1. No category

B130012 COVER SHEET
REQUEST FOR BID #B130012
FOR:
UNIFIED SCIENCE CENTER A/V EQUIPMENT
RETURN BID TO:
THE RICHARD STOCKTON COLLEGE OF NEW JERSEY
101 VERA KING FARRIS DRIVE, PLANT MGMT. BLDG. 70
GALLOWAY, NJ 08205-9441
TOTAL BID PRICE (Attachment A):
$____________________
FEDERAL ID# 222832788
NJ TAX EXEMPT AS PER NJSA 54:32b-1 ET SEQ.
1. BID PROPOSALS MUST BE RECEIVED AT OR BEFORE THE PUBLIC OPENING TIME OF 2:00 PM ON FRIDAY, APRIL 5,
2013 AT THE FOLLOWING ADDRESS (NOTE: TELEPHONE, TELEFACSIMILE OR TELEGRAPH PROPOSALS WILL NOT BE
ACCEPTED):
PURCHASING DEPARTMENT
THE RICHARD STOCKTON COLLEGE OF NEW JERSEY
101 VERA KING FARRIS DRIVE, PLANT MGMT. BLDG. 70
GALLOWAY, NJ 08205-9441
2. THE BIDDER MUST SIGN THIS RFB COVER SHEET
3. THE BID PROPOSAL MUST INCLUDE ALL PRICE INFORMATION. PROPOSAL PRICES SHALL INCLUDE DELIVERY OF ALL
ITEMS, F.O.B. DESTINATION OR AS OTHERWISE PROVIDED. PRICE QUOTES MUST BE FIRM THROUGH ISSUANCE OF
CONTRACT.
4. ALL PROPOSAL PRICES MUST BE TYPED OR WRITTEN IN INK.
5. IN THE EVENT THAT THERE IS A DISCREPANCY BETWEEN THE UNIT PRICES AND THE EXTENDED TOTALS, THE UNIT
PRICES SHALL PREVAIL. IN THE EVENT THERE IS AN ERROR OF THE SUMMATION OF THE EXTENDED TOTALS, THE
COMPUTATION BY THE OWNER OF THE EXTENDED TOTALS SHALL GOVERN.
6. ALL CORRECTIONS, WHITE-OUTS, ERASURES, RESTRIKING OF TYPE, OR OTHER FORMS OF ALTERATION, OR THE
APPEARANCE OF ALTERATION, TO UNIT AND/OR TOTAL PRICES MUST BE INITIALED IN INK BY THE BIDDER.
7. THE BIDDER MUST COMPLETE AND SUBMIT WITH BID ALL REQUIRED BID DOCUMENTS (BID DOCUMENT CHECKLIST)
8. FOR SET ASIDE CONTRACTS ONLY, A BIDDER MUST BE REGISTERED WITH THE N.J. DEPARTMENT OF COMMERCE AS
A SMALL BUSINESS BY THE DATE OF BID OPENING.
9. BY SIGNING THIS RFP COVER SHEET, THE BIDDER CERTIFIES AND CONFIRMS THAT NEITHER THE BIDDER, ITS
REPRESENTATIVES, AGENTS OR LOBBYISTS HAVE INITIATED ANY INAPPROPRIATE CONTACT WITH ANY COLLEGE
EMPLOYEE DURING THE PROCUREMENT TO ATTEMPT TO AFFECT THE BIDDING PROCESS AND SHALL NOT DO SO
AFTER SUBMISSION OF THE BID PROPOSAL.
10. THE BIDDER MUST BE REGISTERED WITH THE DIVISION OF REVENUE AND MUST SUBMIT A BUSINESS
REGISTRATION CERTIFICATE WITH THE BID PROPOSAL.
11. PROPOSALS SHALL REMAIN OPEN FOR ACCEPTANCE AND MAY NOT BE CHANGED OR WITHDRAWN FOR A PERIOD
OF SIXTY (60) DAYS AFTER THE BID OPENING DATE.
TO BE COMPLETED BY BIDDER
12. FIRM NAME: ____________________________________________________________________________________
ADDRESS: _____________________________________________________________________________________
_____________________________________________________________________________________
13. BIDDER TEL#: __________________EXT: _______ 14. FEDERAL EMPLOYER IDENTIFICATION #:
_______________________________________________
15. BIDDER FAX# __________________
16. BIDDER E-MAIL ADDRESS: _________________________
SIGNATURE OF THE BIDDER ATTESTS THAT THE BIDDER HAS READ, UNDERSTANDS, AND AGREES TO ALL TERMS, CONDITIONS, AND
SPECIFICATIONS SET FORTH IN THE REQUEST FOR BID INCLUDING ALL ADDENDA, FURTHERMORE, SIGNATURE BY THE BIDDER
SIGNIFIES THAT ADDENDA ISSUED, THE REQUEST FOR BID, THE COLLEGE’S TERMS AND CONDITIONS (PAGE 2) AND THE RESPONSIVE
BID CONSTITUTE A CONTRACT IMMEDIATELY UPON NOTICE OF ACCEPTANCE BY THE COLLEGE FOR ANY OR ALL OF THE ITEMS BID,
AND FOR THE LENGTH OF TIME INDICATED IN THE REQUEST FOR BID. FAILURE TO ACCEPT THE CONTRACT WITHIN THE TIME PERIOD
INDICATED IN THE REQUEST FOR BID, OR FAILURE TO HOLD PRICES OR TO MEET ANY OTHER TERMS AND CONDITIONS AS DEFINED IN
EITHER ADDENDA OR THE REQUEST FOR BID DURING THE TERM OF THE CONTRACT SHALL CONSTITUTE A BREACH AND MAY RESULT
IN CONTRACT TERMINATION. A DEFAULTING CONTRACTOR MAY ALSO BE LIABLE, AT THE OPTION OF THE COLLEGE, FOR THE
DIFFERENCE BETWEEN THE CONTRACT PRICE AND THE PRICE BID BY AN ALTERNATE VENDOR OF THE GOODS OR SERVICES IN
ADDITION TO OTHER REMEDIES AVAILABLE.
ORIGINAL SIGNATURE OF BIDDER
PRINT/TYPE NAME
DATE
TITLE
1
THE RICHARD STOCKTON COLLEGE OF NEW JERSEY
TERMS AND CONDITIONS
The following terms and conditions apply to all contract or purchase agreements made with The Richard Stockton College of New Jersey unless specifically deleted on the College proposal form.
Vendors submitting offers to the College must cross out any paragraph they do not agree to meet. Any cross out or change to the College terms and conditions will be a factor in the determination of
an award of a contract or purchase agreement.
Bidders are notified by this statement that all terms and conditions will become part of any contract(s) or order(s) awarded as a request for proposal whether stated in part, in summary or by
reference. In the event a vendor’s terms and conditions conflict with the College, the College terms and conditions shall prevail.
1. STATE LAW REQUIRING MANDATORY COMPLIANCE BY ALL VENDORS
1.1 CORPORATE AUTHORITY – It is required that all corporations be authorized to do business in the
State of New Jersey. Corporations incorporated out of the State must file a Certificate of Authority with the
Secretary of State, Department of State, State House, Trenton, New Jersey 08625.Refer to N.J.S.A.Title
14A chapter 13-3.
