Department of the Treasury s1

EXECUTIVE SUMMARY OF PROCUREMENT TO BE AWARDED

The Agency must submit this form (or an approved substitute) for all procurements, together with:

 Certification and Disclosure required by Executive Order 134 – on Form DPP134–C&D: “Executive Order 134 Certification and Disclosure,” and

 Ownership Disclosure Form for the vendor selected for the intended award, in compliance with the Ownership Disclosure statute, N.J.S.A. 52:25-24.2, certified by the vendor within the past six (6) months.

Transaction Information

Full Legal Name of Vendor:

Solicitation, RFP or Contract No.:

Award Amount:

Description of Procurement:

Duration of Procurement:

Agency Contact Information

Agency:

Phone No: E-Mail:

Submit to: Executive Order 134 Review Unit P.O. Box 039 33 West State Street, 4th Floor Trenton, New Jersey 08625

Rev.: 3/4/2005 Page 1 of 1 DPP 134 ESP