BRIDGETON PUBLIC CHARTER SCHOOL

Transcription

1 BRIDGETON PUBLIC CHARTER SCHOOL REQUEST FOR PROPOSALS FOR THE PROVISION OF INSURANCE BROKERAGE SERVICES FOR DISABILITY INSURANCE RFP 15-04(re-issue) ISSUE DATE: May 18, 2015 DUE DATE: June 1, 2015 Issued by: Douglas McGarry, Board Secretary/Business Manager - 1 -

2 GLOSSARY The following definitions shall apply to and are used in this Request for Proposals: "Board" - refers to the (Bridgeton Public Charter School Board of Trustees). "Proposal Statement" - refers to the complete responses to this RFP submitted by the Respondents. Proposed Respondent" - refers to those Respondents who (in the sole judgment of the Board) have satisfied the proposal criteria set forth in this RFP. "RFP" - refers to this Request for Proposals, including any amendments thereof or supplements thereto. "Respondent" or "Respondents" - refers to the interested firm(s) that submit a Proposal Statement. 2

3 SECTION 1 INTRODUCTION AND GENERAL INFORMATION 1.1 Introduction and Purpose The Board is soliciting Proposal Statements from interested persons and/or firms for the provision of consulting services, as more particularly described herein. Through a Request for Proposal process described herein, persons and/or firms interested in assisting the Board with the provision of such services must prepare and submit a Proposal Statement in accordance with the procedure and schedule in this RFP. The Board will review Proposal Statements only from those firms that submit a Proposal Statement which includes all the information required to be included as described herein (in the sole judgment of the Board). The Board intends to accept proposals from person(s) and/or firm(s) that: (a) Possess the professional, financial and administrative capabilities to provide the proposed services; and (b) Will agree to work under the compensation terms and conditions determined by the Board of Trustees to provide the greatest benefit to the Bridgeton Public Charter School Board of Trustees. 1.2 Procurement Process and Schedule The selection of Proposed Respondents is subject to the New Jersey Local Unit Pay-to-Play Law, N.J.S.A. 19:44A-20.4 et seq. The Board has structured a procurement process that seeks to obtain the desired results described above, while establishing a competitive process to assure that each person and/or firm is provided an equal opportunity to submit a Proposal Statement in response to the request and will be evaluated in accordance with the criteria set forth in Section 2 of this RFP. Proposal Statements will be reviewed and evaluated by the Board and its legal advisors. The Proposal Statements will be reviewed to determine if the Respondents have met the minimum professional, administrative and financial areas described in this RFP. Based upon the totality of the information contained in the Proposal Statement, including information about the reputation and experience of each Respondent, the Board will (in its sole judgment) determine which Respondents are qualified (from professional, administrative and financial standpoints). Each Respondent that meets the requirements of the RFP (in the sole judgment of the Board) will be designated as a Proposed Respondent and will be 3

4 given the opportunity to participate in the selection process determined by the Board. The RFP process commences with the issuance of this RFP. The steps involved in the process are found on the Procurement Schedule. The Board reserves the right to, among other things, amend, modify or alter the Procurement Schedule in its sole discretion and in accordance with applicable law. All communications concerning this RFP or the RFP process shall be directed to the designated contact person, in writing. Designated Contact Person(s): Douglas McGarry, Board Secretary OR Christina Murphy, School Business Administrator , ext.301 Bridgeton Public Charter School Board of Trustees 2560 Industrial Way, Unit C. Vineland, NJ Proposal Statements must be submitted to, and be received by, the Board, via mail or hand delivery, by (10:00 AM) Prevailing Time on (June 1, 2015). TABLE 1 ANTICIPATED PROCUREMENT SCHEDULE 1. Issuance of Request for Proposals 2. Receipt of Proposal Statements 3. Opening of Proposals 4. Analysis of Proposals 5. Administrative Review 6. Designation of Proposed Respondents deemed necessary or appropriate by the Board. 4