1.2 ANTI-DISCRIMINATION – All parties to any contract with the College agree not to discriminate in
employment and agree to abide by all anti-discrimination laws including those contained within N.J.S.A.
10:2-1 through 10:2-4 N.J.S.A.10:5-31 through 10:5-38, and all rules and regulations issued thereunder.
1.3 PREVAILING WAGE ACT – The New Jersey Prevailing Wage Act P.L. 1986. Chapter 150, is hereby
made a part of every contract entered into on behalf of the College, except those contracts which are not
within the contemplation of the Act. The bidder’s signature on this proposal is his guarantee that neither he
nor any subcontractors he might employ to perform the work covered by this proposal are listed or are on
record in the Office of the Commissioner of the Department of Labor and Industry as one who has failed to
pay prevailing wages in accordance with the provisions of the Act.
1.4 THE WORKER AND COMMUNITY RIGHT TO KNOW ACT – (P.L. 1983, C. 315: N.J.S.A. 34:5A-1 et
seq.) required employers to label all containers of hazardous substances by March 1, 1985. By August 29,
1986, employers were to label all containers on College premises. Under the terms of the Act, the College is
considered an employer, therefore, all goods offered for purchase to the College must be labeled in
compliance with the provisions of the Act.
1.5 OWNERSHIP DISCLOSURE – Contracts for any work, goods or services cannot be issued to any firm
unless prior to or at the time of bid submission the firm has disclosed the names and addresses of all its
owner holding 10% or more of the firm’s stock or interest. Refer to N.J.P.L.1977 Chapter 33.
1.6 COMPLIANCE– STATE LAWS – It is agreed and understood that any contracts and/or orders placed
as a result of this proposal 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 in New Jersey
courts without regard to principles of conflict of interest. This contract is subject to the New Jersey Tort
Claims Act, N.J.S.A. 59:1-1 et seq. and the New Jersey Contractual Liability Act, N.J.S.A. 59:13-1 et seq.
1.7 COMPLIANCE– LAWS - The vendor must comply with all local, state, and federal laws, rules and
regulations applicable to this contract and to the work to be done hereunder.
1.8 BUSINESS REGISTRATION – Compliance with the requirements of P.L. 2004, c. 57 et seq. (Business
Registration) and throughout the contract term. The firm understands that failure to abide by the
requirements of this statute and to continue to do so, constitutes a material breach of contract in the award
or performance of this contract such that the firm may be disqualified or payments pursuant to the contract
may be withheld until compliance is perfected. Further the firm agrees to advise in writing any
subcontractors of the need to comply with this requirement.
1.9 POLITICAL CONTRIBUTIONS DISCLOSURE –The firm will supply completed disclosure forms when
requested so it is compliant with the Requirements of Public Law 2005, Chapter 51(N.J.S.A.19:44A-20.1320.25) “Political Activity Disclosure”, dated September 22, 2004 and any statutes or regulations which result
thereof. The firm agrees during the course of this contract that it remains compliant with Public Law, Chapter
51and to notify the College if at any time it is no longer compliant. The firm understands that failure to abide
by the requirements of this statute and to continue to do so, constitutes a material breach of contract in the
award or performance of this contract such that the firm may be disqualified or payments made pursuant to
this contract may be withheld until the State Treasurer or his designee gives approval that the requirements
of the Public Law have been met.
2. LIABILITIES
2.1 LIABILITY–COPYRIGHT – The Contractor shall hold and save the College, its officers, agents,
servants and employees harmless from liability of any nature or kind for or on account of the use of any
copyrighted or uncopyrighted composition, secret process, patented or unpatented invention, article or
appliance furnished or used in the performance of this contract.
2.2 INDEMNIFICATION – The Contractor shall assume all risk of and responsibility for, and agrees to
indemnity, defend, and save harmless the College and its employees from and against any and all claims,
demands, suits, actions, recoveries, judgment, and costs and expenses in connection therewith on account
of the loss of life, property or injury or damage to the person, body or property of any person or persons
whatsoever, which shall arise from or result directly or indirectly from the work and/or materials supplied
under this contract. This indemnification obligation is not limited by, but is in addition to the insurance
obligations contained in this agreement. Additionally, the College reserves the right, including but not limited
to the engagement of a third party vendor, to manage, oversee and direct environmental remediation caused
or necessitated as a result of actions by Contractor, its employees, agents, assigns or subcontractors or
failures of their equipment.
2.3 INSURANCE – The successful bidder shall secure and maintain in force for the term of the contract
liability insurance is provided herein. The successful bidder shall provide the College with current certificates
of insurance for all coverages and renewals thereof which must contain the provision that the insurance
provided in the certificate shall not be cancelled for any reason except after thirty days written notice to the
College Purchasing Office. All such policies shall name The Richard Stockton College of New Jersey and
The State of New Jersey as “Additional Insured”.
The insurance to be provided by the successful bidder shall be as follows:
1. Comprehensive General Liability policy as broad as the standard coverage form currently in use in the
State of New Jersey, which shall not be circumscribed by any endorsements limiting the breadth of
coverage. The policy shall include an endorsement (broad form) for contractual liability and products liability
(completed operations). Limits of liability shall not be less than $1,000,000.00 per occurrence for bodily
injury liability and $1,000,000.00 per occurrence for property damage liability, but must be aggregated at
$3,000,000.00 or better. Policy shall be written to state that claims shall be covered as of the date of
occurrence rather than the date of claim. An acceptable alternative is a claims made policy having a
retroactive date the same as the last date of the last occurrence policy, and having an unlimited extended
reporting period. The insurance carriers shall have a Best’s Rating of “B+” or better.
2. Comprehensive General Automobile Liability policy covering owned, non-owned, and hired vehicles with
minimum limits of $1,000,000.00 combined single limits.
3. Worker’s Compensation insurance applicable to laws of the State of New Jersey and Employer’s Liability
insurance with a limit of not less than $1,000,000.00. Upon request, the vendor will provide certificates of such
insurance to the College Purchasing Office prior to the start of the Contract and periodically during the course of
a multi-year contract.
3. TERMS GOVERNING ALL PROPOSALS
3.1 PERFORMANCE GUARANTEE – The vendor hereby certifies; that The equipment offered is standard new
equipment and is the manufacturer’s latest model in production, with parts regularly used for the type of
equipment offered, that such parts are all in production and not likely to be discontinued; also, that no attachment
or part has been substituted or applied contrary to manufacturer’s recommendations and standard practice. All
equipment supplied to the College and operated by electrical current is UL approved. All new machines are to be
guaranteed for a period of one year from time of delivery and/or installation and prompt service rendered without
charge regardless of geographic location. Sufficient quantities of parts necessary for proper service to equipment
will be maintained at distribution points and service headquarters. Trained mechanics are regularly employed to
make necessary repairs to equipment in the territory from which the service request might emanate within a 48hour period or within the time accepted as industry practice. The vendor shall immediately replace any material
which is rejected for failure to meet the requirements of the College. All services rendered to the College shall be
performed in strict and full accordance with the specifications as agreed to in the contract. A service contract
shall not be considered complete until final approval by the College is rendered. Payment to vendors for services
rendered may not be made until final College approval is given.
