proposal

---

00010

REQUEST FOR BID Communication System for the Ender Hall Lab Theatre PUBLIC BID NO. P-2157 BID OPENING: 11:30 AM, Wednesday, December 3, 2014, Room # A-241 This bid packet may contain information on some or all items listed below. Contractors must submit the checked items below with their bids.

SECTION 00010

REQUEST FOR BID

00200 00210 00220

NOTICE TO BIDDERS SPECIAL PROVISIONS CERTIFICATE OF INSURANCE

00300

x

00310

SIGNED BID SHEET STATEMENT OF SUBCONTRACTORS

00400

x

STOCKHOLDER/PARTNERSHIP DISCLOSURE STATEMENT

00410

x

NON-COLLUSION AFFIDAVIT NJ DEPT. OF TREASURY PREQUALIFICATION FORMS (NOTICE OF CLASSIFICATION & TOTAL

00420

AMOUNT OF UNCOMPLETED CONTRACTS)NOTE: Contractor must provide both of the above NJ Dept. of Treasury forms

00425

CONTRACTOR’S QUALIFICATION STATEMENT (AIA DOC. A305, 1986 ED.)

00430

COMPLIANCE WITH NJ PREVAILING WAGE

00500

AGREEMENT (SAMPLE)

00600

FORM OF BID BOND

00610

CONSENT OF SURETY

00620

SURETY DISCLOSURE STATEMENT

00630

CONSENT OF COVERAGE: FIDELITY BOND

00650

MAINTENANCE BOND

00700

GENERAL BID PROVISIONS EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE FOR GOODS, PROFESSIONAL SERVICES AND GENERAL SERVICE CONTRACTS

00810A

x

00810B 00810C

EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE FOR CONSTRUCTION CONTRACTS x

EQUAL EMPLOYMENT OPPORTUNITIES RESPONSE SHEET FOR GENERAL SERVICE CONTRACTS EQUAL EMPLOYMENT OPPORTUNITIES RESPONSE SHEET FOR CONSTRUCTION CONTRACTS

00810D 00830

x

ACKNOWLEDGMENT OF ADDENDA

00840

x

REFERENCE SHEET NJ PUBLIC WORKS CONTRACTOR REGISTRATION CERTIFICATE FOR CONTRACTOR AND ANY NAMED SUBCONTRACTORS

00860 00870

x

BUSINESS REGISTRATION CERTIFICATE FOR CONTRACTOR AND ANY NAMED SUBCONTRACTORS, SUBJECT TO P.L. 2009, c. 315.

00880

x

SUSPENSION AND DEBARMENT CERTIFICATION

00890

x

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN

00900

PROJECT LABOR AGREEMENT LETTER OF ASSENT

00901

PROJECT LABOR AGREEMENT

9/2013

00200

BERGEN COMMUNITY COLLEGE 400 PARAMUS RD. PARAMUS, NEW JERSEY 07652 NOTICE TO BIDDERS PUBLIC BID NO. P-2157 PUBLIC NOTICE is hereby given that SEALED BIDS for the Communication System for the Ender Hall Lab Theatre will be received at the Office of the Director of Purchasing and Services, Bergen Community College, 400 Paramus Road, Paramus, New Jersey until 11:30 AM local time, Wednesday, December 3, 2014, room # A-241 at which time they will be publicly opened and read aloud. A

complete

set

of

bidding

documents

may

be

obtained

by

registering

on

our

website

at

http://www.bergen.edu/community/purchasing/current-vendor-opportunities.

BIDDERS ARE REQUIRED TO COMPLY WITH THE REQUIREMENTS OF N.J.S.A. 10:5-31 et seq. AND N.J.A.C. 17:27, AND MUST SUBMIT WITH THEIR BID THE REQUIRED FORM. BIDDER MUST SUBMIT A COPY OF THE BUSINESS REGISTRATION CERTIFICATE ISSUED BY NEW JERSEY DEPARTMENT OF TREASURY IN ORDER FOR THEIR BID TO BE ACCEPTED, SUBJECT TO P.L. 2009, c. 315. Proposals must be made upon and in accordance with the form of bid to be supplied by the Director of Purchasing and Services and no bidder may withdraw his bid within sixty (60) days after the actual bid and opening thereof. The Board of Trustees of Bergen Community College reserves the right to waive any informalities or to reject any or all bids. Bid envelopes must be marked with Bid No. P-2157 and indicate a "Sealed Bid" in the lower left-hand corner. For Bergen Community College B. Golden, Director Purchasing and Services

Date: October 31, 2014

2/12

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BERGEN COMMUNITY COLLEGE Public Bid # P-2157 Communication System for the Ender Hall Lab Theatre SPECIAL PROVISIONS SECTION (A) 1. The Bidder, if supplying an “or equal“ item, shall provide specification sheets of such item with the bid. 2. All prices are to be all inclusive of the parts, installation and training needed to complete this project including any and all shipping charges. 3. This bid is being awarded as one contract. The bid will not be awarded by sections. 4. INSURANCE Awardee shall furnish proof of insurance coverage in effect prior to commencement of work. Refer to attached sheet for minimum requirements. 5.

SUBCONTRACTORS Any subcontractors to be employed in the work set forth in this bid must be listed by name and address, together with the portion of work to be performed by them. Approval by the College architect or engineer, as applicable, must be obtained for all subcontractors proposed. Subcontractors must submit proof of compliance with the New Jersey Business Registration Certificate Act, PL2004, C57, subject to P.L. 2009, c. 315, to contractor prior to subcontractor entering into a contract with the contractor.

