17 - OSC Form A2.doc

DOC document 85 KB Posted

Attached to
061122 - Rehabilitate Wing A & Demolish Wings B & C-Blake Building
Solicitation number
2120656
Issued by
Jefferson County, New York

About this file

This is a New York State Consultant Services Contractor's Planned Employment form (AC 3271-S) submitted in connection with a State University of New York at Geneseo project to rehabilitate Wing A and demolish Wings B and C of Blake Building. The form is designed to document the contractor's planned employment from the contract start date through the end of the contract term, requiring the contractor to detail employment categories, number of employees, hours to be worked, and amounts payable under the contract. The specific form provided contains all blank fields with zero values across multiple employment categories and shows no populated contract dates, state agency information, contractor name, or contract number.

The form serves as a compliance document for New York State consultant services contracting requirements. The related Blake Building project establishes minority and women business enterprise (MWBE) contracting goals of 15 percent for both minority-owned business enterprises (MBE) and women-owned business enterprises (WBE), along with a Service-Disabled Veteran-Owned Business (SDVOB) goal of 6 percent. No incumbent contractor has held an identical or substantially similar procurement contract within the past five years. The design and construction administration services solicitation indicates that business enterprises should complete this employment planning form as part of their proposal submission, though the specific contract value, timeline, and other financial details are not populated in this particular document.

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Text version

AC 3271-S (Effective 4/12)

FORM A

New York State Consultant Services Contractor’s Planned Employment

From Contract Start Date Through the End of the Contract Term

State Agency Name:

State Agency Department ID:
Agency Business Unit:
Contractor Name:
Contract Number:
Contract Start Date: / /
Contract End Date: / /
Employment Category
Number of Employees
Number of Hours to be Worked
Amount Payable Under the Contract
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
0.00
0.00
$0.00
Total this Page
0.00
0.00
$ 0.00
Grand Total

Name of person who prepared this report:

Title:
Phone #:

Preparer’s Signature: ________________________________

Date Prepared: / /

(Use additional pages, if necessary)

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