UNIFIED CERTIFICATION PROGRAMS MBE/WBE/DBE CERTIFICATION UNIFIED CERTIFICATION APPLICATION

Transcription

1 UNIFIED CERTIFICATION PROGRAMS MBE/WBE/DBE CERTIFICATION UNIFIED CERTIFICATION APPLICATION General Instructions: (PLEASE TYPE OR PRINT CLEARLY. DO NOT LEAVE ANY SPACES BLANK ON THE APPLICATION.) If a question is not applicable to your business, insert N/A in the space provided for your answer. You may make photocopies of the completed Application as necessary. Whenever the space is insufficient to answer the question completely, attach additional sheets of paper as necessary. Use the question number to identify any answer continued on an additional sheet of paper. 1. Name and Street Address of Applicant Firm (Enter the full legal name of the enterprise. For example, a Corporation named ABC Construction, Inc. should be identified as ABC Construction, Inc., not as ABC Construction.) 1a. Doing Business As (D/B/A) Name (Complete if firm does business under an assumed or trade name that is different from its legal name.) 1b. Mailing Address of Applicant Firm (Complete if different from street address.) 2. Business Telephone Number: ( ) - Fax: ( ) - 3. Federal Employer Identification Number OR Social Security Number (A Federal Employer Identification Number is required for most business activities. For an Application and/or additional information, contact the U.S. Internal Revenue Services at (516) Sole Proprietorships may submit Social Security Number of the owner in lieu of the Federal Identification Number.) 4. Name of Company President/Chief Executive Officer/Owner: (Mr./Mrs.) (Mr./Mrs.) 4a. Name and title of Officer of the firm who can be contacted during the Application review process: (Mr./Mrs.) (Mr./Mrs.) 5. This firm is applying for certification as: (Please refer to page 12 of this Application to determine the appropriate designation for your company. One or more categories may be designated.) Minority Business Enterprise (MBE) Disadvantaged Business Enterprise (DBE) Women-Owned Business Enterprise (WBE) 6. Does this firm have current Small Business Administration (SBA) 8(a) Status? 1

2 No Yes (If yes, please attach a copy of the SBA Letter of Approval.) 7. Are you currently involved in a bidding process or other contract/purchase order negotiations with any governmental agency, department or authority? No Yes (If yes, please identify agency, department or authority.) 8. Type of ownershiip: Sole Proprietorship Certificate of Trade Name on file in Date Established County Partnership Business Certificate of Partners on file in Date Established County Corporation Certificate of Incorporation on file in Date Established County 8a. Did the business exist under a different type of ownership pror to the date indicated in question 8? No Yes (If yes, Explain) 8b. Has your Certificate of Incorporation or business certificate been amended? No Yes (If yes, Explain) 8c. Method of Acquisition (Check all applicable): Start of New Business Secured Franchise Other: Bought Existing Business Secured Concession Inherited Business Merger or Consolidation Date of Acquisition: 8d. Name and Position of all person(s) with ownership interest: (Check all that are applicable. If no positions are held, state none.) Name Position Group Code* % Owned Sex US Citizen or Permanent Resident Alien Male Female Yes No Male Female Yes No Male Female Yes No Male Female Yes No *Group Code (Please refer to Page 13 for Definitions.) 01 - African American 02a - Hispanic 03a - Asian-Pacific 04 - Native American 02b - Portuguese 03b - Asian-Indian 05 - Non Minority (F/M) 02c - Spanish 06 - Other 9. Please identify the cash and capital contributions to the firm by those identified in 8d (including gifts, equipment, loans and 2

3 expertise): Contributor/Source Amount/Value Type/Date of Contribution 10. If the firm is a Partnership, please complete for all partners: Name Total Amount/Value of Contributions Date Of Ownership 10a. If the firm is a Corporation, please complete for all shareholders: Name Number of Shares Common or Preferred Amount Paid When Purchased Date of Ownership 10b. If a Corporation, please provide the number of shares: Common Authorized Preferred Authorized Common Issued Preferred Issued 11. Gross Receipts (Sales) - Please provide gross receipts for the last three (3) years: (If in business for less than 3 years, complete as applicable.) $ $ $ Current Year ( ) Last Year ( ) Previous Year ( ) 12. Number of Employees: Full-Time Part-Time Permanent Full-Time Part-Time Temporary 3

4 13. If licensing, permits or accreditations are required to conduct the business, please identify: Type of License/Permit Issued by Issue Date Expir. Date Holder/Registrant 14. Check all that best describe the business operation: Construction Services Broker Wholesale Trade Professional Services Manufacturing Retail Trade Technical Services Finance/Insurance Transportation Other (explain) 14a. Describe principal products/commodities sold, specialties or services offered (please explain): 15. Identify those individuals responsible for managerial operations (State if owner or non-owner.): (*For Group Codes, please refer to Page 13) Name And Title Sex Group Code* Owner or Non-Owner 1) Financial Decision 2) Estimating 3) Preparing Bids 4

