STONY BROOK REGIONAL SEWERAGE AUTHORITY

PRINCETON, NEW JERSEY 08540

SUPPLY OF SCHWING PUMP PARTS

BID PACKAGE

NOTICE TO BIDDERS BID SPECIFICATIONS FOR THE

SUPPLY OF SCHWING PUMP PARTS The Stony Brook Regional Sewerage Authority, Princeton, New Jersey, is requesting sealed bids for the supply and delivery of SCHWING PUMP PARTS.

The contract will run from July 1, 2019, through June 30, 2020.

Sealed bids will be received at the Authority's office, 290 River Road, Princeton, New Jersey, until 11:30 a.m. prevailing time, June 12, 2019, at which place, and time sealed bids will be publicly opened and read aloud. Bids which are mailed to the Authority's office shall be sealed and will not be opened until the date and time specified above. No bids shall be accepted or considered that are received after the date and time specified above.

Bidder must submit with the sealed bid, a bid proposal, Non-Collusion Affidavit, Statement of Ownership Disclosure, Acknowledgment of Receipt of Notices, Revision or Addenda to Bid Documents, Disclosure of Investment Activity in Iran, Affirmative Action, and Business Registration Certificate.

Bidders are required to comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27.

Contract Documents may be obtained at the office of the Stony Brook Regional Sewerage Authority, 290 River Road, Princeton, New Jersey 08540, or faxing a request to 609-924-2857 attention Madelene Karlowitsch, Purchasing Coordinator, or request via email at purchasing@sbrsa.org. There is no charge for obtaining the contract documents. The contract documents provide bidding requirements, contract forms and detailed specifications.

The Stony Brook Regional Sewerage Authority reserves the right to reject any and all bids, should the Authority determine it is in the public interest to do so.

Any questions regarding this bid, please contact Mr. Jerry Ireland, Assistant Plant Manager, at (609) 924-8881 ext. 216.

STONY BROOK REGIONAL SEWERAGE AUTHORITY

Antonia F. Shurott-Pchola, Secretary

IB - 1

INFORMATION FOR BIDDERS: Signed bids shall be submitted in sealed envelopes, addressed to the STONY BROOK REGIONAL SEWERAGE AUTHORITY, and delivered to Madelene Karlowitsch, Purchasing Coordinator, on or before the date and time specified in the Notice to Bidders and on the Bid Proposal Form, and shall be plainly marked "BID FOR THE SUPPLY OF SCHWING PUMP PARTS".

The STONY BROOK REGIONAL SEWERAGE AUTHORITY reserves the right to reject any or all bids, or to waive informalities or defects in bids, as may be permitted by law if it is deemed in the best interest of the Authority to do so.

The STONY BROOK REGIONAL SEWERAGE AUTHORITY is a political subdivision of the State of New Jersey and is exempt from the New Jersey Sales and Use Tax, pursuant to Section 9(a) of the New Jersey Sales and Use Tax Act (P.L. 1966, c.30 and c.53).

The Bidder will indemnify and hold harmless the Authority and their agents and employees from and against all claims, damages, losses and expenses, including attorney's fees arising out of or resulting from the performance of the work, provided that any such claims, damages, loss or expenses is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property including the loss of use resulting therefrom; and is caused in whole or in part by a negligent or willful act or omission of the Bidder, any Subcontractor, anyone directly or indirectly employed by any of them, or anyone for whose acts any of them may be liable.

Bidders may withdraw a proposal at any time prior to the stipulated time for opening such proposals. However, no proposals may be withdrawn after the bid opening date.

Bidders are encouraged to visit the sites of the STONY BROOK REGIONAL SEWERAGE AUTHORITY wastewater treatment plants to examine all facilities that are to be in connection with the performance of the proposed service.

The Authority reserves the right at any time during the life of the contract to increase or decrease the quantity of material at the unit price bid.

