SALEM COUNTY IMPROVEMENT AUTHORITY REQUEST FOR PROPOSAL FOR THE POSITION OF AUTHORITY ENGINEER-ANNUAL TOPOGRAPHICAL SURVEY

Similar documents
BARNEGAT TOWNSHIP SCHOOL DISTRICT 550 BARNEGAT BOULEVARD NORTH BARNEGAT, NEW JERSEY (609) FAX (609)

Proposals due May 18 th, 2018 at 4:30 PM. Indicate on the Sealed Envelope Do Not Open with Regular Mail.

Request for Proposals (RFP) RFP NO. E&CD GRANT WRITING AND ADMINISTRATION SERVICES

REQUEST FOR PROPOSAL. Virginia s Region 2000 Local Government Council Region 2000 Services Authority

REQUEST FOR PROPOSAL. Virginia s Region 2000 Local Government Council Region 2000 Services Authority

MORRISTOWN HOUSING AUTHORITY NOTICE

CITY OF LOMPOC REQUEST FOR PROPOSALS DEVELOPMENT IMPACT FEE UPDATE STUDY

MAGNOLIA BOARD OF EDUCATION 131 Elm Ave Woodlynne, New Jersey 08107

REQUEST FOR PROPOSAL FOR POLICE OPERATIONS STUDY. Police Department CITY OF LA PALMA

INSTRUCTIONS FOR REINSTATEMENT, REACTIVATION AND RESUMPTION OF PRACTICE APPLICATION OF A NEW JERSEY LICENSE

Purchasing and Support Services County Administration Building 44 N. San Joaquin Street, Suite 540 Stockton, CA 95202

Request for Proposal: Merced Community College District CONSULTANT FOR THE DEVELOPMENT OF A DISTRICT FACILITIES MASTER PLAN

REQUEST FOR PROPOSAL Architectural Services

FOR CONSULTING SERVICES FOR DISASTER RESPONSE, ENGINEERING, AND GRANT MANAGEMENT SUPPORT

TERREBONNE PARISH REQUEST FOR QUALIFICATIONS FOR ENGINEERING SERVICES. Generator Sizing and Installation

RFP # Request for Proposal Grant Writing Services. Date: May 11, Proposals must be submitted by 3:00 PM: June 10, 2016

REQUEST FOR PROPOSALS

Consulting Services for Update of Countywide Impact Fee Study

Request for Qualifications/Request for Proposals For General and Specialized Consulting Engineering Services for Wastewater Facilities

All proposals must be received by August 30, 2016 at 2:00 PM EST

RFP #: SB06-PO1617 EMERGENCY RESPONDER TRAINING FACILITY Page 1

Request for Proposal for Digitizing Document Services and Document Management Solution RFP-DOCMANAGESOLUTION1

Date: April 6, 2018 SUBJECT: REQUEST FOR QUALIFICATIONS. RFQ # Business Analyst Services

REQUEST FOR QUALIFICTIONS MARKETING AND PUBLIC RELATIONS FOR YEAR ENDING DECEMBER 31, 2018 ISSUED BY: Suffolk County Industrial Development Agency

Request for Qualifications. Professional Design and Construction Services as a Design-Builder. For. Delhi Township Fire Station

Request for Qualifications Construction Manager

Request for Proposal Professional Auditing Services

HORRY COUNTY SOLID WASTE AUTHORITY, INC.

REQUEST FOR PROPOSALS FOR DESIGN PROFESSIONAL SERVICES

PPEA Guidelines and Supporting Documents

REQUEST FOR PROPOSALS: AUDIT SERVICES. Issue Date: February 13 th, Due Date: March 22 nd, 2017

B Request for Proposal for. Qualified Firms. Financial Advisory Services. Grossmont-Cuyamaca Community College District

INVITATION TO BID (Request for Proposal)

Request for Proposals Emergency Response Plan, Training and Vulnerability Assessment

Town of Derry, NH REQUEST FOR PROPOSALS PROFESSIONAL MUNICIPAL AUDITING SERVICES

REQUEST FOR PROPOSALS FOR DESIGN PROFESSIONAL SERVICES

REQUEST FOR PROPOSAL

Request for Proposals for Baggage Handling System / Checked Baggage Inspection System (CBIS)

