Jalloh & Jalloh L L C
Attorneys at Law
21 West Blancke Street, 2"" Floor
Linden, NJ 07036
Phone: (908) 363-9899
Fax:
(908) 363-9899

Bernice Martina Jalloh
Member, NJ Bar
tiallohesq @ gmail.com

Mohamed S. Jalloh
Member, NJ Bar
miallohesq@gmail.com

Suzanna M . Polhamus
of Counsel, Member, NJ Bar
spolhamusesq@gmail.com

November 30,2018

Andrew J. Casais, RM, QPA,
Borough Clerk / Qualified Purchasing Agent
110 East Westfield Avenue
Roselle Park, NJ 07204
Re:

Roselle Park Request for Qualification
Labor Attorney
Qualification Statement

Dear Mr. Casais:
Please accept this correspondence and the enclosed curriculum vitae, on behalf of the partners of
the firm: Mohamed S. Jalloh, Esq., as our technical qualification of the position for Municipal Land Use
Board Attorney requested by the Borough of Roselle Park. The scope of our services include, but are
not limited to, preparation of pleadings, motions, and discovery documents, participating in all discovery
including attendance at all depositions, participation in and attendance at settlement conference, pre-trial
motions and trials.
Specifically, and as described in greater detail in the enclosed curriculum vitae, the Law Office of
Jalloh & Jalloh, LLC ("Firm") is a full service law firm, which is located at 21 West Blancke Street,
Linden, New Jersey 07036. The firm offers a full array of legal services in such diverse practice areas as
residential and commercial real estate, estate matters, matrimonial, personal injury litigation, civil
litigation, utility regulation, transactional analysis, contract law, municipal law. City representation,
government compliance, labor law, criminal law, non-profit and corporate laws.
Attorney Mohamed S. Jalloh, Esq., has been a licensed practicing attorney in New Jersey since
2004. His experience has been with litigation as well as transactional work, working for nonprofit
organizations, private law firms and public entities. Relevant to the immediate application, Mr. Jalloh has
represented the County of Union as assistant County Counsel in various aspects including but not limited
to: civil litigation and tort claim cases, employment and labor cases, disciplinary procedures, other labor
matters, and direct advice to various departments of the County. He has appeared at various planning
boards throughout the State of New Jersey and has been the attorney for the Municipal Land Use Board of
Roselle Park for the last two years.
In addition to the representation of public entities, Mr. Jalloh has also established an expertise in
full representation of not-for-profit entities, family law general litigation, municipal court matters,
drafting and reviewing contracts, commercial and residential real estate transactions, business formation

 and land use. In that regard, Mr. Jalloh was most recently recognized by the New Jersey Garden State
Bar Association Young Attorney of the Year.
While many firms have sought to specialize their practice areas to focus on certain narrow areas
of the law, our firm has chosen instead to offer broad, professional legal representation and advice in a
variety of legal areas. This breadth of experience allows the firm to maintain its commitment to
excellence through the firm's comprehensive analysis of all components of a particular client's problem.
With regard to experience defending municipalities the firm currently provides legal service for the
following: the City of Plainfield; the City of Union; City of Trenton, the Roselle Park Planning Board,
the Roselle Board of education; the City of Newark; and the City of Linden.
Based on the foregoing and enclosed, we believe our qualifications along with our specific
experience in the Litigation practice area make our firm ideal for the position. Neither my firm nor any
individual associated with my firm are disbarred, suspended or otherwise prohibited from professional
practice by any federal, state, or local agency. Jalloh & Jalloh, LLC has had no judgments, claims or suits
against the firm wherein the firm was adjudicated liable for professional malpractice within the last three
(3) years. The firm is not now nor has it in the last 10 years been involved in any bankruptcy or reorganization proceedings. My firm is in compliance with all applicable affirmative action (or similar)
requirements with respect to business activities. The firm agrees to provide full representation for the
board meetings, document review drafting resolutions, and review drafting of all documents in
preparation of the regular meetings for the flat rate of $8,000.00 for the year. In the event that there is
litigation or additional service required by the Board, the firm agrees to provide same at the rate of
$150.00 per hour.
Very truly yours.

