23222i_attachment-05-bidder-information-questionnaire_20210204.xlsx
XLSX spreadsheet 25 KB Posted
- Contract number
- 23222
- Issued by
- New York
About this file
This document is a Bidder Information Questionnaire for Group 10150 - Personal Protective Equipment (PPE) & Related Items, specifically designed for a New York State procurement solicitation. The form is a comprehensive questionnaire for potential vendors seeking to provide PPE and related products to New York State governmental entities, with a focus on capturing detailed vendor information, contact details, business characteristics, and compliance requirements.
The questionnaire covers critical vendor evaluation criteria including business size, manufacturing locations, minority/women-owned business status, service-disabled veteran ownership, purchasing card acceptance, online ordering capabilities, prompt payment discounts, and product sustainability features (such as recycled materials, remanufactured items, and Energy Star compliance). Notable elements include provisions for NYS Purchasing Card acceptance for orders up to $50,000, potential additional discounts for card purchases, and requirements for vendors to disclose prior contract performance, including any non-responsibility determinations by governmental entities within the past four years. The document is designed to comprehensively assess vendor qualifications for a state contract in the Personal Protective Equipment category.
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General Questions
| ATTACHMENT 5 - BIDDER INFORMATION QUESTIONNAIRE (Revised 2/4/21) | |
| Group 10150 - Personal Protective Equipment (PPE) & Related Items | |
| General Questions |
Bidder Name
Instructions: Complete all questions below. Questions may have a drop-down menu from which to select your response.
NOTE TO BIDDER: FAILURE TO ANSWER THE QUESTIONS WILL DELAY THE EVALUATION OF YOUR BID AND MAY RESULT IN REJECTION OF YOUR BID.
| # | Question | Response |
| 1 | Bidder Name | |
| 2 | Address | |
| 3 | City | |
| 4 | State | |
| 5 | Zip Code | |
| 6 | Bidder Contact Name | |
| 7 | Bidder Contact Telephone Number | |
| 8 | Bidder Contact E-mail | |
| 9 | Bidder's PRINCIPAL PLACE OF BUSINESS: "Principal Place of Business" is the location of the primary control, direction and management of the enterprise (State of): | |
| 10 | Does Bidder have the required NYS 10 digit vendor ID number? | |
| 11 | If yes, please provide | |
| 12 | If no, did Bidder complete and submit the OSC Substitute W-9 form to OGS as described in NYS Vendor File Registration, prior to submitting this bid document? | |
| 13 | Is Bidder a disregarded entity for tax purposes? | |
| 14 | If yes, please list the name of Bidder’s owner/parent company | |
| 15 | If yes, please list the FEIN of Bidder’s owner/parent company | |
| 16 | Does Bidder have a contract with any other federal, state or local governmental entity, including General Services Administration (GSA) / Veterans Affairs (VA), on similar products, quantities, terms and conditions? If yes, provide a link for each contract, if available. | |
| 17 | Are prices quoted for this solicitation the same as or lower than those quoted other federal, state or local governmental entities (including GSA/VA contracts) on similar products, quantities, terms and conditions? | |
| 18 | If Bidder answered "No" to question above, please explain: | |
| 19 | Does Bidder offer an online web-based ordering system? | |
| 20 | If awarded a contract, will Bidder accept the NYS Purchasing Card (see Appendix B, Purchasing Card) at no additional charge, for orders up to and including $50,000? | |
| 21 | If Bidder requires a minimum purchase amount for orders placed using the NYS Purchasing Card, please indicate the minimum purchase amount: | |
| 22 | If Bidder limits the maximum acceptable purchase amount for orders placed using the NYS Purchasing Card, please indicate the maximum purchase amount: | |
| 23 | If Bidder offers an additional discount for purchases made with the NYS Purchasing Card, enter it here (%): | |
| 24 | Does Bidder offer a prompt payment discount for payments made in less than 30 days after receipt of a proper invoice? | |
| 25 | If yes, please detail the additional discounts by providing the percentage of discounts and the specific number of days within which payment must be made for the discounts to apply (for example: 2% / 15 days; 1% / 20 days): | |
| 26 | Are any Products offered manufactured from recycled materials? If yes, please attach price list with noted products. | |
| 27 | Are any Products offered remanufactured (i.e., restored to |
their original performance standards and function)? If yes, please attach price list with noted products.