5 Section 1.3 Conditions Applicable to RFP Upon submission of a Proposed Statement in response to this RFP, the Respondent acknowledges and consents to the following conditions relative to the submission, review and consideration of its Proposed Statement: The Board reserves the right to reject for any reason any and all responses and components thereof and to eliminate any and all Respondents responding to this RFP from further consideration for this procurement. The Board reserves the right to reject any Respondent that submits incomplete responses to this RFP, or a Proposal Statement that is not responsive to the requirements of this RFP. The Board reserves the right, without prior notice, to supplement, amend, or otherwise modify this RFP, or otherwise request additional information. All Proposal Statements shall become the property of the Board and will not be returned. All Proposal Statements will be made available to the public or the other Respondents at the appropriate time, as determined by the Board (in the exercise of its sole discretion) in accordance with law. The Board may request Respondents to send representatives to the Board for interviews. Any and all Proposal Statements not received by the Board by 10:00 AM Prevailing Time on June 1, 2015 will be rejected. All Proposal Statements shall remain firm for a period of sixty (60) days after the date specified for the receipt of proposals and must stipulate that commissions are guaranteed for sixty (60) days following receipt. Neither the Board, nor its respective staffs, consultants or advisors shall be liable for any claims or damages resulting from the solicitation or preparation of the Proposal Statement, nor will there be any reimbursement to Respondents for the cost of preparing and submitting a Proposal Statement or for participating in this procurement process. 5

6 Section 1.4 Rights of Board The Board reserves, holds and may exercise, at its sole discretion, the following rights and options with regard to this RFP and the procurement process in accordance with the provisions of applicable law: To determine that any Proposal Statement received complies or fails to comply with the terms of this RFP. To supplement, amend or otherwise modify the RFP through issuance of addenda to all prospective Respondents who have received a copy of this RFP. To waive any technical non-conformance with the terms of this RFP. To change or alter the schedule for any events called for in this RFP upon the issuance of notice to all prospective Respondents who have received a copy of this RFP. To conduct investigations of any or all of the Respondents, as the Board deems necessary or convenient, to clarify the information provided as part of the Proposal Statement and to request additional information to support the information included in any Proposal Statement. To suspend or terminate the procurement process described in this RFP at any time (in its sole discretion.) If terminated, the Board may determine to commence a new procurement process or exercise any other rights provided under applicable law without any obligation to the Respondents. The Board shall be under no obligation to complete all or any portion of the procurement process described in this RFP. 1.5 Addenda or Amendments to RFP During the period provided for the preparation of responses to the RFP, the Board may issue addenda, amendments or answers to written inquiries. Those addenda will be noticed by the Board and will constitute a part of the RFP. All responses to the RFP shall be prepared with full consideration of the addenda issued prior to the proposal submission date. 6

7 1.6 Cost of Proposal Preparation. Each proposal and all information required to be submitted pursuant to the RFP shall be prepared at the sole cost and expense of the respondent. There shall be no claims whatsoever against the Board, its staff or consultants for reimbursement for the payment of costs or expenses incurred in the preparation of the Proposal Statement or other information required by the RFP. 1.7 Proposal Format Responses should cover all information requested in the Questions to be answered in this RFP. Responses which in the judgment of the Board fail to meet the requirements of the RFP or which are in any way conditional, incomplete, obscure, contain additions or deletions from requested information, or contain errors may be rejected. 1.8 Term The Broker for Disability will be subject to a one-year contract. The Board reserves the right to exercise an annual renewal thereafter. The length of term for the Broker for Disability Contract is as follows: January 1, 2015 to June 30, 2015 and July 1, 2015 to June 30, Cost The Broker shall provide a description of the compensation structure proposed by the brokerage firm. The description shall include all bases for remuneration proposed by the firm, i.e., commission, fee, other. Broker shall complete the Letter of Intent (Attachments), providing all rates, commissions, fees and other expenses for a total proposal price. The Broker shall describe all available fee structures offered by your firm; including travel charges and any other cost that may be passed on to the Bridgeton Public Charter School. Successful bidders shall fully disclose the commissions or other compensation received from anyone in the performance of brokerage services on behalf of the District. 7

8 1.9 Compliance A proposal will not be a valid proposal and will not be read unless the following items are included in the proposal documents: Firm s Certificate of Insurance; Affirmative Action Questionnaire; Stockholders Disclosure Statement; Vendor Questionnaire/Certification; New Jersey Business Registration Certificate; Chapter 271 Political Contribution Disclosure Form; Non-Collusion Affidavit; Disclosure of Investment Activities in Iran. 8