MSJ:gei
Attachments -

Qualification Statement Checklist
Mandatory Equal Employment Opportunity Notice Acknowledgment
Non-Collusion Affidavit
Disclosure or Ownership Form
Business Registration Certificate
Disclosure Statement
Certification Regarding Contributions
Certificate of Employee Information Report
Resumes and References

Statement:

Affirmative Action Statement:

 Statement: Jalloh Jalloh, LLC is in compliance with all applicable affirmative action requirements with
respect to its business activities.

Statement: Submitter will comply with the General Terms and Conditions required by the Borough
of Roselle Park and enter into the Borough?s standard Professional Services Contract.

Statement: Submitter anytime in the past, been involved in any
bankruptcy or reorganization proceedings in the last ten years. Submitter has no judgments within the
last three years and has not been adjudicated liable for professional malpractice. Submitter has all

appropriate federal and state licenses to perform the activities described within the scope of the

services and elsewhere within this RFQ.

BOROUGH OF R O S E L L E PARK
SUBMISSION C H E C K L I S T
T H E F O L L O W I N G ITEMS, AS INDICATED BELOW SHALL BE PROVIDED
W I T H T H E R E C E I P T O F S E A L E D SUBMISSIONS

Initial
Here

Completed RFP Checklist
Completed Submission Fomi / Qualification Statement
Statement of Ownership Disclosure
Non-Collusion Affidavit
Required EEO/Affirmative Action Evidence & Signed Compliance Notice
Acknowledgement of Americans with Disabilities Act Language of 1990
Disclosure of Investment Activities in Iran
Insurance Requirement Acknowledgement Form
Certification Regarding Political Contributions
New Jersey Business Registration Certificate 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:

Jalloh & Jalloh, LLC

Signature:
Print Name: Mohamed S. Jalloh, Esq.

Title:

Member

Page 7 of26

Date:

November 27, 2018

 BOROUGH OF R O S E L L E PARK
SUBMISSION F O R M / O U A L I F I C A T I O N S T A T E M E N T
(ATTACH ADDITIONAL SHEETS AS NECESSARY,
BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS
AND TYPE/WRITE: "SEE ATTACHED")
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:

Mohamed S. Jalloh, Esq., will perform the services requested in the RFQ. Mr. J
performed as a Labor Attorney tor a years. He will attend meetings, draft docum
and perform all general legal services, Including litigation.

Education:

Mr Jalloh received his B.S in Rhetoric and Cornmunications from the University
in May 2 0 0 1 . He received his J.D. from Rutgrs University school of Law in Newa
May 2004. Please see the attached resumer for more details.

Page 8 of26

 SUBMISSION F O R M / O U A L I F I C A T I O N S T A T E M E N T
(CONTINUED)
(ATTACH ADDITIONAL SHEETS AS NECESSARY,
BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS
AND TYPE/WRITE: "SEE ATTACHED")
2. References and record of success of same or similar service:
Daniel Antonelli
1uuu btuyvesant Ave., Ouite
I Ininn, New Jersey 07083
(908) 623-367

Robert Barry
10 Elizabethtown Plaza
Elizabeth, New Jersey 07207
(908) 527-4250

David Minchello
Rainone Coughlin Minchello L i C
1 Woodbridge Center, Suite 515
Woodbridge Township, NJ 07095
732-709-4182

Page 9 of26

 SUBMISSION F O R M / O U A L I F I C A T I O N S T A T E M E N T
(CONTINUED)
(ATTACH ADDITIONAL SHEETS AS NECESSARY,
BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS
AND TYPE/WRITE: "SEE ATTACHED")
3. Description of ability to provide the services in a timely fashion (including staffing, familiarity and
location of key staff):

Jalloh & Jalloh, LLC has a mobile computer operating system and can operate fro
remote locations

Page 10 o f 26

 SUBMISSION F O R M / O U A L I F I C A T I O N S T A T E M E N T
(CONTINUED)
(ATTACH ADDITIONAL SHEETS AS NECESSARY,
BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS
AND TYPE/WRITE: "SEE ATTACHED")
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:

Jalloh & Jalloh agrees to provide full representation for the Board meetings, d
review, drafting resolutions and review drafting of all documents tor the tiat
$8,000.00. For litigation or additional services, we propose $150.00/hr.

