Deptford Notices

 

 

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TOWNSHIP OF DEPTFORD
REQUEST FOR QUALIFICATIONS
100% AFFORDABLE HOUSING PROJECT
FOR 81 AGE-RESTRICTED RENTAL UNITS

DEVELOPMENT OF THE DONASON TRACT

 

 

BLOCK 4.01, LOT 1

ALMONESSON ROAD AND CAULFIELD AVENUE

DEPTFORD, NEW JERSEY

 

 

 

 

 

 

DATED: June 10, 2021

 

ISSUED BY:

TOWNSHIP OF DEPTFORD

COUNTY OF GLOUCESTER

1011 COOPER STREET

DEPTFORD, NEW JERSEY 08096

(856) 845-5300

 

I.         Purpose of the Request for Qualifications

 

The Township of Deptford has issued this Request for Qualifications (RFQ) as a means of implementing a portion of its court-approved Housing Element and Fair Share Plan for the Third Round of housing obligation.  The Township seeks a profit or non-profit developer to enter into a contractual relationship with the municipality to apply for, receive, construct and operate a 100% affordable senior rental project of 81 units (plus one non-income restricted manager’s unit if required) for a minimum period of 30 years.  The anticipated major funding vehicle is through the New Jersey Housing Mortgage and Finance Agency’s 9% low income housing tax credit program (LIHTC).  The initial application for funding is intended for the 2022 funding round.

 

Upon designation as the redeveloper, the successful respondent shall enter into an Escrow Agreement with the Township to facilitate the necessary development of the project.  Neither the Township’s acceptance of the Respondent’s Proposal nor the designation of a successful respondent as the redeveloper will create any rights or obligations regarding such respondent until the execution by the Township of the Redevelopment Agreement.

 

The Township in its sole discretion will have the option to terminate negotiation of a Redevelopment Agreement at any time without cause including on the basis that the Township is no satisfied with the progress of negotiations and the ability of the respondent to meet target completion dates.

 

II.        Site Information

 

The site is located at the intersection of Almonesson Road (C.R. 621) and Caulfield Avenue.  The site is currently vacant, wooded, and is owned by the municipality.  The site consists of 21.43± acres and is known as Block 4.01, Lot 1 on the tax assessment maps of the municipality.  The site is adjacent to the NJ Turnpike to the north, Township parkland across Almonesson Road, the Steeplechase townhouse neighborhood across Caulfield Avenue to the south and Nicole Court townhouses to the west.  Almonesson Road provides access to the Deptford Mall, approximately 1.1 miles to the south.  Deptford Township is well situated to the regional highway network with easy access to I-295, I-76, Rt. 42, Rt. 55, the New Jersey Turnpike and the Atlantic City Expressway.

 

The site has tidally-influenced streams that connect to the Big Timber Creek and riparian buffers that apply to the property.  While wetlands and floodplains are found on the property, they are subsumed within the riparian buffer limits.  The site is also encumbered by a 30-foot wide Sinclair Oil Pipeline and a 50-foot wide Colonial Oil Pipeline that parallel the NJ Turnpike (and somewhat overlap with each other).  Developable land exists in three separate parcels with the largest of these approximately five acres in size.  A sample layout with an “L”-shaped four-story building of 82 units, which shows the known extent of the constraints, is attached as Exhibit A to this RFQ.  Access is expected from Almonesson Road in a four-legged intersection with Montague Lane, which is the name of the driveway providing access to the Deptford Township Baseball Complex, Indoor Recreation Center and Stauffer Softball Complex.

 

While public water and sewer are located in both Caulfield Avenue and Almonesson Road, the site was removed from the sanitary sewer service area with the county-wide WQMP update in 2006, notwithstanding the fact that the site has been included in the Township’s affordable housing plans since 1989.  In 2017, the Township joined with 25 other municipalities and the Gloucester County Municipal Utilities Authority to amend the WQMP and restore this site, as well as other numerous sites in Deptford and throughout the County to the sanitary sewer service area.  A 24” RCP sanitary sewer line is located along the entire length of the Caulfield Avenue frontage and adequate capacity exists to handle the size of the project contemplated.  Adequate public water and natural gas is also located in Caulfield Avenue sized sufficiently for the proposed project.  Smaller sized utilities are located in Almonesson Road. 