The successful bidder shall be paid monthly upon submission of a properly executed Authority voucher for services rendered during the previous month. Bills are paid once per month during our regular Authority board meetings which are normally scheduled for the fourth Monday of each month. Vouchers and invoices must be received a minimum of seven (7) working days prior to the meeting date. Copies of delivery and/or pickup tickets signed by authorized personnel of the STONY BROOK REGIONAL SEWERAGE AUTHORITY shall be included with the voucher submitted for payment.

The term of this agreement shall commence on or about July 1, 2019 after the award of this Bid and shall expire on June 30, 2020.

IB - 2

Bidders are advised that as allowed by N.J.S.A. 40A: 11-13(d) and N.J.A.C. 5:34-9.1(a) 1.i and 2.i and as authorized by SBRSA Resolution 2019-11 dated February 25, 2019 the BID shall include Schwing parts manufactured by or for Schwing Bioset. No alternate is acceptable.

The Authority will award the contract or contracts or reject all bids within such time as may be specified in the Notice to Bidders, but in no case more than 60 days, except that the bids of any bidders who consent thereto may, at the request of the Authority, be held for consideration for such longer period as may be agreed.

DS - 1

DETAILED SPECIFICATIONS: The Stony Brook Regional Sewerage Authority (SBRSA) is accepting BID for the supply of spare parts for Schwing Pumps, models KSB-10 and KSB-17. See Section H for a representative list of parts to be supplied.

Only Original Equipment Manufacturer (OEM) parts made by or for Schwing Pump Parts are acceptable. No substitutes or aftermarket parts will be accepted.

See attached resolution specifying Proprietary Replacement Parts for the Schwing Pumps.

Section H 1 - 6

Section H, detailed specifications - 12 Month Contract * All parts to be OEM, Schwing America * All parts to be tagged with part number, part name as specified by the manufacturer

Item # Quantity Item Unit Bid Price

1 1 39601062 ASM - A11VO130K79 HYD PUMP

2 1 30600153 ASSEMBLY - A11VO40K01 HYD PUMPW/ACCESSORIES

3 1 39603358 ASM-HYD PUMP GEAR 22+4CC W/ RELIEF (OLD)

4 1 39606062 ASM-VALVE HYD FWD/REV OPEN 24V TANK OVER

5 1 30353068 COUPLING-HUB W3516 SPLINE M500W35X2X30X16X9G DIN5480

6 1 30332007 COUPLING INSERT SIZE 500

7 1 30334230 COUPLING-HUB 2-1/8"BORE 1/2"KW M500

8 1 30356389 COUPLING-HUB ROTEX 65-01 W50X2X30X24X9GSPLINE DIN5480, CROSS

9 1 10133485 COUPLING-INSERT ROTEX 65 SPIDER

10 1 30356388 COUPLING-HUB 65-01 STEEL 1-7/8"BORE 1/2"KEY

11 1 39113531 COOLER-AIR/OIL 1/2HP 480V AKG ARL40

12 1 30327178 FILTER-HYD, SPIN-ON ELEMENT

13 1 39603516 KIT-FILTER HYD IN-TANK Replaces: 30330646

14 1 30336655 SEAL KIT FOR HYD FILTER #30330645

15 1 30336656 O-RING - 145.4 X 7

16 1 30336657 O-RING - 130.2 X 5.34

17 1 30339958 SEAL, BYPASS FILTER SEAL

18 1 30336658 GASKET, 180 X 165 X 3 F/FILTER

19 1 30336659 O-RING - 10.3 X 2.4 20 1 30311654 CAP FILLER BREATHER (HYD TANK) 21 1 30358027 OIL ADDITIVE CORROSION INHIBITOR

22 1 39603374 ASM-LOAD BYPASS 24VDC 4500 PSI 60 GPM

23 1 39110196 HARN-CABLE PRESS/TEMP XMTR EFECTOR 10M

24 1 39603361 ASM-HYD PRESS XMTR 0-5800PSI 24V G1/4"

25 1 39603291 ASM-TEMP/LEVEL SWITCH 150°F 5.5"