9 SECTION 2 SCOPE OF SERVICES It is the intent of the Board to solicit Proposal Statements from Respondents that have expertise in the provision of consulting services regarding the evaluation and obtaining of insurance coverage for the position of Disability Insurance Consultant. Firms and/or persons responding to this RFP shall be able to demonstrate that they will have the continuing capabilities to perform these services. The services detailed below are those services expected to be provided by the Broker pertaining to disability benefits. Actual work will be directed by Bridgeton Public Charter School and may involve other consulting services that are not listed below. 1. Conduct strategic planning meetings to establish goals, priorities and identify areas of concern. 2. Financial underwriting and claims analysis, including renewal analysis and negotiations, budget projections, funding levels and alternatives, large claims analysis and quarterly reporting of the plan s financial performance. 3. Evaluate plan design in light of industry trends and labor market conditions, claims cost trends, alternative delivery systems and legal requirements. Evaluate eligibility, cost-sharing and benefit structure and network savings. 4. Prepare Requests for Proposals for insurance services or other employee benefit programs; analyze and make appropriate recommendations. 5. Apprise Bridgeton Public Charter School of local and national trends and innovative ideas, and recommend new products, programs and services to ensure a competitive benefits plan. 6. Review and analyze claims experience data, claims service, efficiency and accuracy of claims administration to ensure that Bridgeton Public Charter School is receiving optimum service and benefits from all carriers and vendors. 7. Review on-going employee communications program, including a review of booklets, announcement materials and benefit statements. 9

10 8. Manage carrier/vendor relationships, review and advise on master contracts, review carrier service levels and compare to performance guarantees, resolve administrative issues, conduct periodic meetings as necessary. 9. Act as a technical resource and provide periodic updates on legislative developments and emerging trends. 10. Evaluate in-house administration procedures including recommendations for improving services and efficiency through the use of technology. Additional Information: Insurance Plan Administration: For all coverage written, timeliness is essential and the selected broker shall agree to place coverage and issue binders prior to the expiration of each policy. Policies and/or endorsements are expected to be provided as soon as practicable after inception or renewal of the contract. Access to Records: The selected broker must agree to provide full and free access to those records maintained with respect to the insured, as well as other books, records, and information reasonably related to the scope of services provided by the producer to the Bridgeton Public Charter School Board of Trustees. Expenses: The selected broker will agree that they are responsible for their own expenses including travel and meals incurred in servicing the insured s account. Any extraordinary expenses that the producer expects to incur as the result of providing such special services to the insured should be delineated and agreed to in advance. Schedule of Insurance: On an annual basis, the selected producer will provide the Board of Education with a schedule detailing the coverages placed through the firm. Allocation of premium should be provided as required by the School System. Additional schedules must also be provided as needed by the School System. 10

11 Section 3.1 General Requirements SECTION 3 SUBMISSION REQUIREMENTS The Proposal Statement submitted by the Respondent must meet or exceed the professional, administrative and financial Proposals set forth in this Section and shall incorporate the information requested below. In addition to the information required as described below, a Respondent may submit supplemental information that it feels may be useful in evaluating its Proposal Statement. Respondents are encouraged to be clear, factual, and concise in their presentation of information. Section 3.2 Administrative Information Requirements The Respondent shall, as part of its Proposal Statement, provide the following information: 1. An executive summary (not to exceed two (2) pages) of the information contained in all the other parts of the Proposal Statement. 2. An executed Letter of Proposal (See Appendix A to this RFP). 3. Name, address and telephone number of the firm or firms submitting the Proposal Statement pursuant to this RFP, and the name of the proposed key contact person who would manage the Board s account. 4. A description of the business organization (i.e., corporation, partnership, joint venture, etc.) of each firm, its ownership and its organizational structure: a) Provide the names and business addresses of all Principals of the firm or firms submitting the Proposal Statement. For purposes of this RFP, "Principals" mean persons possessing an ownership or interest in the company. If the Respondent is a corporation, "Principals" shall include each investor who would have any amount of operational control over the Respondent and every stockholder having an ownership interest of 10% or more in the firm. b) If a firm is a partially owned or a fully-owned subsidiary of another firm, identify the parent company and describe the nature and extent of the parents' approval rights over the activities of the firm submitting a Proposal Statement. Describe the approval process. 11