6.

Awardees are advised that other contractors may be working in the area and that every effort should be made to coordinate this project with others.

7. The Contractor, if required, shall secure and pay for the building permit and all other permits, fees and licenses necessary for the execution of the work. 8.

As to bids that are not hand-delivered to the Purchasing Department, Room A-237, any risk of nondelivery is the sole responsibility of the bidder.

9. DISPUTES AS TO THE AWARD OR NON-AWARD OF BIDS Bidder acknowledges that this bid and the award of a contract are governed by the County College Contracts Law N.J.S.A. 18A:64A-25.1, et seq., and that any legal challenges to the bidding process, the award or non-award of a contract, or the rejection of any bids, must be pursued before the Board of Trustees in accordance with P.L.. 1994 CH. 48, Sec. 6(f). The challenge or objection must be presented by filing a Petition with the Secretary of the Board of Trustees within ten (10) calendar days of the decision to award or not award a contract. Proceedings on the Petition shall be governed by the Rules governing hearings before the Board of Trustees of Bergen Community College, which Rules may be obtained at the Office of the College President. 10. The deadline to submit questions in writing related to the above bid is 10 AM, Monday, November 10, 2014. 11. No construction is allowed on campus on Sundays due to Bergen County’s blue laws. Page 1 of 6

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12. All questions related to bid requirements and specifications should be directed, in writing, via fax to:

Gloria Fyfe, Buyer Bergen Community College 400 Paramus Road Paramus, NJ 07652 Fax No. (201) 447-7850 SECTION (B) 1. Distribution of Bids: The issuance of the Bid Specifications (including the location where the Bid Specifications are available to be picked-up by interested firms) has been advertised in accordance with the provisions of the County College Contracts Law. The Bid Specifications may have been distributed to those firms known to have made proposals or submitted bids similar to those requested hereunder to the College, as well as to those firms who have requested a copy of the same from the College. In addition, copies of the Bid Specifications were available at the offices of the College for pick-up by any interested person or firm. 2. Cost of Bid Preparation: Each Bid and all information required to be submitted pursuant to the Bid Specifications shall be prepared at the sole cost and expense of the Bidder. There shall be no claims whatsoever against the College, its staff, or its consultants for reimbursement for the payment of costs or expenses incurred in the preparation of the Bid or other information required by the Bid Specifications. 3. Disclosure of Information: Bidders are advised that all Bids received by the College are deemed government records subject to public disclosure pursuant to the Open Public Records Act, N.J.S.A. 47:1A-1 et seq. However, if the Bidder chooses to include material of a proprietary nature in the Bid, the College will attempt to keep such information confidential to the extent permitted by Applicable Law. The Bidder must specifically identify the section of its Bid that contains such information by properly marking the applicable pages. Preferably, any sections which contain material of a proprietary nature shall be severable or removable from the Bids to assist the College in protecting this information. Bidders also shall include the following notice in the introduction of the relevant Bid: “The data on pages ___ identified by ___ (symbol) and labeled “Proprietary Information”, contain information that is a trade secret and/or which, if disclosed, would cause substantial injury to (Bidder’s) competitive position. (Bidder) requests that such data be used only for the evaluation of the Bid, and understands that disclosure will be limited only to the extent that the College determines it proper or to the extent that the College deems disclosure necessary according to law. If a contract is awarded to (Bidder), the College will have the right to use or disclose the data as provided in the applicable agreement executed with the Bidder.” The College will use its best efforts to prevent the unauthorized disclosure of this information in applying the proprietary standard to marked data. However, the College will assume no liability for any loss, damage, or injury that may result from any disclosure or use of marked data or any disclosure of this or other information during the review of the Bids. Notwithstanding the above, Bid forms (including cost information) will not, under any circumstances, be considered proprietary or confidential information. 4. Bid Acceptance/Rejection: The College reserves the right to accept any Bid that results in the achievement of the lowest responsible cost for the services as described herein. In addition, the College also reserves the right to (a) abandon this procurement process, (b) reject any or all Bids, (c) waive any informality in the Bids, and (d) accept the Bid or Bids that, in its judgment, best serves the interest of the College, all in Page 2 of 6

