0085-2014 REQUEST FOR PROPOSAL RISK MANAGER/INSURANCE BROKER SERVICES

NOTE: The County of Hunterdon will consider proposals only from firms or organizations that have demonstrated the capability and willingness to provide high quality services in the manner described in this Request for Proposal. 0085-2014 REQUEST FOR PROPOSAL RISK MANAGER/INSURANCE BROKER SERVICES ISSUED November 10, 2014 DUE November 20, 2014

Issued by: The County of Hunterdon GLOSSARY The following definitions shall apply to and are used in this Request for Qualifications or Request for Proposal: County refers to the County of Hunterdon. JIF refers to Joint Insurance Fund "Qualification Statement" -refers to the complete responses to a RFP submitted by the Respondents. "Qualified Respondent" - refers to those Respondents who (in the sole judgment of the County) have satisfied the qualification criteria set forth in a RFP. "Proposal" - refers to a complete response to an RFP submitted by a Respondent. "RFP" - refers to this Request for Proposal, including any amendments or supplements thereto. "RFQ" - refers to this Request for Qualifications, including any amendments thereof or supplements thereto. "Respondent" or "Respondents" -refers to the interested firm(s) that submit a Qualification Statement or Proposal 01

SECTION 1 INTRODUCTION AND GENERAL INFORMATION 1.1 Introduction and Purpose The County of Hunterdon is soliciting Proposals from interested firms for the provision of the professional services described herein. Through a Request for Proposal ( RFP ) process described herein, firms interested in assisting the County with the provision of such services must prepare and submit a Proposal in accordance with the procedure and schedule in this RFP. The County will review only those Proposals that include all the information required to be included as described herein (in the sole judgment of the County). The County intends to qualify firm(s) that (a) possess the professional capabilities to provide the proposed services, and (b) will agree to work under the compensation terms and conditions determined by the County to provide the greatest benefit to the taxpayers of Hunterdon County. 1.2 Procurement Process and Schedule The County is soliciting Proposals through a fair and open process in accordance with New Jersey Local Unit Pay to Play Legislation, N.J.S.A. 19:44A-20.4 et seq. and P.L. 2005 c. 271. The County has structured a procurement process that seeks to obtain the desired results described above, while establishing a competitive process to assure that each firm is provided an opportunity to submit a Proposal in response to the RFP. Proposals will be evaluated in accordance with the criteria set forth in Section 2 of this RFP, which will be applied in the same manner to each Proposal received. Proposals will be reviewed and evaluated by the County and its appropriate staff to determine if the Respondent has met the minimum professional, administrative and financial areas described in this RFP. Under no circumstances will a member of the evaluation committee review responses to an RFP if they or their firm have submitted a response or any firm with which they have a financial interest. Based upon the totality of the information contained in the Proposal, including information about the reputation and experience of each Respondent, the County 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 County) will be designated as a Qualified Respondent and will be given the opportunity to participate in the selection process determined by the County. The RFP process commences with the issuance of this RFP. The steps involved in the process and the anticipated completion dates are set forth in Table 1, Procurement Schedule of the Supplement. The County reserves the right to, among other things, amend, modify or alter the Procurement Schedule upon notice to all potential Respondents. 02

All communications concerning this RFP or the RFP process shall be directed to the County s Designated Contact Person, in writing. Designated Contact Person: Beth Schermerhorn, Chief Financial Officer, County of Hunterdon, PO Box 2900, Flemington, NJ 08822 908-788-1120 Responses to this RFP must be submitted to John P. Davenport III, Purchasing Agent, County of Hunterdon, 71 Main Street, PO Box 2900, Flemington, NJ 08822, and be received by, the County, via mail or hand delivery, by 3:00 p.m. Prevailing Time on November 20, 2014. Proposals not received by 3:00 p.m. on November 20, 2014 will be rejected. Responses will not be accepted by facsimile transmission or e-mail. Subsequent to issuance of this RFP, the County (through the issuance of addenda to all firms that have received a copy of the RFP) may modify, supplement or amend the provisions of this RFP in order to respond to inquiries received from prospective Respondents or as otherwise deemed necessary or appropriate by (and in the sole judgment of) the County. 1.3 Conditions Applicable to RFP Upon submission of a Proposal in response to this RFP, the Respondent acknowledges and consents to the following conditions relative to the submission and review and consideration of its Proposal: All costs incurred by the Respondent in connection with responding to this RFP shall be borne solely by the Respondent. The County reserves the right (in its sole judgment) 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 County reserves the right (in its sole judgment) to reject any Respondent that submits incomplete responses to this RFP, or a Proposal that is not responsive to the requirements of this RFP. The County reserves the right, without prior notice, to supplement, amend, or otherwise modify this RFP, or otherwise request additional information. All Proposals shall become the property of the County and will not be returned. All Proposals will be made available to the public at the appropriate time, as determined by the County (in the exercise of its sole discretion) in accordance with law. 03