C E R T I F I C A T I O N O F PROPOSAL
(Sign Below)
Firm: Ja'loh & Jalloh, LLC
Date: Nn\/Pmhpr ?Q 2018
Authorized Representative (Print): Mohamed S. Jalloh
Signature: _
Title: Membei
Telephone No.: (908) 363-9899
^
(908) 363-9899
Fax No.:
^
'

Page I I o f 26

 BOROUGH O F R O S E L L E PARK
STATEMENT O F OWNERSHIP DISCLOSURE
N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)
THIS STATEMENT SHALL B E C O M P L E T E D , C E R T I F I E D TO, AND INCLUDED WITH A L L
BID AND PROPOSAL SUBMISSIONS.
F A I L U R E TO SUBMIT T H E REQUIRED
INFORMATION IS CAUSE FOR AUTOMATIC R E J E C T I O N OF THE BID OR PROPOSAL.
Name of Organization: Jalloh & Jalloh, LLC
Organization Address:

^1 W. Blancke Street, Linden, NJ 07036

Parti
Check the box that represents the type of business organization:
Q

Sole Proprietorship (skip Parts I I and I I I , execute certification in Part IV)

^DNon-Profit Corporation (skip Parts I I and I I I , execute certification in Part IV)
For-Profit Corporation (any type)
^3 Limited Liability Company (LLC)
^3 Partnership
^3 Limited Partnership
C3 Limited Liability Partnership (LLP)
^3 Other (be specific):
Part II
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. ( C O M P L E T E T H E LIST
ON T H E 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 o f 26

 STATEMENT O FOWNERSHIP DISCLOSURE
(Continued)
(Please attach additional sheets if more space is needed):
Name of Individual or Business Entity

Home Address (for Individuals) or Business Address

Mohamed S. Jalloh, Esq.

722 Green Lane, Union, NJ 07083

Bernice M. Jalloh, Esq.

7 Benjamin Griggs Dr., Franklin, NJ 08823

Part III
DISCLOSURE OF 10% OR G R E A T E R OWNERSHIP IN THE STOCKHOLDERS, PARTNERS
OR L L C MEMBERS L I S T E D 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 beneficial interest in the publicly traded parent entity as of the last annual federal
Security and Exchange Commission (SEC) or foreign equivalent filing, 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 beneficial interest in the publicly traded parent entity, along with the relevant page numbers
of the filing(s) that contain the information on each such person. Attach additional sheets if more space
is needed.
Website (URL) containing the last annual SEC (or foreign equivalent) filing

Page #'s

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. 52:25-24.2 has been
listed. Attach additional sheets if more space is needed.
Stockholder/Partner/Member and
Corresponding Entity Listed in Part II

Home Address (for Individuals) or Business Address

Page 13 o f 26

 STATEMENT O F OWNERSHIP DISCLOSURE
(Continued)
Part I V
Certification
I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto
to the best of my knowledge are true and complete. 1 acknowledge: that 1 am authorized to execute this
certification 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 certification through the
completion of any contracts with the Borough of Roselle Park to notify the Borough of Roselle Park in writing
of any changes to the information contained herein; that 1 am aware that it is a criminal offense to make a false
statement or misrepresentation in this certification, and i f 1 do so, 1 am subject 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 certification void and unenforceable.

Full Name (Print):

Mohamed S. Jalloh

Signature:

Title:

Member

Date: 11/29/2018

Page 14 o f 26

 BOROUGH OF R O S E L L E PARK
NON-COLLUSION AFFIDAVIT
State of New Jersey
County of Union

I

Mohamed S. Jalloh

the Connty of Union

Union

of the City of

and State of

New Jersey

in
fnil age, being duly

sworn according to law on my oath depose and say that:
1 am a Member
(Title or Position)

ofthefirmof

Ja"oh & Jalioh, LLC
(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 tmth of the statements contained in
said proposal and in the statements contained in this affidavit in awarding the contract for the said project.
1 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 fide employees or bona fide employees or bona fide established commercial or selling agencies
maintained by

(name of contractor).

