Common use of PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN Clause in Contracts

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted (Bidder's Initials) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price Schedule

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN USE ADDITIONAL SHEET(S) OF PAPER. Name PAGES Name: Relationship to Bidder Bidder/Vendor: Description of Activities Activities: Duration of Engagement Engagement: Anticipated Cessation Date Bidder Bidder/Vendor Contact Name Name: Contact Phone Number 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 abovebelow-referenced person or entity. I acknowledge that the County Township of Ocean Old Bridge 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 Township of Old Bridge to notify the County Township of Old Bridge 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(sagreements(s) with the County Township of Ocean Old Bridge and that the County Township of Old Bridge at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Bidder/Vendor: XXXXXXXX, SUSPENDED and DISQUALIFIED BIDDER AFFIDAVIT STATE OF NEW JERSEY ) ) COUNTY OF ) I, of the Township of in the county of and the State of being of full age, being duly sworn according to law on my oath depose and say that; I am , an officer of the firm(s) of the bidder making the proposal for the above named work, and that I executed the said proposal with full authority to do so; that said bidder at the time of making this bid, {as applicable, insert “is” or “is not”} included on the State of New Jersey, State Treasurer’s List of Debarred, Suspended and Disqualified Bidders; and that all statements contained in said proposal and in this affidavit are true and correct, and made with the full knowledge that as Local Unit relies upon the truth of the statements contained in said proposal and in the statements contained in this affidavit in awarding the contract for said work The undersigned further warrants that should the name of the firm making this bid appear on the State Treasurer’s List of Debarred, Suspended and Disqualified Bidders at any time prior to, and during the life of the contract, including the Guarantee Period, that the Local Unit shall be immediately so notified by the signatory of this Eligibility Affidavit. The undersigned understands that the firm making the bid as a contractor is subject to debarment, suspension and/or disqualification in contracting with the State of New Jersey and the Department of Environmental Protection if the contractor, pursuant to N.J.A.C. 7:1-5.2, commits any of the acts listed therein, and as determined according to applicable law and regulation. Name and Address of Contractor Name and Title of Affiant Subscribed and Sworn Before me this day Of , 20 Notary Public of My commission expires , 20 Signed: By: Signature of Officer or Individual If BIDDER is: An Individual By (Individual’s Name) Doing business as Business Address: Phone Number: A Partnership By (SEAL) (Firm Name) (General Partner) Business Address: Phone Number: A Corporation By (SEAL) (Corporation Name) (State of Incorporation) By (Name of Person Authorized to Sign) (Title) (Corporate Seal) Attest (Secretary) Business Address: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted Phone Number: A Joint Venture By (Bidder's InitialsName) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID(Address) By (Name) (Address) (Each joint venturer must sign. X Statement The manner of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities signing for each individual, partnership, and corporation that is party to the joint venture should be in Iran X Price Schedulethe manner indicated above)

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted required Items submitted with bid (BidderXxxxxx's InitialsINITIALS) † A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price Schedule†

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT NO. II Items Required Items Submitted with Bid (Bidder's Initials) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price Schedule)

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes box(es) below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. Name Relationship to Bidder Bidder/Offeror Description of Activities Duration of Engagement Anticipated Cessation Date Bidder Contact Bidder/Offeror Contract Name Contact Phone Number CertificationList Additional Activities on Separate Sheet 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 the County State of Ocean New Jersey 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 State to notify the County State 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 the County State of Ocean New Jersey and that the County State at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid TitleSCOPE OF WORK Intensive-Level Architectural Survey Ocean City Historic District Ocean City, Cape May County, N.J. PROJECT NO. X0000-00 XXXXX XX XXX XXXXXX Honorable Xxxxx Xxxxxxxx, Governor Honorable Xxx Xxxxxxxx, Lt. Governor DEPARTMENT OF THE TREASURY Ford X. Xxxxxxx, Treasurer DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION Xxxxxxxxxxx Xxxxxxxx, Director Date: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted (Bidder's Initials) August 30, 2017 PROJECT NAME: Intensive-Level Architectural Survey PROJECT LOCATION: Ocean City Historic District PROJECT NO: P1164-00 DATE: August 30, 2017 TABLE OF CONTENTS SECTION PAGE I. OBJECTIVE 4 II. CONSULTANT QUALIFICATIONS 4 A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25CONSULTANT & SUB-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price ScheduleCONSULTANT PRE-QUALIFICATIONS 4