5 Name And Title Sex Group Code* Owner or Non-Owner 4) Negotiating Bonding 5) Negotiating Insurance 6) Marketing and Sales 7) Hiring and Firing 8) Supervising Field Operations 9) Purchasing Equipment/Supplies 10) Managing and Signing Payroll 5

6 11) Negotiating Contracts Name And Title Sex Group Code* Owner or Non-Owner 12) Signatures for Business Accounts 15a. Please identify additional staff persons. If any individuals also work for another firm, please check yes and provide the person s name, position, other firm s name, address and telephone number. 1) Office Staff Name and Position Other Firm Name/Address Business Telephone Yes No Yes No 2) Field/Supervisory Staff Yes No Yes No 3) Estimator Yes No Yes No 4) Controller Yes No Yes No 5) Consultant (for firms involved in providing consultant/technical service or advisory service) Yes No Yes No 6

7 15b. If this firm shares the following with any other firm, please provide the other firm s name, address and telephone number: Other Firm Name Address Telephone Number 1) Office Space 2) Yard Space 3) Equipment (include rentals) 16. List rented, leased or owned warehouse, plant, yard and office facilities: Owner or Name of If Rented or Leased Facility Type Lessor and/or Rental Agent Amount of Yearly Rent Payment 16a. List major equipment or machinery that is owned or leased by the firm: Depreciated Acquisition Payment Type Dollar Value Date Terms 17. Do any principals, officers and/or owners of the firm have an affiliation (i.e., business interest or employment) with any other firm? No Yes (If yes, please complete the following:) Nature of Nature of Name of Person Name of Firm Business Telephone Business Affiliation 7

8 ( ) ( ) ( ) ( ) 18. Attorney for Firm: Name Street Address ( ) City State Zip Code Business Telephone 19. C.P.A. or Accountant for Firm: Name Street Address ( ) City State Zip Code Business Telephone 20. Complete attached Personal Net Worth Affidavit (financial sheet). 20a. Has the firm applied for certification as an MBE/WBE or DBE with another governmental agency, department or authority? No Yes (If yes, please complete the following:) Agency Date Contact Person Business Telephone Specifiy: M/W/DBE 1) Pending with: ( ) ( ) ( ) 2) Certified by: ( ) ( ) 8

9 ( ) 3) Registered by: ( ) ( ) 4) Withdrawn/Closed Out: ( ) 5) Rejected by: ( ) 6) Denied by: ( ) 7) Decertified by: ( ) 20b. Are there appeals pending on any of the above Applications or Certifications? No Yes Agency Date of Appeal Contact Person Business Telephone ( ) ( ) ( ) 21. List the three (3) largest accounts for which the Applicant has provided goods or services for within the last two (2) years: Account Dollar Location Of Firm Name and Telephone Amount Performance Duration 22. Identy Bank(s) where firm s accounts are maintained: Bank Name Address Contact Type of Account Account No. 9

10 23. Do you have a line of Credit? No Yes (If yes, identify) Source Limit Name of Guarantor(s) 24. List major current Creditors and/or Lenders and types of Investments and/or Loans to the firm: Type of Investment/ Dollar Value of Investment/Terms/ Name of Creditor/Lender Credit/Loan Credit/Loan 25. If your company is owned in full or in part by another firm, please identify the firm and the percentage of ownership interest. Include venture capitalists and other similar investors: Firm Name Address Percentage Ownership 26. Is the Applicant firm bonded? (If yes, specify type and limit.) No Yes Bonding Company Address Telephone ( ) - Contact Person: (Mr./Mrs.) Type Limit 10