JaUoh & Jalloh, LLC

Subscribed and sworn to
before me this

day

Mohamed S. Jalloh, Esq.
(Type or print name of affiant under signature)
Notary public of

New Jersey

My Commission expires Jgp 30 2 0 2 0
Page 15 o f 26

 BOROUGH OF R O S E L L E PARK
A F F I R M A T I V E ACTION COMPLIANCE NOTICE
N.J.S.A. 10:5-31 and N.J.A.C. 17:27
GOODS, PROFESSIONAL S E R V I C E
AND G E N E R A L S E R V I C E 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
andN.J.A.C. 17:27-1 et seq.
The successful bidder shall submit to the public agency, after notification 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 affirmative action program (good for one year from the date of the letter);
OR

b)

A photocopy of a Certificate of Employee Information Report approval, issued in accordance with
N.J.A.C. 17:27-4;
OR

c)

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 Affirmative Action Employee Information Report (AA302) from the contracting
unit during normal business hours.
The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and
Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public
agency, and the vendor copy is retained by the vendor.
The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements of N.J.S.A.
10:5-31 and N.J.A.C. 17:27.1 et seq. and agrees to fumish 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 N.J.S.A. 10:5-31 andN.J.A.C. 17:27-1 et seq.

COMPANY:

Jalloh & Jalloh,

LLC

SIGNATURE:
PRINT NAME:
TITLE:

Mohai^fed

S. Jalloh

Member

DATE: November

29,

2018

Page 16 o f 26

 BOROUGH OFR O S E L L E PARK
EXHIBIT A
MANDATORY E Q U A L 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 S E R V I C E AND G E N E R A L S E R V I C E CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant
for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or
sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to
affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal
employment opportunity is afforded to such applicants in recruitment and employment, and that employees
are treated during employment, without regard to their age, race, creed, color, national origin, ancestry,
marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
Such equal employment opportunity shall include, but not be limited to the following: employment,
upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay
or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees
to post in conspicuous places, available to employees and applicants for employment, notices to be provided
by the Public Agency Compliance Officer setting forth provisions of
this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees
placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for
employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional
or sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor will send to each labor union, with which it has a collective bargaining
agreement, a notice, to be provided by the agency contracting 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.J.A.C. 17:27-5.2.
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 job-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 agrees to review all
procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken
Page 17 of 26

 EXHIBIT A
MANDATORY E Q U A L 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 S E R V I C E AND G E N E R A L S E R V I C E 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 notification of award but prior to execution of a
goods and services contract, one of the following three documents:
Fetter of Federal Affirmative Action Plan Approval
Certificate of Fmpioyee Information Report
Employee Information Report Form AA302 (electronically provided by the Division and distributed to
the public agency through the Division's website at ww.state.nj.us/treasury/contract compliance).
The contractor and its subcontractors shall furnish such reports or other documents to the Division of
Purchase & Property, CCAU, FFO Monitoring Program as may be requested by the office from time to
time in order to carry out the purposes of these regulations, and public agencies shall fumish such
information as may be requested by the Division of Purchase & Property, CCAU, FFO 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 R O S E L L E PARK
A M E R I C A N S W I T H D I S A B I L I T I E S A C T O F 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 U.S.C. SI21 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, benefit, or service on behalf of the owner pursuant to this contract, the contractor agrees
that the performance shall be in strict compliance with the Act. In the event that the contractor, its agents,
servants, employees, or subcontractors violate or are alleged to have violated the Act during the
performance of this contract, the contractor shall defend the owner in any action or administrative
proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the
owner, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or
damages, of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The
contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any
and all costs and other expenses arising from such action or administrative proceeding or incurred in
connection therewith. In any and all complaints brought pursuant to the owner's grievance procedure, the
contractor agrees to abide by any decision of the owner which is rendered pursuant to said grievance
procedure. If any action or administrative proceeding results in an award of damages against the owner, or
i f 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, I f any action or administrative
proceeding is brought against the owner or any of its agents, servants, and employees, the owner shall
expeditiously forward or have forwarded to the contractor every demand, complaint, notice, summons,
pleading, or other process received by the owner or its representatives.
It is expressly agreed and understood that any approval by the owner of the services provided by the
contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act
and to defend, indemnify, protect, and save harmless the owner pursuant to this paragraph.
It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless
the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of
their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that
the provisions of this indemnification clause shall in no way limit the contractor's obligations assumed in
this Agreement, nor shall they be construed to relieve the contractor from any liability, nor preclude the
owner from taking any other actions available to it under any other provisions of the Agreement or
otherwise at law.
The undersigned vendor consents to the full understanding of the forgoing Americans with Disabilities Act
Fanguage of 1990:
Bidder/Vendor: Jalloh & Jalloh, LLC
Signature:
c iiivT
/D •
Full Name (Print):