The County may request Respondents to send representatives to the County for interviews. Neither the County, nor its respective staffs, shall be liable for any claims or damages resulting from the solicitation or preparation of the Proposal, nor will there be any reimbursement to Respondents for the cost of preparing and submitting a Proposal or for participating in this procurement process. Respondents are advised of the responsibility to file an annual disclosure statement of political contributions with the New Jersey Election Law Enforcement Commission pursuant to N.J.S.A. 19:44A20.13 (P.L. 2005, c.271, s.3) if the Respondent receives contracts in excess of $50,000 from public entities in a calendar year. It is the Respondent s responsibility to determine if filing is necessary. Additional information on this requirement is available from ELEC at (888) 313-3532 or at www.elec.state.nj.us. 1.4 Rights of County The County 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 Proposals 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 County deems necessary or convenient, to clarify the information provided as part of the Proposal and to request additional information to support the information included in any Proposal. To suspend or terminate the procurement process described in this RFP at any time (in its sole discretion.) If terminated, the County may determine to commence a new procurement process or exercise any other rights provided under applicable law without any obligation to the Respondents. The County shall be under no obligation to complete all or any portion of the procurement process described in this RFP. 04

1.5 Addenda or Amendments to RFP During the period provided for the preparation of responses to the RFP, the County may issue addenda, amendments or clarifications to written inquiries. Those addenda will be noticed by the County 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. 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 County, its staff or consultants for reimbursement for the payment of costs or expenses incurred in the preparation of the Proposal or other information required by the RFP. 1.7 Proposal Format Responses should cover the information requested in Section 3, infra. Responses which in the judgment of the County 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. 05

SECTION 2 SCOPE OF SERVICES It is the intent of the County to solicit Proposals from Respondents that have expertise in the provision of the services described in the Scope of Services. Firms responding to this RFP shall be able to demonstrate that they will have the continuing capabilities to perform these services. TABLE 1 ANTICIPATED PROCUREMENT SCHEDULE 1 Issuance of Request for Proposals November 10, 2014 2 Receipt of Responses November 20, 2014 3 Completion of Evaluation of Responses November 26, 2014 4 Consideration of Evaluation Committee November 28, 2014 Recommendations, Award of Contract Scope of Services 2.1(a) Risk Manager - Property and Casualty The successful candidate will provide the County with Fund Administrative services related to, but not limited to: Provide assistance to the County in identifying its insurable Property and Casualty exposures and recommending professional methods to reduce, assume or transfer the risk or loss. Provide advice to Hunterdon County on matters relating to a Joint Insurance Fund s operation and coverages, as well as private insurance companies or other venues to obtain the best possible coverage for the lowest possible price. Design, market and implement the broadest property insurance program at the most reasonable cost that adequately protects the County and other designated parties against the risks arising out of the County s past, present and future operations. Assist the County in understanding and selecting, the numerous coverages available from the competing Joint Insurance Funds (JIF) and the Municipal Excess Liability Joint Insurance Fund where applicable. Assist the County with the evaluation of options received from the insurance market. Review with the County any additional coverage that the RISK MANAGER feels 06

should be carried, but are not available from the JIF subject to the County authorization; place such coverage outside the JIF. Assist the County in the preparation of applications, statements of values, and similar documents requested by the JIF, it being understood that this Agreement does not include any appraisal work by the RISK MANAGER. Review the assessment as prepared by the JIF and assist the County in the preparation of their annual insurance budget. Respond to questions related to coverage and the placement process; provide ongoing coverage analyses and critique of policy language. Obtain answers to policy coverage questions. Review the loss and engineering reports and generally assist the County in the loss containment objectives. Assist in the settlement of claims Attendance at meetings of the County Any other services required by the County s through it s responsibility to the Bylaws of the selected JIF. Providing regular Risk Management services to the County and its staff while acting on behalf of the County with the selected JIF insurers. Assist the County in the resolution of any outstanding legacy issues arising from its prior property insurance programs. Provide risk control services Attending meetings of Fund Commissioners or Executive Committee meetings of the Fund. Provide claims management services Provide loss control and safety services Reviewing the County s assessment and assisting in the preparation of the County s insurance budget. Review hold harmless indemnification agreements as required in the County s contracts. Provide advice to the County on the insurance risk management issues arising from its contracts, agreements and leases. 2.1 (b) Risk manager/broker services - Health Insurance Provide assistance to the County in identifying its insurable Casualty exposures and recommending professional methods to reduce, assume or transfer the risk or loss. Assist the County with the evaluation of options received from the insurance market. Assist the County in understanding and selecting, the numerous coverages available from the insurance market Assist where needed in the settlement of claims Attendance at meetings of the County Providing regular Risk Management services to the County and its staff while acting on behalf of the County with selected insurance carriers. Assist the County in the resolution of any outstanding legacy issues arising from its prior property insurance programs. Provide loss control services. 07

