Borough of Roselle Park 2019 Risk Manager Insurance Broker Presented by: David Feuerstein Vice President TABLE OF CONTENTS TAB Cover Letter Executive Summary Public Sector Expertise Proactive Response For Weather Related Emergencies Sample Client List References and Recommendations Standard and Property Casualty Services Meet the Team Licenses and Certi?cations Fee Proposal Required Forms I I msun?ucg 2018 Brown Brown, Inc. All rights reserved um 3.1.va Vauw'rrln ?hm mun- MM awn-n. Borough Clerk/Qualified Purchasing Agent Andrew J. Casais, RMC, QPA 110 East Westfield Avenue Roselle Park, NJ 07204 Re: 2019 RISK MANAGER INSURANCE BROKER Dear Mr. Casais: Brown Brown Metro, LLC of New Jersey is pleased to submit our quali?cations for Risk Manager Insurance Broker for the year 2019. Our ?rm is highly interested in providing insurance consultant services to the Borough of Roselle Park. With expenses rising and increasing budget pressures, expert guidance and management of insurance programs is essential to controlling costs. With Brown Brown, the City will continue to have a partner that can provide these services in a way that does not add risk to the Borough in any way. We remain committed to providing the experienced professionals needed to work with you to: Coordinate safety and loss control meetings. Assist with monitoring of PEOSH training compliance. Oversee and manage carrier and IF relationships; Provide guidance with new regulations affecting the Borough?s coverage Review the Borough?s insurance program and make recommendations as appropriate; Negotiate renewals and make recommendations on renewals; Present to committees, employees or the Borough on insurance topics as requested; Provide key assistance in the day to day operations and management of the Borough?s insurance program; 0 In general guide the Borough in the management of their insurance programs. As you know, Brown Brown Metro, LLC of New Jersey is a full service brokerage and consulting ?rm specializing in public entity risk management and employee bene?t plans. Brown Brown Insurance is the seventh largest brokerage ?rm in the United States which provides our ?rm with a strong market presence with all insurance carriers. Presently, we represent over 350 Public Entities in the State of New Jersey and our staff of over 115 employees stands ready to meet any and all requirements of the Borough. Our increasing base of experience and expertise has enabled us to offer a broad range of services to municipalities, school districts, government agencies, real estate communities and the general public. Our growing record of accomplishments has helped to establish Brown Brown Metro, LLC of New Jersey as a leader in our ?eld. We are presently the risk manager and/or insurance broker for many of the public entities in the State of New Jersey that participate in non- traditional insurance programs such as Joint Insurance Funds or self-funded insurance II if? INSURANCE. 2018 Brown Brown, Inc. All rights reserved alternatives. We work hand in hand with third party administrators and attorneys in managing these programs. In addition to you, over the past several years, Brown Brown Metro, LLC of New Jersey has provided risk management consultant services to the Township of North Bergen, City of Jersey City, County of Hudson, Township of West?eld and the Township of Kearny among others. We are very familiar with their coverages and procedures and fully understand the exposure and risks of each of the clients that we represent. We will continue to provide our Safety Loss Control procedures that have proven to be a successful tool in reducing the frequency of Workers? Compensation claims. In addition, Brown and Brown Metro, LLC of New Jersey personnel will continue to attend all required meetings as well as all appropriate meetings of the Joint Insurance Funds. The combination of our experience, our marketplace position and our tireless attention to detail make us a powerful ally for any employer, particularly a public entity. We believe we will be a valuable asset to the Borough of Roselle Park in these dif?cult ?nancial times. We thank you for the opportunity to provide our quali?cations. We look forward to the opportunity to discuss our quali?cations and any questions at your convenience. Sincerely, . David Feuerstein Vice President Brown Brown Metro, Inc. hm ll 4 L'n'nn INSURANCE. 2018 Brown Brown, Inc. All rights reserved 1 EXECUTIVE SUMMARY Company Pro?le: As an independent insurance intermediary, Brown Brown provides a variety of insurance products and services through our licensed subsidiaries. Our four major business divisions provide insurance products and services to general businesses, corporations, governmental institutions, professional organizations, trade associations, families, and individuals. Built on integrity, innovation, superior capabilities, and stability, we thrive in the competitive insurance environment. Our culture of success enables us to identify new opportunities, adapt our products and services to best meet market demands, and satisfy the various needs of our clients. Our drive to provide the best service to our clients has made us one of the largest and most respected independent insurance intermediaries in the nation with more than 75 years of continuous service. Brown Brown is ranked as the sixth largest insurance intermediary in