| 28 | Are any Products offered Energy Star Compliant? If yes, please attach price list with noted products. |
| 29 | Person to contact for questions relating to this Bid submission: |
| Name: | |
| Title: | |
| Telephone Number: | |
| Toll Free Telephone Number: | |
| E-Mail Address: | |
| 30 | Person to contact for Contract Administration issues: |
| Name: | |
| Title: | |
| Telephone Number: | |
| Toll Free Telephone Number: | |
| E-Mail Address: | |
| 31 | Customer Service contact for New York State Contract Orders during normal business hours: |
| List normal business hours (Specify M-F, Sat, Sun): | |
| Name: | |
| Title: | |
| Telephone Number: | |
| Toll Free Telephone Number: | |
| E-Mail Address: | |
| 32 | Person to contact in the event of an emergency occuring after normal business hours or on weekend/holidays: |
| Name: | |
| Title: | |
| Telephone Number: | |
| Toll Free Telephone Number: | |
| E-Mail Address: | |
| 33 | Is Bidder listed as a certified Minority- or Women-Owned Business Enterprise in the NYS Empire State Development Directory of Certified Minority- and Women-Owned Businesses, |
https://ny.newnycontracts.com/frontend/vendorsearchpublic.asp?
| 34 | If yes, please indicate Minority-Owned (MBE), Women-Owned (WBE), or Minority- and Women-Owned (MWBE). |
| 35 | Is Bidder listed as a certified Service-Disabled Veteran Owned Business Division of Service-Disabled Veteran's Business Development at: https://ogs.ny.gov/Veterans/default.asp |
| A Bidder that is a Small Business as defined in New York State Finance Law Section 160(8) will be identified by OGS in the OGS Contract Award Notification upon award of the Contract. |
"Small Business" means a business which:
(a) is resident in New York State;
(b) is independently owned and operated;
(c) is not dominant in its field; and,
(d) employs one hundred or fewer persons
| 36 | Is Bidder a New York Small Business as defined above? |
| 37 | Total number of people employed by your business: |
| 38 | Total number of people employed by your business in New York State: |
| 39 | Place of manufacture of Product(s) bid: |
| 40 | Are all Product(s) bid manufactured in NYS? |
| 41 | Are all Product(s) bid manufactured outside NYS? |
| 42 | Are the Product(s) bid manufactured both in NYS and outside NYS? |
BIDDER/OFFERER DISCLOSURE OF PRIOR NON-RESPONSIBILITY DETERMINATIONS
Pursuant to Procurement Lobbying Law (SFL § 139-j)
| 43 | Has any Governmental Entity made a finding of non-responsibility regarding the Bidder in the previous four years? |
| 44 | If yes, was the basis for the finding of non-responsibility due to a violation of State Finance Law § 139-j? |
| 45 | If yes, was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a Governmental Entity? |
If yes, please provide details regarding the finding of non-responsibility below.
| Governmental Entity: |
| Date of Finding of Non-Responsibility: |
| Basis of Finding of Non-Responsibility: |
(add additional pages if necessary with content clearly labeled)
| 46 | Has any Governmental Entity terminated a Procurement Contract with or withheld a Procurement Contract from the Bidder due to the intentional provision of false or incomplete information? If yes, please provide details below. |
| Governmental Entity: | |
| Date of Termination or Withholding of Contract: | |
| Basis of Termination or Withholding: |
(add additional pages if necessary with content clearly labeled)
&10Group 10150 Personal Protective Equipment (PPE) and Related Items
&K000000&F
Page &P of &N
Control
| Valid answers for County |
| Albany |
| Allegany |
| Bronx |
| Broome |
| Cattaraugus |
| Cayuga |
| Chautauqua |
| Chemung |
| Chenango |
| Clinton |
| Columbia |
| Cortland |
| Delaware |
| Dutchess |
| Erie |
| Essex |
| Franklin |
| Fulton |
| Genesee |
| Greene |
| Hamilton |
| Herkimer |
| Jefferson |
| Kings |
| Lewis |
| Livingston |
| Madison |
| Monroe |
| Montgomery |
| Nassau |
| New York |
| Niagara |
| Oneida |
| Onondaga |
| Ontario |
| Orange |
| Orleans |
| Oswego |
| Otsego |
| Putnam |
| Queens |
| Rensselaer |
| Richmond |
| Rockland |
| Saratoga |
| Schenectady |
| Schoharie |
| Schuyler |
| Seneca |
| St. Lawrence |
| Steuben |
| Suffolk |
| Sullivan |
| Tioga |
| Tompkins |
| Ulster |
| Warren |
| Washington |
| Wayne |
| Westchester |
| Wyoming |
| Yates |
General Questions - &A GROUP 73003 - Administrative Services
&D Attachment 6 of 12 Page &P of &N
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