2.2. Term The individual or firm will serve at the will of the Board. 3.1 General Requirements SECTION 3 SUBMISSION REQUIREMENTS The Proposals submitted by the Respondent must meet or exceed the professional, administrative and financial qualifications 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. Respondents are encouraged to be clear, factual, and concise in their presentation of information. THE SUCCESSFUL RISK MANAGERS(S) WILL BE REQUIRED TO REPRESENT THE INTERESTS OF THE COUNTY IN THE NEGOTIATION, PLACEMENT AND SERVICING OF ITS INSURANCE AND RISK MANAGEMENT PROGRAMS, PROPOSALS SUBMITTED BY INSURANCE AGENTS SHALL BE DISCLOSED AS SUCH. Any Broker candidate that operates as a managing general agent, managing general underwriter, has any ownership interest in an entity which contracts with a Joint Insurance Fund, has any financial interest in any joint insurance fund, or in any similar capacity for any underwriting organization shall fully disclose the nature and extent of its service as such. Such statement shall include confirmation that such service shall not present a conflict of interest with regard to the Broker(s) responsibilities to the County which shall be paramount under any circumstance. 3.2 Content and Form of Proposal Response a. Proposal Format. Proposal content and completeness will be important criteria in the evaluation process. In order to streamline the evaluation process and insure that all proposals are evaluated on an equal basis, it is required that proposals adhere to the standard format outlined below for presentation of the requested information. Section Title 1. Letter of Transmittal 2. Qualifications a. Experience of the Firm b. Key Personnel 3. Fee Proposal 08

b. Proposal Content i. Letter of Transmittal (Section 1) The Respondent must provide a Letter of Transmittal signed by the individual who is authorized to commit the firm to the Scope of Services of this RFP. This letter must incorporate the following: An acknowledgment of receipt of this RFP stating that it is understood that all conditions contained in this RFP may be incorporated into any resulting contract. A narrative statement of the Respondent s understanding of the County s needs and goals. A statement that guarantees that the proposal is valid for 90 days from the date of receipt by the County. A statement acknowledging that all information contained in the proposal is factual and accurate. A statement that the Respondent is in compliance with all applicable affirmative action regulations. A statement acknowledging that the individual signing the letter of transmittal has the County to commit the firm to all the provisions contained in this RFP and the firm's corresponding proposal. In its proposal, the vendor must identify any existing or potential conflicts of interest, and disclose any representation of parties or other relationships that might be considered a conflict of interest with regard to this engagement, or the Fund. The submission shall be accompanied by (a) a Non-Collusion Affidavit, (b) a Disclosure of Ownership Form, (c) an Insurance Requirement Acknowledgement Form, (d) a Mandatory Equal Employment Opportunity Notice Acknowledgement, (e) a copy of the applicable Business Registration Certificate, (f) a Professional Services Entity Information Form, (g) a Data Form, (h) Disclosure of Investment Activities in Iran (i) Political Contribution Form, and (j) Disclosure of Investigations and Actions Involving Service Entity. All forms listed above (a through j) shall be completed in their entirety. 09

ii. Qualifications (Section 2) (1) Experience of the Risk Manager/Broker and/or Firm The Respondent must demonstrate the experience and qualifications of the firm. Respondent must provide the following: Brief history of the Risk Manager/Firm; highlight the benefits the firm believes it can contribute to the County. An explanation of fields of expertise and reputation in the field. An explanation of the Risk Manager/Broker s experience and knowledge concerning providing Risk Management services to county or municipalities similar in size to the County of Hunterdon which participate in joint insurance funds. Risk Management Consultant/Producer shall have knowledge, training and experience in all forms of county insurance, including first and third party coverage, general liability, public officials, liability, property damage, automobile, flood insurance, surety, performance and maintenance bonds and all other types of insurance products necessary for the County of Hunterdon. An explanation of licensures held and familiarity and experience with public entity insurance. Indicate knowledge in the area of expertise for the position of Risk Manager Any other information the Respondent deems pertinent and which demonstrates an ability to perform the requested services. A detailed description of the services to be provided including examples. Clearly outline the approach that the Respondent intends to utilize in providing the services outlined in the Scope of Services Provide at least three (3) client references where the services provided were comparable to those requested in the Scope of Services section of this RFP; Identify any existing or potential conflict of interest, or any relationships that might be considered a conflict of interest, that may affect or involve the provisions of Services to the County, including but not limited to conflicts with financial advisors, law firms providing services to the County. 10