BOARD OF FINANCE REQUEST FOR PROPOSALS FOR PROFESSIONAL AUDITING SERVICES

REQUEST FOR PROPOSALS FOR INFORMATION TECHNOLOGY SUPPORT SERVICES

REQUEST FOR PROPOSALS. For: As needed Plan Check and Building Inspection Services

Request for Proposals City School District of Albany Empire State After-School Program Coordination and Programming June 14, 2017

REQUEST FOR QUALIFICATIONS STRUCTURAL ENGINEER PROFESSIONAL SERVICES. June 19, 2017

REQUEST FOR PROPOSAL (RFP) FOR LOCAL COUNSEL LEGAL REPRESENTATION FOR LYCOMING COUNTY IN POTENTIAL OPIOID- RELATED LITIGATION

Londonderry Finance Department

West Central Texas Municipal Water District REQUEST FOR PROPOSALS TO CONDUCT AN INDEPENDENT MANAGEMENT AUDIT

Request for Proposals (RFP) for: Food Waste Curbside Collection Pilot Program. City of South Portland, ME

REQUEST FOR PROPOSALS Noise Monitoring and Flight Tracking System and Noise Monitor Service and Maintenance

Lower Manhattan Development Corporation Avi Schick, Chairman David Emil, President. March 2, 2009

GORDON COUNTY BOARD OF COMMISSIONERS REQUEST FOR PROPOSALS FOR A COMMUNITY DEVELOPMENT BLOCK GRANT WRITER/ADMINISTRATOR

REQUEST FOR PROPOSAL CNC Lathe Machine INSTRUCTIONS TO BIDDERS

TOWN OF BRECKENRIDGE BLUE 52 TOWNHOMES HOA MANAGEMENT SERVICES REQUEST FOR PROPOSALS. Issued August 1, 2017

City of Somersworth, New Hampshire OFFICE OF THE FINANCE DIRECTOR

BUTTE COUNTY DEPARTMENT OF WATER AND RESOURCE CONSERVATION REQUEST FOR PROPOSALS TO

REQUEST FOR PROPOSALS FOR REPLACEMENT OF GENERATOR AT LAKE HILLS 1860 BOOSTER PUMP STATION

REQUEST FOR PROPOSALS For Design Services for New Fire Station

Request for Proposals Ground Lease for the Development and Management of Recreation Facilities At the former Baker Hospital Site

REQUEST FOR PROPOSALS PROFESSIONAL ENGINEERING SERVICES WATER SYSTEM RELIABILITY STUDY CITY OF MT. PLEASANT WATER DEPARTMENT

Request for Proposal. Purchase of New Mobile Trailer Climbing Wall. No November 23, 2015

Request for Proposals Solid Waste Management Available Technology Analysis

City of Georgetown, SC REQUEST FOR PROPOSAL

WILLIAMSON COUNTY PURCHASING DEPARTMENT SOLICITATION Utility Coordination and Utility Engineering Services

REQUEST FOR PROPOSAL AUDITING SERVICES. Chicago Infrastructure Trust

(1) Vendor Acknowledgement (2) Instructions *(3) Scope/Required Information and Documents Outline Including Notarized Certification

REQUEST FOR PROPOSAL Milling Services

DISTRICT OF COLUMBIA WATER AND SEWER AUTHORITY (DC WATER) REQUEST FOR QUOTE RFQ 18-PR-DIT-27

Base Year - July 01, 2016 June 30, 2017, with optional renewal at Board s sole. (520)

REQUEST FOR QUALIFICATIONS HONDO, TEXAS CITY ENGINEERING SERVICES

ADVISORY COMMITTEE ON WATER SUPPLY AND WASTEWATER LICENSED OPERATOR TRAINING ESTABLISHED UNDER NJSA 58:10A 14.6 BY-LAWS

Automatic License Plate Recognition System for the Police Department

Aberdeen School District No North G St. Aberdeen, WA REQUEST FOR PROPOSALS 21 ST CENTURY GRANT PROGRAM EVALUATOR

The CITY OF BAYONNE is soliciting bids for the provision of the following professional services:

REQUEST FOR QUALIFICATIONS MUNICIPAL ENGINEERING SERVICES

REQUEST FOR PROPOSAL

Request for Qualifications # For. Architecture/Engineering Professional Services For Small Projects

OREGON VOLUNTEER FIREFIGHTERS ASSOCIATION

Lyndon Township Broadband Implementation Committee Lyndon Township, Michigan

Summer School Nurse (LPN or RN)