26 1 39603251 ASM-TEMP SENSOR 300MM PROBE W/O DISPLAY

27 1 39603502 ASM-VALVE HYD RELIEF 25GPM 10-315BAR

28 1 39318384 WMT-TUB SD250 2000mm INLET W/ DRAIN, STONYBROOK

29 1 39318390 WMT-SCREW SD250 LH (2PC)

30 1 39318391 WMT-SCREW SD250 RH (2PC)

31 1 39600071 ASM-SD250 5 ROPE DRIVE END

32 1 30323545 ASM-TRANSITION SD250 STRAIGHT W/ BRGS

33 1 39600136 ASM-AUTOLUBE GREASER 24V 4PT SCREW

34 1 39607167 ASM-SENSOR PRESS 0-36 PSI EFECTOR

35 1 39312205 GASKET-SD250 900MM INLET 39312200-05

36 1 10141222 GEAR BOX SD250 883460131020-9

Section H 2 - 6

Item # Quantity Item Unit Bid Price 37 1 10044600 MOTOR-HYD, SD250/350 28CC DIN5480 SPLINE W25x1.25x30x18x9g

38 1 30339889 WMT-PACKING RETAINING RING FOR LANTERN RING & 5 ROPES

39 1 30334176 RING-LANTERN SD250/350

40 1 30344013 ROPE PACKING 1/2"SQR SET OF 10 PCS DIE FORMED3.75"I.D. RING dia. Cut

41 1 30339893 SEAL-QUAD RING Q4344-366Y F/3.75"ø SHAFT

42 1 30339892 SLEEVE-WEAR, SD250/350 DRIVE END

43 1 30339890 SHAFT-DRIVE, SD250/350 5-ROPE

44 1 30321650 WMT-TRANSITION SD250 STR W/ BRGS PC1

45 1 30321651 WMT-TRANSITION SD250 STR S-POPPET PC2

46 1 10082222 SCRAPER 60/70 X 7 47 1 10110624 RING - SPACING 64/75 X 10 883460303080-7 110624 313924 48 1 10082220 SEAL - RADIAL LIP LOADED 60/75 X 8

49 1 10110623 RING - SPACING 75/69 X 10

50 1 30313997 BUSHING BRONZE SD 250 313997

51 1 39312429 BUSHING - SLEEVE, WEAR SD250 REF. GmbH 10110622

52

1 39110028 GREASE PUMP COMPLETE 24V LINCOLN QLS P401WITH 12 PORT DIVIDER WITH 12 PORT DIVIDER BACK MOUNTEDWITH CABLE

53 1 10104402 ASM-HYD DIFF CYL 125/80 X 1000

54 1 10056391 ASM-HYD DIFF CYL 125/80 X 500

55 1 10103740 ASM-MATERIAL CYLINDER DN150X1000 KSP17HD

56 1 10080550 ASM-MATERIAL CYLINDER DN 150X500

57 1 10085128 RAM - FLANGE STYLE, DN 150 NBR 6" KSP884420301030.001-5 85128 316956

58 1 39600361 ASM-SM POPPET VLV UNIT KSP5/10/17V-SFMS

59 1 10100350 ASM-CYL S-POPPET SUCTION VLV DN 125

60 1 39600360 ASM-CYL S-POPPET PRESS VLV W/ SFMS

61

1 10187623 VALVE - CONTROL BLOCK NG20, CAST BODYWITH FORWARD/REVERSE 24V SOLENOIDS

62 1 39113402 VALVE-HYD, CHECK 5PSI 18GPM G1/2" 63 1 10135250 VALVE SWITCHING CPL 2/2 WEGE 350 BAR 510611800230-0

64 1 98316457 VALVE-SOLENOID NG06 24V G2 (SI)

