Township Attorney

Location: New Jersey
Posted: Oct 8, 2026
Due: Oct 29, 2026
Agency: North Bergen township
Type of Government: State & Local
Category:
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Notices > Request for Qualifications Township Attorney Posted: 10/08/2026 - 01:10 AM Due By: 10/29/2026 - 11:00 AM

TOWNSHIP OF NORTH BERGEN

HUDSON COUNTY, NEW JERSEY

PUBLIC NOTICE FOR THE SOLICITATION OF

REQUEST FOR QUALIFICATIONS FOR

PROFESSIONAL SERVICE

(One-Year)

NOTICE IS HEREBY GIVEN that sealed request for qualifications submissions will be received by the Township of North Bergen Purchasing Agent for the services set forth below in accordance with the “fair and open process” pursuant to N.J.S.A. 19:44A-20.5, et seq.:

RFQ# PROFESSIONAL SERVICE

RFQ# 2027-4 Township Attorney

Submission package may be examined or obtained at the Township Purchasing Office, Township of North Bergen, 4233 Kennedy Boulevard, North Bergen, NJ, 07047 (phone 201-392-2040), Monday through Friday during business hours, 9:00 a.m. to 4:00 p.m. or downloadable on the Township’s website www.northbergen.org/notices.

Request for qualifications (“RFQ”) responses shall be submitted to Carmen M. Borrell, Purchasing Agent, Township of North Bergen, 4233 Kennedy Boulevard, North Bergen, NJ, 07047, on or before Thursday, October 29, 2026, at 11:00 am prevailing time

Responses must be enclosed in a sealed envelope. The service provider must indicate the following on the outside of the envelope: (1) the name and address of the service provider; (2) the RFQ# and Title of Professional Service; and (3) “Sealed RFQ Response”. Responses may be delivered by hand, overnight courier or mail. The envelope containing the response must be received by the Township of North Bergen by the date and time set forth above. No late responses will be accepted.

All professional service contractors are required to comply with the requirements of N.J.S.A. 52:32-44 (Business Registration of Public Contractors), N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 (Contract Compliance and Equal Employment Opportunities in Public Contracts). N.J.S.A. 52-32.-60.1 Certification of Non-Involvement in Prohibited activities in Russia or Belarus)

Contracts will be awarded based on the most advantageous responses. A form of contract is available upon request from the Law Department. The Township of North Bergen reserves the right to reject any or all responses.

Carmen M. Borrell

Purchasing Agent

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TOWNSHIP OF NORTH BERGEN
County of Hudson
State of New Jersey
REQUEST FOR QUALIFICATIONS (RFQ)
FAIR & OPEN PUBLIC SOLICITATION PROCESS
PROFESSIONAL SERVICE:
RFQ# 2027-4 TOWNSHIP ATTORNEY
Submission Date:
Thursday, October 29, 2026
11:00 A.M. prevailing time
1

TOWNSHIP OF NORTH BERGEN
HUDSON COUNTY, NEW JERSEY
PUBLIC NOTICE FOR THE SOLICITATION OF
REQUEST FOR QUALIFICATIONS FOR
PROFESSIONAL SERVICE
(One-Year)
NOTICE IS HEREBY GIVEN that sealed request for qualifications submissions will be received by the Township of North
Bergen Purchasing Agent for the services set forth below in accordance with the "fair and open process" pursuant to N.J.S.A. 19:44A-
20.5, et seq.:
RFQ# PROFESSIONAL SERVICE
RFQ# 2027-4 Township Attorney
Submission package may be examined or obtained at the Township Purchasing Office, Township of North Bergen, 4233
Kennedy Boulevard, North Bergen, NJ, 07047 (phone 201-392-2040), Monday through Friday during business hours, 9:00 a.m. to 4:00
p.m. or downloadable on the Township's website www.northbergen.org/notices.
Request for qualifications ("RFQ") responses shall be submitted to Carmen M. Borrell, Purchasing Agent, Township of North
Bergen, 4233 Kennedy Boulevard, North Bergen, NJ, 07047, on or before Thursday, October 29, 2026, at 11:00 am prevailing time
Responses must be enclosed in a sealed envelope. The service provider must indicate the following on the outside of the
envelope: (1) the name and address of the service provider; (2) the RFQ# and Title of Professional Service; and (3) "Sealed RFQ
Response". Responses may be delivered by hand, overnight courier or mail. The envelope containing the response must be received
by the Township of North Bergen by the date and time set forth above. No late responses will be accepted.
All professional service contractors are required to comply with the requirements of N.J.S.A. 52:32-44 (Business Registration
of Public Contractors), N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 (Contract Compliance and Equal Employment Opportunities in
Public Contracts). N.J.S.A. 52-32.-60.1 Certification of Non-Involvement in Prohibited activities in Russia or Belarus)
Contracts will be awarded based on the most advantageous responses. A form of contract is available upon request from the
Law Department. The Township of North Bergen reserves the right to reject any or all responses.
Carmen M. Borrell
Purchasing Agent
2