CITY OF GAINESVILLE REQUEST FOR PROPOSAL

REQUEST FOR PROPOSAL For East Bay Community Energy Technical Energy Evaluation Services

Request for Proposal For Audit Services Years Ending June 30, 2014, 2015, and 2016

Request for Proposal (RFP) The Klamath Tribes Youth Fitness Center Klamath Tribes Housing Department (KTHD) RFP # 09-KTHD17

REQUEST FOR PROPOSALS. Architectural Services for Conceptual Design. Maplewood Memorial Library 51 Baker Street Maplewood, NJ 07040

ROWAN UNIVERSITY / RUTGERS CAMDEN BOARD OF GOVERNORS

RFP #WS NEWSMI IMPROVEMENTS

REQUEST FOR PROPOSALS

Request for Proposal PROFESSIONAL AUDIT SERVICES

RFP FOR PROFESSIONAL SERVICES

Suffolk COUNTY COMMUNITY COLLEGE PROCUREMENT POLICY

REQUEST FOR PROPOSALS

REQUEST FOR PROPOSALS ACCOUNTING AND AUDITING SERVICES

OCTOBER 1, 2015 ADDENDUM NO. 1 FOR REQUEST FOR QUALIFICATIONS ( RFQ ) FOR DESIGN CONSULTING SERVICES (TARGET MARKET) SPECIFICATION NO.

Request for Proposal: NETWORK FIREWALL

RFP - PW FDR. ADVERTISEMENT for FUEL DISPENSER REPLACEMENTS

CITY OF CAMARILLO AND CAMARILLO SANITARY DISTRICT WATER AND SEWER RATE STUDIES REQUEST FOR PROPOSAL

REQUEST FOR PROPOSAL (RFP) PROFESSIONAL AUDITING SERVICES

SOLICITATION FOR PARTICIPATION IN A REQUEST FOR PROPOSALS FOR CHIEF EXECUTIVE OFFICER (CEO) SEARCH SERVICES JACKSONVILLE, FL SOLICITATION NUMBER 94414

REQUEST FOR PROPOSALS (RFP) TRIENNIAL PERFORMANCE AUDIT FOR THE MADERA COUNTY TRANSPORTATION COMMISSION

BOISE CITY AND ADA COUNTY HOUSING AUTHORITIES 1276 River Street Suite 300, Boise, Idaho INDEPENDENT AUDIT SERVICES REQUEST FOR PROPOSAL

PROCUREMENT AND PROPERTY SERVICES P. O. Box NACOGDOCHES, TX REQUEST FOR PROPOSAL RFP NUMBER REALTOR-2016

Transcription:

SALEM COUNTY IMPROVEMENT AUTHORITY REQUEST FOR PROPOSAL FOR THE POSITION OF AUTHORITY ENGINEER-ANNUAL TOPOGRAPHICAL SURVEY Position and Term: The Salem County Improvement Authority (SCIA) or (Authority) requests proposals from New Jersey licensed engineers interested in serving in the position of Authority Engineer for the Annual Topographical Survey of the Solid Waste Division Landfill commencing upon appointment and serving until the next reorganization meeting of the SCIA. In accordance with the N.J.S.A. 40A:11-15 Local Public Contract Laws limits the award of professional services contracts to a maximum of 12 months. Fair and Open Process: These proposals are being solicited through a fair and open process in accordance with N.J.S.A. 19:44A-20.5. Applicants who meet the minimum requirements for the position as set forth below and are willing to provide the described services for the disclosed compensation shall be evaluated based on cost and other factors, such as experience, reputation, knowledge, qualifications, availability, and resources, as set forth in the criteria described below. Proposal Submission: To be considered, applicants must submit one (1) original, signed CLEARLY marked as the ORIGINAL and two (2) full, complete and exact copies of each proposal in a sealed envelope and must be marked with the words AUTHORITY ENGINEER-ANNUAL TOPOGRAPHICAL SURVEY. Proposals are to be submitted on or before 1:00 pm on Thursday, December 6, 2018 to: Julie Acton Executive Director Salem County Improvement Authority 52 McKillip Road, P.O. Box 890 Alloway, New Jersey 08001 Proposals will be publicly opened and announced by the Executive Director on Thursday, December 6, 2018 starting at 1:00 pm in the Landfill Office, 52 McKillip Road, Alloway Township, New Jersey. Responses will not be accepted by fax or e-mail. All documents and information submitted in response to this solicitation shall be available to the public as required by the New Jersey Open Public Records Act N.J.S.A. 47:1A-1 et. sec. The Authority shall not be responsible for any costs associated with the oral or written and/or presentation of the proposals. The Authority reserves the right to