3.2 DELIVERY GUARANTEES – Deliveries shall be made at such time and in such quantities as ordered in strict
accordance with conditions contained in proposal. The vendor shall be responsible for the delivery of material in
first class condition to the College or the purchaser under this contract, and in accordance with good commercial
practice.
3.3 MAINTENANCE OF RECORDS – The vendor shall maintain records for products and/or services delivered
against the contract for a period of three (3) years from the date of final payment. Such records shall be made
available to the College upon request.
3.4 TERMINATION – This order may be terminated by the Purchaser in whole or in part at anytime. Upon receipt
of a notice of termination, the Vendor shall stop all work in connection with this order, unless otherwise directed
by the Purchaser. The Vendor shall immediately take the necessary action to issue stop order to all subcontractors and/or suppliers in connection with any outstanding sub-contracts or orders for equipment, materials,
supplies, services and/or other charges for which the Vendor is committed and which relate directly to the
completion of this order. The Vendor shall furnish the Purchaser with a list of all such outstanding sub-contracts
and/or orders together with a report on their status. The Vendor shall be reimbursed for all reasonable expenses
incurred by reason of any termination of this Purchase Order (except for termination as a result of default by the
Vendor) including the Vendor's termination charges for which the Purchaser shall be liable. The final acceptance
of the Vendor's claim for expenses and termination charges shall be through negotiation and by agreement
between the Purchaser and the Vendor. In the event of such termination pursuant to a Notice of Termination
received by the Purchaser from the United States Government in connection with any Contract, Sub-Contract,
Grant or other form of agreement between the Purchaser and the Government, the Purchaser shall be obligated
hereunder to pay the Vendor only the amount which shall be determined to be, or approved as reimbursable to
the Purchase Order, the Government Contract, Sub-Contract, Grant or other form of agreement with respect to
this Purchase Order.
4. TERMS RELATING TO PRICE QUOTATION
4.1 PRICE FLUCTUATIONS DURING CONTRACT – All prices quoted shall be firm and not subject to increase
during the period of the contract. In the event of a manufacturer’s price decrease during the contract period, the
College shall receive the full benefit of such price reduction of any undelivered purchase order and on any
subsequent order placed during the contract period. The College must be notified in writing of any price reduction
within five (5) days of the effective date.
4.2 DELIVERY COSTS – Unless noted otherwise in the specifications, all prices for items in bid proposals are to
be submitted F.O.B. Destination. Proposals submitted other than F.O.B. Destination may not be considered.
Regardless of the method of quoting shipments, the vendors shall assume all liability and responsibility for the
delivery of merchandise in good condition to the College or designated purchaser. F.O.B. Destination does not
cover “spotting” but does include delivery on the receiving platforms of the College unless otherwise specified. No
additional charges will be allowed for any transportation costs resulting from partial shipments made at vendors
convenience when a single shipment is ordered. The weights and measures of the College receiving the
shipment shall govern.
4.3 TAX CHARGES – The College is exempt from NJ Sales, Use Tax and Local Taxes under N.J.S.A. 54:32B9(A). As a public, non-profit institution the College is exempt from Federal Excise Tax. These taxes must not be
included in vendor quotations or invoices.
4.4 PAYMENT TO VENDORS – Payment will be processed after the following information has been supplied and
receipt of goods or services verified:
After delivery of goods or services, vendor must submit a properly executed and/or signed invoice/billing to the
College Accounts Payable Department. All billings must show the College Purchase Order Number being
referenced. The B/L express receipt and/or packing slip and related papers must be sent to the consignee with
the merchandise. The College agrees to pay invoices within 30 days of the invoice date unless a discount is
given. All interest on late payments is subject to the New Jersey Prompt Payment Act N.J.S.A. 52:32-35.
5. CASH DISCOUNT
A discount period will commence on the date the properly executed and/or signed Vendor’s billing/invoice is
received by the College for goods or services that have been duly accepted by the College in accordance with
the terms, conditions, and specifications of the Contract/Purchase Order.
2
THE RICHARD STOCKTON COLLEGE OF NEW JERSEY
Bid Number:
B130012
Opening Date and Time:
Friday, April 5th, 2013 at 2:00 p.m.
Request for Bid:
Unified Science Center A/V Equipment
The Richard Stockton College (hereinafter the College) is seeking bids from qualified
vendors (also referred to herein as “Respondent”) in accordance with the terms and
conditions of this solicitation.
The primary medium for communication regarding this Bid shall be via the internet. The
Bid, Required Forms, Addendums, Questions and Answers can all be accessed once you
login to the Purchasing Office website at www.stockton.edu/purchasing.
It is the
responsibility of the Respondent to monitor the website for any changes, additions,
clarifications, cancellations etc. as related to this Bid.
In the event it becomes necessary to revise any part of this RFB, the addenda will be
advertised and provided via our eRFP notification system to all Respondents who have
registered on the website and downloaded the RFB. Respondents will be required to
acknowledge the receipt of the addendum, if any on the Bid Document Checklist.
Use of the internet has proven to be the most efficient medium for communication with
potential Respondents. It is by no means intended by the College to be exclusionary. If
internet access is not available to an interested Respondent, the Respondent must
immediately provide the College in writing with an alternative method of communication
such as the Respondent’s fax number or mailing address (“Alternative Method of
Communication”).
I.
Scope
The Richard Stockton College of New Jersey is accepting bids for electronic classroom
equipment. Items should be delivered in one bulk shipment the week of May 6th, 2013.
Although it is the College’s objective to obtain the best products at the lowest prices, bids
shall be judged on price and other factors, pursuant to N.J.S.A. 18A:64-6 (w). the
following factors will influence the final determination and should be noted:
A. The ability to efficiently, accurately and successfully perform these services is
considered essential.
B. Meet the RFB timeline for specified items;
3
C. Whether the Respondent responds to all specification requirements, in
sufficient detail for the evaluator(s) to analyze the proposal and make
sound judgments about it. The Respondent’s prior history with regard to these
services will be used in determining whether the Respondent is considered
responsible and whether the award of the contract is most advantageous to the
College.
II.
Price Terms
1.
All Prices shall be firm and not subject to increase during the period of the
contract. No Respondent may withdraw his/her bid proposal within sixty (60)
days after the actual date of the opening thereof.
Please list any discount payment terms available, they will be considered in
the evaluation of the bid.
The successful Respondent shall assume all liability and responsibility for the
delivery of the merchandise in good condition to its intended destination.
If you cannot supply an item, mark the column “no bid”. Proposals
containing blank spaces will be rejected.
Substitutions: All requests for substitutions from any specified manufacturer
must be submitted on the attached forms known as Attachment B and must
be submitted by the last day for questions (and in the same format),
Thursday, March 21, 2013 by 10AM. All substitutions will be reviewed by
the College. The College will issue a final decision on the equivalency of the
proposed item(s) in an Addendum.
2.
3.
4.
5.
III.
General Instructions and Conditions
A. Proposal
An official authorized to bind the vendor must sign the proposal. Any vendor awarded
this contract must be registered with the Department of Revenue of the State of New
Jersey at the time of award. Erasure and pencil marks will be cause for rejection. Any
corrections must be whited-out, corrected in ink, and initialed by the individual signing
the bid.