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accordance with and pursuant to the County College Contracts Law. ANY BIDDER THAT SUBMITS A BID AND TAKES ANY EXCEPTIONS OR MAKES ANY ADDITIONS TO ANY TERM OR CONDITION OF THE BID SPECIFICATIONS OR THE AGREEMENT SET FORTH HEREIN MAY BE REJECTED BY THE COLLEGE AS NON-RESPONSIVE. Additionally, the College reserves the right to decline to award the subject contract for any lawful purpose. 5. Disposal of Bids: All Bids are the property of the College and will not be returned. At the conclusion of the procurement process, the College may dispose of any and all copies of the Bids received in whatever manner it deems appropriate, in accordance with the requirements of P.L. 1920, c.46 (N.J.S. 47:2-3 et seq.), P.L. 1953, c.410 (N.J.S. 47:3-26 et al.), P.L. 1994, c.140 (N.J.S. 47:3- 26 as amended), and Chapter 3 of Title 15 of the New Jersey Administrative Code. Prior to such disposal the College will use its best efforts to prevent the unauthorized disclosure of proprietary information, provided same is properly identified as proprietary. However, in no event will the College assume liability for any loss, damage or injury that may result from any disclosure or use of marked data which occurs prior to disposal of Bids. 6. Completeness: Each of the instructions set forth herein must be followed in order for a Bid to be deemed to be responsive to the Bid Specifications. In all cases, the College reserves the right to determine, in its sole discretion, whether any aspect of the Bid meets the submission requirements of the Bid Specifications. The College reserves the right to reject any Bid that, in its judgment, does not comply with the submission guidelines set forth in these Bid Specifications. In addition, notwithstanding any of the provisions hereof, the College reserves the right to waive any informality in the Bids. 7. Bid Forms: The Bid forms contained herein specifically enumerate the requirements set forth in these Bid Specifications. A complete set of Bid forms must be included in the Bid. Data from these forms will be used in the Bid evaluations. Each Bidder must fill out all of the forms completely. Use N/A to specify items in the Bid Forms that are not applicable to the Bidder. It should be noted however, that the failure to fully complete all applicable Bid Forms by incorrectly providing that certain Bid forms (or portions thereof) are not applicable to a Bidder may result in a determination that the Bid is non-responsive. To provide additional information, use separate sheets following the Bid form format. In cases where a written price is used with a numeric price, the written price will govern. If a discrepancy exists between totals and itemized breakdowns, the totals will govern. 8. Contract Submission: If requested by the College, after contract award the successful Bidder must submit within 10 days a copy of the Agreement executed by a duly authorized representative of the Bidder. In addition, the Bidder also must submit a corporate resolution or other evidence that the signatory to such agreement is duly authorized to execute the same. In the event the successful bidder fails to deliver an executed copy of the form of Agreement signed by its authorized signatory within such ten 10 day period, the award may be withdrawn and the bidder may be deemed disqualified at the sole discretion of the College. SUBMISSION OF A SUBSTITUTE OR REVISED AGREEMENT IS NOT PERMITTED. Any submission that includes anything other than an executed copy of a form of agreement included herein may be deemed non-responsive and disqualified at the sole discretion of the College. 9. Bid Evaluation: The Bids will be evaluated in conformance with the requirements of the County College Contracts Law, and the contract will be awarded to the lowest, responsible Bidder, giving due regard to the Bidder’s ability to perform the work (as demonstrated by the information submitted with the Bids). 10. Reservation of Rights: The College reserves, holds, and may exercise, at its sole discretion, the following rights and options with regard to the Bid Specifications and the Bid process in accordance with, and pursuant to, the County College Contracts Law: Page 3 of 6

       11.

00210

To reject all Bids or any non-responsive Bid. To supplement, amend, or otherwise modify the Bid Specifications through issuance of addenda to all prospective Bidders who have received a copy of the Bid Specifications. To waive any technical non-conformance of the Bids. To change or alter the schedule of any events called for in the Bid Specifications upon the issuance of notice to all prospective Bidders who have received a copy of the Bid Specifications. To conduct investigations of any or all of the Bidders and their Bids as the College deems necessary or convenient, to clarify the information provided as part of the Bid, and to request additional information to support the information included in any Bid. To decline to award the Contract for any lawful purpose or to abandon this procurement process. To accept the Bid(s) which, in the College’s judgment, best serves the interest of the College. Prompt Payment Law – P.L. 2006, c.96

P.L. 2006, c.96, provides, in part, as follows: “If a prime contractor has performed in accordance with the provisions of a contract with the owner and the billing for the work has been approved and certified by the owner or the owner’s authorized approving agent, the owner shall pay the amount due to the prime contractor for each periodic payment, final payment or retainage monies not more than 30 calendar days after the billing date, which for a periodic billing, shall be the periodic billing date specified in the contract. The billing shall be deemed approved and certified 20 days after the owner receives it unless the owner provides, before the end of the 20-day period, a written statement of the amount withheld and the reason for withholding payment, except that in the case of a public or governmental entity that requires the entity’s governing body to vote on authorizations for each periodic payment, final payment or retainage monies, the amount due may be approved and certified at the next scheduled public meeting of the entity’s governing body, and paid during the entity’s subsequent payment cycle, provided this exception has been defined in the bid specifications and contract documents.” As a public entity that requires the authorization of its governing body for periodic or final payments, and payments for change orders or release of retainage, the College hereby places Bidders on notice that it is not subject to the twenty (20) day period for the approval and certification of billings and, consistent with P.L. 2006, c. 96, in the event that the College is unable to obtain formal consideration and approval of any billing for work performed by the successful Bidder as the basis for a periodic or final payment, or payments for change orders or retainage within the thirty (30) day time period mandated by P.L. 2006, c.96, the College shall place the billing for work performed on its next regularly scheduled meeting of its Board of Trustees and, should such billing for work performed be approved, pay the approved amount to the successful Bidder during the College’s subsequent payment cycle. It is agreed that any disputes as to whether the College or the successful Bidder has failed to make payments required pursuant to this Agreement shall be submitted to a process of alternative dispute resolution. Alternative dispute resolution agreed upon by the parties to this Agreement shall not apply to disputes concerning the bid solicitation or award process, or to the formation of contracts or subcontracts. SECTION (C) Special Provisions for Federal Grant Funded Purchases 1. Equal Employment Opportunity—"Vendor/Contractor must comply with E.O. 11246, "Equal Employment Opportunity" (30 FR 12319, 12935, 3 CFR 1964-1965 Comp., p. 339), as amended by E.O. 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity," and E.O. 13672, "Further Amendments to Executive Order 11478 Equal Employment Opportunity in the Federal Government, and Executive Order 11246, Equal Employment Opportunity" and as supplemented by regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." Page 4 of 6