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes box(es) below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. Name Relationship to Bidder Bidder/Offeror Description of Activities Duration of Engagement Anticipated Cessation Date Bidder Contact Bidder/Offeror Contract Name Contact Phone Number CertificationList Additional Activities on Separate Sheet 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 the County State of Ocean New Jersey 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 State to notify the County State 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 the County State of Ocean New Jersey and that the County State at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid PROFESSIONAL SERVICES FEE PROPOSAL DIVISION OF PROPERTY MANAGEMENT & CONSTRUCTION THIS FEE PROPOSAL TO BE RETURNED DATE: TBD IN A SEPARATELY SEALED ENVELOPE TO: PROJECT NO.: P1191-00 Division of Property Management & Construction 33 WEST STATE ST 0XX XXXXX, XXXX XXXX X.X. Xxx 000 Xxxxxxx, XX 00000-0000 Attention: XXXXX XXXXXX THIS PROPOSAL DUE DATE, NO LATER THAN 2:00 PM, TBD FIRM NAME THE UNDERSIGNED PROPOSES TO PROVIDE ALL PROFESSIONAL SERVICES AS STATED IN THE REQUEST FOR PROPOSAL AND SCOPE OF WORK HUD/CDBG SURVEYS Blue Acres SURVEYS CONSULTANT SURVEY SERVICES $ $ SUB CONSULTANT SURVEY SERVICES $ $ TOTAL LUMP SUM FEE FOR SURVEY SERVICES $ $ CORNER MARKER SETTING ALLOWANCE $ $ TOTAL CONTRACT AMOUNT $ $ PROPOSAL TO HOLD GOOD FOR 60 DAYS AFTER THE DUE DATE. Signature and Title of Principle or Individual of the firm authorized to sign contractual documents: Signature of the consultant below attests that the Consultant has read, understands and agrees to all terms, conditions and specifications set forth in the Request for Proposal (RFP) and Consultant Proposal Package. Signature: Print Name: Title: SERVICE Date: Witness Signature: Print Name: ATTACH PROOF OF REQUIRED INSURANCE COVERAGE See attached requirements per “General Conditions to Consultant Agreement" Section 27, pp. 18-19 PROFESSIONAL LIABILITY INSURANCE ($100,000 MIN LIMIT/$25,000 MAX DEDUCTIBLE) CONSULTANT TASK/LABOR/FEE SHEET Project # P1191-00 A/E: Project Name: Boundary Surveys for Land Acquisition, Various Parcels Project Location: Pleasantville City, Atlantic County, NJ HUD/CDBG Surveys PROJECT CONSULTANTS LEVEL OF EFFORT IN HOURS/FEE REPROD. COST TOTALS PHASE OR LEVEL 7 6 5 4 3 2 1 PER PHASE INCLUD. PER TASK TASK *HOURLY $ $ $ $ $ $ $ SUB CONSULTANT HOURS RATE DOCUMENTS $ AMOUNT SURVEY SERVICES HOURS AMOUNT $ $ $ $ $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ $ $ $ $ TOTAL HOURS AMOUNT $ $ $ $ $ $ $ $ $ PROFESSIONAL SERVICES HOURS GRAND TOTALS AMOUNT $ CONSULTANT TASK/LABOR/FEE SHEET Project # P1191-00 A/E: Project Name: Boundary Surveys for Land Acquisition, Various Parcels Project