Mol^amed S. Jalloh

Member
Title:
11/29/2018
Date
Page 19 o f 26

 BOROUGH OFR O S E L L E PARK
D I S C L O S U R E O F INVESTMENT A C T I V I T I E S IN IRAN
PART 1: CERTIFICATION
BIDDERS MUST C O M P L E T E PART 1 BY CHECKING E I T H E R 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 certification below to attest, under penalty of perjury, that
neither the person or entity, nor any of its parents, subsidiaries, or affiliates, is identified 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 http://www.state.ni.us/treasui'v/purchase/pdf/Chapter25List.pdf.
Bidders must review this list prior to completing the below certification. Failure to complete the certification
will render a bidder's proposal non-responsive.
P L E A S E C H E C K E I T H E R BOX:
0 I certify, pursuant to Public Law 2012, c. 25, that neither the person/entity listed above nor any of the
entity's parents, subsidiaries, or affiliates is listed on the N.J. 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"). 1
further certify that I am the person listed above, or 1 am an officer or representative of the entity listed above
and am authorized to make this certification on its behalf. 1 will skip Part 2 and sign and complete the
Certification 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 affiliates is listed on the Department's Chapter 25 list. 1 will provide a detailed, accurate and precise
description of the activities in Part 2 below and sign and complete the Certification below. Failure to provide
such will result in the proposal being rendered as non-responsive and appropriate penalties, fines and/or
sanctions will be assessed as provided by law.
PART 2
PROVIDE F U R T H E R INFORMATION R E L A T E D 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 RFLATIVF TO THE ABOVE QUESTIONS.
PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE
ADDITIONAL ENTRIES, USE ADDITIONAL PAGES).
Name:
Relationship to Bidder/Vendor:
Description of Activities:
Duration of Engagement:
Bidder/Vendor:
Contact Name:

Anticipated Cessation Date:
^

^
Contact Phone Number:

Page 20 o f 26

 DISCLOSURE O F 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 certification on behalf of the below-referenced person or entity. 1 acknowledge that the Borough of Roselle
Park is relying on the information contained herein and thereby acknowledge that 1 am under a continuing
obligation from the date of this certification 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. 1 acknowledge that I am aware that it is a criminal offense to make a false statement or
misrepresentation in this certification, and i f 1 do so, 1 recognize that 1 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
certification void and unenforceable.
• Mohamed S. Jalloh
Full Name (Print):
Signature:
Title:
Date
Bidder/Vendor:

11/29/2018
Jalloh & Jalloh, L L C

Page 21 of 26

 BOROUGH O FR O S E L L E PARK
INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM
Certificate(s) of Insurance shall be filed with the Borough Clerk's Office 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 L I A B I L I T Y INSURANCE
Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy
period.
Acknowledgement of Insurance Requirement:

DATE:

SIGNATURE:
Mohamed S. J a l l o l / / Member
(Printed Name & Title)