12 c) If the Respondent is a partnership or a joint venture or similar organization, provide comparable information as required in (b) above for each member of the partnership, joint venture or similar organization. d) A statement that the Respondent has complied with all applicable affirmative action (or similar) requirements with respect to its business activities, together with evidence of such compliance. 5. An executed Letter of Intent (See Appendix B). 6. The number of years the business organization has been under the current management. 7. Confirm appropriate federal and state licenses to perform activities. 8. Insurance Consultant must have a minimum of ten (10) years of experience in insurance consulting/brokerage with a demonstrated focus on boards of education. 9. Insurance Consultant should demonstrate representation of other boards of education of a similar size (in terms of premium sizes, number of covered employees, claims experience, etc.), and must submit a list of all references. 10. Disclose number of employees who are former employees of health insurance companies, and list the health insurance companies. 11. The education, qualifications, experience, and training of all persons who would be assigned to provide services along with their names and titles. The consultant MUST possess both an Agency License and Individual Licenses for those persons who would be assigned to provide services to the Bridgeton Public Charter School Board of Trustees from the New Jersey Department of Banking and Insurance. 12. A listing of all other engagements where services of the types being proposed were provided in the past five (5) years. This should include other boards of education and other levels of government. The following information, with regards to other clients, must be submitted for review: premium sizes, number of employees at other clients, claims experience, experience with negotiations in other districts, preliminary and final settlement figures. 13. A description of all other areas of insurance consulting/brokerage activities, with emphasis on a description of those services of interest to a Board of Trustees client. 12

13 14. Must disclose or confirm the absence of relationships with any ancillary or complimentary health benefit service or offering. Relationships shall include any financial arrangements, joint ownership, joint employment or other similar affiliation. 15. Any judgments, claims or suits pending or outstanding against company. If yes, please explain. 16. Whether the business organization is now or has been involved in any bankruptcy or re-organization proceedings in the last ten (10) years. If yes, please explain. 17. List all immediate relatives of Principal(s) of Respondent who are Board employees or elected officials of the Board. For purposes of the above, immediate relative means a spouse, parent, stepparent, brother, sister, child, stepchild, direct-line aunt or uncle, grandparent, grandchild, and in-laws by reason of relation. 18. The successful insurance consultant shall be able, when necessary, to meet with the Head of School, Business Administrator, Business Manager, Board or designee and attend Board meetings, as necessary. Evidence of compliance with this request, as provided to other districts, must accompany this request for proposals. 19. The successful insurance consultant must provide documentation and financial information, as requested by the Board of Trustees. 20. The successful insurance consultant shall list a principal representative assigned to service the district. If the insurance consultant intends to designate an individual who is not an employee, such sub-contractor shall be named and shall provide all of the information required of the ICE as listed in the request for proposal, including but not limited to the financial agreement between the ICE and subcontractor. 21. The successful insurance consultant shall provide a list of ratings/proof of access to all major insurance companies servicing New Jersey. 13

14 SECTION 4 INSTRUCTIONS TO RESPONDENTS 4.1 Submission of Proposal Statements. Respondents must submit an original and two (2) copies of their Proposal Statement to the Designated Contact Person(s): Douglas McGarry, Board Secretary OR Christina Murphy, School Business Administrator , ext.301 Bridgeton Public Charter School Board of Trustees 2560 Industrial Way, Unit C. Vineland, NJ Proposal Statements must be received by the Board no later than 10:00 AM prevailing time, on June 1, 2015, and must be mailed or hand-delivered. Proposal Statements forwarded by facsimile or will not be accepted. Proposal statements received after this time will not be considered. The Board will not bear responsibility for delays in delivery for any reason. To be responsive, Proposal Statements must provide all requested information, and must be in strict conformance with the instructions set forth herein. Proposal Statements and all related information must be bound, and signed and acknowledged by the Respondent. 14

15 SECTION 5 EVALUATION The Board s objective in soliciting Proposal Statements is to enable it to select a firm or organization that will provide high quality and cost effective services to the citizens of Bridgeton Public Charter School. The Board will consider Proposal Statements only from firms or organizations that, in the Board s judgment, have demonstrated the capability and willingness to provide high quality services to the employees of the Board in the manner described in this RFP. Proposals will be evaluated by the Board on the basis of the most advantageous submission, all relevant factors considered. The evaluation will consider: 1. Experience and reputation in the field as evidenced by references given. 2. Prior experience with the Board and the subject matter addressed under the contract. 3. Availability to accommodate the required meetings of the Board, as well as other factors demonstrated to be in the best interest of the Board. 4. Reasonableness of the fees for the services. 5. Familiarity with Boards of Education of similar size of employees, budget and health benefits budget. 6. History of success with cost savings for Boards of Educations. 7. Evaluation will consider the outcome of reference checks, from the references listed above. 8. Satisfaction of requirements listed in Section Experience working with professionals of the district assigned to administer the health benefits. 15