reject all proposals, with or without cause, and waive any irregularities or informalities in the proposals. The Authority further reserves the right to make such investigations as it deems necessary as to the qualifications of all vendors submitting proposals. If all proposals are rejected, the Authority reserves the right to re-solicit proposals. General Information on the Salem County Improvement Authority: Salem County Improvement Authority operates under the authority of N. J. S. A. 40:37A-44 et.seq. (P.L. 1960 C 183). The Authority is comprised of the Solid Waste Division in Alloway Township, NJ. The SCIA Board generally meets once per month, on the second Thursday of each month, with their annual reorganization occurring in February. The following elements and areas are comprised in the Authority: Solid Waste Division Landfill o NJDEP Solid Waste Operating Permits and other associated operational permits including horizontal and vertical expansions o Groundwater monitoring well field o Leachate collection system o Methane/Landfill Gas Capture system o Methane/Landfill Gas flare o Methane/Landfill Gas to Energy facility (electrical generator) o Wetlands mitigation area o Closure/Post-Closure Plan o Deed Restrictions Bond Financing Selection Process: Proposals will be received by the Executive Director and reviewed to determine responsiveness. Non-responsive proposals will be rejected without evaluation. For vendors that satisfy the minimum requirements and submit all of the necessary documents in their proposal the Authority will evaluate proposals based on the following evaluation criteria, separate or combined in some manner, and not necessarily listed in order of significance: (i) responsiveness to the Qualification Evaluation and other required submissions;; (ii) general experience and reputation in the field including documented experience in successfully completing contracts and performing services of similar size and scope to the engagement addressed by the RFP;; (iii) specific experience/knowledge of the Salem County Improvement Authority and the subject matter to be addressed under the contract;; (iv) qualifications and experience which most closely match the needs of the Authority;; (v) availability to accommodate meeting and interface requirements with the Authority Board and Authority Officials for meetings, phone conferences, attendance at events and office consultations;; (vi) office resources, including backup staff, which are deemed most adequate to service the needs of the Authority including management, supervisory and other key personnel assigned to the engagement, with emphasis on documented experience in successfully completing work on contracts of similar size and scope to the 2

services required under this RFP;; (vii) compensation and fees as specified and provided by the applicant;; (viii) the applicant who is deemed otherwise most advantageous based on all information submitted or gathered in connection with the proposal. The Authority reserves the right to: (i) not select any of the applicants;; (ii) require applicants to submit to a personal interview and/or submit additional or clarifying information;; (iii) to reject any or all proposals;; (iv) to waive any informalities in the proposals;; and (v) procure the articles or services from other sources if deemed most advantageous to the objectives of the Authority. Contract: The Board of the Salem County Improvement Authority shall award the contract for the services. The award of the contract shall be determined by majority vote on a resolution to be read by title at an open public meeting. The Authority will select the vendor deemed most advantageous to the goals and objectives of the Authority, price and other factors considered. The resulting contract will include this RFP, any clarifications or addenda thereto, the selected vendor s proposal and any changes negotiated by the parties. The decision to award said contract shall be final and conclusive. No applicant shall influence, or attempt to influence or cause to be influenced, any Authority Official, officer or employee to use his/her official capacity in any manner which might tend to impair the objectivity or independence of judgment. No applicant shall cause or influence, or attempt to cause or influence, any Authority Official, officer or employee to secure unwarranted privileges or advantages. Minimum Requirements: Applicants do not have to match each item exactly;; the following is what is generally meant when used in this RFP. Scope-magnitude of the project and value of the contract Size-refers to such things as budget, acres of landfill, acres of wetlands mitigation, size of bonds, etc. Similar-refers to such things as public authorities that are partially or wholly in areas of New Jersey that have similar attributes as SCIA. Applicant must be and shall submit proof that they are fully licensed and in good standing to practice civil engineering and surveying in the State of New Jersey. Applicant must have and shall submit proof that they possess an NJPE and NJPLS. Applicant have and shall submit proof that they have a minimum of three (3) years of experience serving as an engineer for other Authorities (Utility, Improvement, Pollution Control) owning and operating a solid waste landfill similar in size to that of SCIA and must have completed at least two annual topographical surveys for a solid waste landfill in the State of New Jersey. 3

