10-4. ECMCC-Exhibit A-3-SDVOB 0% (2024).pdf

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Attached to
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)/ BILEVEL POSITIVE AIRWAY PRESSURE (BIPAP) EQUIPMENT
Solicitation number
202522
Issued by
Erie County, New York

About this file

This is a Service-Disabled Veteran-Owned Business (SDVOB) Utilization Plan form for Erie County Medical Center Corporation (ECMCC) related to a procurement for CPAP and BiPAP equipment and accessories. The form is submitted with proposals or negotiated contracts, or within 48 hours of notification that a respondent is the apparent lowest responsible bidder. The procurement seeks qualified vendors to provide CPAP and BiPAP devices with necessary accessories including tubing, filters, humidifiers, and compatible stands, with an initial order of ten devices and potential for additional purchases during the contract period.

The SDVOB Utilization Plan requires respondents to identify certified Service-Disabled Veteran-Owned Business subcontractors and suppliers, provide their federal identification numbers, describe detailed work to be performed, and specify dollar values or percentages of subcontracts and supplies. For this particular solicitation, the SDVOB goal is set at 0%, meaning no minority or veteran business participation is required. Respondents must submit complete and accurate information on this form, and failure to do so may result in noncompliance findings, bid rejection, or contract termination. ECMCC reviews and approves the utilization plan, issuing notices of deficiency or acceptance as applicable, and any certified SDVOB participation must contribute commercially useful functions toward contract performance.

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Text version

SDVOB Utilization Plan rev 1/24

EXHIBIT A-3

SDVOB UTILIZATION PLAN

INSTRUCTIONS: This form must be submitted with any proposal or proposed negotiated contract or within 48 hours of notice from ECMCC that the respondent is the apparent lowest responsible bidder to an IFB. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Service-Disabled

Veteran-Owned Business (SDVOB) under the contract. Attach additional sheets if necessary.

Respondent’s Name: _____________________________________________________ RFP or Bid No.: __________________________________________________

Federal Identification No.: ___________________________________________ SDVOB Goals in the Contract: 0%

Contract Value: ____________________________________________________

1. Certified SDVOB Subcontractors/Suppliers

Name, Address, Email Address, Telephone No.

2. Federal ID

No.

3. Detailed Description of Work

(Attach additional sheets, if necessary)

4. Dollar Value or percentage of

Subcontracts/

Supplies/Services

1.

2.

3.

4.

5.

6.

SDVOB Utilization Plan rev 1/24

7.

8.

PREPARED BY (Signature):

DATE:

NAME AND TITLE OF PREPARER (Print or Type):

SUBMISSION OF THIS FORM CONSTITUTES THE OFFEROR’S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE SDVOB REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, VETERAN’S SERVICE

LAW ARTICLE 3, 9 NYCRR PART 252, AND THE ABOVE-REFERENCED SOLICITATION. FAILURE TO SUBMIT

COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND/OR REJECTION OF YOUR BID/PROPOSAL AND/OR POSSIBLE TERMINATION OF YOUR CONTRACT. UTILIZATION OF

CERTIFIED SDVOB’s FOR NON-COMMERCIALLY USEFUL FUNCTIONS MAY NOT BE COUNTED TOWARD SDVOB

REQUIREMENTS.

TELEPHONE NO.:

EMAIL ADDRESS:

FOR ECMCC SDVOB USE ONLY

REVIEWED BY:

DATE:

UTILIZATION PLAN APPROVED: YES NO Date:

Contract No.: Project No. (if applicable):

Contract Award Date:

Estimated Date of Completion:

Amount Obligated Under the Contract:

Description of Work:

NOTICE OF DEFICIENCY ISSUED: YES NO Date:______________

NOTICE OF ACCEPTANCE ISSUED: YES NO Date:_____________

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