11 SUPPORTING DOCUMENTS 1. REQUIRED FOR ALL APPLICANTS Attach copies of the following, if applicable. Please indicate documents submitted by checking appropriate boxes. NOTE: If appropriate documents are not submitted AND no written explanation is given, this application will be returned to you. 1. Resumes of all principals, partners, officers and/or key employees of the firm as per Page 2, 8(d), Page 3, 10 and Page 4, 15. Show home address and telephone number, education, training and employment with dates. 2. Bank signature card, bank resolution, or letter from the bank identifying persons authorized to conduct transactions, level of authority and limitations, if any. 3. Current financial statement. 4. Most recent three (3) years Federal and State Tax Returns including all schedules, where applicable. 5. Proof of sources of capitalization/investments. 6. Proof of ethnicity (i.e., Birth Certificate, Baptismal Certificate, U.S. Passport, etc.). 7. Proof of U.S. Citizenship (i.e., Birth Certificate, U.S. Passport, Naturalization Certificate, etc.) 8. Proof of Permanent Resident Alien status (i.e., Permanent Resident Green Card). 9. Lease Agreements per Page 7, All third party agreements including: equipment rental, purchase agreements, management service agreements, etc. 11. Any employment agreements. 12. Vehicle Registration(s). 13. Any Certification, Decertification or Denial of certification documentation. 14. Proof of Small Business Administration 8(a) and Small Disadvantaged Business Enterprise Certifications (copy of all approval letters). 15. Written request for exemption from disclosure regarding trade secrets. 16. Personal Net Worth Affidavit (financial profile). SUPPORTING DOCUMENTS 2. REQUIRED FOR A SOLE PROPRIETORSHIP. Attach copies of the following: (Please indicate documents submitted by checking appropriate boxes.) 1. Copy of Certificate of Trade Name or Business Trade Name filed with County Clerk (if doing business under an assumed name). 3. REQUIRED FOR A PARTNERSHIP AND A JOINT VENTURE PARTNERSHIP. Attach copies of the following: (Please indicate documents submitted by checking appropriate boxes.) 1. Business Certificate 2. Partnership Agreement 11

12 3. Buy-Out-Rights 4. REQUIRED FOR A CORPORATION. Attach copies of the following: (Please indicate documents submitted by checking appropriate boxes.) 1. Articles of Incorporation, including date approved by State 2. Corporation By-Laws 3. Minutes of first Corporate Organizational Meeting and Amendments 4. Copies of all issued Stock Certificates, front and back, as well as next unissued certificates 5. Copy of Stock Ledger 6. If applicable, furnish copies of agreements relating to: 1. Stock options 2. Shareholder agreements 3. Shareholder voting rights 4. Restriction on the disposal of stock loan agreements 5. Facts pertaining to the value of shares 6. Buy Out Rights 7. Restrictions on the control of the Corporation 7. List of current Board of Directors including group code, sex and effective dates: Name Position Group Code* Sex Date Male Male Male Male Female Female Female Female Male Female *For Group Codes, please see Page 13 NOTE: If appropriate documents are not submitted AND no written explanation is given, application will not be processed. NJ TRANSIT UNIFIED CERTIFICATION PROGRAMS GROUP CODES (To be used to answer Question 15, Page 4) 01. African American 02a. Hispanic 02b. Portuguese 02c. Spanish 03a. Asian-Pacific 03b. Asian-Indian 04. Native American 05. Women (regardless of race/ethnicity) 06. Other* *Members of other groups or other individuals found, on a caseby case basis, to be economically and socially disadvantaged by the U.S. Department of Transportation grant recipients or by the Small Business Administration under Section 8(a) of the Small Business Act as amended (15 U.S.C. 637(a)). Minority means a person who is: (1) African American, which is a person having origins in any of the African American racial groups in Africa; or (2) Hispanic, which is a person of Spanish or Portuguese culture, with origins in Mexico, South or Central America, or the Caribbean Islands, regardless of race; or (3) Asian American, which is a person having origins in any of the original peoples of the Far East, Southeast Asia, Indian Sub-Continent, Hawaii, or the Pacific Islands; or (4) Native American (American Indian or Alaska Native), which is a person having origins in any of the original peoples of North America. 12

13 DEFINITIONS Certified means minority or women-owned business has been authenticated as being at least 51% owned and controlled either by minorities or females for participation in State programs requiring certification as judged and determined by the Set- Aside and Certification Office of the Department of Commerce and Economic Development. Disadvantaged Business Enterprise (DBE) (eligible for Federal, State, NJDOT and NJ TRANSIT contracts) means: a) A small business which is at least 51% owned by one or more socially and economically disadvantaged individuals, or in the case of any publicly owned business, at least 51% of the stock which is owned by one or more socially and economically disadvantaged individuals; and b) Whose management and daily business operations are controlled by one or more of the socially and economically disadvantaged individuals who own it. Minority Business Enterprise (MBE) (eligible for NJDOT, NJ TRANSIT and State contracts only) means: a) A Sole Proprietorship, Partnership or Joint Venture owned and controlled by minorities in which at least 51% of the ownership interest is held by minorities and the management and daily business operations are controlled by one or more of the minorities who own it; or b) A Corporation or other business entity authorized under the laws of the United States whose management and daily business operations are controlled by one or more minorities who own it and which is at least 51% owned by one or more minorities or, if stock is issued, a 51% of the stock is owned by one or more minorities. Registered means a minority or women-owned business has completed the process by which the New Jersey Commerce and Economic Growth Commission and Department of Business Policy and Information compiles the information for all small, minority or women-owned business with the State of New Jersey. 13

