10-4. ECMCC-Exhibit A-3-SDVOB 0% (2024).pdf
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- Attached to
- INSURANCE BROKER & CLAIM MANAGEMENT
- Solicitation number
- 202604
- Issued by
- Erie County, New York
About this file
This is a Service-Disabled Veteran-Owned Business (SDVOB) Utilization Plan form submitted to Erie County Medical Center Corporation (ECMCC) in New York for an Insurance Broker & Claim Management contract. The form requires respondents to provide detailed documentation of supplies and services to be provided by certified SDVOB subcontractors and suppliers, including the subcontractor names, addresses, contact information, federal identification numbers, and specific descriptions of work to be performed. Respondents must submit this completed form with their proposal or negotiated contract, or within 48 hours of notification that they are the apparent lowest responsible bidder. The form must be signed by an authorized representative and includes fields for contract number, project number, contract award date, estimated completion date, and the total amount obligated under the contract.
The SDVOB goal for this particular contract is set at 0%, indicating no minority business utilization requirement applies to this specific solicitation. The form serves as the offeror's acknowledgement and agreement to comply with SDVOB requirements under New York State Executive Law, the Veteran's Service Law Article 3, and 9 NYCRR Part 252. Failure to submit complete and accurate information may result in noncompliance findings, bid rejection, or contract termination. The form includes a section for ECMCC review and approval, with options to issue notices of deficiency or acceptance based on the submitted utilization plan. The requirement emphasizes that SDVOB utilization must be for commercially useful functions only.
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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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