 

Proposed WQMP plan amendments go through a negotiation process with NJDEP before an applicant is permitted to make application.  This plan amendment was accepted for application and filed in September 2020.  Approval of the plan amendment is expected by the end of 2021.

 

The site was purchased in 2014 and was investigated prior to purchase for any site contamination.  The property was investigated by Adams, Rehman and Heggan in a Preliminary Assessment Report: Donason Property, Inc., dated July 2012.  It found no specific areas of concern (AOC)in its site investigation and historical research.  The property has previously been farmed up until about 1995 and had at one time contained a farmhouse.  The report identified some possible AOCs associated with this use, including historic pesticide use, septic field, historic fill, and scattered debris.  Since the use is intended for residential purposes, the Township had the consultant conduct a supplemental study for persistent pesticides, arsenic (associated with historic pesticide use) and lead contamination.  This August 7, 2012 report indicated that both elements were found but at concentrations below New Jersey’s Residential Direct Contact Soil Cleanup Criteria and default Impact to Groundwater Soil Screening Criteria.  However, no pesticides were detected.  Both reports are available upon email request from the Township’s Qualified Purchasing Agent, Sharon Paynter (spaynter@deptford-nj.org).

 

III.       Property Ownership

 

The Donason Tract was acquired by Deptford Township on August 11, 2014 for 100% affordable housing purposes.  The Township’s expectation is that a portion of between five and ten acres will be required for the development of age-restricted housing, but that the exact division will be part of an executed agreement between the parties and the submission of a minor subdivision to the Planning Board.  The property containing the age-restricted housing would be conveyed to the developer for a nominal sum or under a long term land lease, whichever is most advantageous towards the scoring in the tax credit application.  The Township of Deptford would retain the remaining land not necessary for the age-restricted development for future affordable housing development.

 

 

IV.      Redevelopment Designation and Redevelopment Plan

 

The property had previous been earmarked for inclusionary housing development beginning in the first round of municipal affordable housing obligation.  The property was zoned Residential Multi-Family 1 in 1989, one of the original inclusionary zoning districts in Deptford.  On March 4, 2015, following the directive of the Township Council, the Planning Board conducted a preliminary investigation of the site and determined that the Donason Tract met the criteria for being designated an area of non-condemnation redevelopment.  The Township Council concurred with the Planning Board’s findings and adopted Resolution R.119.15 on April 20, 2015 which established the area of non-condemnation redevelopment.  The redevelopment plan for the area has not been adopted.  The Township’s expectation is that the selected developer and the Township will jointly create the redevelopment plan that will permit the 81 units of age-restricted multi-family housing (plus one unrestricted manager’s unit, if needed) for review by the Planning Board and adoption by the Township Council that would supersede the existing zoning. 

 

V.       Information from the Respondent

 

VI.      Developer Selection Criteria and Evaluation

 

VII.     RFQ Administration

 

 

 

 

Exhibit A

Checklist for Items to be Submitted with Qualifications Statement

 

 

 

Signature: The undersigned hereby acknowledges that s/he has submitted the required documents with the Qualifications Statement in response to this RFQ and that all documents have been truthfully completed.

 

 

Name of Respondent / Firm:_______________________________________________

 

 

Print Name and Title:____________________________________________________

 

 

Signature:_____________________________________________________________

 

 

Date:­­­­­­­­­­­­­_______________________________

 

Exhibit B

 

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE PER

N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-1.1 et seq.

