Certificate (filed with the Division of Revenue) Annual Report to Secretary of State and Ownership Disclosure Form Annual Report - Charitable Organization Agency By-Laws and Copy of Board Meeting Minutes Business Associate Agreement (unless new provider or revised agreement) Business and Professional Licenses Personnel Manual and Employee Handbook (including current job descriptions for staff) Tax Exempt Certification, Copy of Form 990 U.S Corporation Income Tax Return, Form 1120 Procurement Policy Certificate of Occupancy or Continued Certificate of Occupancy and Health and Fire Certificates Property Lease/Mortgage and Equipment Leases Affirmative Action Policy and copy and acknowledgment of NJ State Police Policy on EEO/AA I hereby certify that all documents are current and are available for review. Agency Director (Please Print or Type) Agency Director’s Signature Agency Date
Certificate (filed with the Division of Revenue) Annual Report to Secretary of State and Ownership Disclosure Form Annual Report - Charitable Organization Agency By-Laws and Copy of Board Meeting Minutes Business Associate Agreement (unless new provider or revised agreement) Business and Professional Licenses Personnel Manual and Employee Handbook (including current job descriptions for staff) Tax Exempt Certification, Copy of Form 990 U.S Corporation Income Tax Return, Form 1120 Procurement Policy Certificate of Occupancy or Continued Certificate of Occupancy and Health and Fire Certificates Property Lease/Mortgage and Equipment Leases Affirmative Action Policy and copy and acknowledgment of NJ State Police Policy on EEO/AA I hereby certify that all documents are current and are available for review. Agency Director (Please Print or Type) Agency Director’s Signature Agency Date
fy17_njicc_annx_a.docx