INVITATION TO SUBMIT QUALIFICATIONS
Proposals are being solicited through a fair and open process in accordance with N.J.S.A. 19:44A-20.1, et seq.
Respondents should submit an original and one copy of their proposals.
Respondents are expected to examine the RFQ with care and observe all its requirements. All questions about the meaning or intent of
this RFQ shall be submitted in writing no less than 5 days prior to the due date of the proposal. All interpretations and clarifications
considered necessary by the Township's representative in response to such comments and questions shall be responded to no less than
3 days prior to the due date of the proposal and will be posted online at www.northbergen.org/notices.
The Township assumes no responsibility and liability for costs incurred by the Respondents prior to the issuance of an agreement. The
liability of the Township shall be limited to the terms and conditions of the contract. Respondents will assume responsibility for all costs
not stated in their proposals. All unit rates either stated in the proposal or used as a basis for its pricing are required to be all-inclusive.
Additional charges, unless incurred for additional work performed by request of the Township, are not to be billed and will not be paid.
Any contract entered into between the Respondent and the Township must be in accordance with and subject to compliance by both
parties with the New Jersey Local Public Contracts Law. The Respondent must agree to comply with the nondiscrimination provisions
and all other laws and regulations applicable to the performance of services there under. The Respondent shall sign and acknowledge
such forms and certificates as may be required by this section.
No corporation or partnership shall be awarded any contract for the performance of any work or the furnishing of any goods, unless,
with receipt of the proposal of said corporation or partnership, there is submitted a statement setting forth the names and addresses of
all stockholders in the corporation or partnership who own ten (10) percent or greater interest therein. The Respondent shall complete
and submit the form of statement that is included in this RFQ.
The Township shall retain all of its rights and interest in any and all documents and property both hard copy and digital furnished by the
Township to the Respondent for the purpose of assisting the Respondent in the performance of this contract. All such items shall be
returned immediately to the Township at the expiration or termination of the contract or completion of any related services, pursuant
thereto, whichever comes first. None of the documents and/or property shall, without the written consent of the Township, be disclosed
to others or used by the Respondent or permitted by the Respondent to be used by their parties at any time except in the performance of
the resulting contract.
Ownership of all data, materials and documentation originated and prepared for the Township pursuant to this contract shall belong
exclusively to the Township. All data, reports, computerized information, programs and materials related to this project shall be delivered
to and become the property of the Township upon completion of the project. The Respondent shall not have the right to use, sell, or
disclose the total of the interim or final work products, or make available to third parties, without the prior written consent of the
Township. All information supplied to the Township may be required to be supplied on CD-ROM media compatible with the Township's
computer operating system, windows based, Microsoft Office Suite 2003 or 2007.
Termination: If, through any cause, the Respondent shall fail to fulfill in a timely and proper manner obligations under the contract or
if the Respondent violates any requirements of the contract, the Township shall have the right to terminate the contract by giving written
notice to the Respondent of such termination at least thirty (30) days prior to the proposed effective date of the termination, unless the
contract contains more favorable terms to the Township. Such termination shall relieve the Township of any obligation for the balances
to the Respondent of any sum or sums as set forth in the contract.
The right to reject any or all proposals and to waive immaterial formalities is reserved by the Township.
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SCOPE OF SERVICES & EVALUATION CRITERIA
The Township of North Bergen ("Township") is soliciting qualifications to provide for the following Professional Services:
RFQ# 2027-4: Township Attorney
Scope of Services:
The Township seeks Request for Qualifications from law firms licensed to practice law in the State of New Jersey that wish to provide
general counsel services to the Township as directed by the Township Mayor and Commissioners or other appropriate official within
the Township for a contract period beginning on or after January 1, 2027 and ending December 31, 2027.
Respondents must have significant experience representing New Jersey Municipalities and/or Public Entities as Municipal Attorney,
General Counsel and/or Corporate Counsel. The successful firm will provide the Township with legal guidance and representation
relating to, but not necessarily limited to the following: performing legal research and providing advisory opinions as needed;
representing the Township in Federal and State Courts, as well as administrative forums; reviewing, analyzing and advising the
Township on any application before it; reviewing and/or drafting resolutions and ordinances; attending all meetings of the Mayor and
Commissioners and any other Board or Committee, as directed; performing all requirements of the position of Township Attorney;
notifying the Township of changes in the law or regulations, as well as Court decisions that may impact the Township and its Official;
and, any other matters directed by appropriate Township Officials.
The Township Attorney shall also have experience with and be able to provide legal services in connection with labor and employment
management, including but not limited to performing legal research and providing advisory opinions as needed; researching and drafting
ordinances, resolutions and collective bargaining agreements; reviewing and/or drafting contracts and other legal documents;
representing the Township in negotiations and litigation in federal and state courts and administrative forums; attending meeting of the
Mayor and Commissioners; conducting programs on specified labor and employment issues for appropriate elected officials and/or
Township employees upon request; and, any other matters as directed by the Township.
The Township Attorney shall supervise and oversee all legal matters, whether or not same are assigned to any designated Special
Counsel.
In summary, the successful firm will provide the Township with legal guidance relating to, but not necessarily limited to:
1. Legal research and/or advisory opinions as needed;
2. Represent the Township in federal and state courts and administrative forums;
3. Review, analyze and advise the Township on any application before it;
4. Review, draft and approve as to form and sufficiency all legal documents, contracts, deeds, ordinances and resolutions made,
executed or adopted by or on behalf of the Township;
5. Attend all meetings of the Township Commissioners and any other board or committee as directed;
6. Designate an attorney primarily responsible for the contract who will act as the Director of Law - Township Attorney and
perform all requirements of the position of Township Attorney;
7. Notify the Township of changes in law or regulations, as well as Court decisions, that impact the Township and its officials;
8. Any other matters as directed by the appropriate Township official(s);
9. Township Attorney shall not provide the following services: Zoning Board Attorney, Planning Board Attorney, ABC Attorney,
Rent Leveling Board Attorney, Public Defender and Municipal Prosecutor
Compensation will be as follows:
* $180.00 per hour
* Copy Cost: $0.05/page for 8 12" x 11"
$0.07/page for 8 12" x 14"
* Postage: Direct Reimbursement
* Travel Expenses: Prevailing IRS rate/mile plus Tolls and Parking
* Court Fees: Direct Reimbursement
* Filing Fees: Direct Reimbursement
* Transcript Cost: Direct Reimbursement
* Any other reasonable and necessary expenses incurred in the course of performing the
contract: Direct Reimbursement
Qualifications responses will be evaluated by the Township of North Bergen on the basis of the most advantageous and other factors
considered. The evaluation will consider:
1. Experience and reputation in the field.
4

