NJ Super 448 (App. Div. 2007). Supreme Court Committee on Professional Corporations State Bar Law Section Member Committee for U. S. Senator Frank Lautenberg on Military Academy Appointments. Recent Lectures NJ Municipal Association of Municipal Clerks on Administrative Law Rutgers University School of Journalism. Lecture on ABC Law and Enforcement- Rutgers University, Union County Municipal Clerks Association regarding ABC Enforcement Clerks Perspective. Author NJ Law Journal on Corporate Name Selection and Legislative Apportionment Weekly Columnist? Worrall Newspapers Member of Corporation Law Revision Commission on Corporate Name Selection Member Transition Team Governor-elect James Florio Very truly your Frank G. Capece One original two copies 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): My of?ce is located within 5 minutes of Roselle Park. My experience in labor law and arguing meet the needs of the Page 10 of 26 SUBMISSION FORM I 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: $135.00 per hour. Mv ?rm has never charged small municipalities such as Roselle Park for expenses not related to attorney services. (Sign Below) Firm: C?ec? Date: . Authorized Representative (Print): F4 (2 {43:04: Signature: I Title: ?061 Teiephone No.: ?70 9533 Fax N0.: 703 133'? Page 11 of 26 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (EL. 1977, c.33, as amended by PL. 2016, 0.43) 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: Organization Address: Part I Check the box that represents the type of business organization: a Sole Proprietorship (skip Parts 11 and execute certi?cation in Part IV) nNon-Pro?t Corporation (skip Parts 11 and execute certi?cation in Part IV) For?Pro?t Corporation (any type) Limited Liability Company (LLC) Partnership Limited Partnership Limited Liability Partnership (LLP) nOther (be speci?c): Part The list beiow contains the names and addresses of ali 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 Pm me (algae; (kW/rd? 543%,; dust, 2sz were: ?wk 0mm. 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 publicly 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?cial interest in the publicly traded parent entity, along with the relevant page numbers of the ?ling(s) that contain the information On each such person. Attach additional sheets if more space is needed. Website containin the last annual SEC or fo alent 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 II 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 Page 13 of 26 STATEMENT OF OWNERSHIP (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. I acknowledge: 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 5 of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false 5 statement or misrepresentation in this certi?cationsubject to criminal 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 certi?cation void and unenforceable. Full Name (Print): Frank G. Capece . Title: Partner Signature: Date: 11?14-48 . Page 14 of 26 BOROUGH OF ROSELLE PARK NON-COLLUSION AFFIDAVIT State of ?'Jr/v County of fr? 1, C'a?aw Ofihe??ati? am/ in the County of and State of full age, being duly sworn according to law on my oath depose and say that: I am fact/Wr- of the ?rm of govt/?1649 6,9,43er (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 full knowledge 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 soiicit 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 rr v6; 1? Catt/2e (name of contractor). Subscribed and sworn to before me this ?day of Masai/ml? ?4?le x. Signature 97406 0a roe 6-: (Type or print name of af?ant under signature) Notary pL?lJc/Of My Commission expires Ur, a ?6:96 Java] Vii/??121 gin/ii: r/ 1410/ BOROUGH OF ROSELLE PARK AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5-31 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 comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. i7 :27~1 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 ietter 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. 17:21-41; OR o) A photocopy of an Empioyee 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. 17:27-4. The successful vendor may obtain the Af?rmative Action Employee Information Report (AA3 02) from the contracting unit during normal business hours. The successful vendor(s) must submit the copies of the AASOZ 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 of 10:5-31 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. 105-31 and N.J.A.C. 17:27?1 et seq. COMPANY: Garrubbo gm, P.C. SIGNATURE: PRINT NAME: Frank G- apece TITLE: Part? er DATE: 1144?18 Page 16 of 26 BOROUGH OF ROSELLE PARK mantra MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (EL. 1975, C. 127) 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 quali?ed 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 officer, 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.I.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-related 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 a to eview all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all su are taken Page 17 of 26 - MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5?31 et seq. (BL. 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 Af?rmative Action Plan Approval Certi?cate of Employee Information Report Employee Information Report Form AA302 (electronically 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 shall 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 of 26 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 ll of the Americans with Disabilities Act of 1990 (the "Act") (42 (1.8. C. 8'12] 01 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, bene?t, 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 ail 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 indemni?cation 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: Garrubbo Qapece, P.C. Signature: Full Name (Print): Frank G. Capece Title: Partner Date 11?14-18 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. PLE CHECK EITHER BOX: I certify, pursuant to Public Law 2012, c. 25, that neither the person/entity listed above not any of the entity?s parents, subsidiaries, or af?liates is listed on the NJ. Department of the Treasury?s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 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 CI 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: ?aw/C Ch ago-L Relationship to Bidder/Vendor: Pa 19A A Description of Activities: 4; Duration of Engagement: f?or Anticipated Cessation Date: 1' [i BidderNendor: ?x wb?vr Contact Name: F/l Contact Phone Number: 2'0 131?" 