Describe any pending, concluded or threatened litigation, administrative proceedings or federal or state investigations or audits, subpoenas, or other information requests of or involving your firm or the owners, principals or employees thereof during the period beginning January 1, 2013 to date. Describe the nature and status of the matter and the resolution, if any. Provide account retention experience for clients similar to the County and employee retention experience. (2) Experience of Key Personnel The Respondent must demonstrate the experience and qualifications of the firm and its professionals who will be performing work for the County. Therefore, Respondent shall provide the following: Resumes of the professionals who will be assigned and committed to the County, identifying each professional's status in the firm, i.e., partner, associate, etc., and his or her applicable experience with other governmental agencies of similar size and budget. A list of all immediate relatives of Principal(s) of Respondent who are County employees or elected officials of the County. 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. Other information Respondent deems pertinent which demonstrates an ability to perform the requested services. iii. Fee Proposal (Section 3) Please submit your fee proposal. 11

Attachment A RFP 0085-2014 NON-COLLUSION AFFIDAVIT Project: STATE OF NEW JERSEY ) COUNTY OF ) ss.: I,, live at, in the County of, State of. I am of full age and being duly sworn according to law on my oath depose and say: 1. I am (title) of the (Bidder), who has made the proposal for the construction of the above named Project. 2. I executed the Proposal with full authority to do so. 3. The proposal is genuine, submitted in good faith and not a sham. 4. Neither the proposer nor any of its employees or agents have, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive proposing in connection with the above-named project. I further certify that neither the proposer, nor any of its employees or agents, have directly or indirectly with any other proposer or person colluded to put in a sham proposal or refrain from submitting a proposal, and have not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference, with any person to fix the prices of the proposer or of any other proposer to secure any advantage. 5. All statements contained in this Proposal and Affidavit are true and correct and were made with full knowledge that the County of Hunterdon relies upon the truth of the statements contained in the Proposal and the truth of the statements contained in the Proposal and the truth of the statements contained in this Affidavit, in awarding the Contract for the Project. I am aware that I am personally subject to the penalties of perjury, as is the proposer, if statements made herein are untrue. 6. I further warrant that no person or selling agent has been employed or retained to solicit or secure this Contract under an agreement or understanding for a commission, percentage, brokerage or contingent fee. If the proposer engages bona fide employees or a bona fide established commercial or selling agency to perform any similar related acts, the names are set forth as follows: (see N.J.S.A. 52:34-15) ( Signature) (Type or print name of Affiant) (Title) (SEAL) Subscribed and sworn to before me this day of, 2014 (Company) A Notary Public of New Jersey My Commission Expires: 12

NOTICE No corporation or partnership shall be awarded any contract for the performance of any work or the furnishing of any materials or supplies, unless, prior to the receipt of the proposal or accompanying the proposal of said corporation or partnership, there is submitted a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners in the partnership who own a ten (10) percent or greater interest therein. Form of Statement shall be completed and attached to the proposal. The Attorney General has concluded that the provisions of N.J.S.A. 52:25-24.2, in referring to corporations and partnerships, are intended to apply to all forms of corporations and partnerships, including, but not limited to, limited partnerships, limited liability corporations, limited liability partnerships, and Subchapter S corporations. Requires proposers to disclose whether they are a partnership, corporation or sole proprietorship. Form shall be completed, signed and notarized. Failure of the proposer to submit the required information is cause for automatic rejection of the proposal. 13

Attachment B RFP 0085-2014 OWNERSHIP DISCLOSURE CERTIFICATION Name of Business I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: Partnership Corporation Sole Proprietorship Limited Partnership Limited Liability Corporation Limited Liability Partnership Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Subscribed and sworn before me this day of, 20. (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) 14

Attachment C RFP 0085-2014 INSURANCE CERTIFICATION (NOTE: THE BIDDER'S INSURANCE COMPANY OR AGENT MUST TYPE THIS ON ITS LETTERHEAD) Date (Not earlier than fifteen days before the initial Opening Date) Hunterdon County Board of Chosen Freeholders P.O. Box 2900 Flemington, New Jersey 08822-2900 Attn: Denise B. Doolan, Clerk Re: 0085-2014, Risk Manager/ Insurance Broker Services Dear Mrs. Doolan: We are an insurance agency authorized to write insurance in the State of New Jersey. We are authorized agents for (insert names of insurance company or companies). We are writing this letter on behalf of (insert name of proposer). We have thoroughly reviewed those portions of the proposal specifications, which set forth insurance requirements in connection with the performance of the contract. (insert name of proposer) has made satisfactory arrangements with our firm, so that should it be awarded the contract, policies of insurance will be issued with limits of liability, the coverage, and the additional insured set forth in the specifications. The policies will be issued with an effective date no later than ten days after notice of award. Copies of the actual policies will be provided upon request no later than thirty (30) days after the notice of proposal award. (Or if this bidder current has insurance) (Insert name of proposer) presently has insurance coverage of the type and in the amount as set forth in the specifications. Insurance certificates to that effect, with a current date, are attached to this letter. If is awarded the contract, this firm will issue endorsement naming the County of Hunterdon and such other parties as set forth in the specifications as additional insured. Copies of the actual policies will be provided upon request no later than thirty (30) days after the notice of the award. This letter is written with the understanding that the County of Hunterdon relies on the truth of the statements made herein. 15