the United States and seventh in the world by Business Insurance. We are listed on the NYSE as BRO. Brown Brown?s clientele is as diverse as the American economy itself. Our clients include Manufacturing, Health/Medical, Retail, Construction, Marine, Transportation, High Technology, Financial, E-Commerce, Legal, Agricultural, Schools, Colleges and Universities, Golf Courses and Country Clubs, Governmental Entities, Aviation, Hotels, Motels and Resorts, Museums, Restaurants, Religious Institutions and many more. II ll CE. 2018 Brown Brown, Inc. All rights reserved Office Pro?le: Brown Brown Metro, LLC is located in Roseland, New Jersey and has a staff of over 115 professionals. We have a reputation for excellence in the products and services we offer. We provide a full range of brokerage services including employee bene?ts, property and casualty, and ?nancial and retirement products and services. In addition to our own professional staff and value-added services, our ?rm is able to provide a wealth of resources to our clients through prestigious national af?liations. Our Property and Casualty team provides innovative solutions to our clients While keeping costs manageable in today?s ever changing marketplace. Our teams of experienced industry professionals offer a complete spectrum of Property and Casualty Insurance and Risk Management Consultants. Our department is committed to help clients make informed decisions based upon recommendations tailored to ensure success. Our team consists of: I Richard A. Knudson, Jr., President I David Feuerstein, Vice President I Robert Gemmell, Senior Account Executive I Juanita Perez, Account Manager I Shakirah Stanford, Account Manager I Adam Becker, Account Manger Target Clientele: I Municipalities I School Districts I Utility Authorities I Other Publicly Funded Organizations 2018 Brown Brown, Inc. All rights reserved Brown Brown Culture Statement Brown Brown is a lean, decentralized, highly competitive, pro?t-oriented sales and service organization comprised of people of the highest integrity and quality, bound together by clearly de?ned goals and prideful relationships. Brown and Brawn Metro. LLC Missitm Statement . Deliver the highest level of customer service to our clients by acting as advisors and advocates . Provide our employees with opportunities for professional growth, personal satisfaction, and ?nancial security by embracing the idea of a Meritocracy Leverage strong and mutually bene?cial relationships with specialized insurers and professionals to limit our clients' total cost of risk a Endeavor to have the Brown Brown Metro, LLC name be recognized as the Paragon of Public Entity Risk Management and Insurance in the State of New Jersey II il'w: it ll INSURANCE, 2018 Brown Brown, Inc. All rights reserved Brown Brown At?A-Glance I Founded in 1939 and headquartered in Daytona Beach, Florida I 6th largest US insurance brokerage ?rm as ranked by Business Insurance I 8,500+ employees I Strong ?nancial pro?le and 2017 revenues of I 307 locations across 41 U.S. states, Bermuda, London, and Toronto 307 Iocntions across 4 gates in the S. and locations in Bermuda, Toronto, Canada and London, K. I?ll? II I'i?iu??cla 2018 Brown Brown, Inc. All rights reserved .- v. rr . :r'mhm- {Humid-?H .- my? Public Sector Expertise I Brown Brown Metro represents over 350 Public Sector clients I Brown Brown Metro works with 15 Public Sector throughout the State of New Jersey I Over 40+ Years of Experience Operating in the Public Sector I Size and Scope of Clientele Creates Bargaining Power I Administer the ERIC West Sub-Fund for NJ SIG Fri .. WSURANCE- 2018 Brown Brown, Inc. All rights reserved Brown Brown?s Proactive Response For Potential Weather Related Emergencies We Plan Ahead, Not After! I Storm Preparation Setup Cellular Contacts Listing Provide Disaster Clean-up Contacts Distribute Loss Control Information Regarding Storm Preparedness and Asset Protection Coverage Review Flood, Wind, Deductibles, Sub-Limits I Contact Clients and Setup Claim Process within Hours of Super Storm Sandy?s Landfall I Organize and Attend Claim Meetings Conference Calls I Negotiate Advanced Release of Claims Payments I Focus on Claim Adjustment with Special Attention Paid to Valuations and Coverage Determinations Continued Claim Review I'H'x'l ll 13.: lt'l?t'u I'l WSURWCE 2018 Brown Brown, Inc. All rights reserved Public Entity Client References with Contact Information: This is a sample listing of Brown Brown?s public entity clients and is not exhaustive. The full list is available upon request. MnnicipalitieslAuthorities: Client Entity Contact Title Phone Number Address Township of South Since Village 101 South Orange Avenue Orange Village 2010 Adam Loehner Administrator (973) 378?7715 South Orange, NJ 07079 Town 6808 Park Avenue Town of Guttenberg 1999 Cosmo Cirillo Administrator (201) 868-2315 Guttenberg, NJ 07093 230 Hamiton Street Borou of Bound Borou Brookg 2000 Hector Herrera Admin?strator (732) 359-0833 Bound Brook, NJ 08305 - 118 Serpentine Road Borough of Demarest 2003 Susan Crossman ?g?g Borough (201) 768-0167 Demarest, 07627 Borough 50 Washington Avenue Borough of Dumont 1998 Sue Connolly Administrator (201) 387-5022 Dumont, NJ 07628 13.0. Box 228 City of Englewood 2007 Ed Hynes City Manager (201) 871-6637 Englewood, NJ 07631 - 2 Jake Garzio Drive . . James P. Township . Township of Ew1ng 2007 McManimon Administrator (609) 883-2900 Ewmg, NJ 08628 Townshi 1 Municipal Plaza Township of Freehold 2002 Peter Valesi A dministri'ator (732) 294-2000 Freehold, NJ 07723 - . 