CITY OF BAYONNE
OPEN PUBLIC RECORDS ACT REQUEST FORM
Office of the City Clerk, 630 Avenue C, Bayonne, NJ 07002
Phone (201) 858-6029 Fax (201) 823-4391
E-Mail: OPRARE
Madelene C. Medina, City Clerk, Records Custodian
Fill out and submit this form to the Records Custodian to request public records from the City of Bayonne.
If you do not wish to fill out this form, you may also submit a written request which satisfies the requirements of N.J.S.A. 47:1A-1 et seq.
Requestor Information – Please Print
Payment Information
First Name
MI
Last Name
E-mail Address
Mailing Address
City
State
Zip
Telephone
FAX
Preferred Delivery:
Pick
Up
US Mail
On-Site
Inspect
Fax ________ E-mail _________
If you are requesting records containing personal information, please circle one: Under penalty of N.J.S.A.
2C:28-3, I certify that I HAVE / HAVE NOT been convicted of any indictable offense under the laws of New
Jersey, any other state, or the United States.
Signature
Date
Maximum Authorization Cost $
Select Payment Method
Cash
Check
Money Order
Fees:
Letter size pages - $0.05
per page
Legal size pages - $0.07
per page
Other materials (CD, DVD,
etc) – actual cost of material
Delivery:
Delivery / postage fees
additional depending upon
delivery type.
Extras:
Special service charge
dependent upon request.
Record Request Information: Please be as specific as possible in describing the records being requested. Also, please note that your
preferred method of delivery will only be accommodated if the custodian has the technological means and the integrity of the records will not
be jeopardized by such method of delivery.
AGENCY USE ONLY
AGENCY USE ONLY
AGENCY USE ONLY
Est. Document Cost
Est. Delivery Cost
Est. Extras Cost
Total Est. Cost
Deposit Amount
Estimated Balance
Deposit Date
Disposition Notes
Custodian: If any part of request cannot be
delivered in seven business days,
detail reasons here.
In Progress
-
Open
Denied
-
Closed
Filled
-
Closed
Partial
-
Closed
Tracking Information
Final Cost
Tracking #
Total
Rec’d Date
Deposit
Ready Date
Balance Due
Total Pages
Balance Paid
Records Provided
Custodian or his Assignee Signature
Date
Page 2 of 4
CUSTODIAN’S RESPONSE TO YOUR REQUEST
(To be completed by the Custodian of Records – check the box of the response as it applies to the records requested)
Please find attached all public records in the possession of the City of Bayonne which are responsive to your request.
The City possesses no public records responsive to your request.
The responsive public records which are in the possession of the City of Bayonne are available for pickup in the Office of
the City Clerk. Please bring a check, cash or money order in the amount of $___________ which is the statutory copying
fee for ____ pages of records. All checks should be made payable to “City of Bayonne”.
Please sign the foregoing statement upon picking up the records.
I, (PRINT NAME) ________________________________, have picked up the records released to me by
the City of Bayonne in relation to this OPRA request. I am either the requestor or an agent of the
requestor sent to pick up the records. I picked up these records on (DATE) __________________.
SIGNATURE: ______________________________ DATE OF SIGNATURE: ______________
The responsive public records in the possession of the City of Bayonne are available and will be mailed or otherwise
provided to you upon receipt of a check, cash or money order in the amount of $__________ which is the statutory copying
fee for ____ pages of records. All checks should be made payable to “City of Bayonne.
More information is needed to respond to your request. Please provide the following: ______________________________
__________________________________________________________________________________________________
The Documents you seek are not currently available. Kindly allow _______ days for the City to obtain the requested
records.
Your request has been forwarded to the Law Department for legal review and processing. Kindly allow _______ days
for the City’s response to your request. Any questions or concerns may be directed to the Law Department by phone at
(201) 858-6094, by fax to (201) 858-6092, or by letter to City of Bayonne Law Department, ATTN: OPRA Secretary,
630 Avenue C, Bayonne, NJ 07002.
ADDITIONAL COMMENTS
YOUR REQUEST FOR RECORDS IS DENIED FOR THE FOLLOWING REASON(S):
(To be completed by the Custodian of Records – circle the bullet point of the OPRA exception as it applies to the records requested)
N.J.S.A. 47:1A-1.1
o Inter-agency or intra-agency advisory, consultative or deliberative material
o Legislative records
o Law enforcement records:
Ø Medical examiner photos
Ø Criminal investigatory records (however, N.J.S.A. 47:1A-3.b. lists specific criminal investigatory
information which must be disclosed)
Ø Victims’ records
o Trade secrets and proprietary commercial or financial information
o Any record within the attorney-client privilege
o Administrative or technical information regarding computer hardware, software and networks which, if disclosed
would jeopardize computer security
o Emergency or security information or procedures for any buildings or facility which, if disclosed, would jeopardize
security of the building or facility or persons therein
o Security measures and surveillance techniques which, if disclosed, would create a risk to the safety or persons,
property, electronic data or software
o Information which, if disclosed, would give an advantage to competitors or bidders
o Information generated by or on behalf of public employers or public employees in connection with:
Ø Any sexual harassment complaint filed with a public employer
Ø Any grievance filed by or against an employee
Page 3 of 4
Ø Collective negotiations documents and statements of strategy or negotiating
o Information that is a communication between a public agency and its insurance carrier, administrative service
organization or risk management office
o Information that is to be kept confidential pursuant to court order
o Certificate of honorable discharge issued by the United States government (Form DD-214) filed with a public
agency
o Social security numbers
o Credit card numbers
o Unlisted telephone numbers\
o Drivers’ license numbers
o Certain records of higher education institutions:
Ø Research records
Ø Questions or scores for exam for employment or academics
Ø Charitable contribution information
Ø Rare book collections gifted for limited access
Ø Admission applications
Ø Student records, grievances or disciplinary proceedings revealing a students’ identification
o Biotechnology trade secrets N.J.S.A. 47:1A-1.2
o Convicts requesting their victims’ records N.J.S.A. 47:1A-2.2
o Ongoing investigations of non-law enforcement agencies (where disclosure is inimical to the public interest)
N.J.S.A. 47:1A-3.a.
o Request is overly broad and burdensome. Spectraserve, Inc. v. Middlesex County Utilities Authority, 416 N.J.