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 take affirmative action to ensure that such applicants are recruited and employed, 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 action 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, where applicable, will send to each labor union or representative or workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer advising the labor union or workers' representative of the contractor's commitments under this act 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 employ minority and women workers consistent with the applicable county employment goals established in accordance with N.J.A.C. l7:27-5.2, or a binding determination of the applicable county employment goals determined by the Division, pursuant to N.J.A.C. 17:27-5.2.

 

 

 

 

 

Exhibit B – Continued

 

The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age, 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 applicable 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, 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

 

The contractor and its subcontractors shall furnish such reports or other documents to the Div. of Contract Compliance & EEO 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 Div. of Contract Compliance & EEO for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27-1.1 et seq.

 

Exhibit C

 

AMERICANS WITH DISABLITIES ACT OF 1990

EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABILITY

 

The RESPONDENT and the TOWNSHIP OF DEPTFORD (herein referred to as the TOWNSHIP) do hereby agree that the provisions of Title 11 of the Americans With Disabilities Act of 1990 (the “Act”) (42 U.S.C. S.12101 et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs and activities provided or made available by public entities, and the rules and regulation promulgated pursuant thereunto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the TOWNSHIP pursuant to this contract, the RESPONDENT agrees that the performance shall be in strict compliance with the Act. In the event the RESPONDENT, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the RESPONDENT shall defend the TOWNSHIP in any action or administrative proceeding commenced pursuant to this Act. The RESPONDENT shall indemnify, protect, and save harmless the TOWNSHIP, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages of whatever kind or nature arising out of the alleged violation. The RESPONDENT shall, at its own expense, appear, defend, and pay any and, all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the TOWNSHIP’S grievance procedure, the RESPONDENT agrees to abide by any decision of the TOWNSHIP, which is rendered pursuant to, said grievance procedure. If any action or administrative proceeding result in an award of damages against the TOWNSHIP or if the TOWNSHIP incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure the RESPONDENT shall satisfy and discharge the same at its own expense.

 

The TOWNSHIP shall, as soon as practicable after a claim has been made against it, give written notice thereof to the RESPONDENT along with full and complete particulars of the claim. If any action or administrative proceeding is brought against the TOWNSHIP or any of its agents, servants, and employees, the TOWNSHIP shall expeditiously forward or have forwarded to the RESPONDENT every demand, complaint, notice, summons, pleading, or other process received by the TOWNSHIP or its representatives.

 

It is expressly agreed and understood that any approval by the TOWNSHIP of the services provided by the RESPONDENT pursuant to this contract will not relieve the RESPONDENT of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the TOWNSHIP pursuant to this paragraph.

 

It is further agreed and understood that the TOWNSHIP assumes no obligation to indemnify or save harmless the RESPONDENT, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the RESPONDENT expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the RESPONDENT’S obligations assumed in this Agreement, nor shall they be construed to relieve the RESPONDENT from any liability, nor preclude the TOWNSHIP from taking any other actions available to it under any other provisions of this Agreement or otherwise at law.

 

Exhibit C – Continued

 

ACKNOWLEDGEMENT:

 

Name of Respondent / Firm:_______________________________________________

 

 

Print Name and Title:____________________________________________________

 

 

Signature:_____________________________________________________________

 

 

Date:­­­­­­­­­­­­­_______________________________

 

 

Exhibit D

 

STATEMENT OF OWNERSHIP DISCLOSURE

N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)

 

This statement shall be completed, certified to, and included with all bid and proposal submissions.  Failure to submit the required information is cause for automatic rejection of the bid or proposal.

 

Name of Organization:_____________________________________________________

 

Organization Address:_____________________________________________________

 

Part I  Check the box that represents the type of business organization:

?Sole Proprietorship (skip Parts II and III, execute certification in Part IV)

?Non-Profit Corporation (skip Parts II and III, execute certification in Part IV)

?For-Profit Corporation (any type)   ?Limited Liability Company (LLC) 

?Partnership         ?Limited Partnership           ?Limited Liability Partnership (LLP)

?Other (be specific): ______________________________________________

 

Part II

 

?   The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION)

 

                                                      OR

?   No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be.  (SKIP TO PART IV)

 

 

 

 

 

 

 

 

 

 

 

 

Exhibit D – Continued

 

(Please attach additional sheets if more space is needed):

 

 

 

Part III  DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II

 

If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annual federal Security and Exchange Commission (SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s) containing the last annual filing(s) with the federal Securities and Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filing(s) that contain the information on each such person.  Attach additional sheets if more space is needed.