65 1 39600079 ASM - DISCHARGE DN100 TO 4" GRUVLOK 7004EG

66 1 39102212 MOTR-ELEC-WEG 2HP 56C 460/3/60

67 1 30363132 PUMP-WATER

68

1 30359726 ELECTRICAL PRESSURE TRANSMITTER 0-100 BAR,3-WIRE4-20MA/0-10V OUTPUT, G1 PORT, LED DISPLAY

69 1 30345260 ASSEMBLY - LUBE RING SPOOL SLIP-IN 6" 600#SCH80W/O FF FLANGES

70 1 39318385 WMT-TUB SD250 2000mm INLET W/ DRAIN, STONYBROOK

71 1 30361827 WMT-SCREW SD250 LH 5 ROPE 90° 2000MM INLET REF 30350703-16

72 1 30361828 WMT-SCREW SD250 RH 5 ROPE 90° 2000MM INLET REF 30350704-16

73 1 39318387 WMT-TUB SD250 900mm INLET W/ DRAIN, STONYBROOK

74 1 30359194 WMT-SCREW SD250 LH 5 ROPE 90° 900MM INLET REF 30350703-05

75 1 30359196 WMT-SCREW SD250 RH 5 ROPE 90° 900MM INLET REF 30350704-05 Item # Quantity Item Unit Bid Price

Section H 3 - 6

76 1 39318386 WMT-TUB SD250 900mm INLET W/ DRAIN, STONYBROOK

77 1 39600322 ASM-TRANSITION SD250 90° W/ BRGS

78 1 10000424 O-Ring 135x5

79 1 10000457 O-Ring 27x3

80 1 10000462 O-Ring 28x5

81 1 10000470 O-Ring 158x5

82 1 10000478 O-Ring 160x3

83 1 10000507 O-Ring 34.2x3

84 1 10000511 O-Ring 174x3

85 1 10000511 O-Ring 174x3

86 1 10000652 O-Ring 38 X 4

87 1 10000677 O-Ring 44x3

88 1 10000721 O-Ring 52x4

89 1 10000968 O-Ring 78x4

90 1 10001087 O-Ring 115x5

91 1 10001186 Screw M12x30 8.8

92 1 10001188 Socket head screw M12x35 Gr8.8

93 1 10001208 Socket head screw M12x80 Gr8.8

94 1 10001270 Nut-Acorn, DIN 1587 M12 Gr6 ZP

95 1 10001286 Poppet nuts

96 1 10001419 Disc

97 1 10001465 Split pin M6.3x40

98 1 10001483 Hydraulic fitting joint

99 1 10001509 Flat washer

100 1 10001727 Threaded pin M8x20 10.9

101 1 10001730 Wedge ring

102 1 10001743 Hyd. End Caps

103 1 10001748 M12 Nut

104 1 10001767 Plug Screw R 3/8"

105 1 10001776 Plug

106 1 10001808 Hex head screw M8x25

107 1 10001825 Hex head screw M8x50

108 1 10001840 Plug

109 1 10001901 M16 SS flat washer

110 1 10002052 Washer Flat M16

111 1 10002056 Ram bolts washers

112 1 10002329 Scraper

113 1 10003146 Throttle valve

Section H 4 - 6

Item # Quantity Item Unit Bid Price 114 1 10003421 Sealing gland set 115 1 10003897 Locking screw M20x1.5 116 1 10003945 Hydraulic tubes 117 1 10004662 Pressure gauge 118 1 10004663 Pressure gauge

119 1 10004672 O-Ring 135x5

120 1 10006180 Screw-HHCS, DIN 933 M12x350 Gr8.8 ZP

121 1 10006288 S2 Piston

122 1 10006333 Screw-HHCS M16x70

123 1 10006520 Eye bolt pin

124 1 10006855 O-Ring 54x3

125 1 10007054 Piston sealing ring

126 1 10008006 Hose connecting fitting

127 1 10008012 Hose connecting fitting

128 1 10008022 Pipe coupling body

129 1 10008023 Pipe coupling body

130 1 10008100 Hose connecting fitting

131 1 10008118 Hose connecting fitting

132 1 10008120 Fitting

133 1 10008400 Nut M30

134 1 10009304 Throttle check valve

135 1 10013043 Eye screw M30x280

136 1 10013195 O-Ring 155x5

137 1 10014213 Hex head screw M20x140-10.9

138 1 10014343 Piston 139 1 10015185 Sealing gland set 140 1 10017517 Spacing disc

