REQUEST FOR PROPOSAL TRANSIT VILLAGE COMMUNITY VISIONING PLANNING SERVICES FOR THE BOROUGH OF ROSELLE PARK November 30, 2018 Prepared By: Victor E. Vinegra, PE, PP, PLS License No. 34460 Harbor Consultants, Inc. 320 North Avenue East Cranford, NJ 07016 908-276?271 5 908?709-173 8 victow@hcicg.net 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 Completed Submission Form Quali?cation Statement Statement of Ownership Disclosure Non?Collusion Af?davit Required EEO/Af?rmative Action Evidence Signed Compliance Notice Acknowledgement of Americans with Disabilities Act Language of 1990 Disclosure of Investment Activities in Iran Insurance Requirement Acknowledgement Form Certi?cation Regarding Political Contributions New Jersey Business Registration Celti?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 ofvendor: Harbor Consultants Inc Date: Signature: X. PrintName: Victor E. Vinegra 7 Title: President Page 10 of 29 BOROUGH OF ROSELLE PARK SUBMISSION FORM QUALIFICATION STATEMENT (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 1. Names and roles of the individuals who will perform the services and description of their education and experience with projects similar to the services contained herein: Victor E. Vinegra, P.E., P.P., P.L.S. Education: Bachelor of Science Degree in Civil Engineering, New Jersey institute of Technology, 1983 Professional Engineer State of New Jersey #34460 Professional Planner State of New Jersey #34460 Professional Engineer State of Delaware #8003 President, New Jersey Board of Professional Planners Mr. Vinegra is President of Harbor Consultants inc., and oversees the management and operation of firm, as weli as providing engineering, and land surveying services for the past 25 years. His extensive experience includes the design and management of engineering projects, scheduling of project teams and professional testimony at public hearings. As a Professional Engineer, Land Surveyor and Planner, Mr. Vinegra specialized in the field of land use planning and value based engineering. He has completed advanced degrees in environmental engineering and advanced engineering practice in open and closed hydraulic systems. He has worked on a variety ofjobs and projects such as sanitary sewage pumping facilities, environmental cleanup and remedial design, roadway design, traffic analysis and feasiblity studies. He has created and implemented Master Plans for various townships, site plans and subdivision plans form initial concept design to total project build?out. He excels in the field of Construction Management, inspection and Consuiting. As a Professionai Engineer, he has testified before numerous Planning and Zoning Boards of Adjusernent throughout the State of New Jersey. Harbor Consultants performs engineering and design services for construction projects which total over 100 million construction dollars annuaiiy. Page 8 01?26 BOROUGH OF ROSELLE PARK SUBMISSION 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: Michael Mistretta, PP, LLA Education: Bachelor of Science Degree in Environmental Planning and Landscape Architecture Rutgers, The State University of New Jersey, Cook College, 1987 Professional Planner State of New Jersey: #33Lt00575900 Licensed Landscape Architect State of New Jersey: 21A800086100 Member of the American Planning Association Member of the American Society of Landscape Architecture Mr. Mistretta specializes in land use and zoning redevetopment and environmental planning causes in the State of New Jersey. He is the consulting muncipai planner for the Township of Berkeley Heights, Township of Berkeley Heights Zoning Board of Adjusmtment, Township of Scotch Plains Planning Board, Township of Hillside Zoning Board of Adjustment, Borough of Englewood Cliffs, Township of Cranford, City of Hackensack, City of Elizabeth and provides assistance with the firms planning responsibilities for the Borough of Garwood as well as the City of Elizabeth Planning Board and Zoning Board of Adjustment. in these positions, Mr. Mistretts is responsible for the preparation of Redevelopment Studies, Redevelopment Plans, Land Use Ordinances, Master Plans, and Council on Affordable Housing (COAH) Plans. He regularly prepares project review reports on site plan, subdivision and use variance applications and testifies before the various boards and governing bodies for the municipalities the firm represents. He also manages a private client group ranging from mixed use residential developments to commercial and industrial projects throughout New Jersey. Mr. Mistretta has extensive experience in obtaining a wide range of complex regulatory approvais at the local, county and state level with an emplhasts on the Department of Land Use Regulation Program, Waterfront Development, Freshwater Wetland and Flood Hazard Area Permits. Page 8 of26 BOROUGH OF ROSELLE PARK SUBMISSION 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: Anthony