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2. Copeland “Anti-Kickback” Act (18 U.S.C. 874 and 40 U.S.C. 276c)—Contracts and subgrants in excess of $2000 for construction or repair awarded by recipients and subrecipients must comply with the Copeland “Anti-Kickback” Act (18 U.S.C. 874), as supplemented by Department of Labor regulations (29 CFR part 3, “Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States”). The Act provides that each contractor or subrecipient shall be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he is otherwise entitled. The recipient shall report all suspected or reported violations to the Federal awarding agency. 3. Davis-Bacon Act, as amended (40 U.S.C. 276a to a-7)—When required by Federal program legislation, all construction contracts awarded by the recipients and subrecipients of more than $2000 must comply with the Davis-Bacon Act (40 U.S.C. 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR part 5, “Labor Standards Provisions Applicable to Contracts Governing Federally Financed and Assisted Construction”). Under this Act, contractors shall be required to pay wages to laborers and mechanics at a rate not less than the minimum wages specified in a wage determination made by the Secretary of Labor. In addition, contractors shall be required to pay wages not less than once a week. The recipient shall place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation and the award of a contract shall be conditioned upon the acceptance of the wage determination. The recipient shall report all suspected or reported violations to the Federal awarding agency. 4. Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333)—Where applicable, all contracts awarded by recipients in excess of $2000 for construction contracts and in excess of $2500 for other contracts that involve the employment of mechanics or laborers must comply with sections 102 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), as supplemented by Department of Labor regulations (29 CFR part 5). Under section 102 of the Act, each contractor shall be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a 1 rate of not less than 1 /2 times the basic rate of pay for all hours worked in excess of 40 hours in the work week. Section 107 of the Act is applicable to construction work and provides that no laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. 5. Rights to Inventions Made Under a Contract or Agreement—Contracts or agreements for the performance of experimental, developmental, or research work shall provide for the rights of the Federal Government and the recipient in any resulting invention in accordance with 37 CFR part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the awarding agency. 6. Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.), as amended—For contracts exceeding $100,000 the recipient agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.). Violations shall be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). 7. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors who apply or bid for an award of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier shall also disclose any lobbying with non-Federal funds Page 5 of 6

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that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient. 8. Debarment and Suspension (E.O.s 12549 and 12689)—A contract award with an amount expected to equal or exceed $25,000 and certain other contract awards (see 2 CFR 180.220) shall not be made to parties listed on the government-wide Excluded Parties List System, in accordance with the OMB guidelines at 2 CFR part 180 that implement E.O.s 12549 (3 CFR, 1986 Comp., p. 189) and 12689 (3 CFR, 1989 Comp., p. 235), “Debarment and Suspension.” The Excluded Parties List System contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than E.O. 12549. 9. Bonds: Bonds, if required, shall be obtained from companies holding certificates of authority as acceptable sureties pursuant to 31 CFR part 223, “Surety Companies Doing Business with the United States.” 10. Access to Records: The State of New Jersey, the College, the Federal awarding agency, the Comptroller General of the United States, or any of their duly authorized representatives, shall have access to any books, documents, papers and records of the contractor/vendor which are directly pertinent to a specific program for purposes of making audits, examinations, excerpts and transcriptions.

10/17/2014

Page 6 of 6

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BID SHEET Public Bid # P-2157 The undersigned, having familiarized himself with all of the Bid documents, hereby proposes to furnish the equipment required in accordance with the Bid documents, instructions to bidders, special provisions, and specifications, all of which are attached hereto and made a part hereof for the price set forth, exempt from all taxes. All prices are to be all inclusive of the parts, installation and training needed to complete this project including any and all shipping charges.

1.)

QTY

U/M

DESCRIPTION

1

EA

Clear-Com 2001 HMS-4X HELIXNET BASE OR EQUAL

$_________________/EA

2.)

3

EA

$_________________/EA

3.)

1

EA

$_________________/EA

4.)

7

EA

$_________________/EA

5.)

1

EA

$_________________/EA

6.)

2

EA

$_________________/EA

7.)

1

EA

$_________________/EA

$__________________________________/TOTAL

Clear-Com 2002 HBP-2X BELTPAC 2 CH OR EQUAL $__________________________________/TOTAL

Clear-Com 2004 HLI-2W2 OR EQUAL $__________________________________/TOTAL

Clear-Com 4001 CC-300-X4 SINGLE EAR HS OR EQUAL $__________________________________/TOTAL

Clear-Com 3820 TEMPEST 900 CM-922 WIRELESS BASE 2 CH OR EQUAL $__________________________________/TOTAL

Clear-Com 3822 CP-922A BELTPAC 2 CH OR EQUAL $__________________________________/TOTAL

Clear-Com 3823 CCT-9RT REMOTE ANTENNA OR EQUAL $__________________________________/TOTAL

TOTAL BID PRICE $_____________________________________________________________________ (ITEMS 1-7)

TOTAL BID PRICE IN WORDS_____________________________________________________________ (ITEMS 1-7)

Page 1 of 2

2/15/2011

00300

NAME OF COMPANY_______________________________________________ ADDRESS________________________________________________________ CITY _______________________ STATE ___________ ZIP _______________ TELEPHONE_____________________ FAX____________________________ EMAIL ADDRESS__________________________________________________ REPRESENTED BY (PLEASE PRINT NAME)____________________________ AUTHORIZED SIGNATURE__________________________________________ DATE:________________________ WITNESS:_________________________________________________________