Attachment D RFP 0085-2014 HUNTERDON COUNTY MANDATORY EQUAL EMPLOYMENT OPPORTUNITY NOTICE (N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq.) GOODS, PROFESSIONAL SERVICES AND GENERAL SERVICE CONTRACTS This form is a summary of the successful professional service entity s requirement to comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq. The successful professional service entity shall submit to the Hunterdon County, after notification of award but prior to execution of this contract, one of the following three documents as forms of evidence: (a) (b) A photocopy of a valid letter that the vendor is operating under an existing Federally approved or sanctioned affirmative action program (good for one year from the date of the letter); OR A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-1.1 et seq.; OR (c) A photocopy of a completed Employee Information Report (Form AA302) provided by the Division of Contract Compliance and completed by the vendor in accordance with N.J.A.C. 17:27-1.1 et seq. The successful professional service entity may obtain the Employee Information Report (AA302) from the Hunterdon County during normal business hours. The undersigned professional service entity certifies that he/she is aware of the commitment to comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq. and agrees to furnish the required forms of evidence. The undersigned professional service entity further understands that his/her submission shall be rejected as non-responsive if said professional service entity fails to comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq. COMPANY: SIGNATURE: PRINT NAME: TITLE: DATE: 16

Attachment E RFP 0085-2014 New Jersey Business Registration Requirements Please attach as Attachment E a copy of your Business Registration Certificate All proposers shall comply with P.L. 2009, C315 in accordance with N.J.S.A. 52:32-44 as amended on January 18, 2010. The bidder will be required to be registered as defined in the law at the time of contract. Hunterdon County encourages the bidder to submit the proof with it s proposal. In response to a request for proposals for goods and services, a bidder shall include proof of its own business registration and proofs of business registration of those subcontractors required to be listed in the contractor s submission (i.e., named subcontractors. ) The proof of business registration shall be provided at the time the proposal is officially received and opened by the contracting agency. N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly provide goods or perform services for a contractor fulfilling this contract: 1) the contractor shall provide written notice to its subcontractors to submit proof of business registration to the contractor; 2) prior to receipt of final payment from a contracting agency, the contractor must submit to the contracting agency an accurate list of all subcontractors or attest that none was used; 3) during the term of this contract, the contractor and its affiliates shall collect and remit, and shall notify all subcontractors and their affiliates that they must collect and remit to the Director, New Jersey Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A. 54:32B-1 et seq.) on all sales of tangible personal property delivered into this State. A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed $50,000 for each business registration not properly provided or maintained under a contract with a contracting agency. Information on the law and its requirements is available by calling (609) 292-9292. Registering a business with the New Jersey Department of the Treasury Business organizations or individuals doing business in New Jersey are required to register with the department of the treasury, division of revenue. Registration is free and is a one-time action there are no fees to register. However, you should update your contact and tax eligibility information as needed. Registration is required to conduct most business with any state, County, municipal, local board of education, charter school, County college, authority, or state college or university. The contracting agency may be required to have a copy of the proof of registration certificate submitted as part of a public proposal or prior to issuing a purchase order. To register: businesses must complete form NJ-REG and submit it to the division of revenue. The form can be filed form online or by mailing a paper form to the division. Online filing is strongly encouraged. Register online at http://www.state.nj.us/treasury/revenue/busregcert.shtml. Click the online link and then select register for tax and employer purposes. Download the paper form and instructions at www.state.nj.us/treasury/revenue/revprnt.shtml. Call the division at 609-292-1730 to have a form mailed to you. Write to the division at: Client Registration Bureau, Po Box 252, Trenton, NJ 08646-0252 17