Description of Services: Firm must be multi-disciplined with expertise in solid waste management, landfill construction and operations, construction management, planners, landscape, environmental assessments (wetlands, endanger species, hydrologic studies), GIS, surveying, traffic studies, drainage. The firm will serve as Topographic Engineer for the Salem County Improvement Authority and will be required to attend periodic meetings with the Authority Board, Executive Director, Landfill Manager and other officials as requested. Firm will be required to complete an annual aerial fly over of the SCIA Solid Waste Division Landfill and complete annual topographical report due to the NJDEP by May 1, 2017. The SCIA requires all survey and topographical work to use the most recent NJDEP datum. The 2019 topographical survey will include the original landfill (Cells 1-7, 8 and 9). The firm shall request, by e-mail approximately 30 days in advance, from the Executive Director or her designate, landfilled tonnage reports from the previous topographical survey to the current topographical survey in advance of the preparation for the topographical survey report. The firm shall meet with the Executive Director or the Landfill Supervisor no later than April 15, 2019, to review results of the annual topographical survey. Firm shall deliver annual topographical survey directly to the NJDEP following internal review and shall copy the Executive Director on the transmittal. The aerial photograph shall be presented in vertical format, 24 inches by 36 inches, and the aerial photograph shall be taken in high resolution format. The photograph shall depict all pertinent aspects of the landfill property owned by SCIA, including, but not limited to identification of the location of the flare, generator, cell tower, all individual cells numbered 1 through 9 and Cell 11, stockpile, leachate tanks, convenience center, recycling staging area, storm water basins and the physical addresses, including block and lot numbers, of all buildings. Firm shall supply SCIA with one (1) additional set of the topographical map as well as one (1) set of the aerial photograph laminated with legends marked and property boundaries outlined and four (4) sets of the aerial photograph with legends marked and property boundaries included, that are not laminated for the Authority s use in providing information to our local emergency management officials. Firm shall coordinate with SCIA Solid Waste Engineer regarding transmittal of topographic information for permitting, budgeting and compaction rates as needed for reporting. Firm shall interface with Executive Director on a periodic basis to track and/or administer all solid waste projects, including but not limited to landfill expansion projects, environmental permitting and compliance with NJDEP and EPA requirements including storm water, landfill monitoring, air testing, spill prevention, groundwater well installation and surveying, gas well surveying and permitting, etc. that may affect the topographical survey. Compensation: Respondents shall specify all 2019 costs associated with specific tasks as outlined on the cost proposal spreadsheet below. The Proposer should input the lump sum cost per task. Subtotals for the annual costs of each task as well as a total cost including all categories must be provided. Performing additional projects or tasks requested that are not specified or know at the time of this RFP will be compensated in the form of a per hour fee and should be input on the cost proposal spreadsheet below. A proposal showing a minimum and maximum range of fees is not acceptable. 4

Respondents shall also specify any reimbursable expenses, including but not limited to, mileage, reproduction of documents, etc., that you may charge the Authority while performing the requirements of this contract. Cost Proposal TASK Not to Exceed Amount Per Event Annual Cost Aerial Flyover Actual Flyover $ $ Additional Topo Map $ $ Additional Sets of Aerial Photographs $ X 4 $ Laminated Aerial Photographs $ X 2 $ Subtotal Aerial Flyover * * * * * $ Annual Topographical Annual Topographical Report / due to DEP May 1, 2019 $ $ Subtotal Annual Topographical Report * * * * * $ Total Cost (Aerial Flyover, Additional Topo Map, Additional Sets of Aerial Photographs, Laminated * * * * * $ Per Hour Rate for Additional Projects or Tasks Requested-not specified or known at time of RPF $ $ 5