 

 

 

Exhibit D – Continued

 

 

Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part II other than for any publicly traded parent entities referenced above.  The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed.

 

 

 

Part  IV    Certification

 

I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to execute this certification on behalf of the bidder/proposer; that the Township of Deptford (Township) is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the completion of any contracts with Township to notify the Township in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the, permitting the Township to declare any contract(s) resulting from this certification void and unenforceable.

 

 

 

 

 

Exhibit E

 

NON-COLLUSION AFFIDAVIT

 

I, ______________________________ of the City 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 Respondent herein, and I executed the Respondent with full authority to do so; that the Respondent has not directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive proposing in connection with the above-named Vendor, and that all statements contained in the Qualifications Statement and in this affidavit are true and correct, and made with full knowledge that the Township of Deptford relies upon the truth of the statements contained in the Qualifications Statement and the statement in this affidavit in awarding the contract.

 

I further warrant that no person or selling agency has been employed or retained to solicit or secure a contract upon an 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 Vendor).

 

 

____________________________

Signature

 

 

____________________________

Print or Type Name and Title

 

 

Exhibit F

 

C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM

Contractor Instructions

Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a “fair and open” process (defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of P.L. 2005, c. 271, s.2 (N.J.S.A. 19:44A-20.26).  This law provides that 10 days prior to the award of such a contract, the contractor shall disclose contributions to:

The disclosure must list reportable contributions to any of the committees that exceed $300 per election cycle that were made during the 12 months prior to award of the contract.  See N.J.S.A. 19:44A-8 and 19:44A-16 for more details on reportable contributions.

 

N.J.S.A. 19:44A-20.26 itemizes the parties from whom contributions must be disclosed when a business entity is not a natural person.  This includes the following:

When the business entity is a natural person, “a contribution by that person’s spouse or child, residing therewith, shall be deemed to be a contribution by the business entity.” [N.J.S.A. 19:44A-20.26(b)]  The contributor must be listed on the disclosure.

Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed by ELEC in an amount to be determined by the Commission which may be based upon the amount that the business entity failed to report.

The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official and/or candidate campaign committees are affected by the disclosure requirement.  It is the contractor’s responsibility to identify the specific committees to which contributions may have been made and need to be disclosed.  The disclosed information may exceed the minimum requirement.

The enclosed form, a content-consistent facsimile, or an electronic data file containing the required details (along with a signed cover sheet) may be used as the contractor’s submission and is disclosable to the public under the Open Public Records Act.

The contractor must also complete the attached Stockholder Disclosure Certification.  This will assist the agency in meeting its obligations under the law.

 N.J.S.A. 19:44A-3(s):  “The term "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 section 16 of P.L.1993, c.65 (C.19:44A-10.1) for the purpose of receiving contributions and making expenditures.”

Exhibit F - Continued

 C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM

Required Pursuant To N.J.S.A. 19:44A-20.26

 

This form or its permitted facsimile must be submitted to the local unit

no later than 10 days prior to the award of the contract.

 

Part I – Vendor Information

Vendor Name:
Address:
City:				State:	Zip:

 

The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form.

 

 

_________________________                   ____________________________              _________________________

Signature                                                    Printed Name                                            Title

Part II – Contribution Disclosure

 

Disclosure requirement: Pursuant to N.J.S.A. 19:44A-20.26 this disclosure must include all reportable political contributions (more than $300 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local unit.

 

• cCheck here if disclosure is provided in electronic form.