Page 22 of 26

11/29/2018

 BOROUGH OFR O S E L L E PARK
CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS
STATE OF NEW JERSEY
: SS.
COUNTY OF
1,

UNION

Mohamed S. Jalloh

Union

,

a Member of Jalloh & Jalloh

in the County of Union

of

the

Township

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
Member
of the firm of
Jalloh & Jalloh, LLC
, the Professional Service Entity making the
submissions for the above named Service, and that 1 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 (S200.00) dollars to a campaign
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 officeholders, 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, i f any, and any child
living at home; person; firm; corporation; professional corporation; partnership; organization; or
association. The definition of a service provider includes all principals who own one (1%) percent or more
of the equity in the corporation or business trust, partners, and officers in the aggregate employed by the
provider as well as any subsidiaries directly controlled by the service provider.
I further warrant that I have reviewed Borough Code Section 2-4.
1 hereby certify that the foregoing statements made by me are true. 1 am aware that i f any of the foregoing
statements made by me are willfully false, 1 am subject to punishment for contempt of Court.
Subscribed and sworn to before me
this 29th
day of November , 20J8

y^,ru1^-(^%^
(Signature of Notary)
(Affix SealJ

(Sigtrature of Professional)
Narrte: Mohamed S. Jalloh
Title: Member

  

 

 

 



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Certification

^6748

CERTIgglfJg^ OF EMPLOYEE INFORMATION REPORT

^.5vyhas^u^nriitt^(?ap^STtptoyee
infonnatlon Report pursuant to
This is to certify that the contractor
listed
has'approved'saicr^port. This approval will remain In
N.J.A.C. 17:27-1.1 et. seq. andT-rfeasurer
the Si
^•-2018'
•
15'^MAY-2025
effect for the period of
^ ^

JALLOH & J A L L O H .
LLC
2 1 W. BLANKE S T . ,
2ND
LINDEN
NJ
ELIZABETH MAHER MUOlO
State Treasurer

 Form

Request for Taxpayer
Give Form to the
requester. Do not
Identification Number and Certification

w - 9

(Rev. November 2017)
Department of ttie Treasury
Internal Revenue Service
1

Go t o

for instructions and the latest information.

s e n d t o t h e IRS.

Name (as sinown on your income tax return). Name is required on ttiis line; do not leave tills line blank.

Jalloh & Jalloh, LLC
2

Business name/disregarded entity name, if different from above

2019 Municipal Land Use Board Attorney
3

a.
c
o
. V)

o
c
Q. O

0

Limited liability company. Enterthe tax classification (C=C corporation, S=S corporation, P=Partnership) ••

P

Note: Check the appropriate box in the line above for the tax classification of the single-member
owner.
not check
Exemption
fromDoFATCA
reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
code
(if
any)
another LLC that is n o t disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) '

II
Q. U

o
CO

4 1.
Exemptions
(codes
apply
Check appropriate box for federal tax classification of the person whose name is entered on line
Check only
o n e of
the only to
following seven boxes.
certain entities, not individuals; see
instructions on page 3):
• orC Corporation
•
8 Corporation
•
Partnership
•
Trust/estate
I I Individual/sole proprietor
single-member LLC
Exempt payee code (if any)

5

Address (number, street, and apt. or suite no.) See instructions.

6

Requester's name and address (optional)

Borough of Roselle Park
110 East Westfield Avenue
Roselle Park, NJ 07204

21 West Blancke Street
City, state, and ZIP code

Linden, NJ 0 7 0 3 6
List account number(s) here (optional)

Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see a
later.
or
Note: If the account is in more than one name, seethe instructions for line 1. Also see
guidelines on whose number to enter.