G. Gaiterano, P.E., PP. Education: Bachelor of Science Degree in Civil Engineering New Jersey institute of Technoiogy 1983 Professional Engineer State of New Jersey: Professional Engineer State of Professional Engineer State of New York: 6735709 Professional Planner State of New Jersey: 33Ll00402100 lVlr. Gallerano is a principal engineer of Harbor Consuitants, inc, and provides engineering, professional pianning, project management and design services for projects in both the public and private sectors. His experience is in the area of site development, subdivisions, municipal engineering, solid waste management, recreational facilities, public bidding and educational facilities. He has provided planning and engineering consulting for municipal planning boards and zoning board of adjustments including application review, expert engieering and planning testimony, zoning ordiance review, master plans and preparation of municipai ordiances. His experience includes site design. subdivision. stormwater management. water quality design. utilities design, floodplain managment, grading design, roadway improvements, iighting and iandscaping plans, underground storage tank removat, spill presention plans, water system design, pumping stations, soil erosion and sediment control plans, iandtill design and reguiatoiry compliance. Mr. Gallerano is a licensed Professional Engineer in the State of New Jersey, and New York and is a licensed Professional Planner in the State of New Jersey. Page 8 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 2. References and record of success of same or similar service: Borough of Garwood: Roadway and Drainage improvements; Stormwater Management Design and inspection Services; Site inspections; Planning Board Service and Review; Zoning Board of Adjusment Service and Review; Land Surveying Services Reference: Christina M. Ariemma, RMC Borough Clerk 5308?7890710 City of Elizabeth: Professionai Planning Services; Planning Board reviews; Zoning Board of Adjustment reviews; Site inspections; Roadway improvements; Development Application Review; Master Plan Road Reconstruction Projects; Geographic information System Deveiopment Reference: Eduardo Rodriguez, Director of Department of Planning Community Deveiopment 908620-4160 Township of Berkeley Heights: Township Planner, Redeveiopment Studies; Zoning Board of Adjustment Reviews; Municipal Parking Lot Design; Roadway improvements; Master Plan Reference: John Bussiculo, Borough of Kenilworth: Municipal Engineer; Stormwater Management Design and inspection Services Preparation of Stormwater Management Ordinance; Preparation of Municipal Stormwater Mangement Plan; Master Pian; Roadway improvements; Road Reconstruction Projects; Construction Observation Land Surveying Services; Roadway Resurfacing Projects Reference: Laura Reinertsen, Borough Clerk 908?276?9090 Page 9 of26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 3. Description of ability to provide the services in a timely fashion (including staf?ng, familiarity and location of key staff): Harbor Consultants, Inc. is a progressive engineering, planning and land surveying firm with over 30 years experience in New Jersey. Our Professional staff provides a full range of consulting services to our clientele on a multitude of projects. Utilizing the latest advances in technology, Harbor Consultants can expedite your project to meet the most stringent of time frames. provides diversity in the consulting field by servicing both the public and private sectors. Completed proiects range from mini mails to regional mega mails; plot plans to 300 unit subdivisions; roadway resurfacing to major highways; sewer force mains to submerged pipelines; GPS surveys to title surveys; underground tunnei surveying to aerial digital orthro photography. is presently the consuiting Planner for the City of Elizabeth, the Township of Berkeley Heights, the Township of Scotch Plains, Township of Craford, Borough of Englewood Cliffs, Township of Hillisde, the Borough of Kenilworth, the Borough of Garwood and the City of Hackensack. Harbor Consultants is also the Consulting Engineer for the City of Elizabeth and the Borough of Garwood. In addition is the Municipal Engineer for the Borough of Kenllworth. Harbor Consuttants satisfies the requirements and is certified a Small Business Enterprise (SBE) in the State of New Jersey. assists clients in meeting quotas on Set?Aside projects for the New Jersey Department of Transporation (NJDOT), New Jersey Transit, New York New Jersey Port Authority and the New Jersey Turnpike. will furnish all equipment, office space and supplies to perform the work and field work necessary for the completion of the project within the time period alloted. The persons who will be assigned to perform the specified work are as follows: Victor E. Vinegra, PE, PLS, Anthony Gallerano, PE, Michael PP, Christian Cueto, PE, Jose Betances, PE, Katherine O'Kane, PP, All