   

  Contributor Name

  Recipient Name

  Date

  Dollar Amount

   

   

   

  $

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

• cCheck here if the information is continued on attached page(s)

   

  Exhibit F - Continued

  List of Agencies with Elected Officials Required for Political Contribution Disclosure

  N.J.S.A. 19:44A-20.26

   

  Township Name:  Deptford Township, Gloucester County

   

  State: Governor, and Legislative Leadership Committees

   

  Legislative District Numbers:  3, 4 & 5

   

  State Senators   General Assembly

   

  County: Glouceser

   

                Freeholders                     County Clerk                  Sheriff                Surrogate                       

   

  Municipal Bodies (Mayor and members of governing body, regardless of title):

   

                Township of Deptford

                Deptford Township Board of Education

                James H. Johnson Memorial Library (Deptford Township Library)

                Deptford Township Municipal Utilities Authority

                Deptford Township Fire District

   

   

   

   

  Exhibit G

   

  Acknowledgement of Receipt of Addenda

   

   

  The undersigned hereby acknowledges receipt of the following Addenda:

   

  Addendum Number                          Dated

   

  ________________ ______________

   

  ________________ ______________

   

  ________________ ______________

   

   

  Acknowledged for:

   

  Respondent Name: ______________________________________

   

   

  Name: ________________________________________________

   

   

  Title: _________________________________________________

   

   

  Signature: _____________________________________________

   

   

   

  Exhibit H

   

  Disclosure of Investment Activities in Iran

   

  Part 1: Certification

   

  BIDDERS ARE TO COMPLETE PART 1 BY CHECKING EITHER BOX

  Failure to check one of the Boxes will render the Proposal Non-Responsive.

   

  Pursuant to P.L.2012, c.25, N.J.S.A.52:32-55 et al., any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certification below to attest, under penalty of perjury, that neither the person or entity, nor any of its parents, subsidiaries, or affiliates, is identified on the Department of the Treasury’s Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found on the Division’s website at http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Bidders must review this list prior to completing the below certification. Failure to complete the certification may render a bidder’s proposal non-responsive. If the Director finds a person or entity to be in violation of the law, s/he shall take action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party.

   

  PLEASE CHECK THE APPROPRIATE BOX:

   

• cI certify, pursuant to P.L. 2012, c. 25, that neither the bidder listed above nor any of the bidder’s parents, subsidiaries, or affiliates is listed on the N.J. Department of the Treasury’s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 (“Chapter 25 List”). I further certify that I am the person listed above, or I am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. I will skip Part 2 and sign and complete the Certification below.

   

  OR

   

• cI am unable to certify as above because the bidder and/or one or more of its parents, subsidiaries, or affiliates is listed on the Department’s Chapter 25 List. I will provide a detailed, accurate and precise description of the activities in Part 2 below, sign and complete the Certification below.

 

PART 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN

 

You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran on additional sheets provided by you.

 

Certification: I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person or entity. I acknowledge that the Township of Deptford is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with the Township to notify the Township in writing of any changes to the answers of information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the Township of Deptford, New Jersey and that the Township at its option may declare any contract(s) resulting from this certification void and unenforceable.

 

Full Name (Print)________________________________ Signature: __________________________________

 

Title _____________________________________________ Date:____________________

*This form need not be submitted. It is provided for use in assuring compliance with all required documentation.

Exhibit I

 

TOWNSHIP OF DEPTFORD

 

SEALED SUBMISSION LABEL FOR REQUEST FOR QUALIFICATIONS – DEVELOPMENT OF DONASON TRACT

 

Please Tape this Label to the Front of Your Sealed Submission

 

 

DO NOT OPEN

SEALED SUBMISSION ENCLOSED

 

 

 

Respondent: __________________________________________

 

Address:                       __________________________________________

 

                                     __________________________________________

 

                                     __________________________________________

 

 

 

 

Township of Deptford

Attention: Sharon Paynter

1011 Cooper St.

Deptford, NJ 08096