Attachment F RFP 0085-2014 HUNTERDON COUNTY PROFESSIONAL SERVICE ENTITY INFORMATION FORM If the Professional Service Entity is an INDIVIDUAL, sign name and give the following information: Name: Address: Telephone No.: Tax Identification No.: Fax No.: E-Mail address: If individual has a TRADE NAME, give such trade name: Trading As: Telephone No.: *********************************************************************************************************************************** If the Professional Service Entity is a PARTNERSHIP, give the following information: Name of Partners: Firm Name: Address: Telephone No.: Fax No.: Federal I.D. No.: E-Mail address: Tax Identification No. Signature of authorized agent: ************************************************************************************************************************************* If the Professional Service Entity is INCORPORATED, give the following information: State under whose laws incorporated: Location of principal office: Telephone No.: Federal I.D. No.: Fax No.: E-Mail address: Name of agent in charge of said office upon whom notice may be legally served: Telephone No.: Name of Corporation: Signature: 18

Attachment G RFP 0085-2014 DATA FORM DATA FORM SUMMARY YEAR Firm Name: Address: Phone: Fax: 1.) List all parties having or deriving any interest, right or benefit in the firm. Name Address Interest 2.) List all senior officers and directors who will be servicing Hunterdon County, along with a description of professional qualifications. Name Title Qualifications I hereby certify that the information on this disclosure is accurate and complete, and that I am an officer of the firm and am duly authorized to supply this information on behalf of the firm. Signature: Title: Print: Date: 19

Attachment G RFP 0085-2014 DATA FORM (Print or Type) Name and Address of Professional Service Entity In connection with the above-named company, I hereby make representations and supply information about myself as hereinafter set forth. (attach addendum or separate sheet if space hereon is insufficient to answer any question fully.) IF ANSWER IS NONE or NO EXCEPTION, SO STATE. 1. Affiant s Full Name: 2. Other Names Used at any Time: 3. Date of Birth: Place of Birth: 4. Tax Identification Number: 5. For the last 10 years, I have lived at the following address or addresses: ADDRESS CITY DATES 6. Schooling: College: Graduate: or Professional: Degree (List): (ATTACH LIST OF ALL EDUCATIONAL INSTITUTIONS AND LOCATION-CITY AND STATE) 7. Member of Professional Societies or Associations (List): 8. I presently hold or have held, in the past, the following professional, occupational, and vocational licenses issued by public or governmental licensing agencies or authorities (state date license issue, issuer of license, date terminated, reason for termination): 9. Present Chief Occupation: Position or Title: Employer s Name Address: 20

How long in this position? How long with this employer? Where? 10. Other jobs, positions, directorates or officerships concurrently held at present. 11. Complete Employment record for Past 20 Years: DATES EMPLOYER AND ADDRESS TITLE (attach further history if necessary) 12. I control directly or indirectly or own legally or beneficially 10% or more of the outstanding capital stock (in voting power) of the following companies: 12a. If any of the above stock is pledged or hypothecated in any way, please detail fully: 13. I have never been adjudicated as bankrupt, except as follows: 14. I have never been convicted or had a sentence imposed or suspended, or had pronouncement of a sentence suspended, or been pardoned for conviction of, or pleaded guilty of an nolo contendere to an information an indictment charging a felony for embezzlement, theft or larceny, mail fraud, or violating any corporate securities statute or any insurance law, nor have I been the subject of a cease and desist order or consent order of any federal or state regulatory agency, except as follows: 15. During the last 10 years, I have neither been refused a professional, occupational vocational license by any public or governmental licensing agency or regulatory authority, nor has such a license held by me ever been suspended or revoked, except as follows: 21

16. I have never been an officer, director, key employee or controlling stockholder of a company which, while I occupied any such position or capacity with respect to it, became insolvent or was enjoined form or ordered to cease and desist from violating any law, except as follows: 17. Neither I nor any company of which I was an officer, director or key management person at the time has ever been subject to any civil action alleging fraud, negligence or violation of any applicable racketeering statutes (state or federal), except as follows: 18. I am not and none of my family members, the employees, officers or directors of: (name of company) is an employee, officer or director, contractor or sub-contractor of The County of Hunterdon or do I or any of my family members, the employees, officers or directors of (name of company) have a direct or indirect financial interest in a company, servicing organization, contractor or sub-contractor to which this RFQ may apply, except as follows: 18a. Any direct or indirect financial interest or any position held as employee, officer or director in any other company, servicing organization, contractor or sub-contractor of the County of Hunterdon or to which this RFQ may apply, as described above, has been disclosed to the County of Hunterdon. (Yes/No) Dated and signed this day of at. I hereby certify under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge and belief and further, by the affixation of my signature herein, I hereby give my certified consent to the New Jersey Department of Insurance to verify the representations and information supplied in response to all questions on the biographical data form, with any Federal, State, municipal or other agency which may have knowledge an/or information thereon. (Signature of Affiant) 22