2. Knowledge of the Township of North Bergen and of legal matters concerning the Township, and of the subject matter to be
addressed under the area of expertise.
3. Familiarity with courts and administrative tribunals before which Township matters may be brought.
4. Two (2) samples of the attorney's work product prepared within the past 24 months.
5. The amount of resources, including the number of attorneys and staff available to attend to Township matters.
6. Other factors if demonstrated to be in the best interest of the Township of North Bergen.
Each criteria will be scored from 0 - 10, 0 being the lowest, 10 being the highest for each factor. Each criteria have equal weight on
scoring.
Scoring of submissions will be made by an evaluation committee, except that if any submission is made by a law firm with which the
Township Attorney is associated, the Township Attorney will not participate in any way with the review of that submission.
SCHEDULE OF EVENTS
EVENT DATE
RFQ Issue Date .............................................................................................................................................................................. 10/8/26
RFQ Response Due Date ............................................................................................................................................................. 10/29/26
1.5 GENERAL REQUIREMENTS
1.5.1 Acceptance of Standard Terms and Conditions/Contract. By submitting a response to this RFQ, proposer agrees
to acceptance of the standard terms and conditions as set out in this RFQ and the form of contract available from the Township Attorney.
Much of the language included in the standard terms and conditions reflects requirements of New Jersey law. Requests for additions or
exceptions to the standard terms and conditions including any necessary licenses, or any added provisions must be submitted to the
procurement officer referenced above by the date for receipt of written/e-mailed questions and must be accompanied by an explanation
of why the exception is being sought and what specific effect it will have on the proposer's ability to respond to the RFQ or perform the
contract. Any material exceptions requested and granted to the standard terms and conditions language will be addressed in any formal
written addendum issued for this RFQ and will apply to all proposers submitting a response to this RFQ. The Township will make any
final determination of changes to the standard terms and conditions.
1.5.2 Resulting Contract. This RFQ and any addenda, the proposer's RFQ response, including any amendments and any
clarification question responses, shall be included in any resulting contract. The Township's contract contains the contract terms and
conditions which will form the basis of any contract between the Township and the selected proposer. In the event of a dispute as to the
duties and responsibilities of the parties under this contract, the contract, along with any attachments prepared by the Township, will
govern in the same order of precedence as listed in the contract.
1.5.3 Mandatory Requirements. To be eligible for consideration, a proposer must meet the intent of all mandatory
requirements. The Township will determine whether a proposer's RFQ response complies with the intent of the requirements. RFQ
responses that do not meet the full intent of all requirements listed in this RFQ may be subject to point reductions during the evaluation
process or may be deemed non-responsive.
1.5.4 Understanding of Specifications and Requirements. By submitting a response to this RFQ, proposer agrees to an
understanding of and compliance with the specifications and requirements described in this RFQ.
1.5.5 Proposer's Signature. The proposals must be signed in ink by an individual authorized to legally bind the business
submitting the proposal. The proposer's signature on a proposal in response to this RFQ guarantees that the offer has been established
without collusion and without effort to preclude the Township from obtaining the best possible supply or service. Proof of authority of
the person signing the RFQ response must be furnished upon request.
1.5.6 Offer in Effect for 60 Days. A proposal may not be modified, withdrawn or canceled by the proposer for a 60-day
period following the deadline for proposal submission as defined in the Schedule of Events and proposer so agrees in submitting the