29 Park Avenue of Berkele Heights 2003 Barbara Russo Administrator (908) 464-2700 Berkeley Heights, NJ 07922 - 4 Washin ton Street Borough of Roselle Clty 9 Park 2006 Stephen Marks Administrator (201) 420-2087 Hoboken, NJ 07030 567 Pavonia Avenue County of Hudson 1999 Ed Shea Risk Manager (201) 795-6234 Jersey City, NJ 07305 - - 280 Grove Street City of Jersey City 1989 Brian Platt i?ym?l??tlfa??sr (201) 547?5147 Jersey City, NJ 07302 29 Church Street Raymond Borough Borough of Keansburg 1999 O?Hare Administrator (732) 787?0215 Keansburg, NJ 07734 - - 39 Central Avenue Kev1n Executive Kearny MUA 2003 O?Sullivan Director (973) 465-5367 Kearny, NJ 07032 . Town 420 Kearny Avenue Town of Kearny 1999 Robert Administrator (201) 955-7400 Kearny, 07032 . Personnel 301 N. Wood Avenue Clty of Linden 2001 esswa Sheehy Director (908) 474-8452 Linden, NJ 07036 Hm CE. 2018 Brown Brown, Inc. All rights reserved Entity Client Since Contact Phone Number Address 150 oline Avenue Long Branch Sewerage . . Executive Authority 2003 Tom Director (732) 222 0500 Long Branch, 07740 - - 120 Route 522 of . Townsh1p Manalapan 1998 Tara Administrator (732) 446-83 15 Manalapan, NJ Executive 6200 Tonnelle Avenue North Bergen MUA 2000 Frank Pestana Director (201) 422-0100 North Bergen, NJ 07047 - - - 4233 Kenned Boulevard of North Christopher Townsh1p Bergen 1999 Pianese Administrator (201) 392-2024 North Bergen, NJ 07047 One Municipal Plaza Borough of Oakland 2004 Richard Kunze B?r?9gsh (201) 337-81 1 1 Oaklands NJ 07436 Adm1n1strator - 131 N. Ma le Avenue . . Heather . Village of Ridgewood 2004 Mailander Manager (201) 667-5500 R1dgewood, NJ 07451 - - Polhemus Lane Somerset Raritan Ronald Executive Valley Sewerage Auth. 2005 Anastasio Director (732) 469-4019 Br 1dgewater, NJ 08807 - - 204 Hillside Avenue Essex County Regional . . Executwe . Health Commission 2007 Game Nawrockl Director (973) 251 2059 L1v1ngst0n, NJ 07039 II t. )1 INSHRANCE, 2018 Brown 84. Brown, Inc. All rights reserved Boards of Education: Entity Client Since Contact Title Phone Number I 11 Fcoxro? Drive Address BOB 1998 (973) 535'3000 Livingston, NJ 07039 Morris Hills BOE 2015 X?sggciiliman 1333::th (973) 664-2280 ?33323]? 07866 . Business 302 Elm Street West?eld BOE 2015 Dana Sullivan Administrator (908) 789?4414 West?eld? NJ 07090 Business 834 Leonardville Road Middletown BOB 2010 Amy Gallagher Administrator (732) 671?3 350 Leonardo, NJ 07737 Jersey City BOE 2000 John Chester 2333:3255: (201) 915-6279 ?3r2?1?:??NntJ 3:336 Business P.O. BOX 579 Howell BOE 2002 Ron Sanasac Administrator (732) 751-2480 Howell, NJ 07731 Hackettstown BOE 2012 aaoicekowski 23:?fliftl?ator (908) 852'2800 Business 19 Senator Stout Road Delaware Valley BOE 2000 Teresa Barna Administrator (908) 996-2727 Frenchtown, NJ 08825 Business 67 Ridgedale Avenue lorham Park BOE 2002 John Csatlos Administrator (97 3) 822-3880 Florham Park, NJ 07932 Business 50 North Road Chester BOE 2012 Tonya Dawson Administrator (908) 879-73 73 Chester, 07930 - Business 281 Route 46, PO. Box 74 Great Meadows BOE 2000 Administrator (903) 63 7-6576 Great Meadows, NJ 07838 Business 240 John Street South Amboy BOE 2013 Peter Frascella Administrator (732) 525-2100 south Amboy, NJ 08879 alfalfa vocatlonal 1998 Karl igiliril?isstrator (73 2) 257 -3300 heitlh?iti?fk, NJ 08816 Business 1 Evergreen Place Umty Charter 2002 Charlene Jones Administrator (973) 292-1308 Morris Township, NJ 07960 2002 Nanci Dvorsky Director (908) 362-1114 82121158331233 07825 2018 Brown St Brown, Inc. All rights reserved my? muw'rrhemn :mmrmu wr-?M nwn. Property Casualty Services Daily Services Direct contact to the service team for handling of all requests relating to policy changes, endorsements, preparation of binders, certi?cates of insurance, invoices, auto ID cards, loss runs and similar items Timely response to all general inquiries Correspond with insurance carriers and clients as required Service team to attend to client visits and safety meetings as requested Certi?cate of Insurance review Contract and lease review Processing and veri?cation of all endorsements, audits and other adjustments Coordination of safety and loss?control inspection and training Claims Handling Services ll1\\ ll INSURANCE. Claim servicing involves referral to carrier, documenting a carrier claim number, handling questions, reviewing coverage and performing a coverage analysis and communicating when needed with carrier and the insured Participating with the client and the carrier in any carrier claim review meeting Claims analysis, review and trend identi?cation Identify high hazard risk areas Implement risk transfer process Investigate potentially fraudulent claims Coordination between bene?ts plan as applicable 2018 Brown Brown, Inc. All rights reserved Marketing Services - Meet to discuss marketing objectives Market all Lines of Property Casualty coverage?s, as requested by your business, utilizing the broadest Viable spectrum of insurance marketplace and all funding options requested I Complete initial marketing and analysis and for each year thereafter, as requested by client - Maintain knowledge of carrier products, industry appetites and services including: Financial Ratings Claims and Risk Management Services Billing Options Responsiveness and professionalism of underwriters, claims adjusters and loss control representatives Renewal Services - Request renewals for all lines of coverage Review renewals policies for accuracy Negotiate with carrier(s) on your business?s behalf for most competitive rates and terms Provide coverage and carrier alternatives when applicable Inform carriers of renewal decision Ensure implementation of policy changes with carrier(s) Review and analyze policies, endorsements and forms for accuracy, recommending changes or amendments as necessary -- Irwin mull 2018 Brown Brown, Inc. All rights reserved up. hmwi?u Mau- t.Inwaw.v.'