2 7

1 3 5 1 6 8 5

Part II Certification

Under penalties of perjury, I certify that;
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to m
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified b
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) t
no longer subject to backup vyithholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. Youmust crosscut item 2 above if you have been notified by the IRS that you are currently subject to
you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mo
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA),
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the

Sign
Here

- November 29, 2018

23

 Mohamed S. Jalloh, Esq.
722 Green U-me, Union, New Jersey 07083 (908) 590-2800

Mi;Ulohesq@ignail.com

NJ BAR 2004

EDUCATION
R U T G E R S U N I V E R S I T Y S C H O O L O F L A W - N E W A R K , Ncwiirk, NJ
Juns Doctor,
May 2004
Honors/Activities:
Student Bar Association, Representative
Association of Black Law Students, Parliamentarian
IntellcclniJ Property Society, Member
Bankruptcy Law Journal, Managing Editor
Community & Constitntional law Clinics
SYRACUSE U N I V E R S I T Y , Syracuse, NY
B.S. Rhetoric ;md Communications, May 2001
Honors/Activities:
Recipient of the Syracuse University "Our Time Has Come" Schohu-.sliip
AfricMi American Male Congress Honors Society, President
Talented Tenth Leadership Institute, Director

LEGAL EXPERIENCE
J A L L O H & J A L L O H L L C , Linden, NJ,
Jaiinary 2010- present
( K A N T O R J A L L O H , L L C 2014r20I5)
Specializing in both litigation and tnuisactional work, the linn represents and provides legal guidiuice to small
businesses including, restaurants, churches, charter schools and other non- profit organizations in the areas ol contract
negotiations and drafting, business Ibrmation ;uid organization, real estate, re-develoj)ment, policies and proc edures,
;uid fitigatioii. The firm represents individuals in the areas ol divorce ;uid family law, wills and estate, landlord tciiiuit
;uid housing laws, contract review, trallic court, criminal municipal court, real estate transactions and general litigation.
The finn ;Jso represents public entities in both litigation and transactional matters. Practice areas include:
Matrimonial, Personal Injuiy, General litigation; Real estate law; Education law; employment law; Contract
Negotiation; Rc-developmerit law.
Municipal Public Defender, Newark NJ
2010- October 2010
Represented low income individuals in municipal court cases both criminal and quasi criminal included hut not limited
to traffic, D U I , simple assault and drug possession, paraphcnialia cases. Trial experience in all meas.
C O U N T Y O F UNION, Elizabeth NJ
2006- December 2009
Iii-bonsc Counsel f or the County of Union. Provided legal advice guidance and rciircsentation to the Board of Chosen
Freeholders, County Manager and the Depiu-tmciits of County Government. Provided support and enforcement for
directors. Rcvieweel legal forms ol contracts ;md other related documents. Represented the Connty in civil litig-ation &
tort claim cases. Hearing officer for internal employment disputes, disciiiliiiarics, other labor matters. Direct Liaison
to the dcpiu^tmcnts of County parks, recreation and facilities ;uid the division of health and emergency mimagcment.
L A W O F F I C E O F C L A R E N C E B A U K N I G H T L L C , Elizabeth NJ
August 2006- J;mn;uy 2008
General Practitioner, represent clients in civil litigation cases including fiunily law & domestic violence matters.
Proficient in transactioii;il work including contract review, wills trusts and estate matters.
E S S E X N E W A R K L E G A L SERVIES, Newark, NJ
Housing and Income Maintenance August 2005- August 2006
Helped clients tlnongli litigation, advice and/or sclllemeiits to prevent loss of housing, illegal lockouts and evictions.
Worked to help clients maintain Federal and State subsidies.
L E G A L SERVICES O F N O R H T W E S T JERSEY, Newton, NJ
General practitioner November 2004- August 2005
Aided clients through litigation, advice, ;uid/or settlements in the areas of Housing, Consumer, Bankruptcy, ;uid Family