Proposals are to include the following items:
1)
2)
the Bid Document Checklist and all forms indicated as a required
submission;
the vendor’s proposal with authorized signature and the total bid amount
indicated on the cover page; and
4
3)
The completed pricing lists known as “Attachment A Unified Science
Center - AV Vendor Bid Worksheet”.
The award of the Bid will be for the response which is most advantageous to the College,
and the above listed documents will service as the basis of or will be incorporated by
reference into any contract between the College and the vendor.
This solicitation does not commit The Richard Stockton College to award a contract, to
pay any costs incurred in the preparation of a proposal, or to procure or contract for the
goods or services. The Richard Stockton College reserves the right to accept or reject
any or all bids received, or to award the contract in whole or in part if deemed to be most
advantageous to the College.
B.
Mailing
The Richard Stockton College assumes no responsibility for unmarked envelopes. Nor
will the College be responsible for the failure to deliver any bid by USPS, Fed Ex, UPS
or any other carrier/mail service. It is the responsibility of the vendor to ensure timely
delivery of your bid. The time for the submittal of bids is firm.
Sealed proposals are to be submitted to:
The Richard Stockton College
Purchasing Department
Bldg. 70 Plant Mgmt.
101 Vera King Farris Drive
Galloway, NJ 08205
Proposals must arrive at the Purchasing Office not later than 2:00 p.m. local time on
Friday, April 5th, 2013 at which time the Respondent proposals to this request will be
publicly read aloud.
C. Questions
All questions, inquiries and/or substitution requests must be submitted by e-mail to
Annette Hamm at hamma@stockton.edu or faxed to 609-626-3801. Please reference the
bid number B130012. Answers to questions will be posted on the website as they are
received. It is the responsibility of the Respondent to monitor the website to view
questions submitted and the answers thereto, unless specific arrangements have been
made with the College for an Alternative Method of Communication. The deadline for
questions (and substitution requests) is Thursday, March 21, 2013 by 11:00 a.m.
5
IV.
Additional General Conditions of the Contract
Law Against Discrimination
Compliance with the requirements of P.L. 1975, c. 127 (N.J.A.C. 17:27)
(Law Against Discrimination in Public Contracts) and throughout the
contract term.
Business Registration
Compliance with the requirements of P.L. 2004, c. 57 et seq. (Business Registration) and
throughout the contract term. The firm understands that failure to abide by the
requirements of this statute and to continue to do so, constitutes a material breach of
contract in the award or performance of this contract such that the firm may be
disqualified or payments pursuant to the contract may be withheld until compliance is
perfected. Further the firm agrees to advise in writing any subcontractors of the need to
comply with this requirement. The firm shall maintain a current list of such
subcontractors and their addresses and shall submit that list with its proposal and as
needed by the College during the course of performance of this contract. The firm shall
provide with its proposal a copy of its valid Business registration certificate, pursuant to
P.L. 2004, c.57 and ensure that such registration remains in effect throughout the period
of this contract. The firm agrees to notify the College if at anytime its Business
Registration becomes invalid.
Further, the firm agrees to procure from any subcontractor’s proof of compliance with the
Act prior to performing any services pursuant to this contract. Should firm or any
subcontractors fail to maintain a valid registration they understand that RSC is prohibited
from issuing payments under this contract until a valid registration is obtained.
Political Contributions Disclosure
The firm will supply the completed disclosure forms as part of its proposal so it is
compliant with the Requirements of Public Law 2005, Chapter 51(N.J.S.A.19:44A20.13-20.25) “Political Activity Disclosure”, dated September 22, 2004 and any statutes
or regulations which result thereof. The firm understands the College is prohibited from
awarding this contract or issuing payments until the State Treasurer or his designee gives
approval that the requirements of the Public Law have been met.
If awarded the contract, the firm agrees during the course of this contract that it remains
compliant with Public law, Chapter 51.and to notify the College if at any time it is no
longer compliant.
Upon approval by the State, the Certification and Disclosure of Political Contributions
from is valid for a two (2) year period. Any change in the Vendor’s ownership status
and/or political contributions during the two-year period will require the submission of
6
new Chapter 51/EO 117 forms to the College/State. Please note that it is the vendor’s
responsibility to file new forms if such changes occur.
The firm understands that failure to abide by the requirements of this statute and to
continue to do so, constitutes a material breach of contract in the award or performance of
this contract such that the firm may be disqualified or payments made pursuant to this
contract may be withheld until compliance is perfected.
.
7
The Richard Stockton College of NJ
REV 002
B130012 - Attachment A
Unified Science Center A/V Equipment
Project Bidding Worksheet
This is an example
Attachment A is posted
separately as an Excel
Worksheet
Vendor Name:
AV Vendor B130012 Bid Worksheet
QTY
19
34
23
17
44
5
5
17
2
17
17
17
17
22
17
17
17
17
17
21
6
51
2
19
17
25
17
12
17
5
22
2
2
104
51
5
5
22
17
22
17
17
5
10
17
8
17
3
3
3
34
17
17
5
27
48
17
17
22
5
34
39
8
PART #
FG1905-18
FG1311-16-SB
P6B
AP7900
APPLE
APPLE
APPLE
APPLE
AT-HD560DVI
26955
V11H542020
V13H010L76
V13H134A43
60-716-0A
70-268-01
70-269-01
26-655-01
DP-HDMIF/6
26-662-09
60-872-02
101-020-01
26-667-03
26-650-75
26-663-15
26-663-09
26-614-03
26-618-01
101-021-10
26-679-06
26-490-03
GENERIC
COL0809Z1
HHA88016GR
C24CT MICROPLUS
K64186FM
920-002359
910-002225
910-001354
920-003070
7ND-00012
EB1
EB2
CAB-COOL
TW12
UTR1
UP1
SS
VT1-CP12
VT2-CP12
VT3-CP6
NC3FX
EW 512 G3
SP518-NB
KDL-60EX645
USB2UBADC1M
RoomWizard II
TN-MZMZ-25
SP-PF
SPIKECUBE
3523
GENERIC
GENERIC
VZ-8 Lite4
Updated: 02/25/13
DESCRIPTION
AMX DVX 3155 HD-T, 70/100V, 75W
Master Quote: 25686
AMX Novara 16 Button Keypad (Black) SP-16-AX-TR-US
APC SurgeArrest Essential (6 Port)
APC Switched Rack PDU 1U 15A 120V (8 Outputs)
Apple 12W USB Power Adapter (iPad/iPhone)
Apple 30-Pin Digital AV Adapter
Apple Lightning to 30-Pin Adapter
Apple Lightning to USB Cable 1m
Atlona Converter Scaler Embedder
C2G 3m DVI Male to HD15 VGA Male Video Cable
Epson PowerLite Pro G6750 WU
Epson PowerLite Pro G6750 Replacement Lamp ELPLP76
Epson PowerLite Pro G6750 Replacement Filter ELPAF43
Extron Cable Cubby 200
Extron Cable Organizer AAP Accessory
Extron Cable Organizer AAP Accessory
Extron DisplayPort to HDMI Active Adapter M-F
Extron DisplayPort to HDMI, Active Adapter Cable 6'
Extron DVID SL Ultra/9
Extron HDMI 101 Plus