FOR BCC USE ONLY DATE BID OPENED________________ TIME___________________________ OPENED BY:_____________________ WITNESS:____________________

___

Page 2 of 2

2/15/2011

00400

BERGEN COMMUNITY COLLEGE 400 PARAMUS ROAD PARAMUS, NJ 07652-1595 STOCKHOLDER OR PARTNERSHIP DISCLOSURE REQUIREMENT No corporation "or partnership" 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 of any public funds by the State, or of any county, municipality or school district, or any subsidiary or agency of the State, or of any county, municipality or school district, or by any authority, board or commission which exercises governmental functions, unless prior to the receipt of the bid or accompanying the bid of said corporation or said partnership, there is submitted a statement setting forth the names and addresses of all stockholders in the corporation "or partnership" who own 10% or more of its stock, of any class "or all individual partners in the partnership who own a 10% or greater interest therein, as the case may be." If one or more such stockholder or partner 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. It is mandatory that this form be completed and submitted with bid. ______________________________________________________________________________ Vendor Name and Address ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership ______________________________________________________________________________ Stockholder's Name and Percentage of Ownership USE ADDITIONAL SHEETS FOR OTHER STOCKHOLDERS  No individual stockholder or partner owns 10% or more of this corporation or partnership. By:_______________________________ Signature of Contractor

______________________________ Address

THIS FORM MUST BE RETURNED WITH YOUR BID/PROPOSAL. 8/14

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BERGEN COMMUNITY COLLEGE FORM OF NON-COLLUSION AFFIDAVIT STATE OF

___________________________________ SS:

COUNTY OF ___________________________________ _____________________________________________, being first duly sworn, deposes and says: that he is _____________________________

(PARTNER OF THE FIRM) (CORPORATE OFFICER) of ___________________________________________________________________, the party making the foregoing proposal or bid, that such is genuine and not collusive or sham; that said Bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any Bidder or person in respect to this proposal or any other proposal, or submitting of proposals, of the contract for which this proposal is submitted, to put in a sham bid, or that such other person shall refrain from bidding and has not in any matter, directly or indirectly sought by agreement or collusion, or communication or conference, with any person to fix bid price or affiant or any other bidder, or to fix any overhead cost or cost element of such bid price, or that of any other bidder, or to secure any advantage against Owner, or any person interested in proposed contract; and that all declarations and statements contained in said proposal or bid are true to the best of his knowledge and belief; and that further, such Bidder has not, directly or indirectly, submitted his bid, or contents thereof, or divulged information or data relative thereto to any association or to any member or agent thereof. That no person interested in this proposal is directly or indirectly interested or connected with any other bidder or proposal for said work, and no member of the Owner or other employee of the college is directly or indirectly interested therein or any other portion thereof. That neither he nor his agents or any other party for him has paid or agreed to pay, directly or indirectly, a person, firm, corporation any money or valuable consideration for assistance in procuring or attempting to procure the contract herein referred to, and further agrees that no such money or award shall be hereinafter paid. _______________________________________ SIGNATURE OF BIDDER, IF INDIVIDUAL SIGNATURE OF BIDDER, IF PARTNERSHIP SIGNATURE OF BIDDER, IF CORPORATION SWORN AND SUBSCRIBED TO BEFORE ME AT_______________________________ THIS _____DAY OF __________________ 20____ __________________________________ NOTARY PUBLIC COMMISSION EXPIRES:_______________ NOTE: THIS FORM MUST BE RETURNED WITH YOUR BID/RFP. 12/19/2012