14 Women Business Enterprise (WBE) (eligible for NJDOT, NJ TRANSIT and State contracts only) means: a) A Sole Proprietorship owned and controlled by a woman; b) A Partnership or Joint Venture owned and controlled by women in which at least 51% of the ownership is held by women and the management and daily business operations of which are controlled by one or more women who own it; or c) A Corporation or other business entity authorized under the laws of the United States whose management and daily business operations are controlled by one or more who own it and which at least 51% of the stock is owned by one or more women. UNDER EACH CERTIFICATION CATEGORY, OWNERSHIP MUST BE REAL, SUBSTANTIAL AND CONTINUING. THE APPLICANT MUST HAVE AND EXERCISE THE AUTHORITY TO INDEPENDENTLY CONTROL THE BUSINESS DECISIONS OF THE ENTERPRISE. 14

15 NJ TRANSIT UNIFIED CERTIFICATION PROGRAMS DEFINITIONS Certified means a minority or women-owned business has been authenticated as being at least 51% owned and controlled either by minorities or females for participation in State programs requiring certification as judged and determined by the Set- Aside and Certification Office of the Department of Commerce and Economic Development. Disadvantaged Business Enterprise (DBE) means: (for NJDOT and NJ TRANSIT contracts only) a) A small business which is at least 51% owned by one or more socially and economically disadvantaged individuals, or in the case of any publicly owned business, at least 51% of the stock which is owned by one or more socially and economically disadvantaged individuals; and b) Whose management and daily business operations are controlled by one or more of the socially and economically disadvantaged individuals who own it. Minority means a person who is: (1) African American (Black): which is a person having origins in any of the African American racial groups in Africa; or (2) Hispanic, which is a person of Spanish or Portuguese culture with origins in Mexico, South or Central America, or the Caribbean Islands, regardless of race; or (3) Asian American, which is a person having origins in any of the original peoples of the Far East, Southeast Asia, Indian Sub-Continent, Hawaii or the Pacific Islands; or (4) Native American (American Indian or Alaska Native), which is a person having origins in any of the original peoples of North America. Minority Business Enterprise (MBE) means a business which is: a) A Sole Proprietorship, Partnership or Joint Venture owned and controlled by minorities in which at least 51% of the ownership interest is held by minorities and the management and daily business operations are controlled by one or more of the minorities who own it; or b) A Corporation or other business entity authorized under the laws of the United States whose management and daily business operations are controlled by one or more minorities who own it and which is at least 51% owned by one or more minorities or, if stock is issued, at least 51% of the stock is owned by one or more minorities. Registered means a minority or women-owned business which has: Completed the process by which the New Jersey Commerce and Economic Growth Commission and Department of Business Policy and Information compiles the information for all small, minority or women-owned business enterprises seeking to do business with the State of New Jersey. Women Business Enterprise (WBE) means a business which is: a) A Sole Proprietorship owned and controlled by a woman; b) A Partnership or Joint Venture owned and controlled by women in which at least 51% of the ownership is held by women and the management and daily business operations of which are controlled by one or more women who own it; or c) A Corporation or other business entity authorized under the laws of the United States whose management and daily business operations are controlled by one or more who own it and which is at least 51% owned by women or, if stock is issued, at least 51% of the stock is owned by one or more women. 15

16 FRAUD The undersigned does hereby swear that the statements contained in this Application and all attachments which have been provided in support of this Application (hereafter referred to as this Application ) are true, accurate, and complete and include all material information necessary to identify and explain the ownership and operation of: (Insert Full Name of Applicant Company Here) Further, the undersigned does covenant and agree to provide NJ TRANSIT (or any other portion of the New Jersey State Government working on behalf of NJ TRANSIT - hereafter collectively referred to as NJT ) with current, complete and accurate information regarding this Application, its attachments, or any project or contract issued by the State of New Jersey. The undersigned further agrees that, as part of this certification procedure, NJT may freely contact any person or organization named in this Application to verify statements made in this Application and/or to secure additional information or data required to grant to, or withhold from the applicant company certification as a Minority Business Enterprise, a Women Business Enterprise (or both) or a Disadvantaged Business Enterprise. The Undersigned understands and agrees that failure to submit required materials and/or to consent to interview(s), audit(s), and/or examination(s) will be grounds for immediate rejection of this Application for certification or Recertification. It is recognized and acknowledged that the statements contained in this Application have been given under oath and that any material misrepresentation will be grounds for denial of certification or for decertification and may result in not awarding or terminating contracts which may be awarded as the result of information contained in this Application. The undersigned further acknowledges that information contained in this Application may be shared with any public department, agency, etc., which is responsible for providing funds of the State of New Jersey or the United States Government which are used to fulfill contracts arising from the representations made in this Application. The release of such information will be subject to all laws of the State and Federal Government applicable to the treatment of confidential information and/or material. It is further understood that certification as a MBE/WBE/DBE will be suspended for a period of up to, but not exceeding, two years if, after proper investigation by NJT, the applicant is determined to be engaging in activities which circumvent the intent of the New Jersey Unified Certification Programs. The applicant further understands that misrepresentations made in this Application are subject to all laws of the State of New Jersey, which deal with civil and criminal fraud. Under these laws, convictions may result in fines up to $100,000 (or any higher amount equal to double the pecuniary gain to the offender or loss to the victim) or a jail term of between five and ten years. The undersigned further acknowledges that certification is for 3 years (subject to change) with an annual review. NJ TRANSIT retains the right to re-evaluate the contents of this Application at any time. I have read and acknowledge the foregoing (Signature of Applicant) 16