Extron HDMI Cable Lacing Bracket; Package of 50 Extron HDMI Micro Series 3' M-M
Extron HDMI Pro Series 75' CL2 M-M
Extron HDMI Ultra Series 15' M-M
Extron HDMI Ultra Series 9' M-M
Extron HDMI-DVID 12' M-M
Extron HDMIF-DVIDF Adapter
Extron LockIt Adapter Tether; Package of 10 Extron Mini DisplayPort Adapter Cable 6' MDP-HDMIF/6
Extron VGA M-M 12' with 3.5mm Audio
Generic 6' USB 2.0 (A-B) Cable
Grainger Clamp 1BAB5, 1/2" with Cushion 50pk
Grainger Wood Screw 1KU96, #8x1/2" Zinc 100pk
JBL Control 24CT MicroPlus Ceiling Speaker w/ can & rails
Kensington MicroSaver Lock - Master Keyed
Logitech Wireless Illuminated Keyboard K800
Logitech Wireless Mouse M185
Logitech Wireless Presenter R400
Logitech Wireless Touch Keyboard K400
Microsoft LifeCam HD 5000
Middle Atlantic 1U Spacer
Middle Atlantic 2U Spacer
Middle Atlantic CabCool Cabinet Cooler Fan
Middle Atlantic Cable Management Straps 8"
Middle Atlantic Half/Third Rackshelf (1U)
Middle Atlantic Rack Mount Utility Panel
Middle Atlantic Sliding Shelf
Middle Atlantic Vented 1U Rack Mount Blocker (Contractor Pack)
Middle Atlantic Vented 2U Rack Mount Blocker (Contractor Pack)
Middle Atlantic Vented 3U Rack Mount Blocker (Contractor Pack)
Neutrik Female 3-Pin XLR Connector
Sennheiser Lavalier Condenser Mic with Wireless Receiver
Smart Podium 518 with Smart Notebook 10
Sony 60" EX645 LED Internet TV
StarTech Apple 30-pin Dock Connector or Micro USB to USB Combo Cable 2'
Steelcase RoomWizard II
TEC-NEC 25' Audio Cable 3.5mm
TEC-NEC SP-PF 1/4" Phono-M to RCA-F
Tripplight SpikeCube Surge Protector
USB A Female to USB B Female Panel Mount Adapter
USB Extender Cable 3'
USB Extender Cable 6'
Wolfvision Document Camera 4th Edition
Shipping and Handling
U/P
EXT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Bid Amount:
8
ATTACHMENT B
VENDOR SUBSTITUTION REQUEST FORM
BID: ___________________________
The undersigned, as contractor for the above BID, requests that the following product be accepted for use
By the College:
PRODUCT: __________________________________________________________________________
PART NO: _________________________________________________________________________
MANUFACTURER:
__________________________________________________________________
ADDRESS: __________________________________________________________________________
The above product would be used in lieu of
PRODUCT: __________________________________________________________________________
specified in
ATTACHMENT : ___________________________________________________________________________-
Reason for substitution request: _____________________________________________________________
_______________________________________________________________________________________
Attached are the following circled items:
1. Product description including specifications, performance and product data sheets including installation and
warranty, and applicable reference standards.
2. Drawings
3. Samples
4. Tabulated comparison with specified product.
5. For items requiring color selections, full range of manufacturer’s color samples.
6. Documentation of reason for request.
7. Cost data for comparing proposed substitution with specified product.
8. Other:_____________________________________________________________________________
The undersigned certifies that the following statements are correct. Explanations for all items which are not true
are attached.
1. Proposed substitution has been thoroughly investigated and function,
and quality meet or exceed that of specified product.
TRUE FALSE
2. Same warranty will be provided for substitution as for specified product.
TRUE FALSE
Vendor Substitution Request Form
1
9
ATTACHMENT B
VENDOR SUBSTITUTION REQUEST FORM
3. No aspect of Project will require re-design.
TRUE FALSE
4. Use of substitution will not adversely affect:
a. The existing surface.
TRUE FALSE
b. Installation schedule and date of completion.
TRUE FALSE
c. Work of other trades.
TRUE FALSE
5. Proposed substitution will meet the project timeline.
TRUE FALSE
6. All changes to Contract Sum related to use of proposed
substitution are included in price listed below. Vendor
waives claims for additional costs related to acceptance of
substitution which may subsequently become apparent.
TRUE FALSE
7. Costs of any tests caused by use of proposed
substitution will be paid for by the Contractor.
TRUE FALSE
If substitution request is accepted:
Contract Sum will be [decreased] [increased] by $ __________________________________________
Contract Time will be [decreased] [increased] by _________________________________ calendar days.
Submitted by:
VENDOR: ____________________________________________________________________
ADDRESS: ________________________________________________________________________
TELEPHONE NUMBER: _____________________________________________________________
NAME OF PERSON SUBMITTING REQUEST: __________________________________________
TITLE: ____________________________________________________________________________
DATE: ____________________________________________________________________________
Vendor Substitution Request Form
2
10
THE RICHARD STOCKTON COLLEGE OF NEW JERSEY
BID DOCUMENT CHECKLIST
A. Failure to submit the following documents is a mandatory cause for the bid to be rejected.
Required with
Submission of Bid
(Owner’s “X”)
Initial Each Item
Submitted with Bid
(Bidder’s Initials)
x
Signature on Page 1 of Request For Proposal
x
A statement of ownership, pursuant to N.J.S.A. 52:25-24-2
x
Acknowledgement of Equal Employment Opportunity Language
x
Employee or Relative Disclosure Requirement
x
Submission of a Non-Collusion Affidavit (form must be Notarized)
Public Works Contractor Registration Act P.L.1999.c238
x
Certificate of Registration with the Division of Revenue PL 2001, c.134
x
W-9 Form Request for Taxpayer Identification Number and Certification
A bid guarantee as required by N.J.S.A. 18A:64-67
A surety company certificate, pursuant to N.J.S.A. 18A:64-68
x
If Applicable, bidder’s acknowledgement of receipt of any notice(s) or
revision(s) or addenda to an advertisement, specifications or bid document(s)
Affidavit of Outreach
x
Public Law 2005, Chapter 51 (formerly Executive Order 134) and Executive
Order 117 (2008)
x
Public Law 2005, Chapter 92 (formerly Executive Order 129)
Source Disclosure Certification Form
B. Signature: The undersigned hereby acknowledges and has submitted the above listed requirements.
Name of Bidder:
Authorized Representative Signature:
Print Name & Title:
Date:
11
STATEMENT OF OWNERSHIP, PURSUANT TO N.J.S.A. 52:25‐24‐2 PLEASE FOLLOW THE LINK BELOW FOR AN OWNERSHIP DISCLOSURE FORM. PLEASE COMPLETE AND SUBMIT IT ALONG WITH THE OTHER REQUIRED DOCUMENTS FOR THE THIS REQUEST FOR PROPOSAL. http://www.state.nj.us/treasury/purchase/forms/StandardRFPForms.pdf 12
(REVISED 4/10)
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.
13
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.
14
AFFIRMATIVE ACTION COMPLIANCE NOTICE
N.J.S.A. 10:5-31 and N.J.A.C. 17:27
GOODS AND SERVICES CONTRACTS
(INCLUDING PROFESSIONAL SERVICES)
This form is a summary of the successful bidder’s requirement to comply with the requirements of N.J.S.A. 10:531 and N.J.A.C. 17:27-1 et seq.