BERGEN COMMUNITY COLLEGE 400 PARAMUS ROAD PARAMUS, NJ 07652 (THE COLLEGE) GENERAL BID PROVISIONS

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1. BID PROCEDURE A. All Bids shall be made on the “Specification and Bid Sheet” or “Bid Form”. B. All Bids shall be sealed and distinctly marked with “Bid number” and the date and time of Bid opening in the lower left hand corner. Persons in the office of the college shall be absolved of all responsibility for the premature opening of any proposal not so marked. C. No Bidder may withdraw a Bid within 60 days after the actual date of the opening thereof. D. All Bidders are to indicate unit prices (when feasible) for individual items, a total Bid price for each individual item, and total Bid price for the entire group. The price quoted for any one item shall in no way be conditional upon the purchase of any other item or group of items. 2. QUALIFICATIONS OF BIDDERS The College may make such investigation as it deems necessary to determine the ability of the Bidder to perform the terms of the contract and the Bidder shall furnish the College all the information for this purpose as the College may request. The College reserves the right to reject all Bid if its investigation of the Bidder reveals that, in the opinion of the College, the Bidder is not properly qualified to carry out the obligations of the contract. Conditional Bids will not be considered. 3. AWARD The award will be made to the lowest responsible Bidder provided his Bid is reasonable and will be made as soon after the opening of Bids as practicable. The right is reserved to waive any informality in, or reject, all or any part of all Bids submitted and to make awards in total or in part or in any manner in the best interest of Bergen Community College. 4. ADDENDA AND INTERPRETATION Should the Bidder find discrepancies or omissions in the specifications, he shall at once notify the College which will send written instructions to all Bidders. Requests for such interpretation shall be addressed in writing to the Purchasing Department; and to be given consideration, should be received consistent with the date established in the Special Provisions of the Bid specifications. All such interpretations and supplemental instructions will be in the form of written addenda to the specifications and drawings and become a part of the contract documents. Failure to receive any such addenda shall not relieve any Bidder from any obligation under his Bid as submitted. In the event of a dispute as to the true meaning of these instructions or the specifications, the interpretation of the College shall be final and binding. 5. EQUALS, ALTERNATES, MANUFACTURES TRADE NAME & CATALOG REFERENCES A. When the specifications state that “equals or alternates are not allowed” any Bid or portion thereof not in compliance shall be considered non-responsive. B. When equals or alternates are allowed, a catalog reference or part number follows as the description of the item. Such catalog reference is intended as a means of more fully describing the item in the shortest possible space, and is to be regarded as part of the description of the item. C. These catalog numbers have been adopted from their respective sources for purposes of identification and to establish minimum requirements for quality and design. D. The College will consider products of manufacturing which are in equal quality and appearance to the items on the equipment list and in all ways meet the specifications. E. Any material or article which will perform adequately the duties imposed by the general design will be considered equal and satisfactory provided the material or article so proposed is in the opinion of the College of equal substance and function. F. In any instance, where the proposed supply or equipment differs from the item on the equipment list contained in these specifications, such differences must be explained by way of detailed specifications and descriptions submitted as part of the Bid. G. Failure to change descriptions as above will be interpreted to mean that the Bidder intends to furnish the particular make of the article specified, and the College will insist upon delivery of the specified item. Substitutions will not be permitted after the Bids have been opened. H. The decision of the College as to whether an alternate or substitution is in fact “equal” shall be final. 6. SAMPLES A. The College reserves the right to request a representative sample of the item quoted upon prior to the award. B. Samples, when required, must be submitted in accordance with instructions, otherwise, Bids may not be considered. C. When samples are requested subsequent to Bid openings, they shall be delivered within 10 days of the request, or as directed. D. Samples shall be delivered free of charge and shall be removed by the Bidder at his expense. E. The College will not be responsible for any samples damaged or destroyed by examination. 7. MISTAKES AND BID ALTERATIONS, BIDDER’S REPRESENTATIONS No claim for relief on account of mistakes or omissions in the Bid shall be considered. By providing a Bid, the Bidder waives its rights, if any, to claim mistakes or omissions for any reason whatsoever. Erasures or other changes in the Bid shall be initialed by the Bidder. A. Bidder’s Representations 1. The Bidder by making a Bid represents that: 1.1 The Bidder has read and understands the Bidding Documents and the Bid is made in accordance therewith. 1.2 The Bidder has read and understands the Bidding Documents or contract documents, to the extent that such documentation relates to the Work for which the Bid is submitted, for other portions of the Project, if any, being Bid concurrently or presently under construction. 1.3 The Bidder has visited the site, become familiar with local conditions under which the Work is to be performed and has correlated the Bidder’s personal observations with the requirements of the proposed Contract Documents. 1.4 The Bid is based upon the materials, equipment and systems required by the Bidding Documents without exception. 1.5 The Bidder has carefully studied and compared the Bidding Documents with each other, and with other work being Bid concurrently or presently under construction to the extent that it relates to the Work for which the Bid is submitted, and has examined the site and local conditions, and shall at once report to the Architect errors, inconsistencies or ambiguities discovered. 8. CONFLICT In the event of conflict between the General Bid Provisions and the Specifications, the specification shall govern. 9. DELIVERY AND INSTALLATION A. If applicable, Bidders shall acquaint themselves with conditions to be found at the site and shall assume all responsibility for placing and installing the equipment in the location required. All freight or other delivery charges shall be prepaid by the vendor. B. The College will accept deliveries during normal business hours (9 a.m. to 4 p.m.) on normal business days (Monday through Friday). 10. PREVAILING WAGES Persons or firms Bidding on equipment which requires installation by the contractor are advised that the provisions of Chapter 105, Laws of 1962 (Prequalification Act) and of Chapter 150 Laws of 1963 (N.J. Prevailing Wage Act) as amended will apply to and be part of all such contracts.

1

11. GOVERNING LAW The terms of any agreement resulting here from shall be construed in accordance with and governed by the laws of the State of New Jersey, any disputes shall be venued in Bergen County Superior Court. 12. ASSURANCES BY SUCCESSFUL BIDDER A. When applicable, the successful Bidder guarantees: 1. To furnish adequate protection from damage for all work and to repair damages of any kind for which he or his workmen are responsible. 2. To carry insurance in the amount set forth by the College in the specifications to protect the College from any claims by or on behalf of any person, firm or corporation arising out of any action or work performed by the successful Bidder or his agents relating to the performance of the contract. 3. The College reserves the right to request proof of adequate insurance at the time of execution of the contract. 13. TAXES Bergen Community College is established under authority of the State of New Jersey and is entitled to exemption from State, Federal and local taxes. 14. GENERAL GUARANTY Neither the final certificate of payment nor any provision in the contract documents nor partial or entire use of the equipment and/or supplies by the College shall constitute an acceptance thereof if not in accordance with the specifications or relieve the contractor of liability in respect to any express warranties or responsibility for faulty materials or workmanship. The contractor shall promptly remedy any defect without cost of the College which shall appear within a period of one year from the date of final acceptance unless a greater period is specified. The College will give notice of observed defect with reasonable promptness. 15. PROHIBITED INTERESTS No official of the College who is authorized in such capacity and on the behalf of the College to negotiate, make, accept or approve, or to take part in negotiating, making, accepting, or approving any material or supply contract or any subcontract in connection with the furnishing of supplies and/or equipment, shall become directly or indirectly interested personally in this contract or in any part thereof. 16. ASSIGNMENTS The contractor shall not assign the whole or any part of this contract or any moneys due or to become due hereunder without written consent of the College. In case the contractor assigns all or any part of any monies due or to become due under this contract, the instrument of assignment shall contain a clause substantially to the effect that it is agreed that the right of the assignee in and to any moneys due or to become due to the contractor shall be subject to prior liens of all persons, firms, and corporations for services rendered or materials supplied under this contract. 17. BID SECURITY As a guarantee of good faith, the College may require a form of Bid security. The requirements for such security shall be set forth in the Bid specifications when applicable. 18. AUTHORIZED SIGNATURES If Bidder is a corporation, this Bid must be executed by an authorized official and attested by its Secretary or Assistant Secretary and the Corporate Seal affixed hereto. If Bidder is a partnership, then Bid must be individually signed by at least one (1) partner. 19. NON-COLLUSION The Bidder certifies that the prices in this Bid or proposal have been arrived at independently without collusion with any other Bidder or offeror or with any competitor and that the prices in this Bid have not been and will not be knowingly disclosed, prior to opening of Bids, to any other Bidder, offeror or competitor and that no attempt has been made to induce any other person or firm to submit or not to submit a Bid. 20. NON DISCRIMINATION IN EMPLOYMENT During the performance of this contract, the contractor agrees to perform all of its equal employment opportunity obligations as a matter of law as set forth on Form 810 attached here to. 21. AMERICANS WITH DISABILITIES ACT Equal Opportunity for Individuals with Disabilities The CONTRACTOR and the OWNER do hereby agree that the provisions of Title II of the Americans with Disabilities Act of 1990 (the “ACT”) (42 U.S.C. S12101 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 regulations promulgated pursuant thereunto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the OWNER pursuant to this contract, the CONTRACTOR agrees that the performance shall be in strict compliance with the Act. In the event that the CONTRACTOR, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the CONTRACTOR shall defend the OWNER in any action or administrative proceeding commenced pursuant to this Act. The CONTRACTOR shall indemnify, protect, and save harmless the OWNER, its agents, servants, employees from and against any and all suits, claims, losses, demands, or damages of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The CONTRACTOR 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 OWNER’S grievance procedure, the CONTRACTOR agrees to abide by any decision of the OWNER which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the OWNER or if the OWNER incurs any expense to cure a violation of the ADA which as been brought pursuant to its grievance procedure, the CONTRACTOR shall satisfy and discharge the same at its own expense. The OWNER shall, as soon as practicable after a claim has been made against it, give written notice thereof to the CONTRACTOR along with full and complete particulars of the claim. If any action or administrative proceeding is brought against the OWNER or any of its agents, servants, and employees, the OWNER shall expeditiously forward or have forwarded to the CONTRACTOR every demand, complaint, notice, summons, pleading, or other process received by the OWNER or its representatives. It is expressly agreed and understood that any approval by the OWNER of the services provided by the CONTRACTOR pursuant to this contract will not relieve the CONTRACTOR of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the OWNER pursuant to this paragraph. It is further agreed and understood that the OWNER assumes no obligation to indemnify or save harmless the CONTRACTOR, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the CONTRACTOR expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the CONTRACTOR’S obligations assumed in this Agreement, nor shall they be construed to relieve the CONTRACTOR from any liability, nor preclude the OWNER from taking any other actions available to it under any other provisions of this Agreement or otherwise at law. 22. WORKER AND COMMUNITY RIGHT TO KNOW ACT The manufacturer or supplier of chemical substances or mixtures shall label them in accordance with the N.J. Worker and Community Right to Know Act (N.J.S.A. 34:5A-1 et seq., and N.J.A.C. 5:89-5 et seq.,). Containers that the law and rules require to be labeled shall show the Chemical Abstracts Service number of all the components and the chemical name. Further, all applicable Material Safety Data Sheets (MSDS) aka hazardous substance fact sheet, must be furnished to the College. 8/14 2

(REVISED 9/14) 00810A

BERGEN COMMUNITY COLLEGE EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 Executive Order No. 13672 (2014) 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.

EXHIBIT A (Cont) 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 or the Federal Department of Labor as may be requested by such office from time to time in order to carry out the purposes of the state or federal regulations, and public agencies shall furnish such information as may be requested by the Division of Public Contract Equal Employment Opportunity Compliance and/or such other federal agency for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27 and any such federal regulations enacted pursuant to Executive Order No. 13672.

Submitted by: Name of Firm _____________________________________ Signature _________________________________________ Title _____________________________________________ Date _____________________________________________

NOTE:

THIS FORM IS TO BE SIGNED AND RETURNED WITH YOUR BID/PROPOSAL.

00810C

Bergen Community College EQUAL EMPLOYMENT OPPORTUNITIES RESPONSE SHEET

GOODS, PROFESSIONAL SERVICES AND GENERAL SERVICE CONTRACTS

IF AWARDED A CONTRACT YOUR COMPANY/FIRM WILL BE REQUIRED TO COMPLY WITH THE REQUIREMENTS OF N.J.S.A. 10:5-31 et seq., N.J.A.C. 17:27 EXECUTIVE ORDER NO. 13672 (2014)

The successful firm(s) shall submit to Bergen Community College, after notification of award, but prior to execution of this contract one of the following three documents as forms of evidence: 1. A photocopy of a valid letter that the firm is operating under an existing Federally approved or sanctioned affirmative action program (good for one year from the date of the letter); or 2. A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4 or 3. If the Contractor has neither of the above, Bergen Community College will provide the Contractor that will be awarded the contract, with an A.A.302 Employee Information Report Form which is to be completed and submitted to the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts, Department of Treasury of the State of New Jersey, with a copy to the College. Upon submission and review by the Department of Treasury, this report shall constitute evidence of compliance with the regulations. The undersigned understands that the College must reject their bid as non-responsive if said firm(s) fail to comply with the requirements of N.J.S.A. 10:5-31, N.J.A.C. 17:27 and Federal Executive Order 13672.

_______________________________________ ___________________________________ Signature Name of Firm

NOTE: THIS FORM IS TO BE SIGNED AND RETURNED WITH YOUR BID/PROPOSAL.

9/16/14

00830

ACKNOWLEDGMENT OF RECEIPT OF ADDENDA

The bidder acknowledges receipt of Bid Specifications and Addenda which have been issued during the period of bidding and agrees that said Addenda shall become a part of this contract. The bidder shall list below the numbers and issuing dates of the Addenda.

ADDENDUM NO.

ISSUING DATE

______________________

____________________

______________________

____________________

______________________

____________________

(NAME OF BIDDER)

__________________________________________________ COMPANY NAME

__________________________________________________ NAME (PRINT)

__________________________________________________ SIGNATURE

__________________________________________________ TITLE

NOTE: IF NO ADDENDUMS ARE RECEIVED, PLEASE WRITE “NONE”, SIGN FORM AND RETURN WITH YOUR BID.

00840

REFERENCE SHEET NAME OF BIDDER: _____________________________________________________________ Provide below a list of similar projects completed/serviced in the past two years. (1) Location____________________________________________________________________ Name_______________________________Title______________________________________ Address_______________________________________________________________________ Phone Number_________________ Date of Work_________ Contract Amount ______________ Description of Project____________________________________________________________ (2) Location____________________________________________________________________ Name_______________________________Title______________________________________ Address_______________________________________________________________________ Phone Number_________________ Date of Work_________ Contract Amount ______________ Description of Project____________________________________________________________ (3) Location____________________________________________________________________ Name_______________________________Title______________________________________ Address_______________________________________________________________________ Phone Number_________________ Date of Work_________ Contract Amount ______________ Description of Project____________________________________________________________ (4) Location____________________________________________________________________ Name_______________________________Title______________________________________ Address_______________________________________________________________________ Phone Number_________________ Date of Work_________ Contract Amount ______________ Description of Project____________________________________________________________ THIS FORM MUST BE FILLED OUT COMPLETELY AND RETURNED WITH YOUR BID/PROPOSAL. 8/09

00870 NJ BUSINESS REGISTRATION CERTIFICATE

Bidder must submit with his/her bid photocopy of the Business Registration Certificate issued by the New Jersey Department of Treasury, Division of Revenue for contractor and any named subcontractors, subject to P.L. 2009, c. 315. Below are samples of the Business Registration Certificate. For additional information on New Jersey Business Registration Certificates or to register on line refer to website: http://www.nj.gov/treasury/revenue/busregcert.shtml

NOTE: BUSINESS REGISTRATION CERTIFICATE MUST BE SUBMITTED WITH YOUR BID, SUBJECT TO P.L. 2009, c. 315. 2/11

00880

BERGEN COMMUNITY COLLEGE

Communication System for the Ender Hall Lab Theatre Public Bid # P-2157

SUSPENSION AND DEBARMENT CERTIFICATION Vendor/Bidder/Contractor certifies that neither it nor its principals are debarred, suspended, proposed for debarment or declared ineligible by any Federal, and or state agency.

Company Name____________________________________________________ Address___________________________________________________________ City____________________________ State______________________________ Telephone_____________________ Fax_________________________________ Authorized Signature_________________________________________________ Printed Name_______________________________________________________ Date______________________________________________________________

This form must be returned with your bid/proposal

3/13

BERGEN COMMUNITY COLLEGE DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN

00890

Pursuant to Public Law 2012, c. 25, 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 the person or entity, or one of the person or entity's parents, subsidiaries, or affiliates, is not identified on a list created and maintained by the Department of the Treasury as a person or entity engaging in investment activities in Iran. If the Department of Treasury finds a person or entity to be in violation of the principles which are the subject of this law, the Department of Treasury 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 person or entity. I certify, pursuant to Public Law 2012, c. 25, that the person or entity listed below for which I am authorized to bid:

 

is not providing goods or services of $20,000,000 or more in the energy sector of Iran, including a person or entity that provides oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas, for the energy sector of Iran, AND is not a financial institution that extends $20,000,000 or more in credit to another person or entity, for 45 days or more, if that person or entity will use the credit to provide goods or services in the energy sector in Iran.

In the event that a person or entity is unable to make the above certification because it or one of its parents, subsidiaries, or affiliates has engaged in the above-referenced activities, a detailed, accurate and precise description of the activities must be provided below to Bergen Community College under penalty of perjury.

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 outlined above by completing the boxes below. PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, USE ADDITIONAL PAGES Name:

Relationship to Bidder/Vendor:

Description of Activities:

Duration of Engagement: Bidder/Vendor Contact Name:

Contact Phone Number:

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 below-referenced person or entity. I acknowledge that Bergen Community College 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 contracts with the College to notify the College 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 agreements(s) with Bergen Community College and that the College at its option may declare contract(s) resulting from this certification void and unenforceable. Full Name (Print):

Signature:

Title:

Date:

Bidder/Vendor: THIS FORM MUST BE SIGNED AND RETURNED WITH YOUR BID/PROPOSAL