141 1 10018351 Backing ring

142 1 1001857 "Screw - HHCS DIN 931 M20X110 Gr 10.9 ZP"

143 1 10024454 Guide bushing

144 1 10025944 Adapter

145 1 10033845 Hydraulic tube assembly

146 1 10044494 Screw plug

147 1 10044600 Hydraulic motor

148 1 10046546 O-Ring 148.6x6.99

149 1 10049946 High pressure hose

150 1 10049949 High pressure hose

151 1 10051671 Approach switch cover

152 1 10059156 Cylinder pipe

Section H 5 - 6

Item # Quantity Item Unit Bid Price 153 1 10059158 Guide bushing

154 1 10059161 Pressure disc

155 1 10059162 Discharge disc valve

156 1 10059163 Disc cone

157 1 10059165 Piston sealing

158 1 10059167 Piston guide

159 1 10059169 Scraper

160 1 10059171 Back ring

161 1 10059176 Pressure disc

162 1 10059177 Disc valve

163 1 10059178 Cone

164 1 10059179 Suction valve seat

165 1 10059190 Screw M16x290 8.8

166 1 10064212 U-Bolts

167 1 10064769 Spacing disc ST 52

168 1 10068821 O-Ring M49.5x3

169 1 10073758 Plug M24x1.5 Gr5.8

170 1 10082220 Seal

171 1 10082222 Scraper

172 1 10084969 Discharge piston rod

173 1 10085128 6 inch ram

174 1 10085281 Discharge valve seat 20mm thick

175 1 10085298 Suction piston rod

176 1 10085532 Pinion/spur gear

177 1 10089549 Hydraulic ball valve

178 1 10104402 Rebuilt differential cylinder

179 1 10114518 Hose connecting fitting

180 1 10118544 Guide bushing

181 1 10124579 Piston rod 80x1292mm

182 1 10129840 "Washer-Conica SKM M12 & 1/2"" Zinc"

183 1 10129842 Pinion washer

184 1 10131365 Piston rod 80x792mm

185 1 10132232 Gear T-67

186 1 10132236 Pinion T-17

187 1 10141222 Gearbox

188 1 10150334 "Fitting - HYD STR GES-16-SR 1/2"" WD"

189 1 10184667 "Ftng-Hyd. EL Banjo RSWS-16-SR 12"" WD RSWS 16 SR-WD"

190 1 10189230 Flat socket head screw M8x16 Gr8.8

191 1 30302973 Throttle valve clamp

Section H 6 - 6

Item # Quantity Item Unit Bid Price 192 1 30309227 Spur Gear

193 1 30313997 Feeder screw bushing

194 1 30314101 Socket head screw M6x16

195 1 30315303 Retainer pinion

196 1 30320502 1/2 Inch NPT coopling

197 1 30321306 Cover S-Poppet

198 1 30321550 Socket cap screw M8x90 304 SST

199 1 30321607 Hydraulic cylinder tie rod

200 1 30323545 ASM-Transition

201 1 30323730 Socket head screw M6x12 304ss 202 1 30327178 Filter Hydraulic (Spin On) 203 1 30334176 Lantern ring 204 1 30336194 Brass nut M12 205 1 30353996 Guide bushing kit 206 1 30358027 Oil Additive Corrosion Inhibitor

TOTAL 12 month contract (Page BPF-1) * * Used for Bid Comparison / basis of award

BPF - 1

BID PROPOSAL FORM SCHWING PUMP PARTS

TO: STONY BROOK REGIONAL SEWERAGE AUTHORITY

Bid proposals will be received at the STONY BROOK REGIONAL SEWERAGE AUTHORITY office, 290 River Road, Princeton, New Jersey, 08540.

The undersigned bidder, having read and being familiar with the Information for Bidders and the Specifications, and intending to be legally bound hereby, submits the following proposal to the Stony Brook Regional Sewerage Authority.