The successful bidder shall submit to the public agency, after notification of award but prior to execution of this
contract, one of the following three documents as forms of evidence:
(a) A photocopy of a valid letter that the contractor is operating under an existing
Federally approved or sanctioned affirmative action program (good for one year from the
date of the letter);
OR
(b) A photocopy of a Certificate of Employee Information Report approval, issued in
accordance with N.J.A.C. 17:27-4;
OR
(c) A photocopy of an Employee Information Report (Form AA302) provided by the
Division and distributed to the public agency to be completed by the contractor in
accordance with N.J.A.C. 17:27-4.
The successful vendor may obtain the Affirmative Action Employee Information Report (AA302) from the
contracting unit during normal business hours.
The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and
Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public
agency, and the vendor copy is retained by the vendor.
The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements of
N.J.S.A. 10:5-31 and N.J.A.C. 17:27.1 et seq. and agrees to 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 N.J.S.A. 10:5-31 and N.J.A.C. 17:27-1 et seq.
COMPANY: ____________________________
SIGNATURE: ____________________________
PRINT NAME:_____________________________
TITLE: _______________________________
DATE: __________________
15
PURCHASING OFFICE
EMPLOYEE OR RELATIVE DISCLOSURE REQUIREMENT
This form is to be completed by all bidders seeking the award of any contract. No bidder shall be awarded any contract nor shall any
agreement be entered into for the performance of any work or the furnishing of any materials or supplies, the cost of which is to be
paid with or out or any public funds by Richard Stockton College of New Jersey unless prior to the receipt of the bid or accompanying
the bid, the bidder has submitted a statement setting forth the information solicited below.
1.
State if you or your employee (if known) are currently employed at Richard Stockton College of New Jersey. YES ____ NO ____
If so, please indicate name and position held at Richard Stockton College of New Jersey.
2.
State if any shareholder who owns 10 % or more of your stock, if a corporation or partner who holds 10% or more of an interest,
if a partnership, is currently employed at Richard Stockton College of New Jersey. YES ____ NO ____
If so, please indicate name and position held at Richard Stockton College of New Jersey.
3.
State if you, or any stockholder, who owns 10% or more of your stock, if a corporation, or any partner who owns 10% or more of
an interest, if a partnership, as the case may be, has any relatives employed at the College. YES ____ NO ____
4.
State if you or your employee (if known) is currently a student at Richard Stockton College of New Jersey. YES ____ NO ____
-
BY:
(Name of Contractor)
(Address)
Signature of Authorized Representative:
Type of Print Name:
Title:
Witnessed by:
Date:
16
NON-COLLUSION AFFIDAVIT
I,
of
of
and the State of
according to law on my oath, depose and say that:
, in the County
of full age, being duly sworn
I am
of the Firm of
The Bidder making the Proposal for the Project, and that I executed the Proposal with the
full authority to do so, that the 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 Project, and that all statements contained in
the Proposal and in this Affidavit are true and correct, and made with full knowledge that
The Richard Stockton College of New Jersey relies upon the truth on the statements
contained in the Proposal and in the statements contained in this Affidavit in awarding
the Contract for the Project.
I warrant that no requirement or commitment was made in reference to and persons, or
elected official and that no undisclosed benefits of any kind were promised to anyone
connected with the project.
I further warrant that no person or selling agent 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 bonafide employees or a bonafide
established commercial or selling agencies maintained by
(N.J.S.A. 52:34-15)
(Name of Contractor)
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.
Subscribed and Sworn to
day
Before me this
of
20
Notary Public of
My Commission expires
.
(Signature of Affiant)
(Print or Type Name of Affiant)
17
W-9
Request for Taxpayer
Identification Number and Certification
Form
(Rev. January 2011)
Department of the Treasury
Internal Revenue Service
Give Form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax
classification (required):
Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/estate
Exempt payee
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) a
Other (see instructions) a
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Employer identification number
–
–
–
Part II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
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 on page 4.
Sign
Here
Signature of
U.S. person a
Date a
General Instructions
Note. If a requester gives you a form other than Form W-9 to request
your TIN, you must use the requester’s form if it is substantially similar
to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign partners’ share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership income.
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) to report, for
example, income paid to you, real estate transactions, mortgage interest
you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners’ share of
effectively connected income.
Cat. No. 10231X
18
Form W-9 (Rev. 1-2011)
Public Law 2005, Chapter 51
(formerly Executive Order 134) and Executive
Order 117 (2008)
INFORMATION AND INSTRUCTIONS
For Completing The “Two- Year Vendor Certification and Disclosure of Political
Contributions” Forms
Background Information
On September 22, 2004, then-Governor James E. McGreevey issued Executive Order 134, the purpose of which was to
insulate the negotiation and award of State contracts from political contributions that posed a risk of improper influence,
purchase of access or the appearance thereof. To this end, Executive Order 134 prohibited State departments, agencies
and authorities from entering into contracts exceeding $17,500 with individuals or entities that made certain political
contributions. Executive Order 134 was superseded by Public Law 2005, c. 51, signed into law on March 22, 2005
(“Chapter 51”).
On September 24, 2008, Governor Jon S. Corzine issued Executive Order No. 117 (“E.O. 117”), which is designed to
enhance New Jersey’s efforts to protect the integrity of procurement decisions and increase the public’s confidence in
government. The Executive Order builds upon the provisions of Chapter 51.
Two-Year Certification Process
Upon approval by the State, the Certification and Disclosure of Political Contributions form (CH51.1R1/21/2009) is valid
for a two (2) year period. Thus, if a vendor receives approval on Jan 1, 2009, the certification expiration date would be
Dec 31, 2011. Any change in the vendor’s ownership status and/or political contributions during the two-year period will
require the submission of new Chapter 51/EO117 forms to the State Review Unit. Please note that it is the vendor’s
responsibility to file new forms with the State should these changes occur.
Prior to the awarding of a contract, the agency should first send an e-mail to CD134@treas.state.nj.us to verify the
certification status of the vendor. If the response is that the vendor is NOT within an approved two-year period, then
forms must be obtained from the vendor and forwarded for review. If the response is that the vendor is within an
approved two-year period, then the response so stating should be placed with the bid/contract documentation for the
subject project.
Instructions for Completing the Forms
NOTE: Please refer to the next section, “Useful Definitions for Purposes of Ch. 51 and E.O. 117,” for guidance when
completing the forms.
Part 1: VENDOR INFORMATION
Business Name – Enter the full name of the Vendor, including trade name if applicable.
Business Type -- Select the vendor’s business organization from the list provided.
Address, City, State, Zip and Phone Number -- Enter the vendor’s street address, city, state, zip code and telephone
number.
Vendor Email – Enter the vendor’s primary email address.
Vendor FEIN – Please enter the vendor’s Federal Employment Identification Number.
DPP c51 - C&D, Rev. 11-17-2008
Page 1 of 4
19
Public Law 2005, Chapter 51
(formerly Executive Order 134) and Executive
Order 117 (2008)
INFORMATION AND INSTRUCTIONS
For Completing The “Two- Year Vendor Certification and Disclosure of Political
Contributions” Forms
Part 2: PUBLIC LAW 2005, Chapter 51 / EXECUTIVE ORDER 117 (2008) DUAL
CERTIFICATION
Read the following statements and verify that from the period beginning on or after October 15, 2004, no contributions as
set forth at subsections 1(a)-(c) have been made by either the vendor or any individual whose contributions are
attributable to the vendor pursuant to Executive Order 117 (2008).