.ulrhv'tml'; mm. wan. MM w.v. ix?n-u. u.7 7 MEET THE TEAM DAVID FEUERSTEIN Vice President David Feuerstein serves as a Vice President at Brown Brown Metro, LLC. David is responsible for bringing in opportunities, analyzing the coverage and policies, as well as negotiate pricing. David joined Brown Brown Metro, LLC after working for the Guardian Life Insurance Company where he was a Producer with a wealth management division. His primary focus was asset protection and estate planning for individual clients. David attended the Sy Sims School of Business and graduated with a Bachelor of Science degree in Business Management and Marketing. He holds Life and Health licenses as well as Property and Casualty in the states of New Jersey and New York. David resides in Hillside, New Jersey with his wife and children. Bob ARM Senior Account Executive Mr. currently serves as a Senior Account Executive specializing in the Public Entity Sector at Brown Brown. Mr. joined the Brown Brown team in 2008 and has been working extensively with School Districts and Municipalities. His responsibilities include the purchase, placement, and oversight of his clients? property and casualty insurance programs, as well as his clients? loss control and risk management programs. Mr. duties also include the administration of one of the largest sub funds in the State of NJ in the Education Sector. Mr. Gemmell earned his Bachelor?s Degree in 2003 from Lebanon Valley College in Annville, He holds a New Jersey and a Insurance Producer?s license with authorities in Property Casualty, Life and Health Insurance. Juanita Perez Account Manager Ms. Perez was born in Newark, NJ and currently resides in Roselle Park, New Jersey with her family. She graduated in 2008 from Eastwick College, earning her Diploma in Business Administration. Juanita began her career in insurance with Plymouth Rock Insurance Company in 2010 in their In-House Agency, servicing Personal Lines Clients. In 2013 she obtained her New Jersey Insurance Producers License with authorities in Property Casualty. October of 2015 Juanita became a part of our Brown and Brown team [Elwin II Ilium . 2018 Brown Brown, lnc. All rights reserved as an Account Manager for our Select Commercial Lines division. As of May 2017 she has joined our Public Entity Division. She has demonstrated a great work ethic and desire to expand her knowledge in different areas of the insurance industry. Juanita is diligently working to expand her knowledge in Risk Management. Ms. Perez continues to expand her insurance knowledge by seeking certi?cations in the insurance industry in her spare time. She enjoys traveling and a healthy lifestyle Shakirah Stanford, CISR Account Manager Shakirah Stanford is an Account Manager in the Public Entity department for Brown and Brown. The Public Entity department within Brown and Brown provides insurance brokerage and risk management services for the Public Entity sector. In this position, Shakirah works extensively with school districts. Her responsibilities include the purchase, placement, and oversight of her clients? property and casualty insurance programs as well as a focus on loss control and risk management. Shakirah has over 25 years of diverse insurance industry experience including claims and insurance brokerage. Prior to joining Brown and Brown, Shakirah began her career at MDA in 1992 as a Claims Adjuster and subsequently accepted a position at Chubb Group of Insurance Companies in 1995. While at Chubb, she held several positions including Workers? Compensation Claims Adjuster, Automobile Claims Adjuster, Recovery Examiner and Automobile Claims Supervisor. Shakirah has successfully continued her career at Brown and Brown as an Account Manager in property, casualty and surety. Shakirah is adept in the placement and servicing of various insurance lines. Through this extensive 25 year experience, she brings the right depth and range of resources to manage risk and insurance programs for many industries. Shakirah holds a New Jersey and New York Property and Casualty Insurance Producer?s license. Adam Becker Account Manager Adam Becker is an Account Manager in the Public Entity department at Brown and Brown, having joined the Public Entity Team in 2018. Mr. Becker is constantly positive, and is always looking to tackle new tasks or challenges. Mr. Becker brings his experience as a Health Claims Specialist for both General and Specialist Physicians to assist both Shakirah and Juanita, as he learns the intricacies of the Public Entity sector. Mr. Becker holds both a New York and New Jersey Property and Casualty Insurance Producer?s license. He also maintains an active lifestyle, with experience as an amateur boxer and as a volunteer coach that he calls upon to remain positive and forward thinking at all times. 