proposal.
1.6 SUBMITTING A PROPOSAL
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1.6.1 Organization of Proposal. Proposers shall organize their proposal into sections that follow the format of this RFQ.
A point-by-point response to all numbered sections, subsections, and appendices is required. If no explanation or clarification is required
in the proposer's response to a specific subsection, the proposer shall indicate so in the point-by-point response or utilize a blanket
response for the entire section with the following statement:
"(Proposer's Name)" understands and will comply.
1.6.2 Failure to Comply with Instructions. Proposers failing to comply with these instructions may be subject to point
deductions.
1.6.3 Late Proposals. Regardless of cause, late proposals will not be accepted and will automatically be disqualified from
further consideration. It shall be the proposer's sole risk to assure delivery at the designated office by the designated time. Late proposals
will not be opened and will be returned to the proposer at the expense of the proposer or destroyed if requested.
1.7 COST OF PREPARING A PROPOSAL
1.7.1 Township Not Responsible for Preparation Costs. The costs for developing and delivering responses to this RFQ
and any subsequent presentations of the proposal as requested by the Township are entirely the responsibility of the proposer. The
Township is not liable for any expense incurred by the proposer in the preparation and presentation of their proposal or any other costs
incurred by the proposer prior to execution of a contract.
1.7.2 All Timely Submitted Materials Become Township Property. All materials submitted in response to this RFQ
become the property of the Township and are to be appended to any formal documentation, which would further define or expand any
contractual relationship between the Township and proposer resulting from this RFQ process.
SECTION 2: RFQ STANDARD INFORMATION
2.0 AUTHORITY
This RFQ is issued under the authority of the Township of North Bergen. The RFQ process is a procurement option allowing the award
to be based on stated evaluation criteria. No other evaluation criteria, other than as outlined in the RFQ, will be used.
2.1 PROPOSER COMPETITION
The Township encourages free and open competition among proposers. Whenever possible, the Township will design specifications,
proposal requests, and conditions to accomplish this objective, consistent with the necessity to satisfy the Township's need to procure
technically sound, cost-effective services and supplies.
2.2 RECEIPT OF PROPOSALS AND PUBLIC INSPECTION
2.2.1 Public Information. All information received in response to this RFQ, including copyrighted material, is deemed
public information and will be made available for public viewing after the time for receipt of proposals has passed with the following
four exceptions: (1) bona fide trade secrets meeting the requirements of the Uniform Trade Secrets Act, Title 30, chapter 14, part 4,
MCA, that have been properly marked, separated, and documented; (2) matters involving individual safety as determined by the
Township; (3) any company financial information requested by the Township to determine vendor responsibility, unless prior written
consent has been given by the proposer and (4) other constitutional protections, or not subject to disclosure according to OPRA
guidelines.
2.2.2 Procurement Officer Review of Proposals. Upon opening the proposals received in response to this RFQ, the
procurement officer in charge of the solicitation will review the proposals and separate out any information that meets the referenced
exceptions in Section 2.2.1 above, providing the following conditions have been met:
* Confidential information is clearly marked and separated from the rest of the proposal.
* The proposal does not contain confidential material in the cost or price section.
* An affidavit from a proposer's legal counsel attesting to and explaining the validity of any trade secret claim asserted by the
proposer.
Information separated out under this process will be available for review only by the procurement officer, the evaluation committee
members, and limited other designees. Proposers must be prepared to pay all legal costs and fees associated with defending a claim for
confidentiality in the event of a "right to know" (open records) request from another party.
6