NOTE: Contributions made prior to November 15, 2008 are applicable to Chapter 51 only.
Part 3: DISCLOSURE OF CONTRIBUTIONS MADE
Check the box at top of page 2 if no reportable contributions have been made by the vendor. If the
vendor has no contributions to report, this box must be checked.
Name of Recipient Entity – Enter the full name of the recipient entity.
Address of Recipient Entity – Enter the recipient entity’s street address.
Date of Contribution – Indicate the date of the contribution.
Amount of Contribution – Enter the amount of the reportable contribution.
Type of Contribution – Select the type of contribution from the list provided.
Contributor Name – Enter the full name of the contributor.
Relationship of Contributor to the Vendor -- Indicate relationship of the contributor to the vendor, e.g. officer or partner
of the company, spouse of officer or partner, resident child of officer or partner, parent company of the vendor, subsidiary
of the vendor, etc.
NOTE: If form is being completed electronically, click “Add a Contribution” to enter additional contributions. Otherwise,
please attach additional pages as necessary.
Part 4: CERTIFICATION
Check box A if the person completing the certification and disclosure is doing so on behalf of the vendor and all
individuals and/or entities whose contributions are attributable to the vendor.
Check box B if the person completing the certification and disclosure is doing so on behalf of the vendor only.
Check box C if the person completing the certification and disclosure is doing so on behalf of an individual and/or entity
whose contributions are attributable to the vendor.
Enter the full name of the person authorized to complete the certification and disclosure, the person’s title or position, date
and telephone number.
DPP c51 - C&D, Rev. 11-17-2008
Page 2 of 4
20
Public Law 2005, Chapter 51
(formerly Executive Order 134) and Executive
Order 117 (2008)
INFORMATION AND INSTRUCTIONS
For Completing The “Two- Year Vendor Certification and Disclosure of Political
Contributions” Forms
USEFUL DEFINITIONS FOR THE PURPOSES OF Ch. 51 and E.O. 117
•
“Vendor” means the contracting entity.
•
“Business Entity” means any natural or legal person, business corporation, professional services corporation,
limited liability company, partnership, limited partnership, business trust, association or any other legal
commercial entity organized under the laws of New Jersey or any other state or foreign jurisdiction. The definition
also includes (i) if a business entity is a for-profit corporation, any officer of the corporation and any other person
or business entity that owns or controls 10% or more of the stock of the corporation; (ii) if a business entity is a
professional corporation, any shareholder or officer; (iii) if a business entity is a general partnership, limited
partnership or limited liability partnership, any partner; (iv) if a business entity is a sole proprietorship, the
proprietor; (v) if the business entity is any other form of entity organized under the laws of New Jersey or any
other state or foreign jurisdiction, any principal, officer or partner thereof; (vi) any subsidiaries directly or indirectly
controlled by the business entity; (vii) any political organization organized under 26 U.S.C.A. § 527 that is directly
or indirectly controlled by the business entity, other than a candidate committee, election fund, or political party
committee; and (viii) with respect to an individual who is included within the definition of “business entity,” that
1
individual’s spouse or civil union partner and any child residing with that person.
•
“Officer” means a president, vice-president with senior management responsibility, secretary, treasurer, chief
executive officer, or chief financial officer of a corporation or any person routinely performing such functions for a
corporation. Please note that officers of non-profit entities are excluded from this definition.
•
“Partner” means one of two or more natural persons or other entities, including a corporation, who or which are
joint owners of and carry on a business for profit, and which business is organized under the laws of this State or
any other state or foreign jurisdiction, as a general partnership, limited partnership, limited liability partnership,
limited liability company, limited partnership association, or other such form of business organization.
•
“Reportable Contributions” are those contributions, including in-kind contributions, in excess of $300.00 in the
aggregate per election made to or received by a candidate committee, joint candidates committee, or political
committee; or per calendar year made to or received by a political party committee, legislative leadership
committee, or continuing political committee.
•
“In-kind Contribution” means a contribution of goods or services received by a candidate committee, joint
candidates committee, political committee, continuing political committee, political party committee, or legislative
leadership committee, which contribution is paid for by a person or entity other than the recipient committee, but
does not include services provided without compensation by an individual volunteering a part of or all of his or her
time on behalf of a candidate or committee.
•
“Continuing Political Committee” includes any group of two or more persons acting jointly, or any corporation,
partnership, or any other incorporated or unincorporated association, including a political club, political action
committee, civic association or other organization, which in any calendar year contributes or expects to contribute
at least $4,300 to aid or promote the candidacy of an individual, or the candidacies of individuals, for elective
public office, or the passage or defeat of a public questions, and which may be expected to make contributions
toward such aid or promotion or passage or defeat during a subsequent election, provided that the group,
corporation, partnership, association or other organization has been determined by the Commission to be a
continuing political committee in accordance with N.J.S.A. 19:44A-8(b).
1
Contributions made by a spouse, civil union partner or resident child to a candidate for whom the
contributor is eligible to vote or to a political party committee within whose jurisdiction the contributor
resides are permitted.
DPP c51 - C&D, Rev. 11-17-2008
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21
Public Law 2005, Chapter 51
(formerly Executive Order 134) and Executive
Order 117 (2008)
INFORMATION AND INSTRUCTIONS
For Completing The “Two- Year Vendor Certification and Disclosure of Political
Contributions” Forms
•
“Candidate Committee” means a committee established by a candidate pursuant to N.J.S.A. 19:44A-9(a), for
the purpose of receiving contributions and making expenditures.
•
“State Political Party Committee” means a committee organized pursuant to N.J.S.A. 19:5-4.
•
“County Political Party Committee” means a committee organized pursuant to N.J.S.A. 19:5-3.
•
“Municipal Political Party Committee” means a committee organized pursuant to N.J.S.A. 19:5-2.
•
“Legislative Leadership Committee” means a committee established, authorized to be established, or
designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the General
Assembly, or the Minority Leader of the General Assembly pursuant to N.J.S.A. 19:44A-10.1 for the purpose of
receiving contributions and making expenditures.
•
“Political Party Committee” means:
1. The State committee of a political party, as organized pursuant to N.J.S.A. 19:5-4;
2. Any county committee of a political party, as organized pursuant to N.J.S.A. 19:5-3; or
3. Any municipal committee of a political party, as organized pursuant to N.J.S.A. 19:5-2.
Agency Submission of Forms
The agency should submit the completed and signed Two-Year Vendor Certification and Disclosure forms, together with a
completed Ownership Disclosure form, either electronically to cd134@treas.state.nj.us or regular mail at Chapter 51
th
Review Unit, P.O. Box 039, 33 West State Street, 9 Floor, Trenton, NJ 08625. Original forms should remain with the
Agency and copies should be sent to the Chapter 51 Review Unit.
Questions & Answers
Questions regarding the interpretation or application of Public Law 2005, Chapter 51 (N.J.S.A. 19:44A-20.13) or Executive
Order 117 (2008) may be submitted electronically through the Division of Purchase and Property website at
http://www.state.nj.us/treasury/purchase/execorder134.htm. Responses to previous questions are posted on the website,
as well as additional reference materials and forms.