Location: Pleasantville City, Atlantic County, NJ Blue Acres Surveys PROJECT CONSULTANTS LEVEL OF EFFORT IN HOURS/FEE REPROD. COST TOTALS PHASE OR LEVEL 7 6 5 4 3 2 1 PER PHASE INCLUD. PER TASK TASK *HOURLY $ $ $ $ $ $ $ SUB CONSULTANT HOURS RATE DOCUMENTS $ AMOUNT SURVEY SERVICES HOURS AMOUNT $ $ $ $ $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ $ $ $ $ TOTAL HOURS AMOUNT $ $ $ $ $ $ $ $ $ PROFESSIONAL SERVICES HOURS GRAND TOTALS AMOUNT $ SUB-CONSULTANT TASK/LABOR/FEE SHEET Project # P1191-00 A/E: Project Name: Boundary Surveys for Land Acquisition, Various Parcels Project Location: Pleasantville City, Atlantic County, NJ HUD/CDBG Surveys PROJECT SUB CONSULTANTS LEVEL OF EFFORT IN HOURS/FEE TOTALS PHASE OR FIRM PER TASK TASK NAME SURVEY SERVICES HOURS AMOUNT $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ TOTALS HOURS AMOUNT $ $ $ $ $ TOTAL * PROVIDE FIRM NAME(S) AT TOP OF COLUMN(S). MAKE COPY OF THIS SHEET IF MORE SPACE IS NEEDED. PLEASE ATTACH PROOF OF SUBCONSULTANT PREQUALIFICATION (48A) WITH DPMC SUB-CONSULTANT TASK/LABOR/FEE SHEET Project # P1191-00 A/E: Project Name: Boundary Surveys for Land Acquisition, Various Parcels Project Location: Pleasantville City, Atlantic County, NJ Blue Acres Surveys PROJECT SUB CONSULTANTS LEVEL OF EFFORT IN HOURS/FEE TOTALS PHASE OR FIRM PER TASK TASK NAME SURVEY SERVICES HOURS AMOUNT $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ HOURS AMOUNT $ $ $ $ $ TOTALS HOURS AMOUNT $ $ $ $ $ TOTAL * PROVIDE FIRM NAME(S) AT TOP OF COLUMN(S). MAKE COPY OF THIS SHEET IF MORE SPACE IS NEEDED. PLEASE ATTACH PROOF OF SUBCONSULTANT PREQUALIFICATION (48A) WITH DPMC FIRM NAME PERCENTAGE OF TIME ASSIGNED TO PROJECT KEY PERSONNEL HOURLY & TITLE SURVEY WAGE SERVICES LEVEL 1-7 INSERT THE WAGE LEVEL FROM 1 TO 7 OF EACH KEY PERSON. DO NOT INSERT ANY HOURLY RATE KEY TEAM MEMBER PROJECT EXPERIENCE DATA SHEET NAME TITLE FIRM PROJECT TITLE LOCATION AND MAINTENANCE TOTAL CONSTRUCTION COST OR FEE A/E OF RECORD FOR THIS REFERENCED PROJECT SPECIFIC TYPE OF WORK EXPERIENCE (STUDY, SCHEMATIC, CONSTRUCTION ADMINISTRATION) TEAM MEMBERS SPECIFIC ROLE OR TITLE ON THE REFERENCED PROJECT DURATION OF TEAM MEMBER'S INVOLVEMENT OF THE REFERENCED PROJECT ( IN MONTHS) % OF TIME DURING DURATION BASED UPON A 40 HOUR WEEK DATES OF THE TEAM MEMBER'S INVOLVEMENT IN THE REFERENCED PROJECT CLIENT NAME CONTRACT PERSON AND PHONE NUMBER * A KEY TEAM MEMBER IS A TECHNICAL OR MANAGEMENT PERSON DEVOTING 20% OR MORE OF THEIR TIME TO ANY PHASE OF THE PROJECT STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted (Bidder's Initials) BETWEEN THE STATE OF NEW JERSEY AND THE CONSULTANT TABLE OF CONTENTS A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price ScheduleConsultant Responsibilities A.1 General A.2 Design Phase A.3 Construction Administration Phase

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted required Items submitted with bid (BidderXxxxxx's Initials) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price ScheduleINITIALS)

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Required Items Submitted with Bid (Bidder's Initials) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price Schedule)

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes box(es) below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. Name _ Relationship to Bidder Bidder/Offeror _ Description of Activities _ _ _ _ Duration of Engagement Anticipated Cessation Date Bidder Contact _ Bidder/Offeror Contract Name _ Contact Phone Number Certification_ List Additional Activities on Separate Sheet 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 the County State of Ocean New Jersey 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 State to notify the County State 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 the County State of Ocean New Jersey and that the County State at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid TitleSCOPE OF WORK Boundary Survey for Land Acquisition Various Parcels Keansburg Borough, Monmouth County, N.J. PROJECT NO. X0000-00 XXXXX XX XXX XXXXXX Honorable Xxxx Xxxxxx, Governor Honorable Xxxxxx Xxxxxx, Lt. Governor DEPARTMENT OF THE TREASURY Xxxxxxxxx Xxxxx Xxxxx, Treasurer DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION Xxxxxxxxxxx Xxxxxxxx, Director Date: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted August 1, 2018 PROJECT NAME: Boundary Survey for Land Acquisition PROJECT LOCATION: Keansburg Borough, Monmouth County PROJECT NO: P1188-00 DATE: August 1, 2018 TABLE OF CONTENTS SECTION PAGE I. OBJECTIVE 4 II. CONSULTANT QUALIFICATIONS 4 A. SURVEY CONSULTANT & SUB-CONSULTANT PRE-QUALIFICATIONS 4 III. PROJECT SCHEDULE 4 A. SCHEDULE 4 B. CONSULTANT’S PROPOSED SCHEDULE 4 IV. PROJECT SITE LOCATION & TEAM MEMBERS 5 A. PROJECT SITE ADDRESS 5 B. PROJECT TEAM MEMBER DIRECTORY 5 1. DPMC Representative: 5 2. DEP Representative: 5 V. PROJECT DEFINITION 6 A. BACKGROUND 6 VI. CONSULTANT RESPONSIBILITIES 6 A. PROJECT CORRESPONDENCE 6 B. GENERAL SURVEY REQUIREMENTS 6 C. PRELIMINARY DELIVERABLE REVIEW 7 D. PROJECT SPECIFIC SURVEY REQUIREMENTS 7 E. CORNER MARKER (Bidder's InitialsMONUMENT) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BIDSETTING 9 F. PROJECT COMMENCEMENT 9 1. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price ScheduleProject Directory 9

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT NO. II Items Submitted (Bidder's Initials) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price Schedule

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes box(es) below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. Name _ Relationship to Bidder Bidder/Offeror _ Description of Activities _ _ _ _ Duration of Engagement Anticipated Cessation Date Bidder Contact _ Bidder/Offeror Contract Name _ Contact Phone Number Certification_ List Additional Activities on Separate Sheet 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 the County State of Ocean New Jersey 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 State to notify the County State 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 the County State of Ocean New Jersey and that the County State at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid TitleSCOPE OF WORK Boundary Survey for Land Acquisition Various Parcels Keansburg Borough, Monmouth County, N.J. PROJECT NO. P1188-00 STATE OF NEW JERSEY Honorable Xxxx Xxxxxx, Governor Honorable Xxxxxx Xxxxxx, Lt. Governor DEPARTMENT OF THE TREASURY Xxxxxxxxx Xxxxx Xxxxx, Treasurer DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION Xxxxxxxxxxx Xxxxxxxx, Director Date: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted (Bidder's Initials) August 1, 2018 PROJECT NAME: Boundary Survey for Land Acquisition PROJECT LOCATION: Keansburg Borough, Monmouth County PROJECT NO: P1188-00 DATE: August 1, 2018 TABLE OF CONTENTS SECTION PAGE I. OBJECTIVE 4 II. CONSULTANT QUALIFICATIONS 4 A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25SURVEY CONSULTANT & SUB-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price ScheduleCONSULTANT PRE-QUALIFICATIONS 4

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, PLEASE ADD AN ADDITIONAL SHEET(S) OF PAPER. 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 the County of Ocean 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 the County of Ocean and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Name of Bidder: Full Name (Print): Signature: Title: Date: BID DOCUMENT CHECKLIST Bid Title: SERVICE AND MAINTENANCE AGREEMENT FOR VARIOUS EQUIPMENT Items Submitted (Bidder's Initials) A. FAILURE TO SUBMIT ANY OF THESE DOCUMENTS IS  MANDATORY CAUSE FOR REJECTION OF BID. X Statement of Ownership (N.J.S.A. 52:25-24.2) X Acknowledgment of receipt of addenda or revisions (if issued) X Disclosure of Investment Activities in Iran X Price Schedule