2.3 CLASSIFICATION AND EVALUATION OF PROPOSALS
2.3.1 Initial Classification of Proposals as Responsive or Non responsive. All proposals will initially be classified as
either "responsive" or "non responsive". Proposals may be found nonresponsive any time during the evaluation process if any of the
required information is not provided; or the proposal is not within the plans and specifications described and required in the RFQ. If a
proposal is found to be nonresponsive, it may be subject to point deductions.
2.3.2 Determination of Responsibility. The Township will determine whether a proposer has met the standards of
responsibility. Such a determination may be made at any time during the evaluation process if information surfaces that would result in
a determination of non-responsibility.
2.3.3 Evaluation of Proposals. The Township will evaluate the proposals and recommend whether to award the contract
to the firm determined to best meet the needs of the Township or, if necessary, to seek discussion in order to determine the firm to be
selected. All responsive proposals will be evaluated based on stated evaluation criteria. The Township may consider such factors as
accepted industry standards and a comparative evaluation of all other qualified RFQ responses in terms of differing quality and
contractual factors. These will be used to determine the most advantageous offering to the Township.
2.3.4 Completeness of Proposals. Selection and award will be based on the proposer's proposal and other items outlined
in this RFQ. Submitted responses may not include references to information located elsewhere, such as Internet websites or libraries,
unless specifically requested. Information or materials presented by proposers outside the formal response or subsequent discussion may
not be considered.
2.3.5 Opportunity for Discussion and/or Oral Presentation/Product Demonstration. After receipt of all proposals and
prior to the determination of the award, the Township may initiate discussions with one or more proposers should clarification be
necessary. In either case, proposers should be prepared to send qualified personnel to the Township of North Bergen to discuss technical
and contractual aspects of the proposal. Oral presentations/demonstrations, if requested, shall be at the proposer's expense.
2.3.6 Contract Award. Contract award, if any, will be made to the proposer or proposers who the Township determines
can best provide the services required and provides all required documents. A formal contract incorporating this RFQ, including
Attachments A and B and the selected proposal, will be executed by all parties.
2.4 TOWNSHIP'S RIGHTS RESERVED
While the Township has every intention to award a contract as a result of this RFQ, issuance of the RFQ in no way constitutes a
commitment by the Township to award and execute a contract. Upon a determination that such action would be in its best interest, the
Township, in its sole discretion, reserves the right to cancel or terminate this RFQ; reject any or all proposals received in response to
this RFQ; waive any undesirable, inconsequential, or inconsistent provisions of this RFQ which would not have significant impact on
any proposal; not award if it is in the best interest of the Township not to proceed with contract execution; or if awarded, terminate any
contract if the Township determines adequate funds are not available.
SECTION 3: PROPOSER QUALIFICATIONS
3.0 REFERENCES
Proposer may provide references that are using services of the type proposed in this RFQ. The references may include county
government, municipalities or universities where the proposer, preferably within the last three years, has successfully completed three
contracts of this type. At a minimum, the proposer may provide the entities name, the location where the services were provided, contact
person(s), contact's position, customer's telephone number, a complete description of the service type, dates the services were provided,
and cost of services. These references may be contacted to verify proposer's ability to perform the contract. The Township reserves the
right to use any information or additional references deemed necessary to establish the ability of the proposer to perform the conditions
of the contract.
3.1 RESUMES/COMPANY PROFILE and EXPERIENCE
Proposer shall specify how long the individual/company submitting the proposal has been in the business of providing services similar
to those requested in this RFQ and under what company name. A resume or summary of qualifications, work experience, education,
skills, etc., which emphasizes previous experience in this area should be provided for all key personnel who will be involved with any
aspects of the contract.
SECTION 4: PAYMENT TERMS
7