 Law. Obtained divorces, restraining orders and custody. Protected clients from illegal lockouts evictions or loss of
housing. Helped client obtain bankruptcies ;md protection against creditors.
J A V E R B A U M , W U R G A F T , H I C K S & ZARIN, Spniigfield, NJ
August 2003-January 2004
Worked closely with certified civil trial attorneys administering depositions and inteirogatorics. Acijuired knowledge
through legal research and wiiting on the ;u-cas ol Medical Malpractice, Insurance, Personal Injury and Employment
laws.
H O N O R A B L E R U D Y B. C O L E M A N , Superior Court, Elizabeth, NJ
£rte January 2003 - May 2003
Conducted legal rcsciirch and drafted memonuidnm in the areas of civil ;uid criminal litigation. Observed trials and
sentencing.
P R U D E N T I A L INSURANCE M A N A G E M E N T , Newark, NJ
]unc 2002 - August 2002
Reviewed prclimimuy offering agreements, leases, and investment management contracts. Conducted legal research
and draf ted memorandum pertaining to securities, real estate, and bankruptcy laws and UCC regulations.
I N T E R E S T S : Speech Coaching and Delivery, Speech Writing, Performing arts, Writing, Sports, Computers.

 BERNICE

M. J A L L O H ,

ESQ.

21 W E S T B L A N C K E S T R E E T , L I N D E N , N J 0 7 0 3 6
P H O N E ( 9 0 8 ) 3 6 3 - 9 8 9 9 • E - M A I L T J A L L O H R S O @,G M A I L . C O M

P R O F I L E SUMMARY
HIGHLY ORGANIZED A N D SKILLED ATTORNEY Wira^EXPERIENCE I N M A N A G I N G MULTIPLE
L E G A L PROJECTS I N F A S T - P A C E D , D E A D L I N E - D R I V E N E N V I R O N M E N T S .
CORE COMPETENCES
•

Municipal Court Mattcr.s

•

Charter Schools

•

Labor & Employment

•

Wills & Estate Planning

•

Real Estate

•

Contracts

•

Matrimony/Domestic Relations

•

_ _ _ _ _ _ _

Landlord/Tenant Matters

•

Property Management

EDUCATION
Rutgers School of Law, Newark NJ
Juris Doctorate, 2006
Rutgers University, Newark NJ
Masters in Public Administration, 1990
Syracuse University, Syracuse N Y
Bachelors o f Science
PROFESSIONAL E X P E R I E N C E

JaUoh & JaUoh L L C , Linden NJ
Parmer, Apnl, 2010 - Present
•

Demonstrated sharp legal acumen in the direct oversight of general practice cases.

•

Exhibit leadership and prioritizing abilities in performing a broad range o f legal and firm management activities.

Law Office of Clarence W. Bauknight I I I , Elizabeth, NJ
Associate Attorney, March, 2 0 0 6 - A p r i l , 2010
•

AppKed strong research capabilities in performing a number o f transactional tasks, including drafting documents and
reviewing contracts.

University of Medicine & Dentistry of NJ, Newark NJ
ActoihistratiVe Director, PatAo/o^ & LaAoratoiy Medicine, August, 2000 - September, 2010
•

Demonstrated superior managerial capabilities in direct oversight o f day-to-day operations o f laboratory, including
conflict resolution between laboratory personnel, nursing staff, physicians, administrators and patients.

•

Certified in Healthcare Compliance

United Health Care Systems, Newark NJ
Director, Training ADeve/opineiit, December, 1994 - M a y , 1997
•

Demonstrated strategic planning and organization skills in proficiently steering projects, including creation o f a
and revision o f the

 Jalloh & Jalloh L L C
Attorneys at Law
21 West Blancke Street, 2"" Floor
Linden, NJ 07036
Phone: (908) 363-9899
Fax:
(908) 363-9899

Bernice Martina Jalloh
Member, NJ Bar
tiallohesq @ gmail.com

Mohamed S. Jalloh
Member, NJ Bar
mjallohesq @ gmail.com

PROFESSIONAL REFERENCES

Daniel Antonelli
1000 Stuyvesant Ave., Suite 1
Union, New Jersey 07083
(908) 623-367

Robert Barry
10 Elizabethtown Plaza
Elizabeth, New Jersey 07207
(908) 527-4250

David Minchello
Rainone Coughlin Minchello LLC
1 Woodbridge Center, Suite 515
Woodbridge Township, NJ 07095
732-709-4182

Suzanna M. Polhamus
of Counsel, Member, NJ Bar
spolhamusesq @ gmail.com