217??) 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. FullName (Print): Frank G- Cap?aes EN Signature: . Title: Partner Date 11?14'18 Bidder/Vendor: Garrubbo 8? Capece, P.C. Page 21 of 26 BOROUGH OF ROSELLE PARK INSURANCE RE UIREMENTS 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: SIGNATURE: DATE: 11-14-18 Frank G. Capece- Partner (Printed Name Title) Page 22 of 26 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE on NEW JERSEY SS. COUNTY OF I, Colt/0622 . of the 5! of 4:er vlobo if, in the County of 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 Far'JzU?x of the ?rm of (Lamb as gar/m ,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 ($200.00) dollars to a carnpaign committee of any Borough of Roselle Park candidate or holder of the public office having ultimate responsibility for the award of the contract, or to any Borough of Roselle Park or Union County Party Committee, or to any political action committee (PAC) that is organized for the primary purpose of promoting or supporting Borough of Roselle Park municipal candidates or municipal of?ceholders, within one (1) calendar year immediately preceding the date of the contract or agreement. I further warrant that pursuant to Roselle Park Borough Section 2-4, a ?professional service provider? seeking a public contract means: an individuai, including the individuai?s spouse, if any, and any child living at home; person; ?rm; corporation; professional corporation; partnership; organization; or association. The de?nition of a service provider includes all principals who own one percent or more of the equity in the corporation or business trust, partners, and of?cers in the aggregate employed by the provider as well as any subsidiaries directly controlled by the service provider. 1 further warrant that I have reviewed Borough Code Section 2-4. I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing I statements made by me are willfully false, I am subject to punishment for contempt of Court. Subsc' 1 ed and sworn to before 1115., day of ad?" ,20 (Signa?fre?of Professional) (Signatur of ry) (Af?x Name: Title: Petr fiver Eb? c. . 1? .4 ?2 5.2.2.4"3322 g3?, .In?f .1: av. .Ma I .1 d?w? ?315: ax gt ..- ?50 32 {3&1 Wz?g?; ?Wt! 23%? i' 15% If i 2524:2325? Ff??h ?ii??m?zrg?iw: .2522. ., a . :3 2?22? i121 2W 2 1 . (Dd. 2&1 ,I?gm "222-55.. ?3222;; :3 132? - 3* 222.223.215?22, ?95123: I 1} #1:!wfi? ?"33 ii?: ?35: 22 299"?? .- :q - 22223? .33? . ?2223?"; 222%.; "3.2.22: 134mg! mg ?2 *2 .2. "I'm .222. .222 32.51?! 3&3? 92133? Egg gnaw W. 1% 5 {if-11$: 9316?: ?I'le I, r' . - ?33.53. IIMSEP ?91: 2?22 - ?aw-IL; i .m??itm:d'uh'm' .1: i - 2-: 5 .2531 22222222223222?? "15% 2. . n. ?2 I: tea: - 2.4%1? 5. ?Wm {3261' r; . - ru?a?'h .02. . 35?? Ea:- If 2311?. was?; If? 12-11. r. .352?; an? .5- Larisa" NJ. Department of Treasury - Division of Revenue, On~Line Inquiry Page 1 of STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Taxpayer Name: GARRUBBO CAPECE, RC. Trade Name: . Address: 2204 MORRIS AV UNION, NJ 07033 Certificate Number: 0074839 I . Effective Data. 09, 2002 Date nf Issuance: June 18, 2018 Ft: 1' Of?ce Use Only: 20180618163510938 RC/servlel/conmmn/BRCLogin 6/18/2018 WHB Request for Taxpayer $3332? 3333: Identi?cation Number and mu 10111.9 ins. tnumwmumnh 1 Name (as yourtmm tax mtumj. lama tsmutrnd on this do not [om mm blank. 2 mmansnm?mudw antitrust-M. "dim-mm {tam 6 Adam: Mmhur. smut. and apt. or autto no} 2204 Morris Avenue, Suite 884 Requester?: namoondadduu [69w 001:9. mun too at Union. New Jamey 01083 Garwbbua Gamma. PS. I 4? 3(ngle {W034i '1!qu 8 01551?me [Escarpuatlon ETrustfostato gm ?$033135? tam-"u a . i Exemptmeocodu 3 a from 1? Para 0 33m dth'cM?th ta 9 "9 P53 godp?u? n. ?3 cataract: hummus: PG 11kt account (??atten Taxpayerldanti?aa?on Number NI ante: 01::le In the bag. 132911? provtded must match the name given on to mold ham?! Formdivlduam. this tsgenamlly your social madly number Howavar. for a seatlm Fan! Insuunllans on pages. For othnr -- NJ. you do not have: a number. see How to get a resident alien, sate a: diarnnardedentt entities. It to your amptoyer Identi?catton number Wan page 3. Note. It that account Is In more than one: nnmo. non {ha truncations to: time '5 and the: chart on page 4 for guidelines on whose numbor to enter. . Sodalsucndw numhnr 01' lm nuptbar 2.Gen?tnatlnn or partunt I sanity that: 1. 1n a number shown on this team in mroorroct taxpayer numbm? {an am waiting fora number to ho Issued to ma}: and Sarina (IR thatt um sutalect to mate): no longer su Joel to backup withholding: and a. I am a 11.8. crotharus. person (da?nsd below]; and 2. I am natau?tfot lo 135de withholding because: Imexemptt?rom arm)! have not bnen noti?ed by thetntems Memo 9 n: a rostnt of a fa?uto to taper! ail ?tment or dividends. or In) tho IRS has nulli?ed me that! am 4.13:: FATGA counts] entered qr. form (It any) Indicating that I am tram FATGA reporting Is current. mustcross out Item 2 above It wt! ham heart notmad by tho IHS that we cummiysubjcot to backup because you have failed to report at] lntamt and deands on your tax retain. For mat estate transnc arts.jtem 3 than not appiy. For mortgage Intoraat paid. newsman or abandonment n! aewmd property. namemttlon contribution to an arrangement (t .nnd genera! . 9mm: other th Instrun am on page 3. amt and dividends, you un?t: required to alert tho cmtl?gntton, but ran must provide your curtain TIN. Sen tho an I. ?9 Here $353.31 auto:? Gang?! Instruct?n?r?t's Section ratatonm to the Internal ?mttuo Outta Mmommaso not?. Future dovnlapntontn. 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