Although total contract costs will not be the determining factor, budget or allocations of funds will be considered.
4.0 Payments for services for contracts awarded will be paid upon the submission of itemized invoices detailing the work done
and the time expended. Block billing will not be permitted. A Purchase Order will be processed and sent to you for signature. Payment
will only be made following the formal approval on the claims list by the Township of North Bergen at its subsequent regular meeting.
SECTION 5: EVALUATION CRITERIA
5.0 EVALUATION CRITERIA AND EVALUATION PROCEDURE
The evaluation committee will review all proposals to determine if they satisfy the RFQ requirements and evaluate the proposals in
accordance with the described above criteria and score each submission to determine which proposals to recommend to the governing
body for award or to seek discussions before awarding a contract. The respondent or respondents determined to best meet the Township
needs will then be recommended to the governing body for award of contract, based on all relevant factors.
5.1 EVALUATION CRITERIA
The evaluation committee will review and evaluate the offers as specified in the "Scope of Services and Evaluation Criteria" section.
8

BUSINESS REGISTRATION
New Jersey Business Registration Requirements
Pursuant to N.J.S.A. 52:32-44, the Township ("Contracting Agency") is prohibited from entering into
a contract with an entity unless the bidder/proposer/contractor, and each subcontractor that is required
by law to be named in a bid/proposal/contract has a valid Business Registration Certificate on file with
the Division of Revenue and Enterprise Services within the Department of the Treasury.
Prior to contract award or authorization, the contractor shall provide the Contracting Agency with its
proof of business registration and that of any named subcontractor(s).
Subcontractors named in a bid or other proposal shall provide proof of business registration to the
bidder, who in turn, shall provide it to the Contracting Agency prior to the time a contract, purchase
order, or other contracting document is awarded or authorized.
During the course of contract performance:
(1) the contractor shall not enter into a contract with a subcontractor unless the subcontractor first
provides the contractor with a valid proof of business registration.
(2) the contractor shall maintain and submit to the Contracting Agency a list of subcontractors and
their addresses that may be updated from time to time.
(3) the contractor and any subcontractor providing goods or performing services under the contract,
and each of their affiliates, shall collect and remit to the Director of the Division of Taxation in
the Department of the Treasury, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A.
54:32B-1 et seq.) on all sales of tangible personal property delivered into the State. Any questions
in this regard can be directed to the Division of Taxation at (609)292-6400. Form NJ-REG can be
filed online at http://www.state.nj.us/treasury/revenue/busregcert.shtml.
Before final payment is made under the contract, the contractor shall submit to the Contracting Agency
a complete and accurate list of all subcontractors used and their addresses.
Pursuant to N.J.S.A. 54:49-4.1, a business organization that fails to provide a copy of a business registration
as required, or that provides false business registration information, shall be liable for a penalty of $25 for
each day of violation, not to exceed $50,000, for each proof of business registration not properly provided
under a contract with a contracting agency.
9

Name of Individual or Business Entity Address

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)
(Please attach additional sheets if more space is needed):
Name of Individual or Business Entity Address
10

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