Super 565 (App. Div. 2010). The OPRA statute is not intended as a research tool litigants may use to force
government officials to identify and siphon useful information. MAG Entm't, LLC v. Div. of Alcoholic Beverage
Control, 375 N.J. Super. 534, 546 (App. Div. 2005). Obtaining the requested records would require an
extraordinary expenditure of time and effort. N.J.S.A. 47:1A-5(c)
o Public defender records N.J.S.A. 47:1A-5.k.
o Upholds exemptions contained in other State or federal statutes and regulations, Executive Orders, Rules of Court,
and privileges created by State Constitution, statute, court rule or judicial case law N.J.S.A. 47:1A-9
o Personnel and pension records (however, the following information must be disclosed):
Ø An individual’s name, title, position, salary, payroll record, length of service, date of separation and the
reason for such separation, and the amount and type of any pension received
Ø When required to be disclosed by another law, when disclosure is essential to the performance of
official duties of a person duly authorized by this State or the US, or when authorized by an individual
in interest
Ø Data contained in information which disclose conformity with specific experiential, educational or
medical qualifications required for government employment or for receipt of a public pension, but not
including any detailed medical or psychological information N.J.S.A. 47:1A-10
o N.J.S.A. 47:1A-1 “a public agency has a responsibility and an obligation to safeguard from public access a citizen's
personal information with which it has been entrusted when disclosure thereof would violate the citizen's
reasonable expectation of privacy.” Burnett v. County of Bergen, 198 N.J. 408 (2009). Without ambiguity, the court
held that the privacy provision “is neither a preface nor a preamble.” Rather, “the very language expressed in the
privacy clause reveals its substantive nature; it does not offer reasons why OPRA was adopted, as preamble
s
typically do; instead, it focuses on the law’s implementation.” “Specifically, it imposes an obligation on public
agencies to protect against disclosure of personal information which would run contrary to reasonable privacy
interests.”
Executive Order No. 21 (McGreevey 2002)
o Records where inspection, examination or copying would substantially interfere with the State's ability to protect
and defend the State and its citizens against acts of sabotage or terrorism, or which, if disclosed, would materiall
y
increase the risk or consequences of potential acts of sabotage or terrorism.
o Records exempted from disclosure by State agencies’ proposed rules.
Executive Order No. 26 (McGreevey 2002)
o Certain records maintained by the Office of the Governor
o Resumes, applications for employment or other information concerning job applicants while a recruitment search is
ongoing
o Records of complaints and investigations undertaken pursuant to the Model Procedures for Internal Complaint
s
Alleging Discrimination, Harassment or Hostile Environments
o Information relating to medical, psychiatric or psychological history, diagnosis, treatment or evaluation
o Information in a personal income or other tax return
o Information describing a natural person's finances, income, assets, liabilities, net worth, bank balances, financial
history or activities, or creditworthiness, except as otherwise required by law to be disclosed
o Test questions, scoring keys and other examination data pertaining to the administration of an examination for
public employment or licensing
o Records in the possession of another department (including NJ Office of Information Technology or State Archives)
when those records are made confidential by regulation or EO 9.
Page 4 of 4
Other Exemption(s) contained in a State statute, resolution of either or both House of the Legislature, regulation, Executive
Order, Rules of Court, New Jersey Case Law, any federal law, federal regulation or federal order pursuant to N.J.S.A.
47:1A-9.a.
PLEASE TAKE NOTICE: The fees for duplication of a government record in printed form are listed on the front of this form. We will
notify you of any special service charges or other additional charges authorized by State law or regulation before processing your
request. Payment shall be made by cash, check or money order payable to the City of Bayonne. The custodian may require a
deposit against costs for reproducing documents sought through an anonymous request whenever the custodian anticipates that the
documents requested will cost in excess of $5 to reproduce. All fees for public records are due upon pick-up of the record/s or else
before they are otherwise delivered to the requester. Where a special service charge is warranted under OPRA, that amount will be
communicated to you as required under the statute. You have the opportunity to review and object to the charge prior to it being
incurred. If, however, you approve of the fact and amount of the special service charge, you may be required to pay a deposit or pay
in full prior to reproduction of the documents. You may be charged a 50% or other deposit when a request for copies exceeds $25 in
prospective fees. The Records Custodian will contact you and advise you of any deposit requirements. Pursuant to N.J.S.A. 47:1A-1
et seq. the City of Bayonne must notify you that it grants or denies a request for access to government records within seven (7)
business days after the agency custodian of records receives the request. If the record requested is not currently available or is in
storage, the custodian must advise you within seven (7) business days after receipt of the request when the record can be made
available and the estimated cost for reproduction if applicable. You may be denied access to a government record if your request
would substantially disrupt agency operations and the custodian is unable to reach a reasonable solution with you. If your request for
access to a government record has been denied or unfilled within the seven (7) business days required by law, you have a right to
challenge the decision to deny access. At your option, you may either institute a proceeding in the Superior Court of New Jersey or
file a complaint with the Government Records Council (“GRC”) by completing their Denial of Access Complaint Form. Information
provided on this form may itself be subject to disclosure under the Open Public Records Act.