13. 2018 Brown Brown, Inc. All rights reserved . 155?. . t. ?lite??759..) .57., LICENSES AND CERTFICATIONS II II 2018 Brown Brown Inc. All rights reserved State of New Jersey Department of Banking and Insmancc 20 WCSI State 5m um?manlnm Trenton, NJ 08625-03 27 Immanuel in ?mm It'll! ?filth THIS CERTIFIES THAT BROWN 8: BROWN METRO, LLC mm.- m- 11:17-15. AT BUSNESS ADDRESS 55 LIVINGSTON AVEMJE serum-ennu- . NJ DVDEE melee-unable IS DULY LICENSED WITH THE FOLLOWING LICENSE TYPEIS) AND AUTHORITIES LICENSE TYPE LINE 0! AUTHORITY mm DATE. EIPIIJUION DATE Immune We: LIFE HEALTH OR BEIIHIZIM 0531 {2020 SICKNESS: FEESDNAI. LINES: mm?: CASUALTY: WSWCE WED 5mm LINES- WSW I Acting Containing of prim: emaizaiu Bathe; and 1115111111122! The Department maintains an intonnattve website at Pteaae visit this web page for valuable information and terms necessary to maintain compile-lee with licensing requirement. Department Contact Information wet: site: m.dobinj.gov phone: [609] 292-4337 fax: {609) 964-5263 The request for any change of license infun-nn?en must be sent to the Department within 30 days ot the change. Make any cheeks endtor money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing Addess: Department of Banking and Insurance 20 West State Street PO. Box 327 Trenton. NJ. 08625-0327 INSURANCE 2018 Brown Brown, Inc. All rights reserved LICENSE NUMBER State of New Jersey 1232557 Department of and Insurance 20 WEST State 3m TH: rim-1:: unset; Trenton. NJ 08625-0327 .amm. Iwm he ll THIS CERTIFIES THAT DAVID FEUERSTEIN ll HMO. 11:11?15. AT BUSINESS ADDRESS BROWN 8; BROWN METRO, INC. 55 LIVINGSTON AVE nmuunmhuu ROSELAND, NJ CITIES-1733 ?mu-?m IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES 0F AUTHORITY EFFECTIVE DATE EXPIRATION DATE PRODUCER LIFE ACCIDENT, HEALTH OR 03"? [2016 02.901201 8 . It ?1 ?ir? I pri'?ld' (I 932mm 1 a Commissioner of?ankmg and Immune: The Department maintains an informative website at Please WBII this web page fer valuabie information and forms necessary to maintain eomplianee with lieensing requirements. Department Contact Information web site: phone: (609) 292-4337 fax: 984-5263 The request for any change at license intermation mustbe sent to the Department within 30 days of the change. Make any checks andior meme)r orders payable to: STATE OF NEW JERSEV. GENERAL TREASURY Mailing Address?epartmenl of Banking and Insurance 20 West State Street PO. Box Trenton. NJ. 08625-0327 . II 2018 Brown Brown, Inc. All rights reserved LICENSE UMBER State of New Jersey 1 133551 Department of Banking and Insurance 20 West State Street Wan-twee mi; Trenton. NJ 08625-032? I THIS CERTIFIES THAT ROBERT P. GEMMELL ll In Ill-1M3. 11:11-15. mm mm mm AT BUSINESS ADDRESS BROWN :5 BROWN METRO INC. ?annular-e 56 LIVINGSTON AVE nmnumuen ROSELAND, NJ Inl?elmueurlmal. IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE rm LINES OF AUIBORITY ?11"!ch DATE EXPIRATION DATE We Drum-.11 LIFE INSURANCE: ACCIDENT. HEALTH OR 10?" I201 3 095011020 SICKNESS: PROPERTY: CASUALTY ..5 W: 10mu2u1e Tallinn? of Banking and Instance The Department maintains an informatlve website at Ptense visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements- Department Contact Information web site: phone: {609} 2924337 fax: {609} 984-52163 The request lor any change of license intonnutim must be een?t to the Department within an days of the change. Matte any checks unmet niertt-iyr orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing AddressDepartment of Banking and Insurance 20 West State Street P.O. Box 327 Trenton, NJ. 08625-0327 II 2018 Brown Brown, Inc. All rights reserved State of New Jersey Department of Banking and Insurance 20 West State Street mammal: Trenton, NJ 08625-0327 mammalian swam THIS THAT SHAKIRAH T. STANFORD 3:23:33; l'??lh II AT BUSINESS ADDRESS BROWN BROWN METRO INC reminding?? SB LIVINGSTON AVE ROSELAND, NJ 07063-1733 Ideas IS DULY LICENSED THE FOLLOWING LICENSE AND AUTHORITIES LICENSE LINES (If amour? EFFECTIVE. DATE EXPIRATION DATE lemme Praline: CASUALTY ?"01 {2018 (12., {6 puri?ed: rem-2m Camdusmne'r again); and Immune-e The Department maintains an informative website at mdobinjgov. Please visit web page tor valuable information and forms necessary to maintain compianee with licensing requirements. Department Contact information web site: phone: (609]: 292-433? tax: (609} 984-5263 The request for any change of license must be sent to the Department within 30 clays of the change. Matte any eheeke andfor money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing AndresszDepartment of Banking and insurance 20 West State Street PO. Box 327 Trenton, NJ. 08625-0327 2018 Brown Brown, Inc. All rights reserved LICENSE NUMBER State of New Jersey 15077;?, of Banking and Insurance 20 West State Street Mill-Immune? Trenton, NJ 03525-032? sine-unmade!? If! in IE II MJAC. 11-IIS CERTIFIES THAT JUANITA N. PEREZ ram- II 11:17-15. mum cm Mmmimm. AT BUSINESS ADDRESS 56 LIVINGSTON AVE FL 2 semen-mane ROSELAND, NJ 071168? 