Dated List of Names, Titles, Addresses, and Terms of Board of ● 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) ● Audit Notification of Licensed Public Accountant (NLPA) - include copy ● of Certification (see separate link) Accountant’s Copy of Single Audit or Independent Audit for recent FY ● Other Supporting Documents Annual Report to Secretary of State ● Annual Report Charitable Organizations – ● Required Required Check if Required for on-site Annually submitted Document Page 3 with first and as with contract DVS – Amended package Form ACH Credit authorization for automatic deposits – ● (for new requests only) W-9 Form (for new Agencies only) ● Additional Division/Office Specific Forms Document Verification Sheet (DVS) ● List of Agency Contracts ● ● Standard Board Resolution (indicating authorized signatories for
Dated List of Names, Titles, Addresses, and Terms of Board of 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) ● Audit Notification of Licensed Public Accountant (NLPA) - include copy of Accountant’s Certification (see separate link) ● Copy of Single Audit or Independent Audit for recent FY ● Other Supporting Documents Annual Report to Secretary of State ● Annual Report – Charitable Organizations ● Page 3 Document Required with first contract Required Annually and as Amended Required for on-site – DVS Form Check if submitted with package ACH – Credit authorization for automatic deposits (for new requests only) ● W-9 Form (for new Agencies only) ● Additional Division/Office Specific Forms Document Verification Sheet (DVS) ● List of Agency Contracts ● Standard Board Resolution (indicating authorized signatories for ●
fy15_njicc_renew.docx