Purchase and Delivery Beach Sand

Bid Document Submission Checklist Township of Long Beach
Furnish, Haul & Unload Beach Sand: Public Works Department
Initial Each
Required with Item
Submission of Submitted
Bid: with Bid
Owner's (Bidder's
Checkmarks: X Initials)
X Authorized Business Agent
X NJ State Business Registration Certificate
Statement of Corporate Ownership/Certification,
X Pursuant to NJSA 52:25-24.2
Disclosure of Investment Activities in Iran, Russia, and
X Belarus
If applicable, Bidder's acknowledgement of Receipt of
any Notice(s)
or Revision(s) or Addenda to an advertisement,
X specifications or bid document(s)
Submission of Non-Collusion Affidavit (THIS FORM MUST BE
X NOTARIZED)
X Acknowledgement of Affirmative Action
X Affirmative Action Mandatory Language
X Americans With Disabilities Act
X Certificate of Insurance (upon award)
X Bid Proposal
X Additional Bid and Contract Provisions
X Indemnification Form
X W-9 (upon award)
Signature: The undersigned hereby acknowledges review and submission of the above-listed
requirements.
Name of Bidder: ________________________________________________________________________
Signature of Authorized Agent: ____________________________________________________________
Name and Title: ________________________________________________________________________
Date: __________________________Contact phone#: __________________________________
Email Address: ____________________________________________________________________
Page 1 of 28

NOTICE TO ALL BIDDERS
PUBLIC NOTICE IS HEREBY GIVEN that sealed bids will be received by the Board of
Commissioners of the Township of Long Beach, County of Ocean, State of New Jersey for the
following in the Purchasing Department, 6805 Long Beach Blvd., Brant Beach, NJ:
* Furnish, Haul & Unload Beach Sand: Public Works Department
On April 23, 2026 at 10:15 A.M. at which time and place they will be publicly opened and read
aloud. No facsimile copies of the bids will be accepted. Specifications and other bid information
may be obtained at the Purchasing Office of the Township of Long Beach, 6805 Long Beach
Blvd., Brant Beach, NJ 08008 (609-361-6634) during regular business hours: 9:00 a.m. to 4:00
p.m. and on the municipal website: www.longbeachtownship.com. Mailing of bid documents will
be made at the bidders' cost.
All bid Addenda will be issued on the website. Therefore, all interested respondents should check
the above website now through the bid opening. It is the sole responsibility of the respondent to
be knowledgeable of all addenda related to this procurement.
Bidders are required to comply with the requirements N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-
1 et seq.
Bidders are required to comply with the requirements P.L. 1977, c.33; and P.L. 1999, c.238
"The Public Works Registration Act" if applicable.
The Minimum Wage rates, if applicable, for labor employed on these contracts shall be as
specified in the "The New Jersey Prevailing Wage Rate Determination", of the New Jersey
Department of Labor and Industry.
The Township of Long Beach hereby reserves the right to consider the bids for sixty (60) days
after the receipt thereof. The Township further reserves the right, which is understood and agreed
to by all bidders, to award the contract award to the lowest responsible bidder based on the lowest
Total Bid Amount and to make such awards or take such action as may be in the best interest of
the Township. The Township of Long Beach reserves the right to make multiple awards for this
contract.
Katlyn Kerlin QPA
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STATEMENT OF OWNERSHIP
N.J.S.A. 52:25-24.2 (P.L. 1977, c.33)
DISCLOSURE CERTIFICATION
This Statement Shall Be Included with Bid Submission
No corporation, partnership, limited partnership, limited liability corporation, limited liability
partnership, Subchapter S corporation or sole proprietorship shall be awarded a contract for the
performance of any work or the furnishing of any materials or supplies, unless, prior to the receipt
of the bid or accompanying the bid of said corporation, partnership, limited partnership, limited
liability corporation, limited liability partnership, Subchapter S corporation or sole proprietorship,
there is submitted a statement setting forth the names and addresses of all stockholders who own
ten (10) percent or more of the stock of any class, or of all individual partners who own a ten (10)
percent or greater interest therein. If one or more such stockholder is itself a corporation or
partnership, the stockholders holding 10% or more of that corporation's stock, or the individual
partners owning 10% or greater interest in that partnership, as the case may be, shall also be
listed. The disclosure shall be continued until names and addresses of every non-corporate
stockholder and individual partner, exceeding the 10% ownership criteria established in this act
has been listed. This form shall be signed and submitted with the bid whether or not a stockholder
or partner owns less than 10% of the business submitting the bid.
The Attorney General has concluded that the provisions of N.J.S.A. 52:25-24.2, in
referring to corporations and partnerships, are intended to apply to all forms of corporations and
partnerships, including, but not limited to, limited partnerships, limited liability corporations, limited
liability partnerships, and Subchapter S corporations.
Bidders are required to disclose whether they are a partnership, corporation or sole
proprietorship. The Stockholder Disclosure Certification form shall be completed, signed and
notarized. Failure of the bidder to submit the required information is cause for automatic rejection
of the bid.
Page 3 of 28