16 APPENDIX A LETTER OF PROPOSAL (Note: To be typed on Respondent's Letterhead. may be made to this letter) No modifications [insert date] Attn: (INSERT CONTACT NAME) (INSERT ENTITY NAME) (INSERT ADDRESS) Dear (INSERT CONTACT NAME): The undersigned has/have reviewed my/our Proposal Statement submitted in response to the Request for Proposals (RFP) issued by the (Insert Entity Name)("Board"), dated (INSERT DATE), in connection with the Board s need for an Insurance Consultant. I/We affirm that the contents of my/our Proposal Statement (which Proposal Statement is incorporated herein by reference) is accurate, factual and complete to the best of our knowledge and belief and that the Proposal Statement is submitted in good faith upon express understanding that any false statement may result in the disqualification of (Name of Respondent). (Respondent shall sign and complete the spaces provided below. If a joint venture, appropriate officers of each company shall sign.) (Signature of Chief Executive Officer) (Typed Name and Title) (Type Name of Firm)* Dated: (Signature of Chief Financial Officer) (Typed name and Title) (Type Name of Firm)* Dated: * If a joint venture, partnership or other formal organization is submitting a Proposal Statement, each participant shall execute this Letter of Proposal

17 APPENDIX B LETTER OF INTENT (Note: To be typed on Respondent's Letterhead. No modifications may be made to this letter) Attn: (INSERT CONTACT NAME) (INSERT ENTITY NAME) (INSERT ADDRESS) [insert date] Dear: The undersigned, as Respondent, has (have) submitted the attached Proposal Statement in response to a Request for Proposals (RFP), issued by the (Insert Entity Name)("Board"), dated (INSERT DATE), in connection with the Board s need for an Insurance Consultant. (Name of Respondent) HEREBY STATES: 1. The Proposal Statement contains accurate, factual and complete information. 2. (Name of Respondent) agrees (agrees) to participate in good faith in the procurement process as described in the RFP and to adhere to the Board's procurement schedule. 3. (Name of Respondent) acknowledges (acknowledge) that all costs incurred by it (them) in connection with the preparation and submission of the Proposal Statement and any proposal prepared and submitted in response to the RFP, or any negotiation which results there from shall be borne exclusively by the Respondent. 4. (Name of Respondent) hereby declares (declare) that the only persons participating in this Proposal Statement as Principals are named herein and that no person other than those herein mentioned has any participation in this Proposal Statement or in any contract to be entered into with respect thereto. Additional persons may subsequently be included as participating Principals, but only if acceptable to the Board. (Name of 17

18 Respondent) declares that this Proposal Statement is made without connection with any other person, firm or parties who has submitted a Proposal Statement, except as expressly set forth below and that it has been prepared and has been submitted in good faith and without collusion or fraud. 5. (Name of Respondent) acknowledges and agrees that the Board may modify, amend, suspend and/or terminate the procurement process (in its sole judgment). In any case, the Board shall have any liability to the Respondent for any costs incurred by the Respondent with respect to the procurement activities described in this RFP. 6. (Name of Respondent) acknowledges that any contract executed with respect to the provision of [insert services] must comply with all applicable affirmative action and similar laws. Respondent hereby agrees to take such actions as are required in order to comply with such applicable laws. (Name of Respondent) submits a proposal containing a fee schedule/summary and associated costs for the following benefit areas: Disability Insurance (Respondent shall sign and complete the space provided below. If a joint venture, appropriate officers of each company shall sign.) Dated: (Signature of Chief Executive Officer) (Typed Name and Title) (Type Name of Firm)* * If a joint venture, partnership or other formal organization is submitting a Proposal Statement, each participant shall execute this Letter of Intent. 18

19 Appendix Forms: Affirmative Action Questionnaire; Vendor Questionnaire/Certification; Non-Collusion Affidavit; Stockholders Disclosure Statement; Chapter 271 Political Contribution Disclosure Form; Disclosure of Investment Activities in Iran. Please also include: New Jersey Business Registration Certificate; Certificate of Insurance 19

