REQUEST FOR PROPOSAL FOR STATE FISCAL YEAR 2012 ADOLESCENT PREGNANCY PREVENTION INITIATIVE CONTACT PERSON: Kathy Arrington, Director Office of Budget & Purchasing MAILING ADDRESS: Atlantic County Government Division of Budget & Purchasing 6th Floor 1333 Atlantic Ave. Atlantic City, NJ 08401 PROPOSAL DUE: 11:00 am APRIL 20, 2011 REQUEST FOR PROPOSALS Public Notice is hereby given that SEALED PROPOSALS will be received by the Purchasing Agent of the County of Atlantic, New Jersey at 11:00am prevailing time on APRIL 20, 2011 in the Atlantic County Conference Room; 3rd Floor; 1333 Atlantic Avenue; Atlantic City, New Jersey for : RFP 201110.3 REQUEST FOR PROPOSALS FOR STATE FISCAL YEAR 2012 ADOLESCENT PREGNANCY PREVENTION INITIATIVE Specifications and blank Bid Forms may be obtained online at the following web address http://bids.aclink.org Any questions concerning this specification must be directed to the Office of Budget & Purchasing in writing by email to purchasing@aclink.org or fax (609) 343-2193 Proposers are required to comply with requirements of NJSA 10:5-31 et seq. and N.J.A.C. 17:27 Proposers must abide by the New Jersey Prevailing Wage Act, P.L. 1963, Chapter 150. The Contractor must comply with the applicable special “Pay to Play” restrictions adopted by the Board of Chosen Freeholders The County of Atlantic reserves the right to reject any or all proposals By order of the County Executive of the County of Atlantic Kathy Arrington; Director, Budget & Purchasing County of Atlantic, New Jersey REQUEST FOR PROPOSAL TABLE OF CONTENTS COVER PAGE COPY OF LEGAL NOTICE TABLE OF CONTENTS GENERAL INFORMATION DETAILED SCOPE OF SERVICES/SPECIFICATIONS PROJECT PROPOSAL (to be submitted with the proposal) Proposal Political Contribution Form Affirmative Action Requirements Non-Collusion Affidavit Recycling Compliance Affidavit APPENDIX Sample Contracts Other Sample Forms (Grants etc) Insurance Requirements RFP CHECKLIST I-1 REQUEST FOR PROPOSALS FOR STATE FISCAL YEAR 2012 ADOLESCENT PREGNANCY PREVENTION INITIATIVE PART I - INTRODUCTION The County of Atlantic is requesting proposals for STATE FISCAL YEAR 2012 ADOLESCENT PREGNANCY PREVENTION INITIATIVE Proposals may be mailed and delivered to: Kathy Arrington, Director of Budget & Purchasing Atlantic County Government 1333 Atlantic Ave.; 6th Floor Atlantic City, NJ 08401 Proposals must be submitted on or before APRIL 20, 2011 by 11:00 a.m. Late submissions will not be entertained. PART II - GENERAL CONDITIONS A. Instructions All questions must be answered. All forms and required certifications, which are located at the end of the RFP, (Affirmative Action, Political Contribution Form, Non-Collusion Affidavit, Recycling and Insurance Certificate) must be completed and submitted with your proposal. Each proposal shall include a Letter of Transmittal which bears the original signature of an authorized representative of the vendor and which also includes the name of individuals authorized to negotiate with the County of Atlantic. Each proposal shall include a full explanation of the services that will be provided. Proposals shall be in sufficient detail to determine and evaluate the services provided. One original and five (5) copies of the completed proposal must be delivered by APRIL 20, 2011 to the Atlantic County Office of Budget and Purchasing, 6th Floor - 1333 Atlantic Avenue, Atlantic City, New Jersey 08401 by 11:00 a.m. EDT on that date. Late proposals will not be eligible for review. Each proposal must be submitted in a sealed envelope bearing on the outside the name and address of the preparer and the name of the subject of the proposal. Proposal prices are to remain firm for a period of not less than sixty (60) days to allow the County to determine the best proposal that shall most economically serve the intentions of this proposal. I-1 B. Proposer Qualifications The proposal must include: the company history, a list of vendor credentials, and experience statement to include but not limited to any experience with similar projects. The preparer shall furnish to the County of Atlantic any and all such information, documentation and data for this purpose, as the County of Atlantic may request. The County of Atlantic reserves the right to reject any proposal should the information submitted by or investigation of such vendor fail to satisfy the County of Atlantic. Proposals must specify any deviations from the requirements. The County reserves the right to reject any or all items covered in the proposal request, or any portion(s) thereof, waive informalities, re-advertise and/or take such other actions decreed necessary and in the best interest of the County of Atlantic. Failure or inability to meet any of the requirements set forth in this RFP will be sufficient reason to disqualify prepares. The County of Atlantic reserves the right not to consider any proposal that is incomplete or that does not meet the specification requirements. C. Statutory Requirements NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Section 1 of P.L. 2001,c.134 is amended to read as follows: An act concerning business registration for providers of goods and services to the State, State colleges and universities, county colleges, local contracting units, boards of educations, water and wastewater contractors and casinos, supplementing Title 54 of the revised Statues and amending P.L.1977,c.110. All non governmental proposers SHOULD submit a copy of their Business Registration Certificate with their proposal. No contract shall be entered into by any contracting agency unless the contractor provides a copy of its business registration. All proposals must comply with the provisions mandated by applicable Federal Law and New Jersey Statutes. Any provisions in the RFP which may be in conflict with any New Jersey statute are amended to conform to the minimum requirement of such statute. I-2 D. Terms The contract will be for the term effective July 1, 2011 to June 30, 2012 E. Cancellation Proposals are subject to : 1. Right of the County to cancel the contracts upon ninety (90) days written notice to the contractor. 2. The County of Atlantic reserves the right to reject any and all proposals and any part thereof and to waive any informalities, formalities, irregularities and errors in the proposals. F. Questions Please submit all questions in writing to : Attn.: Kathy Arrington, Director of Budget & Purchasing 1333 Atlantic Ave. Atlantic City, NJ 08401 or Fax to (609) 343-2193. Responses will be forwarded to all vendors who have picked up RFP packages. No firm intending to submit a proposal or any employee of any firm intending to submit a proposal shall contact any County employee for any reason either directly or indirectly related to this Request for Proposal. Any firm found violating this policy will be automatically disqualified form submitting a proposal. G. Contract The Contractor will be required to signs the standard County Contract, a copy of which is attached hereto as Attachment CT. If the contractor desires to make any modifications to the County’s contract language, or has another contract form that he/she desired the County to sign, in lieu of or in addition to the County Contract form, a sample copy of the contractor’s proposed language modifications or contract form must be submitted with the proposal, or it shall be assumed that the contract documents will consist exclusively of the County’s form contract. Modifications or additions to the County’s form contract will not be entertained after contract award. The County will not agree to sign a contract which includes a provision for dispute resolution by arbitration. H. Insurance Provider must supply with their proposals proof of insurance as detailed in Attachment INS An insurance certificate must be submitted prior to contract execution. I-3 I. Recycling The contractor must provide the County with information regarding their recycling program. The County of Atlantic has, pursuant to P.L. 1987, CH 102, adopted the Atlantic County Recycling Plan and Ordinance # 7 of 1988, which designates the following commercial and institutional materials as recyclable and mandates the recycling thereof. * Glass Food & Beverage containers: Clear, Amber, Green * Newspapers * Aluminum Beverage Cans * Office Paper (White, Non-Colored) * Computer Paper The attached recycling affidavit will need to be completed and submitted with your proposal. (Attachment R) J. Affirmative Action The Contractor will be required to comply with the requirements of PL 1975, C.127 (NJAC: 17:27 see Attachment AA One of the following items must be submitted with each proposal: 1) A copy of he contractor's federal affirmative action plan approval letter for the office of Federal Contract Compliance Programs. 