17 VERIFICATION STATE OF } COUNTY OF } } SS.: A., being duly sworn, states he or she is the owner of (or a partner in) the enterprise making the foregoing Application and that the statements and representations made in the Application are true to his or her own knowledge. B., being duly sworn, states that he or she is the (Name of Corporate Officer), of. (Title of Corporate Officer) (Name of Corporation) The enterprise making the foregoing Application, that he or she has read the Application and knows its contents that the statements and representations made in the Application are true to his or her own knowledge, and that Application is made at the direction of the Board of Directors of the Corporation. (Authorized Signature) (Date) Sworn to before me this Day of Year (Notary Public) Person assisting in completing the Application: (Print Name) (Signature) (Business Telephone Number) PLEASE READ THIS ENTIRE ITEM CAREFULLY!! Only the signature of the owner of a Sole Proprietorship, a Partner of a Partnership or the President of a Corporation is acceptable. (For a Partnership, only a General Partner may sign, the signature of a Limited Partner is not acceptable.) When completed, the entire application must be notarized. NJ TRANSIT 17

18 UNIFIED CERTIFICATION PROGRAMS A. REQUIRED DOCUMENT IDENTIFICATION EXPLANATIONS When submitting the required documents referenced on Page 10 and 11 of the Unified Certification Application, please clearly mark each submitted document with the appropriate exhibits number on the upper right hand corner of the top sheet. The following is a brief explanation of material that will be considered acceptable for each exhibit. Submitting your application using these instructions uniformly will speed the processing of your application. If you have no exhibit to present a particular item, please include a page appropriately marked for the exhibit explaining its absence. EXHIBITS - EXPLANATIONS 1. RESUMES OF ALL OWNERS, DIRECTORS, OFFICERS, OFFICE AND KEY FIELD SUPERVISORS ARE REQUIRED If fairly recent resume copies for each individual are available, as long as they are up-to-date, they may be submitted with your Certification Application. If you must start from scratch, an abbreviated resume which merely itemizes each position held up to the date of submission (business names, dates, major work responsibilities). DO, HOWEVER, LIST ANY LICENSE(S) OR PERMIT(S) RELEVANT TO YOUR BUSINESS AND DATE(S) ACQUIRED (OR QUALIFIED). Examples would be: an electrical contractor s license and date acquired; an asbestos removal certification and date acquired, etc. A BRIEF RESUME FOR EACH INDIVIDUAL MUST BE SUBMITTED. 2. COPIES OF ALL BUSINESS BANK ACCOUNT SIGNATURE CARDS AND RESOLUTIONS Banks are sometimes reluctant to release copies of signature cards for obvious reasons. However, most New Jersey banking insitutions are now familiar with this requirement and you should have no difficulty having a copy of this document forwarded directly to the Certification Office, provided you explain to an officer of the institution the purpose of your request. In the unlikely event this becomes a problem, please have your bank contact the Certification Office at (609) to discuss. IF YOU USE YOUR PERSONAL ACCOUNT(S) FOR BUSINESS PURPOSES, COPIES OF ALL SIGNATURE CARDS ARE REQUIRED. FOR A CORPORATION, COPIES OF ALL CORPORATE (BANKING) RESOLUTIONS ARE 5. PROOF OF SOURCES OF CAPITAL AND INVESTMENTS IN YOUR BUSINESS REQUIRED, IN ADDITION TO THE SIGNATURE CARDS FOR ALL CORPORATE ACCOUNTS. 3. CURRENT BALANCE SHEET AND STATEMENT OF INCOME The BALANCE SHEET is a list of your assets (what you own), your liabilities (your debts), and your equity in those assets. THE INCOME STATEMENT SUMMARIZES THE VARIOUS TRANSACTIONS OF THE BUSINESS DURING A SPECIFIED PERIOD, SHOWING THE PROFIT (OR LOSS). If these statements were prepared within the last twelve (12) months, and there has been no substantial change in owners equity (net worth), or rate of income generated from the enterprise, it is not necessary to prepare special statements for the purpose of applying for certification. Copies of your most recent statements are all that are required for this exhibit. If, however, you have never produced statements, or your last statements are old, then current statements must be submitted. THE MINIMUM ACCEPTABLE STATEMENTS ARE: a) Balance Sheet: Total Assets - Total Liabilities = Net Worth (Owner Equity). b) Statement Of Income: Gross Receipts = Gross Expenses = Gross Income for Period. These statements should be prepared from the standpoint of an applicant applying to a financial institutioon for a working capital line-of-credit. (Statement prepared for Federal Tax purposes, as an attachment to a Corporate or Personal Income Tax filing, are not acceptable here). 4. FEDERAL TAX RETURNS (INCLUDING ALL SCHEDULES The PERSONAL FEDERAL TAX RETURNS FOR EACH OWNER, DIRECTOR AND OFFICER of the enterprise for the past three (3) consecutive years must be submitted. IN ADDITION, THE COMPANY FEDERAL TAX RETURNS FOR THE PAST THREE (3) CONSECUTIVE YEARS ARE REQUIRED. ALL RETURN copies must be complete, with ALL SCHEDULES (related and unrelated to the applicant enterprise). If you started your business with accumulated personal savings, your evidence (proof) should indicate the origin of the initial investment capital. or managerial control, and/or operational control of the enterprise would pass to a second and/or third party in the event of death, disability and/or incapacity of one or more of the 18