1 733 mu heir-m Ionic IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE Tm LINES OF AUTHORITY EFFECTIVE DATE EXPIRATION DATE PRODUCER PROPERTY: CASUALTY 01"" I201 01B La) . . muted- 1309321110 Comm?snon?r and Insurance The Departme nl mlinlaine an informative website at Piease visit this web page for valuahfe information and tonne neceesary to maintain cemptiance wilh licensing requirements. Department Contact Information web site: phone: {609} 292-4337 fax: (609]: 984-5263 The request for anyr change a! license information muet be sent to the Department within 30 days a! the change. Make any checks andter money orders payable to: STATE OF NEW JERSEY. GENERAL TREASURY Mailing Address?epanrnent of Banking and Insurance 20 West State Street PO. Box 327 Trenton. NJ. 08625-032? 2018 Brown 84 Brown, Inc. All rights reserved State of New Jersey Department of Banking and Insurance 20 WEST St?tt SUCH mmu main ?It ll?ih? urn-HI mm ml is il HMO. THIS CERTIFIES THAT ADAM . BECKER 1m" ?Mme II 11: IT-ZE. 2mm.? lulu?: mum AT BUSINESS ADDRESS 58 SOUTH ROCKLAND AVE ?nun-elm: wit-annual 53 SOUTH ROCKLAND AVE annulus-union: I CONGERS, NY 10920 l5 DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES DE AUTHORITY DATE EXPIRATION DATE [Inmate Prom: PERSONAL CASUALTY 11?301?2020 125' prmd: momma Cumin stone: of?ankmg and Imam-amt The Depnnment maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web site: phone: {609} 292-4337 fax: (609} 9544-3263 The request tor any change of license must be sent to the Department within 30 days of the change. Make any checks andi'or money orders payahie to: STATE OF NEW JERSEY. GENERAL TREASURY Mailing Addressznepartment of Banking and Insurance 20 West State Street P.0. Box 327 Trenton, NJ. 036250327 l\ 2018 Brown Brown, Inc. All rights reserved I 330w?; APORD CERTIFICATE OF LIABILITY INSURANCE BELOW. OI mnuan. All THE CMTIFIGITE THII CEWBATE ll A DF AND HO WM THE HOLDER. THII DOES HOT WIHATWELY DH NEGATIVELY AHENCI, EITEND DR ALTER THE SWIM BY THE THIB CEITIFICATE 0F WEE HOT CONSTITUTE A CONTRACT BETWEH THE IMPORTANT: II um hold-r I: .1 ADDITIONAL Human. tho ?Damn-I mun! INSURED or In ?Maud. RMIOGATIDH manner In In It!? nd Emu" ml the 9913. aruln pouch: may mail-I ll'l manna-mm. I. autumnal an In In I . llama?- mm II of Harlan. Inc. mass-ma .. I n: .1 Hum 0m" AIM 19:. m4: Iihl RECEIVED . II. ?Ymmn mumm? I I Em 3? 25514 mm 5 am me am. JAN .wrcomh-nul In. no man FL 52116 mm! a. 3? awn Mara. 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WILL II IN WITH THE manna. mrnmen I WEIRD 1191?? ADDFID CORPORATION. All righll mun-d- Thu ACORD nlrnu and Inga an magnum! cl #60410 2018 Brown Brown, Inc. All rights reserved Give form to the requester. Do not send to the IRS. W-9 (Rev. November 2005) Department of lhe Treasury tnlornll Hod-min Source Name (as shown on your income tax return) Brown and Brown Metro Inc. Request for Taxpayer Identification Number and Certi?cation Ruelnnos name. If from above Addr?ees (number. street. and opt. or suite no.) Requester's name and address (optional) 56 Livingston Ave. 2nd Floor City. state. and ZIP code Roseland. NJ 07068 3 List account number(s) here (optional)? Enter your TIN In the appropriate box. The TIN provided must match the homo given on Line 1 to avoid 500'" "cum! i backup withholding. For Individuals. this Is your social security number (SEN). However. for a resident I .I. I I alien. sole proprietor. or disregarded entity. see the Part I Instructions on page 3- For Other entitIBS. It Is your employer Identification number (EIN). If you do not have a numberpage Of Note. It the account Is In more than one name. see the chart on page 4 for guidelines on whose Employer Identification number numbertoenter. 212l-3I4lsj1jzloisi codification Under penalties of perjury. I certify that: 1. The number shown on this form Is my correct taxpayer Identi?cation number (or I am waiting for a number to be Issued to me), and 2. I am not subiect to backup withholding because: I am exempt from backup withholding, or I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or the IRS has noti?ed me that I am no longer sublect to backup withholding. and 3. I am a U.S. person (Including a U.S. resident alien). Certi?cation instructions. You "lust arose out Item 2 above it you have been notified by the IRS that you are currently to backup withholding because you have tolled to report alt Interest and dividends on your tax return. For real estate transactions, Item 2 door. not apply. For mortgage Interest pold. or abandonment of secured property. cancellation of debt contributions to an Individual retirement arrangement (IRA). and generally. payments other than Interest and dividends. you are not rooulre-d to sign the Certification. but you must Print 81 3. ?Exempt from backup Check appropriate bolt: Bole proprietor '3 [j Pm"mhlp 0m? I. withholding Taxpayer identification Number (TIN) provide your correct TIN. [ti-tee ?lling?! MW: gag-e 4) Sign Signature of Here U.S. person 5 mw'7PL7 Purpose of Form A person who is required to File an ?Information return with the IRS. must obtain your correct taxpayer Identification number (r IN) to report. for example. Income paid to you. real estate transactions. mortgage Interest you paid. acquisition or abandonment of secured property. cancellation of debt, or contributions you made to an IRA. U.S. person. Use Form W-9 onty if you are a U.S. person (Including a resident alien]. to provide your correct TIN to the person requesting It (the requester) and. when EpDiiCabla. to: 1. Certify that the TIN you are giving Is correct (or you are waiting for a number to be issuad). 