20 EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq., N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICES 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 limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants, will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor, where applicable, will send to each labor union or representative or workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer advising the labor union or workers representative of the contractor s commitments under this act and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq. as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to afford equal employment opportunities to minority and women workers consistent with Good faith efforts to meet targeted county employment goals established in accordance with N.J.A.C. 17:27-5.2, or Good faith efforts to meet targeted county employment goals determined by the Division, pursuant to N.J.A.C. 17: The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personal 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, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Affirmative Action Plan Approval Certificate of Employee Information Report Employee Information Report Form AA302 The contractor and its subcontractor shall furnish such reports or other documents to the Division of Public Contracts Equal Employment Opportunity Compliance as may be requested by the Division from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of Public Contracts Equal Employment Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of theadministrative Code at N.J.A.C. 17:27. 20

21 To be completed and returned with the proposal form. AFFIRMATIVE ACTION QUESTIONNAIRE This form is to be completed and returned with the proposal. However, the Board will accept in lieu of this Questionnaire, Affirmative Action Evidence stapled to this page. 1. Our company has a federal Affirmative Action Plan approval. YES NO A. If yes, please attach a copy of the plan to this questionnaire. 2. Our company has a New Jersey State Certificate of Employee Information Report. YES NO A. If yes, please attach a copy of the certificate to this questionnaire. 3. If you answered NO to both questions above, an affirmative action Employee Information Report (AA-302) will be mailed to you. Complete the form and forward it to: Department of Treasury Division of Public Contracts/EEO Compliance P.O. Box 209 Trenton, N.J All fees for this application are to be paid directly to the Division. A copy shall be submitted to the Board of Education within seven (7) days of the notice of the intent to award the contract or the signing of the contract. I certify that the above information is correct to the best of my knowledge. NAME SIGNATURE TITLE DATE NAME OF COMPANY ADDRESS CITY, STATE, ZIP 21

22 To be completed and returned with the proposal form. Vendor Questionnaire/Certification Name of Company Street Address PO Box City, State, Zip Business Phone Number ( ) Ext. Emergency Phone Number ( ) FAX No. ( ) Years in Business Number of Employees References Work previously done for School Systems in New Jersey Name of District Address Contact Person/Title Phone Direct/Indirect Interests Vendor Certification I declare and certify that no member of the Bridgeton Public Charter School, nor any officer or employee or person whose salary is payable in whole or in part by said Board of Trustees or their immediate family members are directly or indirectly interested in this bid or in the supplies, materials, equipment, work or services to which it relates, or in any portion of profits thereof. If a situation so exists where a Board member, employee, officer of the board has an interest in the bid, etc., then please attach a letter of explanation to this document, duly signed by the president of the firm or company. Gifts; Gratuities; Compensation I declare and certify that no person from my firm, business, corporation, association or partnership offered or paid any fee, commission or compensation, or offered any gift, gratuity or other thing of value to any school official, board member or employee of the Bridgeton Public Charter School. Vendor Contributions I declare and certify that I fully understand N.J.A.C. 6A:23A-6.3(a1-4) concerning vendor contributions to school board members. I certify that I am not an official or employee of the Bridgeton Public Charter School. I further certify that I understand that it is a crime in the second degree in New Jersey to knowingly make a material representation that is false in connection with the negotiation, award or performance of a government contract. President or Authorized Agent Signature 22

23 NON-COLLUSION AFFIDAVIT Re: Proposal for the Bridgeton Public Charter School. STATE OF NEW JERSEY) :ss: COUNTY OF ) Date: I, of the City of in the County of and the State of of full age, being duly sworn according to law on my oath depose and say that: I am Position in Company Of the firm of and the bidder making the Proposal for the above names contract, and that I executed the said Proposal with full authority so to do; that I have not, directly or indirectly, entered into any agreement, participated in any collusion, discussed any or all parts of this proposal with any potential bidders, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named bid, and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the Bridgeton Public Charter School relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said bid. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees of bona fide established commercial or selling agencies maintained by (Print Name of Contractor/Vendor) Subscribed and sworn to: (SIGNATURE OF CONTRACTOR/VENDOR) before me this day of,. Month Year Print Name of Notary Public NOTARY PUBLIC SIGNATURE My commission expires,. Seal Month Day Year 23