2) A copy of the contractor’s certificate of employee information report. 3) Contractor’s initial affirmative Action employee information report (Form AA302) K. Attachments The provider must include all of the following with their proposal: A. Non-Collusion Affidavit must be notarized B. Political Contribution Form C. Recycling Agreement must be notarized D. Insurance Endorsement as described E. Affirmative Action requirement F. A Copy of their NJ Business Registration Certificate L. Reservations The County of Atlantic reserves the right to reject any and all proposals, and any part and to waive any formalities, informalities, irregularities and errors in proposals. A written request for the withdrawal of a proposal, or any party thereof, will be granted if the request is received by the County Purchasing Agent prior to the specified time of the proposal opening. M. Interview The County reserves the right to interview proposers, request clarification of proposals, request additional information, request modification or proposals and negotiate contract terms with the successful prepares. Bidders may be asked to explain and/or clarify their proposal to a selection committee. I-4 N. Ordinance # 10 - 2007 Public Contracting (Pay -To - Play) Reform Professional Business Entity - a “professional business entity” means an individual including the individual’s spouse, if any, and child living at home ; person; firm , corporation; professional corporation; partnership; organization; or association. The definition of a professional business entity includes all principals who own 10% or more of the equity in the corporation or business trust, partners, and officers in the aggregate employed by the entity as well as any subsidiaries directly controlled by the professional business entity. This definition excludes non-profit corporations under Internal Revenue Code (IRC), Section 501(c) (3) and their officers and board members. Prohibits Atlantic County from entering into a agreement or otherwise contract to procure professional , banking , insurance coverage services or any other consulting services provided by a licensed professional , including those awarded pursuant to any process including a fair and open process, if such professional business entity has solicited or made any contribution of money or pledge of a contribution, including in-kind contributions to (i) any campaign committee of any candidate for elective County Office or the current holders of any elective County office, or (ii) to any Atlantic County party committees, (iii) to any municipal party committee within Atlantic County , or (iv) to any candidate committee, state or county political party or any Political Action Committee (PAC) that is engaged in the financial or in kind support of candidates for elective Atlantic County offices, County elections and/or Atlantic County political parties in excess of the annual maximum of $ 300 each or up to the amount of reportable contributions as may from time to time be established by the Election Law Enforcement Commission (ELEC) for any purpose to any candidate for elective County Office or current office holder, or $500 to any Atlantic County party committee, or municipal party committee within Atlantic County , or to a single or joint campaign account of a candidate committee, state or County political party or PAC. Additionally, no business entity , which may include principals, partners, and officers of the entity in the aggregate , may not annually contribute for any purpose in excess of $ 2500 to all candidates for elective County offices and to office holders with the responsibility for the award of the contract, who are the County Executive and the members of the County Board of Freeholders. The Ordinance does not cover contributions made prior to October 22, 2007 The Proposer must complete a Political Contribution Form ,see attachment (PC), certifying that it has not knowingly made a contribution in violation of the ordinance and has not made or solicited contributions through intermediaries , third parties, immediate relatives, or Political Action Committee (PAC) for the purpose of concealing the source of the contribution. A Contractor that files an incorrect Political Disclosure Statement will have its contract with the County declared null and void and will be disqualified from being awarded any contract for a period of Four (4) years. I-5 SCOPE OF SERVICES COUNTY OF ATLANTIC REQUEST FOR PROPOSALS FOR STATE FISCAL YEAR 2012 ADOLESCENT PREGNANCY PREVENTION INITIATIVE PURPOSE OF FUNDING: The County of Atlantic is awarding grant funds for the Adolescent Pregnancy Prevention Initiative. The program will target those populations most at-risk of adolescent pregnancy and births, and will address the comprehensive needs of at-risk young women and/or men. CONTRACT PERIOD: The contract period for this Request for Proposal will be July 1, 2011 through June 30, 2012, contingent upon the award of the grant funding from the State of New Jersey. PROGRAM DESCRIPTION: Each Adolescent Pregnancy Prevention Initiative project will employ a Program Coordinator who will provide counseling and service coordination services for a minimum of 60 young women and/or men per site on an annual basis, who are identified as at-risk for adolescent pregnancy. The counseling shall include individual, group or family counseling; crisis counseling, referral and follow-up to other needed services, and provide linkages with the educational, juvenile justice, and DYFS systems. The coordinator will connect the participants to needed social services by providing information, referrals, and follow-up services to outside agencies, including, but not limited to substance abuse counseling, employment counseling, primary and preventative health care, educational support services, and housing. In addition to providing counseling and service coordination, the program coordinator will facilitate the coordination of adolescent pregnancy prevention services to ensure that the participants have access to teen-friendly, comprehensive family planning, sexuality education, and social services. These services may be provided by the managing agency and/or through the collaboration with other local community based organizations serving as partners in this grant initiative. The sexuality education component should utilize an asset building approach, promoting a balanced, comprehensive approach to risk reduction and prevention strategies including sexual abstinence, monogamy, methods of contraception, an understanding of sexual abuse, rape and date rape, and prevention education for HIV and other sexually transmitted infections. Sexuality education should also include life skills building and communication skills such as negotiation, refusal, and relationship development. S-1 The program coordinator will ensure that the participants have access to the following family planning services: reproductive health care, STD testing, pregnancy testing, and sexuality education. [Note: Grant monies can not be used to pay for contraception or abortion services.] TARGET POPULATION: Research shows that the characteristics of youth most at risk of pregnancy include being in the lowest quarter of their school class, being overage for their grade level, and showing the sexual characteristics of adults earlier than peers. They are likely to have a home life that is sexually exploitive, neglectful, chaotic and/or poverty stricken and to have siblings or parents who gave birth during their adolescent years. There is a high correlation between the use of drugs and alcohol and adolescent pregnancy. AMOUNT OF AVAILABLE FUNDING: Funding for this Request for Proposal will be available for State Fiscal Year 2011. A total of $147,717 in grant funds is available for these projects. See program locations for site amounts. LOCATION OF SERVICES: Please note that the resulting contract will be for one agency to provide services to all locations described For the contract period 7/1/11 through 6/30/12, services are to be provided at the following locations: Oakcrest High School, Hamilton Township NJ Total amount of funds available: $62,777** Buena Regional High School, Buena NJ Total amount of funds available: $64,000* Clearey Middle School, Buena Regional School District Total amount of funds available: $20,940 **Program is funded through NJ APPI funds. *Includes $25,000 from Buena School District STAFFING: The Adolescent Pregnancy Prevention Program Coordinator shall have the following qualifications: • MSW, MS, or MA or the equivalent in a social service related field (e.g. social work, counseling, psychology, health education, etc.) for staff funded by State APPI funding. Bachelor’s level staff may be approved on a case by case basis for non State APPI funds. • The ability to provide counseling and service coordination • The ability to work with a community collaborative partnership S-2 • • • • • • Previous experience working with adolescents at-risk for pregnancy and other factors Full time twelve (12) month position* A Licensed clinical social worker is required to provide clinical supervision of the APPI Coordinator* Will attend all statewide meetings and professional development trainings provided by the Department of Children and Families* Will attend a minimum of 2 professional development opportunities pertaining to adolescent health and well being* Agency agrees to participate with the APPI Management Information System (MIS) which includes Internet access and the entry of data as required by the State of New Jersey. In addition, the State of NJ may require additional reporting requirements during the contract period* *Requirements are for program staff hired with NJ APPI funds. Roles: • Serve as a liaison to the school and the local community based organizations collaborating to serve students identified as at-risk for adolescent pregnancy • To counsel program participants individually or in group, when appropriate • To run programs such as pregnancy prevention, HIV prevention, decision making, communication skills, negotiation and refusal skills, life skills, etc. • To provide information to, and help maintain connections to already existing school and community resources • To maintain and expand the collaborative services provided to young women and/or men, who are at-risk of adolescent pregnancy, ensuring that family planning services are teen-friendly and comprehensive • To provide referrals and follow-up when a teen needs the services of outside agencies and/or collaborate with local School Based Youth Services Program(s) when applicable. ALLOWABLE USE OF FUNDS: Funds may be used for: • Salaries/fringe for program staff; • Expanding services of existing programs; • Program materials, supplies and equipment; • Professional development activities (quotes from consultants, price list of training materials, videos, staff release time, substitute costs, and travel); and/or • Costs to the agency to support this grant (up to 10% of the grant amount) S-3 Funds may not be used for: • Purchase/construction of facilities, including additions and extensions, or for the acquisition of land. • Purchase of vehicle(s). REVIEW PROCESS: A review panel composed of representatives of county government and private, not-forprofit agencies will review the applications. The committee will make recommendations on the contract to provide the requested services based on the most advantageous proposal. The award will be made to the most responsive proposer who, in the opinion of the County, best meets all of the conditions and specifications contained in this RFP. The grant applications will be rated on the basis of the criteria listed below. APPLICATION SELECTION CRITERIA: The applications will be evaluated and scored in accordance with the criteria listed below, in the “Proposal Content Outline” section. The maximum score for all proposals shall not exceed 100 points. PROPOSAL CONTENT OUTLINE: Proposals submitted for consideration must include all of the following sections in the order stipulated and numbered in the same manner. Incomplete proposals will not be considered. One signed original and five (5) copies must be submitted. A. Narrative 1. Organization Mission and Goals - Describe your agency’s history, mission, and goals and how they relate to the proposed program. If the agency is a private non profit, please attach the most current listing of your Board of Directors (5 points) 2. Experience of the Agency/Organization - Describe your agency’s administrative, management, and organizational capacity to carry out the proposed program. (5 points) 3. Goals and Objectives - Identify and describe your organization’s goals and objectives concerning the proposed program/services to be provided. (10 points) S-4 4. Location of Services - Identify the specific location/address where each of the various service components will be provided. (5 points) 5. Program Design (specify all services to be provided) Provide a detailed description of the total program design, including the program/services to be provided by your organization and the collaborative partners, and the specific activities that program staff will employ to achieve the program objectives. Outline the program objectives, the total enrollment in the program, the targeted population to be served, strategies to recruit and retain participants, and the days/hours of operation. Include a 12 month detailed timeline for the provisions of services. (30 points) 6. Collaboration - As related to this program, identify by name the community resources with which your organization will be collaborating, the nature of the collaboration and previous experiences with the partnerships, the program/services the collaborating community organizations will be providing, the days/hours/location of their operation and how the collaborative program/services will be coordinated. (10 points) 7. Evaluation – Describe the agency’s ability to evaluate the proposed program. Describe the methodology your organization will utilize to evaluate the effectiveness of the program. For services at the Oakcrest High School APPI funding), the following outcome measures must be addressed: (20 points) • • Goal: Youth will not become pregnant while enrolled in APPI o Outcome: 97% of youth who complete the program will not become pregnant prior to high school graduation. o Objective: To assess sustainability of program goals over the course of the participant’s high school career o Activity: Each small group counseling participant will complete the post survey prior to the end of each school year including the year the participant graduates. There is a survey question that asks if the participant is or has been pregnant. Goal: Youth will demonstrate improved knowledge of safe sex practices. o Outcome: 95% of youth who complete the program will demonstrate improved knowledge of safe sex practices. o Objective: To assess effectiveness of curriculum used and information retained by participants S-5 o