staff is located at: Harbor Consultants inc, 320 North Avenue East, Cranford NJ 07016. Harbor Consultants, lnc., is a corporation in the State of New Jersey, in practlve since May 1985. is a privateiy owned company that has been under the same managment since the creation of the firm. is fully compliant with all Affirmative Action local, state, and federal regulations with regard to Affirmative Page 10 of26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 3. Description of ability to provide the services in a timely fashion (including staf?ng, familiarity and location of key staft): Action A copy of HCi?s Certificate of Employee Information Report is contained in this proposal Currently no individuals at Harbor Consultants are disbarred, suspended or prohibited from professional ptactice. Harbor Consultants has not been tnvoived in any bankruptcy or reorganization proceedings. Currently no individuals at have any immediate relatives who are Authority employees or elected officials. Professional Services provided, including but not limited to: Civii Engineering/Site Development; Construction Management Inspections; Ecoiogical Services; Geotechnical Engineering; Grant and Funding Applications; Hydrographic Services; Land Surveying; Landscape Architecture; Municipal Engineering; Parks and Recreation Planning/Design; Professional Planning; Project Management; Regulatory Compliance; Stormwater Mangement; Structural and Building Design; Traffic and Transporat?on Engineering; Water and Wastewater Engineering; Wetlands Studies; Urban Renewai/Development; Riparian Rights. Page 10 of 26 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 4. Cost details, including the annual fee for primary duties and the hourly rates of each of the individuals who will perform services, and all expenses for any work that is not included in the primary duties: Principal Engineer: $115 Professional Engineer/Board Review: $115 Design Engineer: $95 Junior Engineer: $75 Principal Planner: $115 Professional Planner/Board Review: $115 Project Manager: $115 Certified Landscape Architect: $115 Environmental Planner: $115 Manager: $105 Senior CADD GIS Designer: $95 CADD Designer/G18 Technician: $80 Professional Land Surveyor: $115 Construction Manager: $115 Construction Observation: $105 Field Land Surveying Crew: $190-205 CERTIFICATION OF PROPOSAL (Sign Below) F?mj Harbor Consultants Inc. Dam: 11/28/18 Authorized Representativel(Pr' 1: V1 ctor - V1n99 ra )5 Signature: I T?b: Pres 'ent 908?276-2715 908-709?1738 Pagel4of29 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (BL. 1977, 2.33, as amended by P.L. 2016, (L43) THIS STATEMENT SHALL BE COMPLETED, CERTIFIED TO, AND INCLUDED WITH ALL BID AND PROPOSAL SUBMISSIONS. FAILURE TO SUBMIT THE REQUIRED INFORMATION IS CAUSE FOR AUTOMATIC REJECTION OF THE BID OR PROPOSAL. Name of Organization: Harbor Consultants Inc Organization Address: 320 North Avenue East, Grantord NJ 07016 Part I Check the box that represents the type of business organization: Sole Proprietorship (skip Parts and execute certi?cation in Part IV) UNon?Pro?t Corporation (skip Parts II and execute certi?cation in Part IV) For~Pro?t Corporation (any type) DLimited 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 stockhoider in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited iiability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) Page 12 of 26 STATEMENT OF OWNERSHIP DISCLOSURE (Continued) (Please attach additional sheets if more space is needed): Name of Individual or Business Entity Home Address (for Individuals) or Business Address Victor E. Vinegra 425 Hazel Ave Garwood NJ 07027 Part DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II If a bidder has a direct or indirect parent entity which is 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 beneficial 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 ll 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 52225?242 has been listed. Attach additional sheets if more space is needed. Steekholder/Partner/Member and Home Address (for Individuals) or Business Address Corresponding Entity Listed in Part 11 Victor E. Vinegra 425 Hazel Ave Garwood NJ 07027 Page 13 of 26 STATEMENT OF OWNERSHIP DISCLOSURE (Continued) Part IV Certi?cation I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. 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 ceiti?