19 PROOF OF THE INITIAL CAPITAL CONTRIBUTIONS OF ALL PRINCIPALS OF THE ENTERPRISE IS REQUIRED. Evidence may take the form of copies of mortgage contracts, agreements of sale, loan agreements, promissory notes and/or cancelled check (with the source of funds noted) which were deposited in the business account(s) when the enterprise was started. PROOF OF CONTINUING WORKING CAPITAL FINANCING MUST ALSO BE PROVIDED. This evidence must also clearly indicate the source(s) of the funds. If you started your business with accumulated personal savings, your evidence (proof) should indicate the origin of the initial investment capital. 6. PROOF OF MINORITY, WOMEN OR DISADVANTAGED STATUS MINORITY GROUP MEMBERSHIP: If you are claiming membership in one of the designated minority groups, evidence must be submitted to ensure that the applicant s minority status is clearly established. The minority groups designated are African Americans, Hispanic Americans, Asian Americans and Native Americans. Definitions of these groups for New Jersey Unified Certification purposes are found in New Jersey Public Law 1986, Chapter 195, Unified Certification Act and corresponding Regulations N.J.A.C. 12A: 11-1 et seq. SATISFACTORY EVIDENCE FOR EACH MINORITY INDIVIDUAL INVOLVED may take the form of copies of a birth certificate (which states racial group), picture driver s license, naturalization papers, passport, signed and dated photograph, Indian Tribal Roll registration, or other official document RELATING TO YOUR MINORITY GROUP MUST BE PROVIDED. DISADVANTAGED BUSINESS: Means a small business (for NEW JERSEY DEPARTMENT OF TRANSPORTATION and NJ TRANSIT contracts). FEMALE GENDER MEMBERSHIP: A Women Business Enterprise is eligible for New Jersey Unified Certification under N.J. Public Law 1986, Chapter 195 and per Regulations N.J.A.C. 12A: 11-1, et seq. SATISFACTORY GENDER EVIDENCE FOR EACH WOMAN INVOLVED may take the form of a birth certificate (which states gender), picture driver s license, naturalization papers, passport, or other official document. 6a. OWNERSHIP AGREEMENTS Any and all ownership agreements, whether oral or implied understandings, MUST BE WRITTEN OUT AND A COPY OF EACH SUCH AGREEMENT SUBMITTED. An example of such agreement would be an understanding that ownership and/ applicant owners. A COPY OF ALL EXISTING AGREEMENTS IS REQUIRED. 7. PROOF OF US CITIZENSHIP (Not Required) 8. PROOF OF LAWFUL, PERMANENT RESIDENT STATUS If any owner of the enterprise was not a born citizen of the United States, PROOF OF LAWFUL PERMANENT RESIDENT STATUS IS REQUIRED FOR SUCH OWNER(S). Proof may take the form of a copy of a valid Resident Alient (Green Card) or a copy of an appropriate naturalization certificate. 9., 10. ALL RENTAL, LEASING AND/OR THIRD PARTY AGREEMENTS (for operating premises, major capital equipment and Joint Venture agreements) A COPY OF THE SIGNED LEASE FOR THE OPERATING PREMISES REQUIRED TO INDICATE THAT THE APPLICANT HAS THE LEGAL RIGHT TO USE THE SPACE FOR BUSINESS PURPOSES. If the applicant is operating from owned premises, A COPY OF ANY ONE OF THE FOLLOWING DOCUMENTS WILL SUFFICE AS PROOF OF THE RIGHT OF BUSINESS USE: deed, mortgage, payment coupon, property tax bill, or utility bill. If the applicant uses leased capital equipment, copies of the three (3) largest dollar amount lease documents required. If the applicant is a Joint Venture, a completed copy of the Joint Venture contract must also be included, i.e., signed agreements, together with all addenda, exhibits, changes or modifications attached. 11. ANY EMPLOYMENT AGREEMENTS (Not Required) 12. COPIES OF ALL VEHICLE REGISTRATIONS Copies of all registrations or lease agreements for vehicles which are used by the enterprise, REGARDLESS OF OWNERSHIP, ARE REQUIRED. 13. ALL LETTERS OF CERTIFICATION, DECERTIFICATION AND/OR DENIAL If you have previously qualified for Certification in another State, or at the county or the municipal level, PLEASE SUBMIT A COPY OF EACH CERTIFICATION. If you have been denied or decertified at any governmental level, PLEASE SUBMIT A COPY OF EACH DENIAL OR DECERTIFICATION. RESULTS OR ANY CHALLENGE, APPEAL AND/OR C (2). A COPY OF YOUR PARTNERSHIP 19