Activity: Each small group counseling participant will complete a pre and post survey to assess for improvement between program entry and program exit. 8. D. Staffing - Describe in detail the number, qualifications, and skills of the program staff that will perform the service activities. Describe the management and supervision methods that will be utilized in the operation of the program. (5 points) Budget Narrative (5 points) Provide a narrative that explains the budget and shows a clear link between the services and activities, the core components, and the proposed spending plan. Provide a full description of the functional roles of all proposed program staff. Locate and describe proposed program staff relative to their respective agency’s staffing pattern or table of organization. On a separate sheet, describe the job title, responsibilities, and qualifications for each program staff position. E. Budget Detail Summary (5 points) A separate budget must be provided for each program location. Provide an itemized summary of the budget detailing proposed expenditures. The budget must be shown to be reasonable and practical within the context of the program description and rationale, the goals and objectives, and the program design, for the duration of the grant program. Funds must be allocated appropriately across budget line items and the Budget Detail Summary must support and justify the funds requested in this proposal. S-6 CONTRACT FORMS PROPOSAL FORM Date________________ The undersigned, having read the Notice to Proposers, Invitation to Submit Proposal, Instructions to Proposers, and Scope of Services attached hereto and having thoroughly investigated all existing conditions, equipment, material and labor required for PROVISION OF SERVICES AS OUTLINED IN THESE SPECIFICATIONS in strict accordance with this Request for Proposal, hereby agrees to complete said work, as follows: LOCATION FUNDS REQUESTED Oakcrest High School, Hamilton Township NJ **Program is funded through NJ APPI funds. Buena Regional High School, Buena NJ *Includes funds from Buena School District Clearey Middle School, Buena Regional School District Annual Cost for all Services __________________________ Signature ________________________________________________ PROPOSER MUST COMPLETE AND SIGN ALL PF PAGES PF-1 PROPOSAL FORM Partnership The undersigned is a Corporation under the laws of the State of______________________________ Individual having Principal Offices at ___________________________________________________________ ________________________________________________________________________________, and is authorized to conduct business in the State of New Jersey. NAME OF BIDDER ________________________________________________________________________________ Person Firm/Corporation BY:_____________________________________________________________________________ Signature Print Name ________________________________________________________________________________ Street Address ________________________________________________________________________________ City/State Zip code ___________________________________________________________________________ Telephone Fax Email _____________________________________________ PROPOSER MUST COMPLETE AND SIGN ALL PF PAGES PF-1 ATLANTIC COUNTY ORDINANCE #10 POLITICAL CONTRIBUTION FORM PART I: CERTIFICATION I hereby certify as follows: 1. On or after October 22, 2007, the below-named person or entity has not solicited or made any contribution of money, pledge of contribution, including in-kind contributions, company or organization contributions, as set forth below that would bar the award of a contract to the "professional business entity", pursuant to the terms (Pay-to-Play Reform Ordinance #10). a) Within the 12 months immediately preceding the date of the contract or agreement (exclusive of any contributions made prior to October 22, 2007), the below-named person or organization has not made a contribution to: (i) any campaign committee of any candidate for elective County office or to the current holders of any elective County office, or (ii) any Atlantic County party committee, or (iii) any municipal party committee within Atlantic County, or (iv) any candidate committee, state, or county political party or any Political Action Committee (PAC) that is engaged in the financial or in kind support of candidates for elective Atlantic County offices, County elections and/or Atlantic County political parties, or (v) any intermediary on the condition or with the agreement that it will be contributed to a campaign committee for elective County office or to the current holders of any elective County office. (vi) any intermediary directly or indirectly, through or by any other person or means, do any act which would subject that entity to the restrictions of the (Pay-to-Play Reform Ordinance #10). b) Between the time of first communication between that professional business entity and Atlantic County regarding a specific professional services agreement or goods and services agreement, as the case may be, and the latter of the termination of negotiations or rejection of any proposal or the completion of the contract or agreement (exclusive of any contributions made prior to October 22, 2007), the below-named person or organization has not made a Contribution to: (i) any campaign committee or any candidate for elective County office or to the current holders of any elective County office, or (ii) any Atlantic County party committee, or (iii) any municipal party committee within Atlantic County, or (iv) any candidate committee, state, or county political party or any Political Action Committee (PAC) that is engaged in the financial or in kind support of candidates for elective Atlantic County offices, County elections and/or Atlantic County political parties, or (v) any intermediary on the condition or with the agreement that it will be contributed to a campaign committee for elective County office or to the current holders of any elective County office (vi) any intermediary directly or indirectly, through or by any other person or means, do any act which would subject that entity to the restrictions of the (Play-to-Pay Reform Ordinance #10). ATLANTIC COUNTY ORDINANCE #10 POLITICAL CONTRIBUTION FORM 2. If the “professional business entity” is awarded a contract pursuant to the solicitation for this contract proposal, the below-named person or organization will , on a continuing basis, continue to report any contributions it makes during the term of the contract, and any extension(s) thereof. ____________________________________________________________________________________ CERTIFICATION ON BEHALF OF A COMPANY OR ORGANIZATION FOR A: CORPORATION OR PARTNERSHIP I certify as an officer or authorized representative of the company or organization identified below that, to the best of my knowledge and belief, the foregoing statements by me are true. I am aware that if any of the statements are willfully false, I am subject to punishment. Name of Company or Organization : ______________________________________________ Print Name:_____________________________________ Title:_________________________ Signature: ______________________________________Date:_________________________ The above individual is signing on behalf of the company in the following capacity. ______ as Officer or Executive ______ Subsidiary _____ Principal( more than 10% ownership or control ) ________ Political Organization (PAC) ______________________________________________________________________________ CERTIFICATION BY SOLE PROPRIETORSHIP I certify that , to the best of my knowledge and belief , that foregoing statements by me are true. I am award that if any of the statements are willfully false, I am subject to punishment. Print Name: ____________________________________________________________ Signature: _______________________________________Date: _______________________ ______________________________________________________________________________ Note: “Professional Business Entity” 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 professional business entity includes all principals who own 10% or more of the equity in the corporation or business trust, partners, and officers in the aggregate employed by the entity as well as any subsidiaries directly controlled by the professional business entity. PC POLITICAL CANDIDATE/COMMITTEE ACCOUNTS February 4, 2010 (Two Year Period) Current Holder of Elected Atlantic County Office and Campaign Committee for Elected Atlantic County Office Limit $300 per election cycle (primary and general) per Ord. No. 10 of 2007 Contributions over the limits on this page will disqualify contributors from County contracts Candidate Election Year Office Candidate/Committee Name1 Balles, Frank Carney, James Cooper, Alisa 2008 2005 2008 Sheriff Surrogate Freeholder Curcio, James 2009 Freeholder Dase, Richard 2007 Freeholder Foley, Jill 2007 Freeholder Balles for Sheriff Jim Carney for Surrogate Friends of Alisa Cooper for Freeholder James Curcio Finnerty Curcio and Russo Freeholder Friends of Rich Dase for Freeholder Friends of Jill Foley for Freeholder Formica, Frank Garrett, Charles Giordano, Frank Levinson, Dennis McDevitt, Joe McGettigan, Edward Russo, Thomas Sutton, Frank 2009 2007 Freeholder Freeholder 2009 Freeholder Candidate /Committee Name 2 Charles Thomas Garrett 2007 Giordano, Falcone & Mason Friends of Frank Giordano for Freeholder for Freeholder County Executive Levinson for Executive Friends of Dennis Levinson 2007 2006 Freeholder County Clerk 2006 Freeholder Joe McDevitt 4 Freeholder Ed McGettigan for County Clerk Thomas Russo 2008 Freeholder Sutton for Freeholder Any other candidate for any of the County offices listed above ……………………………………………………………………………. Any Atlantic County Party Committee or Atlantic County Municipal Committee Limit $500 per calendar year per Ord. No. 10 of 2007 Atlantic County Democrat Committee Atlantic County Republican Committee Atlantic County Municipal Committee Others Limited to $500 per calendar year per Ord. No. 10 of 2007 Any Candidate Committee; State Political Party; County Political Party; Any Political Action Committee (PAC) that are involved in the financial or in-kind support of candidates for elective County office; County election and/or Atlantic County political parties Other Disclosable Contributions, but not limited by Ord. No. 10 of 2007 (these these contributions do not disqualify a professional business entity from having or seeking a contract with Atlantic County Government) Election Office Candidate Candidate/Committee Candidate/Committee Year Name 1 Name 2 Albano, Nelson 2009 Assembly Van Drew, Albano for Van Drew, Albano & Milam Assembly for 1st District Amodeo, John 2009 Assembly Amodeo and Polistina for Amodeo for Assembly Assembly Connors, 2007 Senate/Assembly Connors, Rumpf and Connors and Rumpf Christopher VanPelt Van Drew Albano and Milam for Milam, 2009 Assembly st 1 District Matthew Polistino, 2008 Assembly Amodeo and Polistino for Vince Assembly Rumpf, Brian 2009 Assembly Election Fund of Connors Connors, Rumpf and and Rumpf VanPelt Van Drew, Jeff 2007 Senate/Assembly Van Drew and Albano for Van Drew Albano & Milan Assembly for 1st District Whelan, 2007 Senate Friends of Whelan Kuehner Jim Whelan for Assembly James and Spellman Burlington County Democrat Committee Burlington County Republican Committee Cape May County Democrat Committee Cape May County Republican Committee Cumberland County Democrat Committee Cumberland County Republican Committee Ocean County Democrat Committee Ocean County Republican Committee AFFIRMATIVE ACTION INFORMATION Please complete the following: Company Name __________________________________________________ 1. Our Company has a Federal Affirmative Action Plan Approval: YES ______ NO _______ a. If yes, submit a photographic copy of the Approval 2. Our Company has a New Jersey Certificate of Employee Information Report: YES ______ NO _______ a. If yes, submit a Photographic copy of the Certificate 3. Our Company has neither of the above, therefore send us Form AA-302 (Affirmative Action Employee Information Report) SEND AA-302 __________ (check if applicable) I certify that the above information is correct to the best of my knowledge. NAME: _________________________________________ SIGNATURE: ___________________________________ TITLE: _________________________________________ DATE: _________________________________________ AAI NON-COLLUSION AFFIDAVIT State of New Jersey ) ) ss County of __________________ I, _______________________ of __________________________ in the County of _________________ and the State of ____________________________, of full age, being duly sworn according to law on my oath, depose and say, that : I am ___________________________ of the Firm of _____________________, the bidder making the Proposal for the herein project, and that I executed the said Proposal with full authority to do so, that said bidder has not directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project, and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the County of Atlantic relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said project. I warrant that no requirement or commitment was made in reference to any political contribution to any party, person, or elected official and that no undisclosed benefits of any kind were promised to any one connected with County government or any political party in reference hereto. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by _______________________________________ NAME OF CONTRACTOR I further warrant and represent that I have never been convicted of or acknowledge nor admitted to any payment of kickbacks or unlawful gifts to any government official or employee for which conduct the County of Atlantic deems me disqualified from doing business with County of Atlantic under such circumstances. I also understand that the above disqualification does not apply to any vendor who cooperates with the prosecution and gives supporting testimony on behalf of the prosecution in the course of a judicial inquiry. SWORN AND SUBSCRIBED TO BEFORE ME THE ________ DAY OF _____________ 20____ ____________________________ Signature of Notary Public _______________________________ SIGNATURE OF AFFIANT Notary Public of __________________ _______________________________ PRINT OR TYPE NAME OF AFFIANT My Commission Expires _____________ NC AFFIDAVIT OF COMPLIANCE ON CONTRACTOR'S RECYCLING PROGRAM (CONTRACTOR MUST COMPLETE, SIGN AND NOTARIZE THIS FORM AND SUBMIT WITH BID PACKAGE) The County of Atlantic has pursuant to P.L. 1987, Chapter 102, adopted the Atlantic County Recycling Plan and Ordinance #7 of 1988, which designates the following commercial and institutions materials as recyclable and mandates the recycling thereof; Glass, food and beverage containers: clear, amber, green Newspapers Aluminum beverage cans corrugated cardboard White office paper Computer Paper I. a. I hereby acknowledge that compliance with all applicable recycling laws is a material term and condition of my contract with the County of Atlantic. I. b. I hereby certify that _______________________________ Name of Company (check as many as apply) __________ currently is recycling. __________ agrees to commence or continue recycling during the term of this contract with the County. II. The following recyclable waste generated during the performance of this contract, in accordance with the requirements of the applicable N.J. Municipal Recycling Plan, or other applicable State or local recycling law, shall be recycled: _____ Aluminum Cans _____ Glass _____ Plastic _____ Newspaper _____ Office Paper _____ Computer Paper _____ Asphalt _____ Concrete _____ Other Please Specify ______________________________ Signed and sealed before me on _______________, 