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. FullName (Print): Victor E.1Vinegra Title: President Signature: Date: 11 /28/?l 8 Page 17 of 29 BOROUGH OF ROSELLE PARK AFFIDAVIT State of New Jersey County of Union ss: 1, Victor . Vinegra ofthe City of Garwood in the County of Union and State of New ersev full age, being duly sworn according to law on my oath depose and say that: lam President ofthe ?rm of Harbor Consultants Inc . (Title or Position) (Name of Firm) the bidder making this Proposal for the above named project, and that I executed the said proposal with full authority so to do; that said bidder has not, directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and in this af?davit are true and correct, and made with 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 name of contractor . Subscribed and sworn to before me this 2 8th day 0f November I, 101 8 - X. Signature Victor E. Vinegra (Type or print name of af?ant under Signature) [Notary/ 11th of 1 UN ?8th masts ii at St NEW Jags . Commission expires Page 18 of 29 BOROUGH OF ROSELLE PARK AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5-31 and N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS This form is a summary of the successful bidder?s requirement to comply with the requirements of N.J.S.A. 10:5?31 and N.J.A.C. 17227?1 et seq. The successful bidder shall submit to the public agency, after noti?cation of award but prior to execution of this contract, one of the following three documents as forms of evidence: a) A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned af?rmative action program (good for one year from the date of the letter); OR b) A photocopy of a Certi?cate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27?4; OR o) A photocopy of an Employee Information Report (Form AA302) provided by the Division and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4. The successful vendor may obtain the Af?rmative Action Employee Information Report (AA3 02) from the contracting unit during normal business hours. The successful vendor(s) must submit the copies of the AA3 02 Report to the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public agency, and the vendor copy is retained by the vendor. The undersigned vendor certi?es that he/she is aware of the commitment to comply with the requirements of NJ .S.A. 10:5-31 and N.J.A.C. 17:27.1 et seq. and agrees to furnish the required forms of evidence. The undersigned vendor further understands that his/her bid shall be rejected as non?responsive if said contractor fails to comply with the requirements of NJ .S.A. 1025?31 and N.J.A.C. 17:27?1 et seq. COMPANY: Harper/Consultants Inc . SIGNATURE: PRINTNAME: Victor E. Vinegra PreSident 11 2818 DATE: Page 19 of 29 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. 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 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 eveiy 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. Fulthermore, 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: Consultants Inc. Signature: a Full Name (Print): Victor E. Vinegra Title: President Page 22 of 29 BOROUGH OF ROSELLE PARK DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN PART 1: CERTIFICATION BIDDERS MUST CONIPLETE 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 Depaitment of Treasury?s Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found 011 the Division?s website at Bidders must review this list prior to completing the below certi?cation. Failure to complete the celti?cation will render a bidder?s proposal non-responsive. PLEASE CHECK EITHER BOX: I certify, pursuant to Public Law 2012, c. 25, that neither the person/entity listed above nor any of the entity?s parents, subsidiaries, or af?liates 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 FL. 2012, c. 25 (?Chapter 25 List?). I further certify that I am the person listed above, or I am an of?cer or representative of the entity listed above and am authorized to make this certi?cation on its behalf. I will skip Part 2 and sign and complete the Certi?cation below. OR El I am unable to certify as above because I or the bidding entity and/or one or more of its parents, subsidiaries, or af?liates is listed on the Department?s Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below and sign and complete the Certi?cation below. Failure to provide such will result in the proposal being rendered as non?responsive and appropriate penalties, fines 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 celti?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 ??om this certi?cation void and unenforceable. FullName(Print): Victor E. Vinegra . Signature: 452/ Title: President Date 11/28/18 Bidder/Vendor: Harbor Consultants Inc. Page 24 of 29 BOROUGH OF ROSELLE PARK INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM Certi?cate(s) of Insurance shall be filed with the Borough Clerk's Of?ce upon award of contract by the governing body The minimum amount of insurance to be carried by the Professional Service Entity shall be as follows: PROFESSIONAL LIABILITY INSURANCE Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy period. Acknowledgement of Insurance Requirement: SIGNATURE: DATE: 11/28/18 Victor E. Vineqra, President (Printed Name Title) Page 25 of 29 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE OF NEW JERSEY SS. COUNTY OF Union 1, Victor E. Vinegra President of the Firm of Harbor Consultants in the County of Union and the State ofNew Jersey, of_ full age, being duly sworn according to law on my oath depose and say that: I am the President of the ?rm of A Harbor (?on {?gnf 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 Sen/ice 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; firm; corporation; professional corporation; partnership; organization; or association. The definition 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 gy?i day of 201! (Signature of Professional) Name: Victor . Vinegra Title: President (Sigri?atpr? wary) JOHN MUTTA x? (Afflx ATTORNEY new or NEW JERSEY 8/6 I) Page 26 of 29 Taxpayer Identi?cation# 222-673-191I000 Dear Business Representative: Congratulations! You are now registered with the New Jersey Division of Revenue. Use the Taxpayer Identification Number listed above on all correspondence with the Divisions of Revenue and Taxation. as well as with the Department Of Labor (if the business Is subject to unemployment withholdings). Your tax returns and payments will be filed under this number. and you will be able to access Information about your account by referencing it. Additionally. please note that State law (Public Law 2001, [2.134) requires all contractors and subcontractors with State, county and municipal agencies to provide proof of their registration with the Division of Revenue. The law also amended Section 92 of the Casino Control Act. which deals with the casino service industry. We have attached a Proof Of Registration Certi?cate for your use. To comply with the law. If you are currently under contract or entering into a contract with a State. county or municipal agency. you must provide a copy of the certi?cate to the contracting agency. If'you-have any-questions or require more information. feel free to call our Registration Hotline at (609) 1292?1130;. I wish'yOu continuedsuccess in your business endeavors. .. - -.. Sincerely. 62m 4. Patricia A. Chiacchio EFFECTIVE DATE: . 10103I85 WU Director. Division of Revenue- I FORM-BRO 08-0 f? Th 5 Cortl?cato_ NOT an . abiooln bl . II_-mu i Director. Division of Revenue i-?W {13 - (a I STATE OF NEW JERSEY 5 =2 BUSINESS REGISTRATION CERTIFICATE B??gmguFTROFq-Jzug?sum/ FOR STATE AGENCY AND CASINO SERVICE CONTRACTORS po sci-I252 EVE . TRENTON- 08848-0252 53- ?a-vav' v1- .2 If- TAXPAYER NAME: . TRADE NAME: HARBOR CONSULTANTS. INC. TAXPAYER CONTRACTOR 53 222-673-191I000 0105454 ADDRESS ISSUANCE DATE: =5 320 NORTH AVE CRANFORD NJ 07013 10125101 a'u?FFWo'u?h'?'?a 'n i xiv-.1 . i. ?y 1 Wr My: :5..ng H1 31' I i.l Form 9 (Rev. October 2018) Department of the Treasury Internal Revenue Service Harbor Tnh' 2 Business name/disregarded entity name, if different from above Request for Taxpayer Identification Number and Certification Go to for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Give Form to the requester. Do not send to the IRS. following seven boxes. individual/sole proprietor or Corporation single-member LLC Print or type. Other (see instructions) IE Corporation Limited liability company. Enter the tax classification corporation, corporation, P=Partnership) Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single?member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for US. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Partnership Trust/estate Exempt payee code (if any) code (if any) (Applies to accounts maintained outside the US.) 5 Address (number, street, and apt. or suite no.) See instructions. 320 North Avenue East See Specific Instructions on page 3. Requester's name and address (optional) 6 City, state, and ZIP code Cranford NJ 07016 7 List account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Social security number or I Employer identification number 22?2673191 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: i am exempt from backup withholding, or have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a US. citizen or other US. 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. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Signature of Here U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form and its instructions, such as legislation enacted after they were published, go to Purpose of Form An individual or entity (Form requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. 0 Form (interest earned or paid) Date> 11?28?1 8 - Form (dividends, including those from stocks or mutual funds) - Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) - Form 1099?8 (stock or mutual fund sales and certain other transactions by brokers) - Form 1099?8 (proceeds from real estate transactions) - Form 1099-K (merchant card and third party network transactions) - Form 1098 (home mortgage interest), (student loan interest), 1098-T (tuition) - Form 1099-C (canceled debt) - Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a US. person (including a resident alien), to provide your correct TIN. If you do not return Form to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018)