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)
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(Please attach additional sheets if more space is needed):
Name of Individual or Business Home Address (for Individuals) or Business Address
Entity
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.
Website (URL) containing the last annual SEC (or foreign equivalent) filing Page #'s
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.
Page 5 of 28

Stockholder/Partner/Member and Home Address (for Individuals) or Business Address
Corresponding Entity Listed in
Part II
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 Long
Beach (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 the
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.
Full Name
Title:
(Print):
Signature: Date:
Page 6 of 28

ACKNOWLEDGMENT OF RECEIPT OF NOTICES, REVISIONS OR ADDENDA
Pursuant to Local Public Contracts Law 40A:11-23 the contractor/bidder shall acknowledge by
signature the following:
ADDENDUM #1 dated _____________________________
ADDENDUM #2 dated _____________________________
ADDENDUM #3 dated _____________________________

No addenda were received:
Bidder's Signature ________________________________________
Bidder's Printed Name: _____________________________________
Company Name: __________________________________________
Page 7 of 28

NON-COLLUSION AFFIDAVIT
State of ___________________________)
County of___________________________)
I, (Name)____________________________________, of the municipality of
___________________________ in the county of ______________________ in the State of
___________________________, of full age, being duly sworn according to law on my oath
depose and say I am (Title)_____________________________ of the firm of (Name of
Firm)____________________________________, the bidder making the Proposal for the
above-named project, and that I exercise the said Proposal with full authority so to do; that said
bidder has not, directly or indirectly, entered into any agreement, participated in any collusion, or
otherwise taken any action in restraint of free, competitive bidding in connection with the above
named project, and that all statements contained in said Proposal and in this affidavit are true and
correct, and made with full knowledge that the Township of Long Beach relies upon the truth of
the statements contained in said Proposal and in the statements contained in this affidavit in
awarding the contract for the said project. I further warrant that no person or selling agency has
been employed or retained to solicit or secure such contract upon an agreement or understanding
for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona
fide established commercial or selling agencies
maintained by ___________________________________. (N.J.S.A. 52:34-15)
(Name of Contractor)
Name: ________________________________ Title______________________
Signature
Name: ________________________________
Printed
Subscribed and sworn to before me
this_________day of_____________________, 20____
Notary: ___________________________________________
My commission expires: ________________________
Page 8 of 28

Page 9 of 28

Prohibited Russia-Belarus Activities & Iran Investment Activities
Person or Entity
Part 1: Certification
COMPLETE PART 1 BY CHECKING ONE OF THE THREE BOXES BELOW
Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter
into or renew a contract, for goods or services must complete the certification below prior to contract award
to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or
affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as a person or
entity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods or services
can be amended or extended, a person or entity must certify that neither the person or entity, nor any parent
entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list. Both lists
are found on Treasury's website at the following web addresses:
https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf
www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.
As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the
below certification.
A person or entity unable to make the certification must provide a detailed, accurate, and precise description
of the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited
activities in Russia or Belarus and/or investment activities in Iran. The person or entity must cease engaging
in any prohibited activities and provide an updated certification before the contract can be entered into.
If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may
be 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.
CONTRACT AWARDS AND RENEWALS
I certify, pursuant to law, that neither the person or entity listed above, nor any parent
entity, subsidiary, or affiliate appears on the N.J. Department of Treasury's lists of
entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022,

c. 3 or in investment 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. (Skip Part 2 and sign and complete the Certification below.)
Page 10 of 28