2. Certify that you are not subject to backup withholding. or 3. Claim exemption from backup withholding It you are a U.S. exempt payee. In 3 above. If applicable. you are also certifying that as a U.S. person. your allocable share of any partnership Income from a U.S. trade or business Is not subject to the withholding tax on foreign partnere? share of effectively connected income. Note. II a requester gives you a form other than Form W-9 to request your TIN. you must use the requester's form if It Is substantially similar to this Form W-9. For federal tax purposes. you are considered a person If you are: 0 An Individual who Is a citizen or resident of the Unit IlutJ States. 0 A partnership. corporation. company. or association created or organized In the United States or under the laws of the United States. or 0 Any estate (other than a foreign estate) or trust. Sea Regulations sections 301 .7701-6(a) and 7(a) for additional information. Special rules for partnerships. Partnerships that conduct a trade or business In the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further. in certain cases where a Form W-9 has not been received. a partnership is required to presume that a partner Is a foreign person. and pay the withholding tax. Therefore. If you are a U.S. person that Is a partner In a partnership conducting a trade or business In the United States. provide Form to the partnership to establish your U.S. statue and avoid withholding on your share of partnership Income. The person who gives Form W-9 to the partnership for purposes of establishing Its U.S. status and avoiding withholding on Its allocable share of net income from the partnership conducting a trade or business In the United States Is In the following cases: 0 The U.S. owner of a disregarded entity and not the entity. Cat. No. 10231X II ii Form W-9 (Rev. 11-2006) 2018 Brown 84 Brown, Inc. All rights reserved 3" _l STATE or new JERSEY ausINEss REGISTRATION CERTIFICATE I. I I) . DIVISION OF REVENUE PO Box 252 r' I TAXPAYER NAME: TRADE NAME: BROWN Ir BROWN METRO1 ADDRESS: SEQUENCE NUMBER: 58 LIVINGSTON AVE 2115514 ROSELAIND NJ 07063-11006 EFFECTIVE DATE: ISSUANCE DATE: 0328! 17 Haw .IBI lay Dwmon at Rewnuu paws-Mr? .. -.--wvn..nrws.-wr. I. ??5-13 . ?we I - pan-I Certl?catIon 15111 CERTIFICATE OF EMPLOYEE INFORMATION REPORT Tm In In ?my am the cuntmotor law Inforrnatlon Report pursuant to 17274.1 at. seq. and tho .. . pprwaII ppm. Tm approval will romaIn In offactfunhepenodof 15 -2021 am 3mm mm. 56 LIVINGSTON AVE. Rom NJ 070" I .- I roan M. scunoen smeuum %Imn 2018 Brown Brown, Inc. All rights reserved . 5.25.55} arufruamivis .325. .. FEE PROPOSAL Brown and Brown Metro, LLC will not charge a fee to the Borough of Roselle Park. The commissions for services are paid by the insurance carriers at commission schedules established by the carriers or Joint Insurance Fund. mm Lula 2018 Brown Brown, Inc. All rights reserved Mau- wan. luv-.- a-i-H-n. mm. I -. REQUIRED FORMS II )1 II 2018 Brown Brown, Inc. All rights reserved 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 MMW Completed Submission Form Quali?cation Statement MMW Statement of Ownership Disclosure MMW Non-Collusion Af?davit MMW Required EEO/Af?rmative Action Evidence Signed Compliance Notice Acknowledgement of Americans with Disabilities Act Language of 1990 MMW Disclosure of Investment Activities in Iran MMW 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 0Wand?; Brown Brown Metro, LLC Date: 11/27/2018 Signaturc:X. W?w print Name: Marian Murphy-Weiner Title: Vice President Page 7 of 26 BOROUGH OF ROSELLE PARK UBMISSION 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: The names and roles of the individuals involved can be found on Tab 5 Meet the Team. Page 8 of 26 SUBMISSION FORM 1? 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: The references requested can be found on Tab 3- Public Sector Expertise. Sample Client List. Page 9 of 26 SUBMISSION FORM I 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): Description of ability and services can be found on Tab 3 and Tab 4. Page 10 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 4. Cost details, including the annual fee for primary duties and the hourly rates of each of the individuals who will perform services, and all expenses for any work that is not included in the primary duties: Brown and Brown's will not charge a fee to the Borough of Roselle Park. The commissions for services are paid by the insurance carriers at commission schedules established by the carriers or Joint Insurance Fund. Please also see Tab 8 - Fee Proposal. CERTIFICATION OF PROPOSAL (Sign Below) Firm: Brown Brown Metro, LLC Date: 11/27/2018 Authorized Representative (Print): Mariaan?urphy-Weiner Signature: 722/2?- ?51512.: 1.. 7% ,1 Title. Vice resident . Telephone No.: 973-549-1900 Fax No; 973-549-1000 Page 11 of 26 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (P.L. 1977, c.