NOTE: The Chapter 51 Q&A on the website DOES NOT address the expanded pay-to-play requirements imposed by
Executive Order 117. The Chapter 51 Q&A are only applicable to contributions made prior to November 15, 2008. There
is a separate, combined Chapter 51/E.O. 117 Q&A section dealing specifically with issues pertaining to contributions
made after November 15, 2008, available at http://www.state.nj.us/treasury/purchase/execorder134.htm#state.
DPP c51 - C&D, Rev. 11-17-2008
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22
State of New Jersey
Division of Purchase and Property
Two-Year Chapter 51 / Executive Order 117 Vendor Certification and
Disclosure of Political Contributions
For AGENCY USE ONLY
General Information
Solicitation, RFP or Contract No.
Award Amount
Description of Services
Agency Contact Information
Agency
Contact Person
Phone Number
Agency Email
Part 1: Vendor Information
Full Legal Business Name
(Including trade name if applicable)
Business Type
Corporation
Limited Partnership
Limited Liability Company
Sole Proprietorship
Address 1
City
Professional Corporation
General Partnership
Limited Liability Partnership
Address 2
Zip
State
Vendor Email
Phone
Vendor FEIN
Part 2: Public Law 2005, Chapter 51/ Executive Order 117 (2008) Certification
I hereby certify as follows:
1.
On or after October 15, 2004, neither the below-named entity nor any individual whose contributions are attributable to
the entity pursuant to Executive Order 117 (2008) has 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 vendor, pursuant to the terms of Executive Order 117 (2008).
a) Within the preceding 18 months, the below-named person or organization has not made a contribution to:
(i)
Any candidate committee and/or election fund of any candidate for or holder of the public office of Governor
or Lieutenant Governor;
(ii) Any State, county, municipal political party committee; OR
(iii) Any legislative leadership committee.
b) During the term of office of the current Governor(s), the below-named person or organization has not made a
contribution to
(i) Any candidate, committee and/or election fund of the Governor or Lieutenant Governor; OR
(ii) Any State, county or municipal political party committee nominating such Governor in the election preceding
the commencement of said Governor's term.
c) Within the 18 months immediately prior to the first day of the term of office of the Governor(s), the below-named
person or organization has not made a contribution to
(i) Any candidate, committee and/or election fund of the Governor or Lieutenant Governor; OR
Any State, county, municipal political party committee of the political party nominating the successful gubernatorial
candidate(s) in the last gubernatorial election.
PLEASE NOTE: Prior to November 15, 2008, the only disqualifying contributions include those made by the vendor or a principal owning
or controlling more than 10 percent of the profits or assets of a business entity (or 10 percent of the stock in the case of a business entity
that is a corporation for profit) to any candidate committee and/or election fund of the Governor or to any state or county political party
within the preceding18 months, during the term of office of the current Governor or within the 18 months immediately prior to the first day of
the term of Office of Governor.
CH51.1 R1/21/2009
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23
Part 3: Disclosure of Contributions Made
Check this box if no reportable contributions have been made by the above-named business entity
or individual.
Name of Recipient
Address of Recipient
Date of Contribution
Amount of Contribution
Type of Contribution (i.e. currency, check, loan, in-kind
Contributor Name
Relationship of Contributor to the Vendor
Contributor Address
City
State
Zip
If this form is not being completed electronically, please attach pages for additional contributions
as necessary. Otherwise click "Add a Contribution" to enter additional contributions.
CH51.1 R1/21/2009
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Part 4: Certification
I have read the instructions accompanying this form prior to completing this certification on behalf of the above-named business entity.
I certify 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.
I understand that this certification will be in effect for two (2) years from the date of approval, provided the ownership status
does not change and/or additional contributions are not made. If there are any changes in the ownership of the entity or additional
contributions are made, a new full set of documents are required to be completed and submitted. By submitting this Certification and
Disclosure, the person or entity named herein acknowledges this continuing reporting responsibility and certifies that it will adhere to it.
(CHECK ONE BOX A, B or C)
(A)
I am certifying on behalf of the above-named business entity and all individuals and/or entities whose contributions are
attributable to the entity pursuant to Executive Order 117 (2008).
(B)
I am certifying on behalf of the above-named business entity only.
(C)
I am certifying on behalf of an individual and/or entity whose contributions are attributable to the vendor.
Signed Name
Print Name
Phone Number
Date
Title/Position
Agency Submission of Forms
The agency should submit the completed and signed Two-Year Vendor Certification and Disclosure forms, together with a
completed Ownership Disclosure form, either electronically to cd134@treas.state.nj.us, or regular mail at Chapter 51 Review
Unit, P.O. Box 039, 33 West State Street, 9th Floor, Trenton, NJ 08625. The agency should save the forms locally and keep the
original forms on file, and submit copies to the Chapter 51 Review Unit.
CH51.1 R1/21/2009
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Public Law 2005, Chapter 92
Formerly: Executive Order 129
In accordance with Public Law 2005, Chapter 92 (N.J.S.A. 52:34-13.2 et seq., superseding Executive Order
129 (2004)) all bidders submitting a proposal shall be required to submit a Source Disclosure Certification
that all services will be performed in the United States. The bidder shall disclose the location by country
where services under the contract will be performed and any subcontracting of services under the contract
and the location by country where any subcontracted services will be performed.
Public Law 2005, Chapter 92
Formerly: Executive Order 129
SOURCE DISCLOSURE CERTIFICATION FORM
Bidder: _____________________________________
I hereby certify and say:
I have personal knowledge of the facts set forth herein and am authorized to make this Certification on behalf
of the Bidder.
The Bidder submits this Certification as part of a bid proposal in response to the referenced solicitation
issued by the The Richard Stockton College of New Jersey, Office of Administration and Finance, in
accordance with the requirements of Public Law 2005, Chapter 92, (N.J.S.A. 52:34-13.2 et seq., superseding
Executive Order 129 (2004)).
The following is a list of every location where services will be performed by the bidder and all
subcontractors.
Bidder or Subcontractor
Description of Services
Performance Location(s) by Country
Any changes to the information set forth in this Certification during the term of any contract awarded under
the referenced Project Number will be immediately reported by the Bidder to The Richard Stockton College
of New Jersey, PO Box 483, 10 W. Jimmie Leeds Road, Pomona, NJ 08240.
I understand that, after award of a contract to the Bidder, it is determined that the Bidder has shifted services
declared above to be provided within the United States to sources outside the United States, prior to a written
determination by The Richard Stockton College of New Jersey, Office of Administration and Finance, that
extraordinary circumstances require the shift of services or that the failure to shift the services would result
in economic hardship to The Richard Stockton College of New Jersey, the Bidder shall be deemed in breach
of contract, which contract will be subject to termination for cause under its contract with the RSC.
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I further understand that this Certification is submitted on behalf of the Bidder in order to induce RSC to
accept a bid proposal, with knowledge that the State of New Jersey and RSC are relying upon the truth of the
statements contained herein.
I certify 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.
Bidder: ________________________________________
[Name of Organization or Entity]
By: ___________________________________________
Title: _____________________________
Print Name: ____________________________________
Date: _____________________________
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