Applicable Licenses (business and professional licenses) ● Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302 Affirmative Action ● – Employee Information Report) Health/Fire Certificates, Certificate of Occupancy ● Required Required Required for on-site with first Annually Check if Page 2 Document Contract and as DVS submitted – and as Amended Form with amended Checklist package ● Lease or Mortgage for Property and Equipment . ● Certificate of Incorporation ● New Jersey Business Registration Certificate with the Division of Revenue (Public Law 2001, Chapter 134) Documents Required for Non Profit Agencies and as applicable for Profit Agencies Dated List of Names, Titles, Addresses, and Terms of Board of ● Freeholders or Directors Copy of the most recently approved Board Minutes ● Agency By-Laws ● Tax Exempt Certification ● ● Form 990 Return of Organization Exempt From Income Tax ● – Documents Required for Profit Agencies only U.S. Corporation Income Tax Return, Form 1120 ● Chapter 51/Executive Order 117 Vendor Certification and Disclosure of Political Contributions (formerly known as Executive and copy of NJ Business Registration Certificate (see Order 134) separate link) Ownership Disclosure Form (Chapter 51) Agency Policies and Organizational Information Organizational Chart ● Personnel Manual and Employee Handbook (including job ● descriptions of staff) Affirmative Action Policy/Plan ● Conflict of Interest Policy ● Procurement Policy ● Equipment Inventory (contract acquires property with DFD ● funds)
Applicable Licenses (business and professional licenses) ● Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302 – Affirmative Action Employee Information Report) ● Health/Fire Certificates, Certificate of Occupancy ● Page 2 Document Required with first Contract and as amended Required Annually and as Amended Checklist Required for on-site – DVS Form Check if submitted with package . Lease or Mortgage for Property and Equipment ● Certificate of Incorporation ● New Jersey Business Registration Certificate with the Division of Revenue (Public Law 2001, Chapter 134) ● Documents Required for Non Profit Agencies and as applicable for Profit Agencies Dated List of Names, Titles, Addresses, and Terms of Board of Freeholders or Directors ● Copy of the most recently approved Board Minutes ● Agency By-Laws ● Tax Exempt Certification ● ● Form 990 – Return of Organization Exempt From Income Tax ● Documents Required for Profit Agencies only U.S. Corporation Income Tax Return, Form 1120 ● Chapter 51/Executive Order 117 Vendor Certification and Disclosure of Political Contributions (formerly known as Executive Order 134) and copy of NJ Business Registration Certificate (see separate link) Ownership Disclosure Form (Chapter 51) Agency Policies and Organizational Information Organizational Chart ● Personnel Manual and Employee Handbook (including job descriptions of staff) ● Affirmative Action Policy/Plan ● Conflict of Interest Policy ● Procurement Policy ● Equipment Inventory (contract acquires property with DFD funds) ●
fy17_ssi_annex_a.docx