State of County of personally appeared before me, personally known to me, who, being duly sworn, deposes and says that affiant executed the above instrument and that the statements and answers contained therein are true and correct to the best of affiant s knowledge and belief. Subscribed and sworn to before me this day of. (SEAL) Notary Public My Commission Expires 23

Solicitation Number: Bidder: Attachment H RFP 0085-2014 DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN 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 Director finds a person or entity to be in violation of the principles which are the subject of this law, s/he 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 above for which I am authorized to bid/renew: (Please check all statements that are true) 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 in part 2 below to the Division of Purchase under penalty of perjury. Failure to provide such will result in the proposal being rendered as non-responsive and appropriate penalties, fines and/or sanctions will be assessed as provided by law. PART 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN You must provide, 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. NAME: Relationship to Bidder Description of Activities Duration of Engagement Anticipated Cessation Date: Bidder 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 above-referenced person or entity. I acknowledge that Hunterdon County 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 any contracts with the County to notify the County 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 agreement(s) with Hunterdon County, New Jersey and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print) Signature: Title Date: 24

Attachment I RFP 0085-2014 List of Agencies with Elected Officials Required for Political Contribution Disclosure N.J.S.A. 19:44A-20.26 County Name: Hunterdon State: Governor, and Legislative Leadership Committees Legislative District #s: 23 & 24 State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff Surrogate Municipalities (Mayor and members of governing body, regardless of title): Alexandria Township Bethlehem Township Bloomsbury Borough Califon Borough Clinton Town Clinton Township Delaware Township East Amwell Township Flemington Borough Franklin Township Frenchtown Borough Glen Gardner Borough Hampton Borough High Bridge Borough Holland Township Kingwood Township Lambertville City Lebanon Borough Lebanon Township Milford Borough Raritan Township Readington Township Stockton Borough Tewksbury Township Union Township West Amwell Township Boards of Education (Members of the Board): Alexandria Township Bethlehem Township Bloomsbury Borough Califon Borough Clinton Town Clinton Township Delaware Township Delaware Valley Regional East Amwell Township Flemington-Raritan Regional Franklin Township Frenchtown Borough Glen Gardner Borough Hampton Borough High Bridge Borough Holland Township Hunterdon Central Regional Kingwood Township Lambertville City Lebanon Borough Lebanon Township Milford Borough N Hunt/Voorhees Regional Readington Township South Hunterdon Regional Stockton Borough Tewksbury Township Union Township West Amwell Township Fire Districts (Board of Fire Commissioners): East Amwell Township Fire District No. 1 Franklin Township Fire District No.1 Lambertville City Fire District No. 1 25

BUSINESS ENTITY DISCLOSURE CERTIFICATION FOR NON-FAIR AND OPEN CONTRACTS Required Pursuant To N.J.S.A. 19:44A-20.8 COUNTY OF HUNTERDON The following is statutory text related to the terms and citations used in the Business Entity Disclosure Certification form. Local Unit Pay-To-Play Law (P.L. 2004, c.19, as amended by P.L. 2005, c.51) 19:44A-20.6 Certain contributions deemed as contributions by business entity. 5. 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. 19:44A-20.7 Definitions relative to certain campaign contributions. 6. As used in sections 2 through 12 of this act: business entity" means any 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; Temporary and Executing 12. Nothing contained in this act shall be construed as affecting the eligibility of any business entity to perform a public contract because that entity made a contribution to any committee during the one-year period immediately preceding the effective date of this act. ~~~~~~~~~~~~~~~~~~~~~ The New Jersey Campaign Contributions and Expenditures Reporting Act (N.J.S.A. 19:44A-1 et seq.) 19:44A-3 Definitions. In pertinent part p. The term "political party committee" means the State committee of a political party, as organized pursuant to R.S.19:5-4, any county committee of a political party, as organized pursuant to R.S.19:5-3, or any municipal committee of a political party, as organized pursuant to R.S.19:5-2. q. The term "candidate committee" means a committee established pursuant to subsection a. of section 9 of P.L.1973, c.83 (C.19:44A-9) for the purpose of receiving contributions and making expenditures. r. the term "joint candidates committee" means a committee established pursuant to subsection a. of section 9 of P.L.1973, c.83 (C.19:44A-9) by at least two candidates for the same elective public offices in the same election in a legislative district, county, municipality or school district, but not more candidates than the total number of the same elective public offices to be filled in that election, for the purpose of receiving contributions and making expenditures. For the purpose of this subsection: ; the offices of member of the board of chosen freeholders and county executive shall be deemed to be the same elective public offices in a county; and the offices of mayor and member of the municipal governing body shall be deemed to be the same elective public offices in a municipality. 19:44A-8 and 16 Contributions, expenditures, reports, requirements. While the provisions of this section are too extensive to reprint here, the following is deemed to be the pertinent part affecting amounts of contributions: The $300 limit established in this subsection shall remain as stated in this subsection without further adjustment by the commission in the manner prescribed by section 22 of P.L.1993, c.65 (C.19:44A-7.2) 26

BUSINESS ENTITY DISCLOSURE CERTIFICATION FOR NON-FAIR AND OPEN CONTRACTS Required Pursuant To N.J.S.A. 19:44A-20.8 COUNTY OF HUNTERDON Part I Vendor Affirmation The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that the <name of business entity> has not made and will not make any reportable contributions pursuant to N.J.S.A. 19:44A-1 et seq. that, pursuant to P.L. 2004, c. 19 would bar the award of this contract in the one year period preceding (date of award scheduled for approval of the contract by the governing body) to any of the following named candidate committee, joint candidates committee; or political party committee representing the elected officials of the County of Hunterdon as defined pursuant to N.J.S.A. 19:44A-3(p), (q) and (r). Member of the Hunterdon County Board of Chosen Freeholders The office of Hunterdon County Sheriff The office of Surrogate The office of County Clerk The County committee of the Hunterdon County Republican Party Part II Ownership Disclosure Certification I certify that the list below contains the names and home addresses of all owners holding 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business entity: Partnership Corporation Sole Proprietorship Subchapter S Corporation Limited Partnership Limited Liability Corporation Name of Stock or Shareholder Limited Liability Partnership Home Address Part 3 Signature and Attestation: The undersigned is fully aware that if I have misrepresented in whole or part this affirmation and certification, I and/or the business entity, will be liable for any penalty permitted under law. Name of Business Entity: Signed: Title: Print Name: Date: Subscribed and sworn before me this day of, 2. My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) 27

C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Contractor Instructions Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a fair and open process (defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of P.L. 2005, c. 271, s.2 (N.J.S.A. 19:44A-20.26). This law provides that 10 days prior to the award of such a contract, the contractor shall disclose contributions to: any State, county, or municipal committee of a political party any legislative leadership committee * any continuing political committee (a.k.a., political action committee) any candidate committee of a candidate for, or holder of, an elective office: o of the public entity awarding the contract o of that county in which that public entity is located o o 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 The disclosure must list reportable contributions to any of the committees that exceed $300 per election cycle that were made during the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8 and 19:44A-16 for more details on reportable contributions. N.J.S.A. 19:44A-20.26 itemizes the parties from whom contributions must be disclosed when a business entity is not a natural person. This includes the following: individuals with an interest 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 all principals, partners, officers, or directors of the business entity or their spouses any subsidiaries directly or indirectly controlled by the business entity IRS Code Section 527 New Jersey based organizations, directly or indirectly controlled by the business entity and filing as continuing political committees, (PACs). When the 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. [N.J.S.A. 19:44A-20.26(b)] The contributor must be listed on the disclosure. Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed by ELEC in an amount to be determined by the Commission which may be based upon the amount that the business entity failed to report. The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official and/or candidate campaign committees are affected by the disclosure requirement. It is the contractor s responsibility to identify the specific committees to which contributions may have been made and need to be disclosed. The disclosed information may exceed the minimum requirement. The enclosed form, a content-consistent facsimile, or an electronic data file containing the required details (along with a signed cover sheet) may be used as the contractor s submission and is disclosable to the public under the Open Public Records Act. The contractor must also complete the attached Stockholder Disclosure Certification. This will assist the agency in meeting its obligations under the law. NOTE: This section does not apply to Board of Education contracts. * N.J.S.A. 19:44A-3(s): The term "legislative leadership committee" means a committee established, authorized to be established, or designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the General Assembly or the Minority Leader of the General Assembly pursuant to section 16 of P.L.1993, c.65 (C.19:44A-10.1) for the purpose of receiving contributions and making expenditures. 28

C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. Part I Vendor Information Vendor Name: Address: City: State: Zip: The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form. Signature Printed Name Title Part II Contribution Disclosure Disclosure requirement: Pursuant to N.J.S.A. 19:44A-20.26 this disclosure must include all reportable political contributions (more than $300 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local unit. Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Dollar Amount $ Check here if the information is continued on subsequent page(s) 29

Continuation Page C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 Page of Vendor Name: Contributor Name Recipient Name Date Dollar Amount $ Check here if the information is continued on subsequent page(s) 30

STOCKHOLDER DISCLOSURE CERTIFICATION Name of Business: I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: Partnership Corporation Sole Proprietorship Limited Partnership Limited Liability Corporation Limited Liability Partnership Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Subscribed and sworn before me this day of, 2. (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) 31

Attachment J RFP 0085-2014 32