Please mark the appropriate box below to indicate if your pricing proposal includes a portal to portal transportation charge: NO YES- if yes please explain how this rate differs from your regular hourly rate (i.e. how much is the actual difference in price for the portal to portal charge). Qualification evaluation: 1. Minimum requirements. Please attach resume and/or other documentation demonstrating compliance with the minimum requirements detailed above. 2. Describe your experience regarding topographical and other survey services for solid waste landfills in the state of NJ. 3. Please list all public entities/agencies for which you presently serve as Authority Engineer or Topographical Survey Engineer complete with term of appointment, contact person and related phone number. 4. Disclose and describe if you or any member of your firm have ever had their license suspended or revoked in New Jersey or any other state. 5. Disclose the location of the office, if other than the vendor s main office, at which the vendor proposes to perform services required under this RFP. Describe your presence in New Jersey and any familiarity your firm has with the Salem County areas. 6. Describe the resources of your office. Include details of support staff that lists those persons who will be assigned to the engagement if the vendor is selected, including the designation of the person who will be the vendor s officer responsible for all services required under the engagement. This portion of the proposal should include relevant resume information for the individuals who will be assigned. At a minimum, this information should include the person s relevant professional experience, years and type of experience, and number of years with the vendor. Include information on other qualified staff in your office who would be available to Authority Officials in the event you were absent or unavailable. 6

7. 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 regards to this engagement or the Salem County Improvement Authority. Required Forms: Each applicant shall be required to complete, sign and provide/return the below listed forms and information with their proposal. Business Registration - All New Jersey and out of state business organizations must obtain a Business Registration Certificate from the New Jersey Department of the Treasury, Division of Revenue, prior to conducting business in the State of New Jersey. Respondents shall submit with their proposal proof of their valid Business Registration with the Division of Revenue, Department of the Treasury, State of New Jersey. Chapter 33 Corporate Disclosure - No corporation or partnership may be awarded a contract for the performance of work or the furnishing of materials or supplies, unless it lists with its proposal, the names and addresses of all stockholders who own ten (10) percent or more of its stock of any class, or all individual partners who own a ten (10) percent or greater interest therein (N.J.S.A. 52:25-24.2, P.L. 1977, Chapter 33). Affirmative Action Compliance Applicant shall demonstrate compliance with Affirmative Action requirements as set forth in the included form per P.L. 1975, C. 127 (N.J.A.C. 17:27). Professional Liability Insurance - Applicant shall provide to the Authority proof of Professional Liability Insurance coverage for errors and omissions with a limit of not less than $1,000,000.00. Questions: Questions regarding this Request for Proposals shall be directed to: Michele Gamber Purchasing Agent (856) 935-7900, extension 12 Julie Acton Executive Director (856) 935-7900, extension 15 Salem County Improvement Authority, 52 McKillip Road, P.O. Box 890, Alloway, New Jersey, 08001 7

CORPORATE DISCLOSURE STATEMENT I certify that the list below contains the names and addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Partnership Corporation Sole Proprietorship PLEASE CHECK THE APPROPRIATE BOXES ABOVE AND SIGN BELOW. Stockholders Addresses THIS STATEMENT MUST BE INCLUDED WITH YOUR PROPOSAL SUBMISSION Subscribed and sworn before me (Signature of Affiant) this day of, 20 (Notary Public) (Print Name and Title) My Commission expires: 8

AFFIRMATIVE ACTION REQUIREMENTS COMPANY NAME: SIGNATURE: TITLE: RESPONDENTS ARE REQUIRED TO COMPLY WITH THE REQUIREMENTS OF P.L. 1975, c. 127 (N.J.S.A. 10:5-31, et seq.). See also N.J.A.C. 17:27 et seq. REQUIRED AFFIRMATIVE ACTION EVIDENCE A. PROCUREMENT & SERVICE CONTRACTS (which are not subject to a Federally approved or sanctioned affirmative action program). All successful vendors must submit within seven (7) calendar days of the notice of intent to award or the signing of the contract, whichever is sooner, one of the following: 1. A PHOTOCOPY OF THEIR FEDERAL LETTER OF AFFIRMATIVE ACTION PLAN APPROVAL;; OR 2. A PHOTOCOPY OF THEIR CERTIFICATE OF EMPLOYEE INFORMATION REPORT;; OR 3. A COMPLETED AFFIRMATIVE ACTION EMPLOYEE INFORMATION REPORT AA 302. 9

PROPOSAL SUBMITTED FOR: COMPANY: ADDRESS: PROPOSAL SUBMITTED BY: (Please Print) SIGNATURE: TITLE: DATE: TELEPHONE: FACSIMILE: EMAIL ADDRESS: TAXPAYER IDENTIFICATION NUMBER: 10