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My Commission expires                  , 19   .

Note:  A partnership must give firm name and signature of all partners.  A corporation must give full corporate name and signature of official, and the corporate seal affixed.


This questionnaire must be filled out and submitted as part of the Bid Proposal for solid waste collection and disposal for the [CONTRACTING UNIT].  Failure to complete this form or to provide any of the information required herein shall result in rejection of the Bid Proposal.  

Answers should be typewritten or printed neatly in black or blue ink.  Answers must be legible.  Any answer that is illegible or unreadable will be considered incomplete.  If additional space is required, the bidder shall add additional sheets and identify clearly the question being answered.  

1.How many years has the bidder been in business as a contractor under your present name?

2.List any other names under which the bidder, its partners or officers have conducted business in the past five years.

3.Has the bidder failed to perform any contract awarded to it by the [GOVERNING BODY] under its current or any past name in the past five years?  If the answer is "Yes", state when, where and why.  A complete explanation is required.

4.Has any officer or partner of the bidder's business ever failed to perform any contract that was awarded to him/her as an individual by the [GOVERNING BODY] in the past five years? If the answer is "Yes", state when, where and why.  A complete explanation is required.

5.List all public entity contracts which the bidder or its partners is now performing or for which contracts have been signed, but work not begun.  Give the name of the municipality or owner, the amount of the contract and the number of years the contract covers.

6.List the government solid waste collection and disposal services contract that the bidder has completed within the last five years.  Give detailed answers to questions below relating to this subject.

(a)Name of contracting unit;

(b)Approximate population of contracting unit;

New Jersey Department of Environmental Protection

Compliance and Enforcement, Office of Local Environmental Management

Uniform Bid Specifications

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