The Bidder understands that the usage estimates set forth in the Specifications are provided only as a basis for the uniform comparison of bids and are not in any way guaranteed or intended to be relied upon by the bidder as minimum or maximum quantities to be purchased by Stony Brook Regional Sewerage Authority.

All parts are to be Original Equipment Manufacturer (OEM) parts.

The undersigned having carefully examined the Specifications will contract to supply Schwing Pump Parts as per the attached parts list.

Total Form Attached Section H Parts List ** $

12 MONTH CONTRACT (AMOUNT IN WORDS)

** TO BE THE BASIS FOR THE AWARD OF THE BID

The undersigned is (a Corporation) (an Individual) (a Partnership) under the laws of the State of .

COMPANY:

NAME:

ADDRESS:

SIGNATURE:

DATE:

COMPANY CONTACT:

TELEPHONE:

GC - 1

GENERAL CONDITIONS: Sealed bids will be received by the STONY BROOK REGIONAL SEWERAGE AUTHORITY as stated in the Notice to Bidders and in the Bid Proposal Form.

The following items shall be included with the bid in conformance with the Local Public Contracts Law:

Non-Collusion Affidavit:

The Non-Collusion Affidavit will be submitted as a part of the Bid Package. (See attached page BP-1).

Statement of Ownership Disclosure:

Bidders are required by, Public Laws of 1977, c.33, to provide the names and addresses of all the stockholders in the corporation or partnership who own ten percent (10%) or more of its stock of any class, or all individual partners in the partnership who own a ten percent or greater interest therein. (See attached pages BP-2 and BP-3).

Acknowledgement of Receipt of Notices, Revision or Addenda to Bid Documents:

If applicable, bidder’s acknowledgement of receipt of any notice(s) or revision(s) or addenda to an advertisement, specifications or bid document(s) (See attached page BP-4).

Disclosure of Investment Activities in Iran:

P.L. 2012, c.25 prohibits State and local public contracts with persons or entities engaging in certain investment activities in energy or finance sectors of Iran. (Page BP-5).

GC - 2

The following items will be required to be submitted by the Bidder who is awarded this contract:

Affirmative Action Requirements:

If awarded a contract your company/firm will be required to comply with the requirement of N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) and N.J.A.C. 17:27. (See attached pages BP-6 and BP-7 for details).

New Jersey Business Registration Requirements:

Bidders must provide proof of compliance with the New Jersey Business Registration Requirements. (See attached page BP-8).

Agreement for Service:

Successful Bidder will be required and agrees to duly execute the Agreement for Service. (See attached page AFS).

BP - 1

NON-COLLUSION AFFIDAVIT

STATE OF

COUNTY OF

) SS

I, , being first duly sworn, deposes and says that;

1. I am the owner, partner, officer, representative or agent of

, the bidder having submitted the attached;

2. I am is fully informed respecting the preparation and contents of the attached bid and of all pertinent circumstances respecting such bid;

3. Such bid is genuine and is not a collusive or a sham bid;

4. Neither the said bidder nor any of its officers, partners, owners, agents, representatives, employees or

parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other bidder, firm or person to submit a collusive or sham bid in connection with the contract for which the attached bid has been submitted, or to refrain from bidding in connection with such contract or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other bidder, firm or person to fix the price or prices of the attached bid or of any other bidder, or to fix any overhead, profit or coat element of the bid price or the bid price of any other bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the STONY BROOK REGIONAL SEWERAGE AUTHORITY or any person interested in the proposed contract; and,

5. The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion,

conspiracy, connivance or unlawful agreement on the bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

SIGNED:

TITLE:

Subscribed and sworn to before me

this day of ,20

(SIGNATURE)

(NAME)

(TITLE)

BP - 2

STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)

This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure to submit the required information is cause for automatic rejection of the bid or proposal.