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 OR PROPOSAL. Name Of Organization: BFOWH 8t Brown Metro, LLC Organization Address: 56 Livingston Avenue, Roseland NJ 07068 Part I 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 11 and execute certi?cation in Part IV) For-Pro?t Corporation (any type) ELimited Liability Company (LLC) Partnership Limited Partnership Limited Liability Partnership (LLP) Other (be speci?c): 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. (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 il? more space is needed): Name of Individual or Business Entity Home Address (for Individuals) or Business Address Brown Brown, Inc. 220 S. Ridgewood Ave, Daytona Beach, FL 32114 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 (URL) containing the last annual SEC (or foreign equivalent) ?ling Page Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part 11 other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 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 Brown Brown, Inc. 220 S. Ridgewood Ave, Daytona Beach, FL 32114 J. Hyatt Brown 220 S. Ridgewood Ave, Daytona Beach, FL 32114 Page 13 0f26 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 Roselle Park in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certi?cationsubject to 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): Marian Murphy-Weirlgg; Title: Vice president 1/ Signature Wm?w Date: 11/27/2018 Page 14 of 26 BOROUGH OF ROSELLE PARK NON-COLLUSION AFFIDAVIT State of New Jersey County of Essex ss.? 1, Marian urphqueiner Ofthe City of Roseland in the County of Essex and State of New Jersey full age, being duly sworn according to law on my oath depose and say that: 1am Vice President 0fthe?1?m of Brown Brown Metro, LLC (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 Brown 8? Brown Metro, LLC (name of contractor). Subscribed and sworn to before me this 27 day of November . 2018 . X. "70%ersz Wk my Marian Murphy- einer (Type or print name of af?ant under signature) Notary public of My Commission expires Page 15 of26 BOROUGH OF ROSELLE PARK AF FIRMATIVE 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 NJ .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 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 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 ofevidence. 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: Brown Brown Metrqu?LC SIGNATURE: PRINTNAME: rian Murphy- ner TITLE: Vice President DATE: 1 1/27/2018 Page 16 of 26 BOROUGH OF ROSELLE PARK EXHIBIT A MANDATORY EOLIAL 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 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 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 agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken Page 17 Of26 EXHIBIT A MANDATORY E0 UAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (PL. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS (Continued) without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after noti?cation of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal 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 11 of the Americans with Disabilities Act of 1990 (the "Act") (42 US. 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: Brown Brown Metro, LLC Signature: FullNametl rint): Marian Mu -Weiner Title: Vice President Date 1 1/27/2018 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 ccrti?catigg will render a bidder?s proposal non-resPonsive. PLEASE CHECK EITHER BOX: I certify, pursuant to Public Law 2012, c. 25, that neither the person/entity listed above nor any of the entity?s parents, subsidiaries, or 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 THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, USE ADDITIONAL PAGES). Name: Relationship to Bidder/Vendor: Description of Activities: Duration of Engagement: Anticipated Cessation Date: Bidder/ Vendor: Contact Name: Contact Phone Number: Page 20 of 26 DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN (Continued) CERTIFICATION I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certi?cation on behalf of the below-referenced person or entity. I acknowledge that the Borough of Roselle Park is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certi?cation through the completion of contracts with the Borough of Roselle Park to notify the Borough of Roselle Park in writing of any changes to the answers or information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certi?cationrecognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreements(s) with the Borough of Roselle Park and that the Borough of Roselle Park at its option may declare any contract(s) resulting from this certi?cation void and unenforceable. Full Name (Print): Marian MUI?phy-Weiner Signature: W?a?F?r Title: Vice F??sident Date 11/27/2018 Bidder/Vendor: Brown Brown Metro, LLC Page 21 of 26 BOROUGH OF ROSELLE PARK INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM Certi?cate(s) of Insurance shall be ?led with the Borough Clerk's Of?ce upon award of contract by the governing body The minimum amount of insurance to be carried by the Professional Service Entity shall be as follows: PROFESSIONAL LIABILITY INSURANCE . Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy period. Acknowledgement of Insurance Requirement: DATE: 11/27/2018 (Printed Name Title) Page 22 of 26 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE OF NEW JERSEY SS. COUNTY OF Essex I, Murphy-Weiner Marian 0f the Borough of Roseland in the County of Essex 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 Vice President of the ?rm of Brown a Brown Metro. LLC . 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. Subscribed and sworn to before me this 27 day of NOVember . 201_8 4/ (Si nature of Pro si rial} tme: Marian Mu MWeiner Title: Vice President (Signature of Notary) (Af?x Seal) l. 212:2, Page 23 of 26