24 STOCKHOLDER/PARTNERSHIP DISCLOSURE AND STATEMENT OF OWNERSHIP Re: Proposal for the Bridgeton Public Charter School. Proposal Date: Please check one type of Ownership, complete the form, and execute where provided. Corporation-- Limited Partnership-- Partnership-- Limited Liability Corp.-- Sole Proprietorship-- Limited Liability Partnership-- Sub Chapter S Corp.-- Other- 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 material or supplies, the cost of which is to be paid with or out of any public funds, by the State or any county, municipality or school district, or any subsidiary or agency of the State, or by an 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 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 stockholder holding 10% or more of that corporation or partnership 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 PROPOSAL. In the event that there are no persons who own ten percent or more of the stock or ownership of the bidder, then such fact should be certified below as part of this disclosure. Name of Company Address City, State, Zip List of Owners with Ten Percent (10%) or More Interest Owner s Name Home Address Title/Office Held Percent (%) of Partnership Shares Owned NOTE: If you need more space than that provided above, please use an extra sheet for furnishing the above required information for any remaining persons or entities. Signature Date (form continued on next page) To be completed and signed below. 24

25 STOCKHOLDER/PARTNERSHIP DISCLOSURE AND STATEMENT OF OWNERSHIP (con t) If your firm is not a corporation and/or partnership, please explain below how your firm is organized and include a list of the various principals. Our firm,, is organized Names of Principals Title Use additional paper if needed. Check here if additional sheets are attached. Name of Company Address City, State, Zip Authorized Agent Title SIGNATURE OF AUTHORIZED AGENT 25

26 Bridgeton Public Charter School Business Office Chapter 271 Political Contribution Disclosure Form (Contracts that Exceed $17,500.00) Ref. N.J.S.A. 52:34-25 The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that (Business Entity) has made the following reportable political contributions to any elected official, political candidate or any political committee as defined in N.J.S.A. 19: during the twelve (12) months preceding this award of contract: Reportable Contributions Date of Contribution Amount of Contribution Name of Recipient Elected Official/ Committee/Candidate Name of Contributor The Business Entity may attach additional pages if needed. No Reportable Contributions (Please check () if applicable.) I certify that (Business Entity) made no reportable contributions to any elected official, political candidate or any political committee as defined in N.J.S.A. 19: Certification I certify, that the information provided above is in full compliance with Public Law 2005 Chapter 271. Name of Authorized Agent Signature Title Business Entity 26

27 P.L. 2005, c.271 (Unofficial version, Assembly Committee Substitute to A-3013, First Reprint*) AN ACT authorizing units of local government to impose limits on political contributions by contractors and supplementing Title 40A of the New Jersey Statutes and Title 19 of the Revised Statutes. BE IT ENACTED by the Senate and General Assembly of the State of New Jersey: 40A: a. A county, municipality, independent authority, board of education, or fire district is hereby authorized to establish by ordinance, resolution or regulation, as may be appropriate, measures limiting the awarding of public contracts therefrom to business entities that have made a contribution pursuant to P.L.1973, c.83 (C.19:44A-l et seq.) and limiting the contributions that the holders of a contract can make during the term of a contract, notwithstanding the provisions and parameters of sections 1 through 12 of P.L.2004, c.19 (C. 19:44A-20.2 et al.) and section 22 of P.L.1973, c.83 (C.19:44A-22). b. The provisions of P.L.2004, c.19 shall not be construed to supersede or preempt any ordinance, resolution or regulation of a unit of local government that limits political contributions by business entities performing or seeking to perform government contracts. Any ordinance, resolution or regulation in effect on the effective date of P.L.2004, c.19 shall remain in effect and those adopted after that effective date shall be valid and enforceable. c. An ordinance, resolution or regulation adopted or promulgated as provided in this section shall be filed with the Secretary of State. 52: a. Not later than 10 days prior to entering into any contract having an anticipated value in excess of $17,500, except for a contract that is required by law to be publicly advertised for bids, a State agency, county, municipality, independent authority, board of education, or fire district shall require any business entity bidding thereon or negotiating therefor, to submit along with its bid or price quote, a list of political contributions as set forth in this subsection that are reportable by the recipient pursuant to the provisions of P.L.1973, c.83 (C.19:44A-l et seq.) and that were made by the business entity during the preceding 12 month period, along with the date and amount of each contribution and the name of the recipient of each contribution. A business entity contracting with a State agency shall disclose contributions to any State, county, or municipal committee of a political party, legislative leadership committee, candidate committee of a candidate for, or holder of, a State elective office, or any continuing political committee. A business entity contracting with a county, municipality, independent authority, other than an independent authority that is a State agency, board of education, or fire district shall disclose contributions to: any State, county, or municipal committee of a political party; any legislative leadership committee; or any candidate committee of a candidate for, or holder of, an elective office of that public entity, of that county in which that public entity is located, of another public entity within that county, or of a legislative district in which that public entity is located or, when the public entity is a county, of any legislative district which includes all or part of the county, or any continuing political committee. The provisions of this section shall not apply to a contract when a public emergency requires the immediate delivery of goods or services. 27