Name of Organization:

Organization Address:

Part I Check the box that represents the type of business organization: □ Sole Proprietorship (skip Parts II and III, execute certification in Part IV) □ Non-Profit Corporation (skip Parts II and III, execute certification in Part IV) □ For-Profit Corporation (any type) Limited Liability Company (LLC) □ Partnership Limited Partnership Limited Liability Partnership (LLP) □ Other (be specific):

Part II

□ The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION)

OR □ No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual

partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV)

(Please attach additional sheets if more space is needed): Name of Individual or Business Entity Home Address (for Individuals) or Business Address

Part III DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II

If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annual federal Security and Exchange Commission (SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s) containing the last annual filing(s) with the federal Securities and Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filing(s) that contain the information on each such person. Attach additional sheets if more space is needed.

BP - 3

STATEMENT OF OWNERSHIP DISCLOSURE – Continued N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43)

Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part II other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed.

Stockholder/Partner/Member Corresponding Entity Listed in Part II

Home Address (for Individuals) or Business Address

Part IV Certification

I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to execute this certification on behalf of the bidder/proposer; that the Stony Brook Regional Sewerage Authority is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the completion of any contracts with Stony Brook Regional Sewerage Authority to notify the Stony Brook Regional Sewerage Authority in writing of any changes to the information contained herein; 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 am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the Stony Brook Regional Sewerage Authority, permitting the Stony Brook Regional Sewerage Authority to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print): Title:

Signature: Date:

BP - 4

ACKNOWLEDGEMENT OF RECEIPT OF NOTICES, REVISIONS OR ADDENDA TO BID DOCUMENTS FORM

(Name of Local Contracting Unit)

(Name of Project) (Project or Bid Number)

Pursuant to N.J.S.A. 40A: 11-23., the undersigned bidder hereby acknowledges receipt of the following notices, revisions or addenda to the bid advertisement, specifications or bid documents. By indicating date of receipt, bidder acknowledges the submitted bid takes into account the provisions of the notice, revision or addendum. Pursuant to N.J.S.A. 40A:11-23.2, failure of the Bidder to acknowledge the Bidder’s receipt of any notice or revisions or addenda to the advertisement or Contract Documents, in this document shall be deemed a fatal defect that shall render the Bid unresponsive and that cannot be cured by the Stony Brook Regional Sewerage Authority.

Local Unit Reference Number or Title of Addendum/Revision

How Received

(mail, fax, pick-up, etc.)

Date Received

Acknowledgement by bidder:

Name of Bidder:

By Authorized Representative:

Signature:

Printed Name and Title:

BP - 5

STATE OF NEW JERSEY·· DIVISION OF PURCHASE AND PROPERTY DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN

Quote Number: Bidder/ Offeror:

PART 1: CERTIFICATION BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX.

FAILURE TO CHECK ONE OF THE BOXES WILL RENDER THE PROPOSAL NON-RESPONSIVE.

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 neither the person or entity, nor any of its parents, subsidiaries, or affiliates, is identified on the Department of Treasury's Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found on the Division's website at http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Bidders must review this list prior to completing the below certification. Failure to complete the certification will render a bidder's proposal non-responsive. If the Director finds a person or entity to be in violation of 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 party

PLEASE CHECK THE APPROPRIATE BOX: I certify, pursuant to Public Law 2012, c. 25, that neither the bidder listed above nor any of the bidder's parents, subsidiaries, or affiliates is listed on the N.J. Department of the Treasury’s list of entities determined to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 List"). I further certify that I am the person listed above, or I am an officer or representative of the entity listed above and am authorized to make this certification on its behalf. I will skip Part 2 and sign and complete the Certification below. OR I am unable to certify as above because the bidder and/or one or more of its parents, subsidiaries, or affiliates is listed on the Department's Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below and sign and complete the Certification below. 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 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.

EACH BOX WILL PROMPT YOU TO PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, CLICK THE "ADD AN ADDITIONAL

ACTIVITIES ENTRY" BUTTON.