20 SUSPENSION PROCEEDINGS If Certification has been challenged, appealed, suspended or withdrawn for any reason, A COPY OF ANY SUCH ACTION IS REQUIRED. If you are presently engaged in appeal proceedings regarding certification, decertification and/or denial, at any government level, PLEASE SUBMIT A COPY OF ANY SUCH APPEAL(S). 14. SBA SECTION 8(a) PROGRAM PARTICIPATION (Small Business Act) If you have qualified for the Federal Government s Small Business Administration s 8(a) Program, under the Small Business Act, A COPY OF THE MOST RECENT APPROVAL LETTER IS REQUIRED. (For information regarding all United States Federal Government Small Business Administration Programs, please contact your nearest SBA District Office. In New Jersey, the United States Small Business Administration Office can be reached by telephoning (201) Out-of- State inquiries should be directed to the nearest SBA District Office which can be found in your local telephone directory under the headings: United States Federal Government, Small Business Administration.) 15. WRITTEN REQUEST FOR EXEMPTION FROM DISCLOSURE REGARDING TRADE SECRETS (Not Required) B. REQUIRED FOR A SOLE PROPRIETORSHIP B (1). TRADE NAME: IF YOU ARE OPERATING UNDER YOUR OWN FULL NAME, NO AUTHORIZATION IS NEEDED. If you are operating under a variation of your name, or a fictitious or assumed business name, a copy of a fully, executed trade name certificate is required. Please contact your County Clerk s Office to file your trade name certificate if you have not already done so. (Out-of-State proprietorships doing business in New Jersey can file its trade name certificate with the Mercer County Clerk s Office, P.O. Box 8068, Trenton, New Jersey, 08620, telephone (609) ) C. REQUIRED FOR PARTNERSHIP AND A JOINT VENTURE PARTNERSHIP C (1). PARTNERSHIP: AS ABOVE, A COPY OF YOUR FULLY EXECUTED TRADE NAME CERTIFICATE IS REQUIRED JOINT VENTURES; COPIES OF AUTHORIZATIONS, AS DESCRIBED ABOVE, ARE REQUIRED FOR EACH VENTURE PARTICIPANT. AGREEMENT IS REQUIRED If your agreement is an oral or implied Understanding, it must be committed to writing and Submitted. Please include all changes, modifications and any other relevant ownership and control information, INCLUDING AGREEMENTS WITH SILENT PARTNERS. C (3). BUY OUT AGREEMENT An oral agreement or implied understanding to buy out a Partner which is not included in your formal Partnership Agreement, must also be committed to writing and Submitted, EVEN THOUGH IT MAY INCLUDE THIRD PARTIES WHO ARE NOT NEW ACTIVE MEMBERS OF THE PARTNERSHIP. (THIS INCLUDES ALL LIMITED PARTNERS.) D. REQUIRED FOR A CORPORATION CORPORATIONS: If your enterprise is Incorporated in the State of New Jersey, A COPY OF YOUR FULLY EXECUTED (STAMPED BY THE SECRETARY OF STATE S OFFICE) CERTIFICATE OF INCORPORATION IS REQUIRED. FOREIGN CORPORATION ( OUT-OF-STATE CORPORATIONS): Foreign corporations doing business in New Jersey MUST SUBMIT A COPY OF THEIR CERTIFICATE OF AUTHORITY FOR A FOREIGN CORPORATION. Questions regarding Registration as a foreign corporation should be directed to the: New Jersey Department of State, Division of Commercial Recordings, 820 Bear Tavern Road, CN 308, Trenton, New Jersey, , telephone (609) D (1). ARTICLES OF INCORPORATION REGARDLESS OF WHERE INCORPORATED, A COMPLETE, FULLY EXECUTED COPY OF YOUR ARTICLES OF INCORPORATION IS REQUIRED. (THIS IS COMMONLY FOUND IN YOUR CORPORATE KIT). D (2). CORPORATE BYLAWS A complete copy of your Corporate Bylaws including all currently operative amendments and changes is required. PLEASE TAKE CARE TO ENSURE THAT THE BYLAWS SUBMITTED CONTAIN NO BLANKS TO BE FILLED-IN. D (3). FIRST ORGANIZATIONAL MEETING MINUTES (INCLUDE ANY AMENDMENTS) A complete copy of your organizational meeting minutes, 20

21 (including the recording of the election of directors, the appointment of officers and the corporate secretaries is required). PLEASE TAKE CARE TO ENSURE THAT THE DOCUMENTS SUBMITTED CONTAIN NO BLANKS TO BE FILLED-IN; AND THAT ALL RESOLUTIONS ADOPTED AND ALL AMENDMENTS TO THE BYLAWS WHICH ARE RATIFIED, ARE INCLUDED. D (4). COPIES OF ALL STOCK CERTIFICATES ISSUED AND THE NEXT UNISSUED CERTIFICATE. A copy of all stock certificates issued, including the cancelled certificates, if any, must be submitted. A COPY OF THE NEXT BLANK UNISSUED CERTIFICATE MUST ALSO BE INCLUDED. Please take care to ensure that all issued Certificates are fully executed. D (5). STOCK TRANSFER LEDGER A completed copy of your Stock Transfer Ledger is also required. Please have the Corporate Secretary review this document to ensure its accuracy. PLEASE DO NOT SUBMIT A COPY OF A BLANK STOCK TRANSFER LEDGER. D (6). STOCK OPTION AGREEMENTS If you have any written agreements to provide stock options to any individuals, regardless of cost, and regardless of whether such individuals are currently shareholders, A COPY OF ALL SUCH AGREEMENTS IS REQUIRED. IF ANY SUCH AGREEMENT IS AN ORAL OR IMPLIED UNDERSTANDING, IT MUST BE COMMITTED TO WRITING AND SUBMITTED. D (6a). SHAREHOLDER AGREEMENTS If you have any written agreements among shareholders regarding the managerial or operational control of the Enterprise, which are not formalized resolutions or amendments to your Bylaws, A COPY OF ANY SUCH AGREEMENT IS REQUIRED IF ANY SUCH AGREEMENT IS ORAL OR IMPLIED UNDERSTANDING, IT MUST BE COMMITTED TO WRITING AND SUBMITTED. D (6c). RESTRICTIONS ON DISPOSAL OF STOCK If the Corporation has any restrictions whatsoever on the disposal of shares in the enterprise by any shareholder, A COPY OF THESE RESTRICTIONS IS REQUIRED. IF A RESTRICTION IS AN ORAL OR IMPLIED UNDERSTANDING, IT MUST BE COMMITTED TO WRITING AND SUBMITTED. D (6d). FACTS REGARDING CURRENT VALUE OF SHARES If your Corporation holds any inactive assets or assets which are not utilized in the normal conduct of your regular business, and these assets materially affect the value of shares, facts regarding any such assets must be disclosed. A BRIEF DESCRIPTION OF THE NATURE AND VALUE OF ANY SUCH ASSET IS REQUIRED. If you anticipate any changes in the value of shares as a result of a future expected event, A BRIEF DESCRIPTION OF THE EVENT AND ITS ANTICIPATED EFFECT ON THE VALUE OF SHARES IS REQUIRED. D (6e). BUYOUT RIGHTS Any oral agreement or implied understanding to Buyout a partner which is not included in your formal Corporation Agreement, must be committed to writing and submitted, EVEN THOUGH IT MAY INCLUDE THIRD PARTIES WHO ARE NOT NOW ACTIVE MEMBERS OF THE CORPORATION. D (6f). RESTRICTIONS OF THE CONTROL OF THE CORPORATION Any and all restrictions, whether oral or implied restricting control, MUST BE WRITTEN OUT AND A COPY OF EACH SUCH RESTRICTION SUBMITTED. An example of such a restriction would be: an understanding that ownership and/or managerial control, and/or operational control of the enterprise would pass to a second and/or third party in the event of death, disability and/or incapacity of one or more of the applicant owners. A COPY OF ALL EXISTING RESTRICTIONS IS REQUIRED. D (6b). SHAREHOLDER VOTING RIGHTS If you have any agreements regarding the voting of shares among the shareholders of your Corporation, regardless of whether such agreements have been formalized in wirting, A COPY IS REQUIRED. IF ANY SUCH AGREEMENT IS AN ORAL OR IMPLIED UNDERSTANDING, IT MUST BE COMMITTED TO WRITING AND SUBMITTED. 21

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