28 b. When a business entity is a natural person, a contribution by that person's spouse or child, residing therewith, shall be deemed to be a contribution by the business entity. When a business entity is other than a natural person, a contribution by any person or other business entity having an interest therein shall be deemed to be a contribution by the business entity. When a business entity is other than a natural person, a contribution by: all principals, partners, officers, or directors of the business entity or their spouses; any subsidiaries directly or indirectly controlled by the business entity; or any political organization organized under section 527 of the Internal Revenue Code that is directly or indirectly controlled by the business entity, other than a candidate committee, election fund, or political party committee, shall be deemed to be a contribution by the business entity. c. As used in this section: "business entity" means a natural or legal person, business corporation, professional services corporation, limited liability company, partnership, limited partnership, business trust, association or any other legal commercial entity organized under the laws of this State or of any other state or foreign jurisdiction; "interest" means the ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit, as appropriate; and "State agency" means any of the principal departments in the Executive Branch of the State Government, and any division, board, bureau, office, commission or other instrumentality within or created by such department, the Legislature of the State and any office, board, bureau or commission within or created by the Legislative Branch, and any independent State authority, commission, instrumentality or agency. d. Any business entity that fails to comply with the provisions of this section shall be subject to a fine imposed by the New Jersey Election Law Enforcement Commission in an amount to be determined by the commission which may be based upon the amount that the business entity failed to report. 19:44A a. Any business entity making a contribution of money or any other thing of value, including an in-kind contribution, or pledge to make a contribution of any kind to a candidate for or the holder of any public office having ultimate responsibility for the awarding of public contracts, or to a political party committee, legislative leadership committee, political committee or continuing political committee, which has received in any calendar year $50,000 or more in the aggregate through agreements or contracts with a public entity, shall file an annual disclosure statement with the New Jersey Election Law Enforcement Commission, established pursuant to section 5 of P.L.1973, c.83 (C.19:44A-5), setting forth all such contributions made by the business entity during the 12 months prior to the reporting deadline. b. The commission shall prescribe forms and procedures for the reporting required in subsection a. of this section which shall include, but not be limited to: (1) the name and mailing address of the business entity making the contribution, and the amount contributed during the 12 months prior to the reporting deadline; (2) the name of the candidate for or the holder of any public office having ultimate responsibility for the awarding of public contracts, candidate committee, joint candidates committee, political party committee, legislative leadership committee, political committee or continuing political committee receiving the contribution; and 28

29 (3) the amount of money the business entity received from the public entity through contract or agreement, the dates, and information identifying each contract or agreement and describing the goods, services or equipment provided or property sold. c. The commission shall maintain a list of such reports for public inspection both at its office and through its Internet site. d. When a business entity is a natural person, a contribution by that person's spouse or child, residing therewith, shall be deemed to be a contribution by the business entity. When a business entity is other than a natural person, a contribution by any person or other business entity having an interest therein shall be deemed to be a contribution by the business entity. When a business entity is other than a natural person, a contribution by: all principals, partners, officers, or directors of the business entity, or their spouses; any subsidiaries directly or indirectly controlled by the business entity; or any political organization organized under section 527 of the Internal Revenue Code that is directly or indirectly controlled by the business entity, other than a candidate committee, election fund, or political party committee, shall be deemed to be a contribution by the business entity. As used in this section: "business entity" means a natural or legal person, business corporation, professional services corporation, limited liability company, partnership, limited partnership, business trust, association or any other legal commercial entity organized under the laws of this State or of any other state or foreign jurisdiction; and "interest" means the ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit, as appropriate. e. Any business entity that fails to comply with the provisions of this section shall be subject to a fine imposed by the New Jersey Election Law Enforcement Commission in an amount to be determined by the commission which may be based upon the amount that the business entity failed to report. 4. This act shall take effect immediately. --- * Note: Bold italicized statutory references of new sections are anticipated and not final as of the time this document was prepared. Statutory compilations of N.J.S.A. 18A:18A-51 is anticipated to show a reference to N.J.S.A. 40A:11-51 and to N.J.S.A. 52: