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Springfield Free Public Library/Township of Springfield <br />BUSINESS ENTITY DISCLOSURE CERTIFICATION <br />FOR NON -FAIR AND OPEN CONTRACTS <br />Required Pursuant To N.J.S.A. 19:44A -20.8 <br />SPRINGFIELD FREE PUBLIC LIBRARY, TOWNSHIP OF SPRINGFIELD <br />Part I — Vendor Affirmation <br />The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that the <br />The Library Corporation_ <naine of business entity> has not made and will not make any <br />reportable contributions pursuant to N.J.S.A. 19:44A -1 et seq. that, pursuant to P.L. 2004, c. 19 would <br />bar the award of this contract in the one year period preceding on or about April 20, 2010 to any of the <br />following named candidate committee, joint candidates committee; or political party committee <br />representing the elected officials of the Township of Springfield as defined pursuant to N.J.S.A. 19:44A- <br />3(p), (q) and (r). <br />Ziad Shehady <br />Jerry Fernandez <br />Bart Fraenkel <br />Marc Krauss <br />Huh Keffer <br />lYL <br />Pa II — Ownership Disclosure Certification <br />I certify that the list below contains the names and home addresses of all owners holding 10% or <br />more of the issued and outstanding stock of the undersigned. <br />Check the box that represents the type of business entity: <br />❑Partnership ❑Corporation ❑Sole Proprietorship ❑Subchapter S Corporation <br />[Limited Partnership ❑Limited Liability Corporation ❑Limited Liability Partnership <br />Name of Stock or Shareholder Home Address <br />A.H. Murphy 1827 Earle Road, Charles Town, WV 25414 <br />Part 3 — Signature and Attestation: <br />The undersigned is fully aware that if I have misrepresented in whole or part this affirmation and <br />certification, I and /or the business entity, will be liable for any penalty permitted under law. <br />Name of Business Entity : The Libra y Corporation <br />Signature of Affiant le: Director of Finance Printed Name of Affiant <br />Calvin Whittington Date: <br />Subscribed and sworn before me this day of <br />0tt�L� <br />�') <br />41c A , 2 ()10 . <br />lYL <br />(Witnessed or attested by) <br />My Commission expires: <br />'r Y PUP I <br />K <br />V 'V .. �"7 ..s° (,r c p ., a ".. <br />G:1RFP's 20101DraftslSpringfield NJ 4. 1. 101integrated library system 2010.doc <br />Attachment number 3 <br />F -12 Page 236 <br />