20____ ________________________ NAME ________________________ TITLE ________________________ DATE ______________________ NOTARY R FORMS SAMPLE CONTRACT Law File #K.05. AGREEMENT THIS AGREEMENT made this day of COUNTY OF ATLANTIC hereinafter referred to as “COUNTY” and to as “CONTRACTOR”. , 2008, BETWEEN THE hereinafter referred WITNESSETH: WHEREAS, the COUNTY desires to engage the services of the CONTRACTOR to perform various services for the COUNTY as hereinafter provided, and WHEREAS, the CONTRACTOR has represented that it is qualified by training and experience to perform the required services in the manner and on the terms and conditions set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein, the parties hereto agree as follows: ARTICLE I: SCOPE OF SERVICES AND CONTRACT DOCUMENTS A. CONTRACTOR shall provide to the COUNTY the following services: All services shall be provided in strict accordance with the requirements and or representations set forth in one or more of the following applicable documents, as checked herein: The Request for Proposals issued by the County (Exhibit A) The CONTRACTOR’S proposal (Exhibit B) Agreement Scope of Services statement (Exhibit C) In the event of any inconsistencies between the documents the language of the Agreement shall prevail, and the language of the other documents shall be deemed to have the following priority: Exhibit A, Exhibit C, Exhibit B. B. The Exhibits and Appendices to the Agreement listed below shall constitute integral parts of this Agreement and are hereby incorporated herein in their entirety, unless any portions CT-1 SAMPLE CONTRACT thereof have been marked as deleted or modified. These documents collectively shall constitute the Agreement between the parties. Exhibit A (RFP) Exhibit B (Proposal) Exhibit C (Scope of Services Statement) Appendix 1 (Affirmative Action) Appendix 2 (Insurance) ARTICLE II: PAYMENT A. In accordance with the authorization granted by Resolution # ____________, adopted by the Atlantic County Board of Chosen Freeholders on __________________ 2006, the CONTRACTOR shall be compensated in an amount not to exceed $____________________in full consideration of all services performed under this Agreement. The time, rate and manner of payment shall be as follows: B. Any changes to the maximum compensation specified in Article II(A) shall only be effective if such additional compensation is expressly authorized by an amendatory resolution duly adopted by the Atlantic County Board of Chosen Freeholders. Even if the Agreement calls for the provision of services on an hourly rate or other unit price basis or if the Agreement allows for payment of specified reimbursable expenses, CONTRACTOR, understands that CONTRACTOR shall not be entitled to payment for any level of services rendered in excess of the maximum compensation specified in Article II(A) unless additional compensation is expressly authorized by resolution. C. It is the exclusive right of the COUNTY to determine that services have been performed in a proper and satisfactory manner in accordance with the terms and conditions set forth herein prior to approval and payment of invoice submitted by CONTRACTOR. D. Payment shall be made only upon submission by the CONTRACTOR of the required executed standard County invoice, a bill on CONTRACTOR’S letterhead and any other documents deemed necessary by the COUNTY. E. CONTRACTOR agrees to maintain financial records, books and documents plus any evidence necessary to reflect all direct and indirect costs incurred during this Agreement in an auditable format. CONTRACTOR agrees to keep complete and accurate records with respect to the computation of all billing, including receipts for any reimbursable expenses and time records for all persons billed on an hourly rate basis. The CONTRACTOR also agrees to submit all documents and records necessary to assure compliance and completion of this Agreement. CONTRACTOR agrees that all financial records required to be kept be made available for inspection during normal business hours by representatives of the COUNTY. Said records shall be kept for a minimum of three (3) years. ARTICLE III: TERM A. Upon its authorization and execution this Agreement shall be effective for the term commencing _______________ and expiring on ___________________. B. The CONTRACTOR shall complete the performance of services under this Agreement by Click here to type Contract End Date and/or in accordance with any completion schedules set forth in Exhibits A & B. CT-2 SAMPLE CONTRACT C. The County Executive or his designee may extend the time for completion specified by Article III(B). Such extensions shall only be effective if in writing and shall not extend the Agreement term beyond the term specified in the authorizing resolution. In the event that the time for completion is extended, all of the original terms and conditions will remain in effect for the extended period. D. The County Executive may terminate this Agreement at any time by giving written Notice of Termination sent to the CONTRACTOR in the address set forth in Article IX. In the event of termination of this Agreement, the CONTRACTOR shall furnish to the COUNTY such reports or documents that the COUNTY may require based upon work completed under the provisions of this Agreement. The CONTRACTOR shall be compensated in the amount determined by the County Executive to be commensurate with the work performed at the time of termination and upon acceptance of said payment CONTRACTOR shall have no further rights against the County. E. Any of the following events shall constitute a breach of this Agreement and shall make this Agreement voidable at COUNTY’S sole option, upon which event CONTRACTOR shall be entitled to compensation only for work performed to the date of termination: a) Bankruptcy or insolvency, whether liquidating or non-liquidating, of contractor; b) Conviction of any principal of CONTRACTOR of any crime under the laws of the State of New Jersey which, if committed by a public official, would disqualify that person from public employment; c) Breach of any term of the Agreement; d) Abandonment of the work by CONTRACTOR without the express written permission of County; e) failure of CONTRACTOR to pay its subcontractors and/or suppliers. ARTICLE IV: GENERAL PROVISIONS A. The CONTRACTOR’S status shall be that of an independent principal and not as agent or employee of the COUNTY. B. The CONTRACTOR agrees not to assign this Agreement or any monies due hereunder without the prior written approval of the COUNTY. C. The CONTRACTOR agrees that in the performance of this Agreement he will obey, and comply with applicable Federal, State and Municipal laws and regulations. D. This Agreement shall be governed and construed and the rights and obligations of the parties hereto shall be determined in accordance with the laws of the State of New Jersey, and any litigation brought by the parties arising out of this Agreement shall be brought only in the Superior Court, and venued in Atlantic County and the CONTRACTOR hereby voluntarily submits to the jurisdiction of said court. E. All materials, information, reports, drawings, plans or other documents which have been paid for by the COUNTY remain the property of the COUNTY and may be utilized for any County purpose. CONTRACTOR waives and relinquishes all patent, copyright, or other intellectual property rights, whether statutory or common law, in said reports or work products. F. This Agreement may not be altered, modified or rescinded orally, but any changes agreed upon and executed by both parties may be incorporated into this Agreement. CT-3 SAMPLE CONTRACT G. The CONTRACTOR agrees not to sub-contract any of the services described herein without the written prior approval of the COUNTY. H. In any contract requiring submission of reports or work products to appropriate officials of the COUNTY, it is agreed that all work products prepared pursuant to said Agreement are the property of the COUNTY and shall include a statement that such reports were prepared under Agreement with the COUNTY. I. The failure to enforce any of the terms and conditions of this Agreement by either of the parties hereto shall not be deemed a waiver of any other right or privilege under this Agreement or a waiver of the right to thereafter claim damages for any deficiencies resulting from any misrepresentation, breach of warranty, or non-fulfillment of any obligation of any other party hereto. In order for there to be a waiver of any term or condition of this Agreement, such waiver must be in writing and signed by the party making the waiver. J. Should any provision to this Agreement be held invalid or unenforceable by any court of competent jurisdiction, the remaining provisions shall remain in full force and effect. K. If the CONTRACTOR shall fail to comply with any of the terms, conditions, provisions or stipulations of this Agreement, according to the true intent and meaning thereof, then the COUNTY may make use of any or all remedies provided in his behalf in the Agreement or at law and shall have the right and power to proceed in accordance with the provisions thereof. ARTICLE V: WARRANTIES A. The undersigned does hereby warrant and represent that this Agreement has not been solicited or secured, directly or indirectly, in a manner contrary to the laws of the State of New Jersey and that said laws have not been violated and shall not be violated as they relate to the procurement or the performance of this Agreement by any conduct, including the paying or giving of any fee, commission, compensation, gift, gratuity or consideration of any kind, directly or indirectly, to any COUNTY, employee, officer or officials. B. The CONTRACTOR does hereby warrant and represent that he is qualified by training and experience to perform the required services in the manner and on the terms and conditions set forth herein. C. The CONTRACTOR does hereby represent that he is ready, willing and able to perform all services in the timeframe and as required by this Agreement, and that he and/or his subcontractors performing the work presently hold in good standing any and all necessary licenses for the lawful performance of said services within the State of New Jersey. ARTICLE VI: INDEMNIFICATION A. CONTRACTOR agrees to protect, defend, indemnify and save harmless the COUNTY, its officers, agents and servants from any and all losses, claims, actions, costs, expenses, judgment, subrogations or other expenses by reason of any real or alleged injury or damage to the person or property of others arising out of or incidental to the performance of the terms of this contract. CT-4 SAMPLE CONTRACT B. If it becomes necessary for the CONTRACTOR, either as principal or by agent or employee, to enter upon the premises or property of the COUNTY, in order to construct, erect, inspect, make delivery or remove property hereunder, the CONTRACTOR hereby covenants and agrees to take, use, provide and make all proper, necessary and sufficient precautions, safeguards and protections against the occurrence of happenings of any accidents, injuries, damages or hurt to any person or property during the progress of the work herein covered, and to be responsible for, and to the indemnify and save harmless the COUNTY from the payment of all sums of money by reason of all, or any, such accidents, injuries damages or hurt that may happen or occur upon or about such work and all fines, penalties and loss incurred for or by reason of the violation of any municipal or COUNTY ordinance, regulations, or the laws of the State, or the United States, while the said work is in progress. If the COUNTY requires, the CONTRACTOR will carry insurance to indemnify the COUNTY against any claim for loss, damage or injury to property or persons arising out of the services covered by the Agreement and the use, misuse or failure of any equipment used by the CONTRACTOR or his employees or agents, and shall provide certificates of such insurance to the COUNTY. C. The CONTRACTOR shall indemnify and save harmless the COUNTY against any and all claims for royalty, patent infringements or suits for information thereon which may be involved in the manufacture or use of the item to be furnished herein. ARTICLE VII. INSURANCE A. CONTRACTOR shall purchase and maintain during the entire period of this Agreement insurance coverage either: as specified in the insurance requirements set forth in the Request for Proposal (Exhibit A), or as specified in Appendix 2 which is hereby incorporated into this agreement. no insurance is required for this Agreement. B. CONTRACTOR must provide the COUNTY with a certificate of insurance in accordance with the requirements of either Exhibit A or Appendix 2 prior to the COUNTY’S execution of this Agreement and payment of invoices for services rendered under this Agreement. ARTICLE VIII: REGULATORY REQUIREMENTS A. Affirmative Action and Non-Discrimination CONTRACTOR agrees to comply with the requirements of PL 1975 c.127 (N.J.A.C. 17:27), which requirements are set forth in Appendix 1 which is attached hereto and incorporated herein. CT-5 SAMPLE CONTRACT B. Prevailing Wage The New Jersey Prevailing Wage Act, N.J.S.A. 34:11-56.25 (P.L. 19630, Chapter 150), is hereby made a part of every Agreement entered into by the COUNTY OF ATLANTIC, except those Agreements which are not within the scope of the Act. The successful CONTRACTOR and any of its subcontractors shall be obligated to pay the prevailing wage, to submit certified payrolls and documentation of compliance, and to permit onsite monitoring, including interviews with employees and review of subcontracts, by COUNTY representatives. The CONTRACTOR’S signature on this Agreement is his guarantee that neither he nor any subcontractors he might employ to perform the work covered by this bid are listed or are on record in the office of the Commissioner of the New Jersey State Department of Labor as one who has failed to pay prevailing wages in accordance with the provisions of this act. Every CONTRACTOR and subcontractor shall keep an accurate payroll record, showing the name, craft or trade, job title or classification, actual hourly rate of wages paid, hours worked, and total wages paid to each workman employed by him in connection with a public work. The prevailing wage as published by the Department of Labor shall be noted on the payroll journal next to the actual wage rate paid. Payroll records shall be presented for a period of two years from the date of payment. C. Non-Discrimination The parties to this Agreement do hereby agree that the provisions of N.J.S.A. 10:2-1 through 10:2-4, dealing with discrimination in employment on public contracts, and the Rules and Regulations promulgated pursuant thereunto, are hereby made a part of this Agreement and are binding upon them. ARTICLE IX: ADDRESS FOR NOTICE The address given below shall be the address of the representatives parties to which all notices and reports required by this Agreement shall be sent by mail: County of Atlantic County Executive 1333 Atlantic Avenue County Office Building 8th Floor Atlantic City, NJ 08401 Copy to County Counsel 1333 Atlantic Avenue County Office Building 8th Floor Atlantic City, NJ 08401 Any notice or statement by any party shall be deemed to be sufficiently given when sent by prepaid certified mail return receipt requested, to any party at its address set forth hereinabove. This address shall remain in effect unless another address is substituted by written notice. CT-6 SAMPLE CONTRACT IN WITNESS WHEREOF, the parties hereto have duly signed and sealed this Agreement. ATTEST: COUNTY OF ATLANTIC: Sonya Harris , Clerk Board of Chosen Freeholders Dennis Levinson County Executive ATTEST CONTRACTOR: Affix Corporate Seal, if applicable APPROVED AS TO FORM: James F. Ferguson County Counsel prof svcs contract & App 1 CT-7 SAMPLE CONTRACT (REVISED 4/10) EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a notice, to be provided by the agency contracting officer, advising the labor union of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals established in accordance with N.J.A.C. l7:27-5.2. CT-8 SAMPLE CONTRACT The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Affirmative Action Plan Approval Certificate 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 www.state.nj.us/treasury/contract_compliance) The contractor and its subcontractors shall furnish such reports or other documents to the Division of Public Contracts Equal Employment Opportunity Compliance as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of Public Contracts Equal Employment Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27. CT-9 CONTRACTORS INSURANCE REQUIREMENTS A/. GENERAL REQUIREMENTS 1/ The Contractor(s) shall provide and pay for insurance coverage of such type and in such amounts as will completely protect the Contractor and the County, its elected officials, officers, agents, servants employees and assigns against any and all risks of loss (including costs of defense) or liability arising out of this contract. 2/ The insurance should be furnished by insurance companies with and "A- (Excellent) VII" or better or better rating as published in the most recent editions of Best Insurance Key Rating and shall be authorized to conduct business in the State of New Jersey. 3/ It is recognized that in some instances that insurance may be acceptable which is underwritten by an insurance company that is not reported in the BEST GUIDE , or the coverage is extended under a self insured program. This insurance, or self insurance, must be in conformity with the rules and regulations of the Commissioner of Insurance of the State of New Jersey. Any insurance or self insurance of this type is subject to the review and acceptance by the County Risk Manager or the County Counsel. Furthermore written proof of acceptability by the Office of the Commissioner of Insurance may be necessary. 4/ The Contractor(s) shall furnish the County with Certificates of Insurance, as shown under “B” Specific Coverage Requirements, policies for General Liability must be endorsed to include the County of Atlantic as an Additional Insured, a copy of ISO Endorsements CG 20 10 is required along with the certificate. The Certificates of Insurance shall set out the types of coverage, the limits of liability, describe the operation by reference to this contract and provide for (30 days) written notice to the County of cancellation and/or non-renewal. All of the Contractors. Deductibles or Retention's shall be the sole responsibility of the contractor, those in excess of $10,000 are to be disclosed and are subject to approval by the County. If requested actual policy copies or incurred loss information may be required. 5/ The policies and specified limits of coverage must be effective prior to the commencement of work and must remain in force until final acceptance of the work under the contract. Contracts that involve construction, installation, or maintenance repair must maintain completed operations insurance, endorsing the County as an additional insured for a term of two (2) years beginning on the date of the final acceptance. They also must include a copy of I.S O. Endorsement CG 2037 , or its equivalent. 6/ The Contractor(s) shall obtain, and furnish the County, certificates of insurance from their subcontractor(s) or sub sub contractor(s) showing polices in force with coverage and limits as described under these insurance requirements. INS-1 7/ The Certificate of Insurance with a A COPY OF THE ADDITIONAL INSURED ENDORSEMENTS , are to be signed by a person authorized by the insuring company(s) to bind coverage on it's behalf. Neither approval by the County nor failure to disapprove Certificates of Insurance/ furnished by the Contractor shall release the Contractor from full responsibility for all liability including costs of defense. Insurance is required as a measure of protection and the Contractor's liability is not limited thereby. 8/ The Certificates of Insurance, must be submitted to the County and shall be subject to the review and approval of the County Counsel or Risk Manager. 9/ If at any time during the term of this contract or any extension thereof, if any of the required policies of insurance should expire, change or be canceled, it will be the responsibility of the Contractor, prior to the expiration, change or cancellation, to furnish to the County a Certificate of Insurance indicating renewal or an acceptable replacement of the policy so that there will be no lapse in any coverage. In the event of interruption of any coverage for any reason, all payments and work under the contract shall cease and not be resumed until coverage has been restored and a current Certificate of Insurance received and approved. 10/ Any policy of insurance that is written on a claims made basis shall, under the terms of this contract, be renewed or the coverage extended for a period of not less than three years and shall provide coverage for the period operations were performed by the contractor. Proof of such extension shall annually be presented to the Risk Manager for the County of Atlantic and indicate the retroactive date of coverage or indicate that all prior acts coverage is provided. 11/ Insurance or Risk Funding maintained by the County shall be considered as Excess over Contractors Insurance. Insurance or Risk Funding Maintained by the County of Atlantic does not provide protection for Contractors liability. 12/ Certificates of Insurance and Evidence of Property Forms shall show the Certificate Holder as follows: COUNTY OF ATLANTIC COUNTY OFFICE BUILDING 1333 ATLANTIC AVENUE ATLANTIC CITY, NEW JERSEY 08401 ATTN.: ROBERT GRIST, RISK MANAGER Certificates of Insurance not reading as above will not be acceptable and will delay contract signature and/or payment. 13/ Questions regarding these insurance requirements may be directed to Robert Grist at (609)345-6700 Ext. 2495. Certificates for approval may be preliminarily submitted to Robert Grist via fax to (609)-343-2164, or to (609)-343-2373. INS-2 B./ SPECIFIC COVERAGE REQUIREMENTS 1/ The following checked items are the minimum mandatory types of insurance coverage to be carried under the preceding requirements: ------X--------(a) Workers Compensation-Statutory Limits , Employers Liability - with minimum limits of - $1,000,000/1,000,000/1,000,000. -----X----------(b) General Liability in a comprehensive form, with minimum limits as follows: 1/ Each Occurrence $1,000,000 2/ Damage to Rented or Leased Properties $ 100,000 3/ Medical Expense $ 5,000 4/ Personal & Adv. Injury $1,000,000 5/ General Aggregate $2,000,000 6/ Products-Completed Operations Aggregate $2,000,000 -----X---------(c) Motor Vehicle Liability Insurance in a comprehensive form, endorsed to include pollution coverage, with minimum limits of $1,000,0000 CSL 1/ Owned Vehicles 2/ Hired/Leased Vehicles 3/ Non-Owned Vehicles ----X-------(d) Excess/Umbrella liability with minimum limits of $1,000.000 January , 2010 INS-3 REQUEST FOR PROPOSAL CHECKLIST 1. Complete and Sign Proposal /Pricing Pages Include 1 Signed Original and five (5) copies of all Proposals _______ 2. Political Contribution Page _______ 3. Provide a copy of your New Jersey Business Registration Certificate _______ 4. Non-Collusion Affidavit properly signed and notarized. _______ 5. Affirmative Action Page Properly signed and completed _______ 6. Affidavit of Compliance on Contractor's Recycling Program. _______ The undersigned hereby acknowledges the above listed requirements: NAME OF BIDDER: _____________________________ Person, Firm or Corporation _____________________________ Signature Title ATTENTION: Bidder's can not submit their own form of non-collusion affidavit. Use only the forms supplied.