Name Relationship to Bidder/Offeror

Description of Activities

Duration of Engagement

Bidder/Offerer Contact Name

Anticipated Cessation Date

Contact Phone Number

ADD AN ADDITIONAL ACTIVITIES ENTRY

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 State of 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 State to notify the 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 State of New Jersey and that the State at its option may declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print):

Title:

Signature:

Date:

DPP Standard Forms Packet 11/2013

BP - 6

(REVISED 4/10) (09212012) EXHIBIT A

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A.10:5-31 et seq.(P.L. 1975, C. 127) and N.J.A.C.17:27

GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS

During the performance of this contract, the contractor agrees as follows:

The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause.

The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or

on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a

notice, to be provided by the agency contracting officer, advising the labor union of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act.

The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals

established in accordance with N.J.A.C. 17:27-5.2.

The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices.

The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel

testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions.

In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures

relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions.

The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and

services contract, one of the following three documents:

Letter of Federal Affirmative Action Plan Approval

Certificate of Employee Information Report

Employee Information Report Form AA302 (electronically provided by the Division and distributed to the public agency through the Division's website at www.state.nj.us/treasury/contract_compliance)

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EXHIBIT A – Continued

The contractor and its subcontractors shall furnish such reports or other documents to the Division of Purchase & Property, CCAU, EEO Monitoring Program as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of Purchase & Property, CCAU, EEO Monitoring Program for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.

1. Does your company have a current Federal Affirmative Action Plan Approval Letter?

( ) YES (If yes, submit a copy) ( ) NO (If no, complete A below)

A. Does your company have a Certificate of Employee Information Report?

( ) YES (If yes, submit a copy) ( ) NO (If no, complete B below)

B. If you do not have either of the above-mentioned documents, an Affirmative Action

Employee Information Report form (AA-302) will be returned to you for your completion.

2. Are you a minority-owned business?

( ) YES ( ) NO

All successful vendors must submit one of the following forms of evidence:

1. Letter of Federal Approval OR 2. Certificate of Employee Information Report.

I certify that the above information is correct to the best of my knowledge.

Name: Title:

Signature: Date:

Company:

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“NEW JERSEY BUSINESS REGISTRATION REQUIREMENTS”

AFS

AGREEMENT FOR SERVICE

This Agreement, made this , by and between the STONY BROOK REGIONAL SEWERAGE AUTHORITY, hereinafter the "Authority" and , a Corporation hereinafter called the "Supplier".

WITNESSETH: That for and in consideration of the payments and agreements hereinafter mentioned:

1. The Supplier will commence service for all in accordance with their Bid

Proposal of .

2. The Supplier will furnish all of the material, supplies, equipment, labor and other services necessary for the execution of this Agreement.

3. The Supplier will commence the services required by the Contract Documents on or about

. The term of this Agreement shall run until , one (1) year contract, or until , two (2) year contract.

4. The Supplier agrees to perform all of the services described in the Contract Documents and to comply with the

terms therein for the fee more fully described in the Bid Proposal Form (copy attached hereto).

5. The term "Contract Documents" mean and includes the following:

A. Notice to Bidders B. Specifications C. Detailed Specifications D. Bid Proposal E. Non-Collusion Affidavit of Bidder

F. Statement of Ownership G. Acknowledgment of Addenda H. Iran Disclosure I. Affirmative Action Requirements J. New Jersey Business Registration Certificate K. Bid Security

6. The Authority will pay to the Supplier the amount(s) stipulated in the Bid Proposal, upon receipt of properly executed Authority vouchers and Vendor invoices/delivery tickets.

7. This Agreement shall be binding upon all parties hereto and their respective heirs, executors, administrators,

successors and assigns.

IN WITNESS WHEREOF, the parties hereto have executed, or caused to be executed by their duly authorized officials, this Agreement in two (2) copies, each of which shall be deemed an original on the date first above written.

(SEAL) SUPPLIER:

ATTEST:

By: By: Name: Name: Title: Title: Date: Date:

(SEAL) AUTHORITY:

STONY BROOK REGIONAL SEWERAGE AUTHORITY ATTEST:

By: By:

Name: Name:

Title: Title:

Date: Date: