26-036 Library of Attachments.pdf

Required document Type of Submission Included with Bid

Submission Attachment A:

Solicitation Cover Sheet

Include the completed hard copy found on page 2 in this document.

Proof of required experience:

As required in the item 9.B.2 requirements, include proof of being in business performing the specific services required

Acceptable proof includes certification of incorporation or similar documentation illustrating the date that the business was legally established

Attachment C: Bid Quote Sheet Include a signed original & and excell version found in documents folder of Contract Reporter Ad.

Attachment E: Non-Collusive Bidding Certification

Provide a signed and notarized original found on page 7 of this document.

Attachment I: MWBE Goals and EEO policy Statement

Include the signed original found on page 10 of this document.

Attachment I-1: EEO Employment Opportunity Staffing plan

Include the signed original found on page 12 of this document.

Attachment J-1: Offeror’s Affirmation of Understanding

Include the signed original found on page 14 of this document.

Attachment J-2:OMH Offeror Disclosure of Prior Non- Responsibility Determinations

Include the signed original found on page 16 of this document.

Attachment K:

Vendor Responsibility Questionnaire

Submit either hard copy questionnaire or be sure to update the VendRep online questionnaire using NYS VendRep System if applicable.

Attachment L: Business References Include three references on form found on page 18 of this document.

Attachment N:

New York State Business Usage

Submit a completed and signed Attachment N found on page 19 of this document.

Attachment P:

Sexual Harassment Prevention Certification

Submit a completed and signed Attachment O found on page page 20 of this document.

Attachment Q: Gender Based Violence and the Workplace Certificate

Submit a completed and signed Attachment P found on page 21 of this document.

Attachment R: Prohibiting State Agencies from Contracting with Businesses Conducting Business in Russia

Submit a completed and signed Attachment Q found on page 22 of this document.

Workers’ Compensation/NYS Disability Coverage required forms

If required, include verification of required coverage.

Liability Insurance Coverage If required, include verification of required coverage.

Department of Labor Proof of Certificate of Registration.

If required, provide proof of a valid Certificate of Registration with the NYS Department of Labor

Form ST-220 CA: Complete this form to certify that Form ST-220-TD has been filed with NYS Tax Department.

Use the link provided in Section 9.7 of IFB to access the latest revision of the required form.

BID SUBMISSION CHECKLIST

OMH reserves the right to disqualify any bids that do not contain the mandatory items as specified for this Solicitation and the resulting purchase order. Bidders should use the following checklist when submitting bids and include all required documents with bid proposals (mark the box to indicate inclusion of the documents) :

Exhibit D-1:Prevailing Wage Information To be completed by winning bidder and upon completion of contract

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ATTACHMENT A

SOLICITATION COVER

SHEET Bid #: IFB 26-036

Number of Years in Business: ____ Number of Years of Experience Providing Solicited Service: ____

Form submitted to show compliance with New York State Workers Compensation Insurance requirements:

CE-200____ or C-105.2____ or U-26.3____ or SI-12____ or GSI-105.2____

Form submitted to show compliance with New York State Disability Benefits Insurance requirements:

CE-200____ or DB-120.1____ or DB-155____

PLEASE CHECK THE APPROPRIATE BOX:

NYS Minority-owned Business (MBE) Registration #

NYS Women-owned Business (WBE) Registration #

NYS Small Business (SB) Registration #

NYS Disadvantaged Business Enterprise (DBE) Registration #

NYS Service-Disabled Veteran Owned Business (SDVOB) Registration #

None of the above

(Note: Information provided on this form should match, when applicable, to information provided on Vendor Responsibility Questionnaire/ or on the online version of the document.)

NAME OF FIRM

ADDRESS

PRINTED NAME/SIGNATURE

TITLE

EMAIL ADDRESS

PHONE # FAX#

New York State Vendor ID

FEDERAL ID (FEIN) #

DUNS #

IF THE COMPANY USES, OR HAS USED IN THE PAST TEN (10) YEARS, ANY OTHER BUSINESS NAME, FEIN, OR D/B/A PLEASE PROVIDE

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ATTACHMENT B

PRE - BID CONFERENCE

PRE-BID CONFERENCE

DATE: July 14, 2026, at 9:00 AM ET

Web ex call in phone # 1-415-527-5035

Revised (11/15/2024)

ATTACHMENT B-1

NO BID

EXPLANATION

Bid #: 26-036

Please return no later than:

TO: Bureau of Procurement Enterprise Services

Contract Management Specialist 2 Email:

FROM: ________________________________/____________________________

(Print Company Representative Name) Signature

COMPANY NAME: ______________________

(PRINT)

ADDRESS: ______________________

(PRINT)

Email address for designated point of contact: _____________________________

I do not wish to submit a bid for the above solicitation due to:

Ron Foster

Ron.foster@omh.ny.gov

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HAZARDOUS WASTE/CHEMICAL WASTE

Year 1 Year 2 Year 3

Annual Cost ($) Annual Cost ($) Annual Cost ($)

NON-HALOGENATED SOLVENT WASTES (ETHERS,

HEPTANES, HEXANES, XYLENES, ALCOHOLS, ETHYL

ACETATE (D001, F003,F005) LIQUID

120 GALLONS 2 -$ -$ -$ -$

AQUEOUS BUFFERS/ORGANIC SOLVENTS

ALCOHOLS/ACETONITRILE (D001, U003,F003)

LIQUIDS

120 GALLONS 2 -$ -$ -$ -$

PICRIC ACID/Osmeum Tetroxide 20 POUNDS 2 -$ -$ -$ -$

HALOGENATED ORGANIC SOLVENTS

(CHLOROFORM, METHYLENE CHLORIDE,

CHLOROBUTANE) (D001, F002, F003 D022,U044)

LIQUIDS

120 GALLONS 2 -$ -$ -$ -$

FORMALIN 4-10% AQUEOUS WASTE (U122) LIQUID 50 GALLONS 2 -$ -$ -$ -$

FORMALDEHYDE W/4% SODIUM CACODYLATE,

GLUTARALDEHYDE, ETHYL ALCOHOL (D001,

U122,U136) LIQUID

50 GALLONS 2 -$ -$ -$ -$

CHROMIC ACID/SULFURIC ACID IN WATER

(35:35:30) GLASSWARE CLEANER WASTE (D002,

D007) LIQUID

10 GALLONS 2 -$ -$ -$ -$

FORMALIN CLEAN UP RESIDUE W/ ABSORBNT

MATERIAL (SOLID) 15 POUNDS 2 -$ -$ -$ -$

PACK LAB CHEMICALS VARIOUS CORROSIVES 100 POUNDS 2 -$ -$ -$ -$

PACK LAB CHEMICALS (VARIOUS) 250 POUNDS 2 -$ -$ -$ -$

DIAMINOBENZIDINE (DAB) 3 GALLONS 2 -$ -$ -$ -$

PHARMACEUTICAL WASTES/UNUSED PRODUCT,

CAPSULES, TABLETS, PLACEBO (NON-HAZARDOUS) 50 POUNDS 2 -$ -$ -$ -$

PHARMACEUTICAL TOXIC WASTES/UNUSED

PRODUCTS "P"-WASTES 2 POUNDS 2 -$ -$ -$ -$

BROKEN MERCURY THERMOMETER 1 POUNDS 2 -$ -$ -$ -$

GAS CHROMATOGRAPHIC BONDED SILICA

PACKINGS 10 POUNDS 2 -$ -$ -$ -$

WASTE CONTAINERS

FIBER DRUM 5 5-GALLON 2 -$ -$ -$ -$

FIBER DRUM 8 14-GALLON 2 -$ -$ -$ -$

DOT 17E DRUM 5 30-GALLON 2 -$ -$ -$ -$

DOT 17H DRUM 3 30-GALLON 2 -$ -$ -$ -$

VERMICULITE, 4CuFt 1 BAGS 2 -$ -$ -$ -$

LABELS (SHEETS) 4 SHEETS 2 -$ -$ -$ -$

Subtotals Yr 1: -$ Yr2: -$ Yr 3: $ - $ -

Directions: Insert the cost per item for each year, the total cost will calculate automatically, as well as totals per year and total contract value. When finished with all the pages, print the bid quote sheet and complete the bottom.

Submit a hard copy bid quote sheet by the bid due date and save an Excel version. This may be requested as part of the pricing review

ATTACHMENT C: OMH01-T203112-3650454 Bid Quote Sheet Nathan Kline Institute requesting official bids for Hazardous Waste Removal Services

Year 1 Cost /Unit of Measurement ($)

Year 2 Cost /Unit of Measurement ($)

Year 3 Cost /Unit of Measurement ($)

PRODUCT DESCRIPTION

ANNUAL

ESTIMATED

QUANTITY

UNIT OF

MEASUREMENT SIZE

FREQUENCY PER

YEAR PICKUP

Total Amount (Years 1-3)

UNIVERSAL WASTE LAMPS

Year 1 Year 2 Year 3

Annual Cost ($) Annual Cost ($) Annual Cost ($)

FLUORESCENT LAMPS 1500 EACH 2 -$ -$ -$ -$

BALLAST (PCB LAMP BALLAST) 100 POUNDS 2 -$ -$ -$ -$

BALLAST (NON-PCB LAMP,NON-PCB HID

CAPACITORS BALLAST) 500 POUNDS 2 -$ -$ -$ -$

BATTERIES (LEAD) 500 POUNDS 2 -$ -$ -$ -$

BATTERIES (NICKEL,ALKALINE,NICKEL) 300 POUNDS 2 -$ -$ -$ -$

WASTE PAINT/AEROSOL CANS 1000 POUNDS 2 -$ -$ -$ -$

FIBER DRUMS 8 2-FEET 2 -$ -$ -$ -$

FIBER DRUM 8 4-FEET 2 -$ -$ -$ -$

FIBER DRUM EXPANDABLE 1 8-FEET 1 -$ -$ -$ -$

PLASTIC CONTAINERS 3 5-GALLON 2 -$ -$ -$ -$

PLASTIC CONTAINERS 2 30-GALLON 2 -$ -$ -$ -$

PLASTIC CONTAINERS 1 55-GALLON 2 -$ -$ -$ -$

LABELS (SHEETS) 2 SHEETS 2 -$ -$ -$ -$

Subtotals Yr 1: -$ Yr2: -$ Yr 3: -$ $ -

ELECTRONIC WASTE

Year 1 Year 2 Year 3

Annual Cost ($) Annual Cost ($) Annual Cost ($)

COMPUTERS (MONITORS, KEYBOARDS, MOUSE,

ETC) 25 EACH 1 -$ -$ -$ -$

MICROWAVES 5 EACH 1 -$ -$ -$ -$

Subtotals Yr 1: -$ Yr2: -$ Yr 3: -$ $ -

Totals Year 1 Year 2 Year 3 All Years (1-3)

TOTAL CONTRACT VALUE -$

When applicable, OR

Name of Firm_______________________________________________________

Printed Name: ______________________________________________________

Authorized Signature_________________________________________________ Date ________________

ANNUAL

ESTIMATED

QUANTITY

UNIT OF

MEASUREMENT SIZE

FREQUENCY PER

YEAR PICKUP

PRODUCT DESCRIPTION

ANNUAL

ESTIMATED

QUANTITY

UNIT OF

MEASUREMENT SIZE

FREQUENCY PER

YEAR PICKUP

Total Amount (Years 1-3) Year 1 Cost /Unit of

Measurement ($) Year 2 Cost /Unit of

Measurement ($)

Electronic Waste Sub-Total

The signature below attests that I have been on the New York State payroll during the last two years and the N.Y. State Ethics Commission Approval Letter is attached

The signature below attests that I have not been on the New York State payroll during the last two years E. If award is to an individual:

D. The bidder’s signature below attests they have reviewed and understand the requirements stated in the IFB (section 13) and the OMH contract boilerplate (Appendix C) regarding the necessity to accept Electronic Payments for all invoices if awarded this contract, and certifies that it has already applied to participate in the State Comptroller’s Electronic Payment system, or will do so within 10 days of receiving notification of contract selection.

C. The bidder’s signature below attests that they will inform the OMH in writing of the name(s) of any individual(s) who will provide any service under the resulting contract who has not been off the New York State payroll for at a minimum of two years from the start date of the resulting contract. The bidder must notify the OMH such individual(s) prior to the start of the contract or prior to that individual(s) providing any service in accordance with resulting contract.

Year 3 Cost /Unit of Measurement ($)

*Prices are to include all applicable fees. No additional expenses on invoices for freight/labor/gas will be payable.

B. The bidder’s signature below attests to the receipt and understanding of the questions & answers associated with this solicitation.

A. The bidder’s signature below attests that they have reviewed the prevailing wage rates that apply to this solicitation.

Universal Waste (Lamps) Sub-Total Hazardous/Chemical Waste Sub-Total

*Hazardous waste material pick-up schedule shall be once every six months. Please expect to bill your yearly rate quote in two equal 50% installments

Year 1 Cost /Unit of Measurement ($)

Year 2 Cost /Unit of Measurement ($)

Year 3 Cost /Unit of Measurement ($)

Total Amount (Years 1-3)PRODUCT DESCRIPTION

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ATTACHMENT E

NON-COLLUSIVE BIDDING CERTIFICATION

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 1 of 3)

SECTION 139-D, Statement of Non-Collusion in bids to the State:

BY SUBMISSION OF THIS BID, BIDDER AND EACH PERSON SIGNING ON BEHALF OF BIDDER

CERTIFIES, AND IN THE CASE OF JOINT BID, EACH PARTYTHERETO CERTIFIES AS TO ITS OWN ORGANIZATION, UNDER PENALTY OF PERJURY, THAT TO THE BEST OF HIS/HER KNOWLEDGE AND

BELIEF:

[1] The prices of this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purposes of restricting competition, as to any matter relating to such prices with any other Bidder or with any competitor;

[2] Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the Bidder and will not knowingly be disclosed by the Bidder prior to opening, directly or indirectly, to any other Bidder or to any competitor; and

[3] No attempt has been made or will be made by the Bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition.

A BID SHALL NOT BE CONSIDERED FOR AWARD NOR SHALL ANYAWARD BE MADE WHERE [1], [2], [3] ABOVE HAVE NOT BEEN COMPLIED WITH; PROVIDED HOWEVER, THAT IF IN ANY CASE THE

BIDDER(S) CANNOT MAKE THE FOREGOING CERTIFICATION, THE BIDDER SHALL SO STATE AND

SHALL FURNISH BELOW A SIGNED STATEMENT WHICH SETS FORTH IN DETAIL THE REASONS

THEREFORE:

[AFFIX ADDENDUM TO THIS PAGE IF SPACE IS REQUIRED FOR STATEMENT.]

Subscribed to under penalty of perjury under the laws of the State of New York, this _______ day of ___________, 20____ as the act and deed of said corporation of partnership.

8 of 24 Revised (11/15/2024)

NON-COLLUSIVE BIDDING CERTIFICATION

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 2 of 3)

IF BIDDER(S) (ARE) A PARTNERSHIP, COMPLETE THE FOLLOWING:

NAMES OF PARTNERS OR PRINCIPALS LEGAL RESIDENCE

IF BIDDER(S) (ARE) A CORPORATION, COMPLETE THE FOLLOWING:

NAME LEGAL RESIDENCE

President:

Secretary:

Treasurer:

President:

Secretary:

Treasurer:

IF BIDDER(S) (ARE) A LIMITED LIABILITY COMPANY (LLC), COMPLETE THE FOLLOWING:

NAMES OF MEMBERS LEGAL RESIDENCE

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NON-COLLUSIVE BIDDING CERTIFICATION

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 3 of 3)

Identifying Data

Potential Contractor: ___________________________________________________________

Address: ___________________________________________________________ Street

City, Town, etc.

Telephone: __________________________ Title__________________________

If applicable, Responsible Corporate Officer:

Name: ______________________________ Title__________________________

Signature: _______________________________________________________________

Joint or combined bids by companies or firms must be certified on behalf of each participant.

Legal name of person, firm or corporation Legal name of person, firm or corporation

By: _____________________________ ______________________________ Name Name

Title Title

Address: _________________________ Address: _________________________ Street Street

City, State City, State

10 of 24 Revised (11/15/2024)

ATTACHMENT I

MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES – EQUAL EMPLOYMENT

OPPORTUNITY POLICY STATEMENT

I, _________________________, the awardee/contractor, agree to adopt the following policies with respect to the project being developed or services rendered for the Office of Mental Health (OMH) at NYS Office of Mental Health

This organization will and will cause its contractors and subcontractors to take good faith actions to achieve the M/WBE contract participations goals set by the State for that area in which the State-funded project is located, by taking the following steps:

(1) Actively and affirmatively solicit bids for contracts and subcontracts from qualified State certified MBEs or WBEs, including solicitations to M/WBE contractor associations.

(2) Request a list of State-certified M/WBEs from OMH and solicit bids from them directly.

(3) Ensure that plans, specifications, request for proposals and other documents used to secure bids will be made available in sufficient time for review by prospective M/WBEs.

(4) Where feasible, divide the work into smaller portions to enhanced participations by M/WBEs and encourage the formation of joint venture and other partnerships among M/WBE contractors to enhance their participation.

(5) Document and maintain records of bid solicitation, including those to M/WBEs and the results thereof.

Contractor will also maintain records of actions that its subcontractors have taken toward meeting M/WBE contract participation goals.

(6) Ensure that progress payments to M/WBEs are made on a timely basis so that undue financial hardship is avoided, and that bonding and other credit requirements are waived or appropriate alternatives developed to encourage M/WBE participation.

M/WBE

(a) This organization will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, sex, age, disability or marital status, will undertake or continue existing programs of affirmative action to ensure that minority group members are afforded equal employment opportunities without discrimination, and shall make and document its conscientious and active efforts to employ and utilize minority group members and women in its work force on state contracts.

(b)This organization shall state in all solicitation or advertisements for employees that in the performance of the State contract all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex disability or marital status.

(c) At the request of the contracting agency, this organization shall request each employment agency, labor union, or authorized representative will not discriminate on the basis of race, creed, color, national origin, sex, age, disability or marital status and that such union or representative will affirmatively cooperate in the implementation of this organization’s obligations herein.

(d) Contractor shall comply with the provisions of the Human Rights Law, all other State and Federal statutory and constitutional non-discrimination provisions.

Contractor and subcontractors shall not discriminate against any employee or applicant for employment because of race, creed (religion), color, sex, national origin, sexual orientation, military status, age, disability, predisposing genetic characteristic, marital status or domestic violence victim status, and shall also follow the requirements of the Human Rights Law with regard to non-discrimination on the basis of prior criminal conviction and prior arrest.

(e) This organization will include the provisions of sections

(a) through (d) of this agreement in every subcontract in such a manner that the requirements of the subdivisions will be binding upon each subcontractor as to work in connection with the State contract.

EEO

11 of 24 Revised (11/15/2024)

Agreed to this _______ day of ____________________, 2___________

By __________________________________________

Print: _____________________________________ Title: _____________________________

_________________________________is designated as the Minority Business Enterprise Liaison

(Name of Designated Liaison) responsible for administering the Minority and Women-Owned Business Enterprises- Equal Employment Opportunity (M/WBE-EEO) program.

M/WBE Contract Goals

________ % Minority and Women’s Business Enterprise Participation

________% Minority Business Enterprise Participation

________% Women’s Business Enterprise Participation

(Authorized Representative)

Title: ________________________________________

Date: ________________________________________

12 of 24 Revised (11/15/2024)

ATTACHMENT I-1

Equal Employment Opportunity Staffing Plan

Solicitation/Program Name: Bdlg. 69 & 105 Decentralization Project Report includes:

□ Work force to be utilized on this contract

□ Contractor/Subcontractor’s total work force

Offeror’s Name: Reporting Entity:

□ Contractor

□ Subcontractor

Subcontractor’s name Offeror’s Address:

Enter the total number of employees for each classification in each of the EEO-Job Categories identified

EEO-Job Category Total Work force

Work force by Gender

Work force by Race/Ethnic Identification

Total Male (M)

Total Female

(F) White

(M) (F) Black

(M) (F) Hispanic

(M) (F) Asian

(M) (F)

Native American

(M) (F) Disabled

(M) (F) Veteran

(M) (F)

Officials/Administrators

Professionals

Technicians

Service Maintenance Workers Office/Clerical

Skilled Craft Workers

Paraprofessionals

Protective Service Workers

Totals

PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type): SUBMIT COMPLETED WITH BID OR PROPOSAL

13 of 24 Revised (11/15/2024)

General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (04-10) and submit it as part of the bid or proposal package. Where the work force to be utilized in the performance of the State contract can be separated out from the contractor’s or subcontractor’s total work force, the Offeror shall complete this form only for the anticipated work force to be utilized on the State contract. Where the work force to be utilized in the performance of the State contract cannot be separated out from the contractor’s or subcontractor’s total work force, the Offeror shall complete this form for the contractor’s or subcontractor’s total work force.

Instructions for completing:

1. Enter the Solicitation number or RFP number that this report applies to along with the name and address of the Offeror.

2. Check off the appropriate box to indicate if the Offeror completing the report is the contractor or a subcontractor.

3. Check off the appropriate box to indicate if the work force being reported is just for the contract or the Offerors’ total work force.

4. Enter the total work force by EEO job category.

5. Break down the total work force by gender and enter under the heading ‘Work force by Gender’

6. Break down the total work force by race/ethnic background and enter under the heading ‘Work force by Race/Ethnic Identification’. Contact the

Designated Contact(s) for the solicitation if you have any questions.

7. Enter information on disabled or veterans included in the work force under the appropriate headings.

8. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes.

RACE/ETHNIC IDENTIFICATION

Race/ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. For the purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one race/ethnic group. The race/ethnic categories for this survey are:

WHITE (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

BLACK a person, not of Hispanic origin, who has origins in any of the black racial groups of the original peoples of Africa.

HISPANIC a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

ASIAN & PACIFIC a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.

ISLANDER

NATIVE INDIAN (NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal AMERICAN/ ALASKAN affiliation or community recognition.

NATIVE)

OTHER CATEGORIES

DISABLED INDIVIDUAL any person who: -has a physical or mental impairment that substantially limits one or more major life activity(ies) -has a record of such an impairment; or -is regarded as having such an impairment.

VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975.

GENDER

14 of 24 Revised (11/15/2024)

ATTACHMENT J

NEW YORK STATE OFFICE OF MENTAL HEALTH

Summary of OMH Procurement Lobbying Guidelines

OMH has issued Guidelines pursuant to the New York State Finance Law Sections 139-j and 139-k, which prohibit lobbying on procurement contracts. For purposes of the law, procurement contracts include most contracts/Purchase Orders with an estimated annual expenditure in excess of $15,000 per year, as well as amendments and modifications to such contracts which were not contemplated by the original contract and represent a material change in the scope of the contract.

The law provides that, during the Restricted Period of an agency procurement for goods or services, vendors (or Offerors) may only contact the agency’s designated contact person(s), and all contacts, whether permissible or impermissible, shall be recorded:

Vendor Requirements

Must limit communications with OMH during the Restricted Period of each procurement to the OMH-designated point(s) of contact o The Restricted Period is the period from the date of the earliest method by which an agency solicits a response from vendors to a contract opportunity until the date the contract is awarded and, if applicable, approved by the Comptroller’s Office.

Must affirm in writing vendor’s understanding of, and agreement, to comply with the OMH Procurement Guidelines

Must certify whether vendor has been found non-responsible within the previous four years by any Governmental Entity for failure to comply with State Finance Law 139-k or for the intentional provision of false or incomplete information regarding its procurement lobbying law compliance.

OMH Requirements

Must include a summary of OMH’s procurement lobbying guidelines in each initial solicitation document

Must designate a single point or points of contact for each procurement

Must require OMH staff to record all Contacts from Offerors during the Restricted Period of each procurement o A Contact is any communication with OMH under circumstances where a reasonable person would infer that the communication was intended to influence the procurement

Must refer all impermissible Contacts for investigation by OMH

Must make a responsibility determination with regard to State Finance Law Section 139-j and 139-k compliance prior to award of the contract

Must include a provision in all procurement contracts which allows OMH to terminate the contract if the vendor’s certification is found to be intentionally false or intentionally incomplete.

An electronic copy of the complete OMH Procurement Lobbying Law Guidelines is located at:

http://www.omh.ny.gov/omhweb/procurementguidelines/

OMH Summary of Procurement Guidelines: March 27, 2006

15 of 24 Revised (11/15/2024)

ATTACHMENT J-1

OFFEROR’S AFFIRMATION OF, UNDERSTANDING OF, AGREEMENT TO, AND COMPLIANCE WITH

OMH PROCUREMENT LOBBYING GUIDELINES

New York State Finance Law 139-j(6)(b) provides that OMH shall seek written affirmation from all Offerors on their understanding of and agreement to comply with OMH’s procedures relating to permissible contacts during each procurement pursuant to State Finance Law 139-j(3). OMH is expanding on that requirement, requiring that

(1) Offerors affirm they have complied with the OMH Guidelines throughout the procurement process, and (2) Offerors agree that OMH shall have the right to terminate any contract, purchase order or purchase authorization resulting from the procurement in the event that the affirmation is found to be intentionally false or intentionally incomplete.

Solicitation # and/or OMH descriptive name of solicitation: IFB 26-036

I hereby affirm that I have read and understand the OMH Procurement Lobbying Guidelines, and agree to comply with the OMH procedures relating to permissible contacts during this New York State governmental procurement pursuant to State Finance Law 139-j(3). Unless I provide notice otherwise, my execution of this affirmation shall be an ongoing representation that I have complied with, and continue to be in compliance with, the OMH Guidelines.

I understand and agree that: 1) OMH shall have the right to terminate the contract, purchase order or purchase authorization resulting from this solicitation in the event that this affirmation is found to be intentionally false or intentionally incomplete; and 2) upon such finding, OMH may exercise its termination right by providing written notification.

Date:___________ 20__

Signature of Offeror’s Authorized Representative _______________________________

Printed Name and Title ___________________________________________________

Name of Offeror_________________________________________________________

Offeror’s Address: ______________________________________________________

OMH Attachments J1: March 27, 2006

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ATTACHMENT J-2

NEW YORK STATE OFFICE OF MENTAL HEALTH

OMH OFFEROR DISCLOSURE OF

PRIOR NON-RESPONSIBILITY DETERMINATIONS

New York State Finance Law 139-k requires Offerors to disclose findings of non-responsibility within the last four years by a governmental entity where such prior finding of non-responsibility was due to unlawful contacts during a procurement as stated under State Finance Law §139-j or the intentional provision of false or incomplete information to a governmental entity.

Failure to submit this form, the submission of a form with false, misleading or incomplete information, or failure to update this form when required may result in a determination of non-responsiveness and disqualification of the bid, proposal or offer. If the failure to comply is discovered after the contracting process has been completed, it may result in termination of the contract.

(Please circle):

Solicitation # and/or OMH descriptive name of solicitation: IFB 26-036

(1) Has any New York State agency or authority made a finding of non-responsibility regarding the Offeror in the last four years? No Yes

If yes, what was the basis for the finding of the Offeror’s non-responsibility?

Please check all that apply:

__ Unlawful Contacts during a procurement contract (State Finance Law §139-j) __ The intentional provision of false or incomplete information

If yes, please provide details regarding the finding of non-responsibility below:

New York State Agency or Authority: ____________________________________ Year of Finding of Non-Responsibility:____________________________________ Facts Underlying Finding of Non-Responsibility:_____________________________ Add additional sheets if necessary

(2) Has any New York State agency or authority terminated or withheld a procurement contract with the Offeror due to the intentional provision of false or incomplete information? (Please circle): No Yes

If yes, please provide details regarding the termination/withholding below:

New York State Agency or Authority: _____________________________________ Date of Termination/Withholding of Contract:____________Contract #: __________ Facts Underlying Termination: __________________________________________ Add additional sheets if necessary

Offeror certifies that all information provided to OMH with respect to State Finance Law 139-k is complete, true and accurate.

Date:___________ 200_ _________________________________________________ Signature of Offeror’s Authorized Representative

Printed Name and Title of Authorized Representative

Name and Address of Offeror

OMH Attachments J2: March 27, 2006

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ATTACHMENT K

Vendor Responsibility Questionnaire Certification

Vendors are encouraged to file the required Vendor Responsibility Questionnaire online via the New York State VendRep System. To enroll in and use the New York State VendRep System, see the VendRep System Instructions available at www.osc.state.ny.us/vendrep or go directly to the VendRep System online at https://onlineservices.osc.state.ny.us/Enrollment/login?0 . For direct VendRep System user assistance, the Office of the State Comptroller Help Desk may be reached at 866-370-4672 or 518-408-4672 or by email at ciohelpdesk@osc.state.ny.us.Vendors may opt to file a paper questionnaire; the appropriate questionnaire form can be obtained from the VendRep website www.osc.state.ny.us/vendrep/forms_vendor.htm, or vendors may contact the authorized contact at OMH or the Office of the State Comptroller Help Desk for a copy of the paper form.

Vendors enrolled in the online VendRep System are also reminded to recertify existing questionnaires every six months or whenever changes that affect their business entity occur.

Vendor Responsibility Certification

Please check the appropriate box indicating what mechanism has been utilized to submit the Vendor Responsibility Questionnaire; the Questionnaire is to be submitted/certified prior to the bid due date.

Bidder is to indicate the format utilized by checking the appropriate box:

Hard Copy, Paper Format or On-Line Certified Format

Note: If utilizing a hard copy, paper format, that hard copy must be included with the bid quote submission. If utilizing the online format, the Vendor Responsibility Questionnaire must be certified by the bid due date.

Failure to provide the required Vendor Responsibility Questionnaire may result in the bid being rejected for not meeting the minimum mandatory requirement.

Vendor Registration Requirement

The New York State Vendor Management Unit (VMU) relies on State Business Units to obtain a completed Substitute Form W-9 for any vendor not already registered. Any vendor that wants to do business with New York State must complete a Substitute Form W-9, which may be accessed on the NYS Office of the State Comptroller’s Web site at the following link: https://www.osc.state.ny.us/vendors/forms/ac3237s_fe.pdf

Submit the completed form with the required bid documentation. For more information about NYS Vendor Management, please access the NYS Office of State Comptroller's Web site using the following link:

http://www.osc.state.ny.us/vendor_management/index.htm

18 of 24 Revised (11/15/2024)

ATTACHMENT L

Business References for Bid #: IFB 26-036

REFERENCE #1

Company Name

Address

City/State/Zip Code

Contact Name

Contact Phone

Contact E-mail

Dates Work Performed for Reference

REFERENCE #2

Company Name

Address

City/State/Zip Code

Contact Name

Contact Phone

Contact E-mail

Dates Work Performed for Reference

REFERENCE #3

Company Name

Address

City/State/Zip Code

Contact Name

Contact Phone

Contact E-mail

Dates Work Performed for Reference

19 of 24 Revised (11/15/2024)

ATTACHMENT N

New York State Business Usage Form

IFB/Contract #: IFB 26-036

Question Yes No

1. Will subcontractors be used in the performance of this contract?

2. Will New York State Businesses be used as subcontractors in the performance of the contract?

3. Will suppliers be used in the performance of the contract?

4. Will New York State Businesses be used as suppliers in the performance of the contract?

If you answered “Yes” to either questions 2 or 4, please provide identifying information below:

NYS Business

Subcontractor or

Supplier Company Name Company Address

Company Phone #

Company

FEIN

Estimated Amt to NYS Business in the performance of this contract

Name of Firm: ____________________________________________________

Printed Name: ____________________________________________________

Authorized Signature: _______________________________________________ Date: _______________

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ATTACHMENT P

Sexual Harassment Prevention Certification

Solicitation # and/or OMH descriptive name of solicitation:

___IFB 26-036________________________________________________________________

State Finance Law §139-l requires bidders on state procurements to certify that they have a written policy addressing sexual harassment prevention in the workplace and provide annual sexual harassment training (that meets the Department of Labor’s model policy and training standards) to all its employees.

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies its own organization, under penalty of perjury, that the bidder has and has implemented a written policy addressing sexual harassment prevention in the workplace and provides annual sexual harassment prevention training to all of its employees. Such policy shall, at a minimum, meet the requirements of section two hundred one-g of the labor law.

I hereby affirm that ______________________________ (Offeror’s Name) has implemented a written policy addressing sexual harassment prevention in the workplace and provides annual sexual harassment prevention training to all of its employees. Such policy, at a minimum, meets the requirements of section two hundred one-g of the labor law. Unless I provide notice otherwise, my execution of this affirmation shall be an ongoing representation that I have complied with, and continue to be in compliance with State Finance Law §139-l.

I understand and agree that: 1) OMH shall have the right to terminate the contract, purchase order or purchase authorization resulting from this solicitation in the event that this affirmation is found to be intentionally false or intentionally incomplete; and 2) upon such finding, OMH may exercise its termination right by providing written notification.

Date____________________ 20___

Signature of Offeror’s Authorized Representative _______________________________

Printed Name and Title ___________________________________________________

Name of Offeror_________________________________________________________

Offeror’s Address________________________________________________________

21 of 24 Revised (11/15/2024)

● Share Information: Employers must provide information regarding gender-based violence where employees can see and access it, including displaying the NYS Domestic and Sexual Violence Hotline information and a gender-based violence and the workplace poster.

● Refer Employee-Survivors to Services: The policy must require that the employer refer employees who disclose current or past victim status to the NYS Domestic and Sexual Violence Hotline and/or a local service provider. For bidders outside of New York State, referrals should be made to a local provider or statewide hotline. While referrals are required to be provided by the employer, it is not required for the employee to access services.

● Prohibit Retaliation: The policy must clearly state that discrimination or retaliation against employees who identify as victims or survivors of gender-based violence is prohibited.

● Comply with Laws: Ensure your policy follows State law. For employers based in New York State, this means that the policy must follow the SAFE Leave Act, New York State Human Rights Law, and any other relevant laws and regulations.

● Offer Implementation Support: OPDV is able to assist employers in developing and implementing this policy. Employers must provide information to supervisors and human resources, where available, about this technical assistance from OPDV. OPDV can be contacted at workplace@opdv.ny.gov.

By submission of this certification, each person signing on behalf of any organization certifies, and in the case of a joint submission each party thereto certifies its own organization, under penalty of perjury, that they have and have implemented a written policy addressing gender-based violence and the workplace.

Organization’s signature below certifies its compliance with State Finance Law §139-M.

Organization: __________________________________________

By (signature): ____________________________________

Name (Please Print): _______________________________

Title: ____________________________________________

Date: ____________________

This form must be signed by an authorized executive or legal representative.

If the organization cannot make the above certification, they must provide a statement with their bid detailing the reasons therefor:

ATTACHMENT Q

Gender-Based Violence and the Workplace Certification

Solicitation Number and Title: 26-036 .

New York State Finance Law §139-M requires bidders on competitive state procurements to certify that they have a written policy addressing gender-based violence and the workplace and that such policy meets the following minimum requirements:

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ATTACHMENT R

Certification Under Executive Order No. 16

Prohibiting State Agencies and Authorities from Contracting with

Businesses Conducting Business in Russia

Executive Order No. 16 provides that “all Affected State Entities are directed to refrain from entering into any new contract or renewing any existing contract with an entity conducting business operations in Russia.” The complete text of Executive Order No. 16 can be found here.

The Executive Order remains in effect while sanctions imposed by the federal government are in effect. Accordingly, vendors who may be excluded from award because of current business operations in Russia are nevertheless encouraged to respond to solicitations to preserve their contracting opportunities in case the sanctions are lifted during a solicitation or even after award in the case of some solicitations.

As defined in Executive Order No. 16, an “entity conducting business operations in Russia” means an institution or company, wherever located, conducting any commercial activity in Russia or transacting business with the Russian Government or with commercial entities headquartered in Russia or with their principal place of business in Russia in the form of contracting, sales, purchasing, investment, or any business partnership.

Is Vendor an entity conducting business operations in Russia, as defined above? Please answer by checking one of the following boxes:

1. No, Vendor does not conduct business operations in Russia within the meaning of Executive Order No. 16.

2. a. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order No. 16 but has taken steps to wind down business operations in Russia or is in the process of winding down business operations in Russia. (Please provide a detailed description of the wind down process and a schedule for completion.)

2.b. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order No. 16 but only to the extent necessary to provide vital health and safety services within Russia or to comply with federal law, regulations, executive orders, or directives. (Please provide a detailed description of the services being provided or the relevant laws, regulations, etc.)

3. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order No. 16.

The undersigned certifies under penalties of perjury that they are knowledgeable about the Vendor’s business and operations and that the answer provided herein is true to the best of their knowledge and belief.

Vendor Name:

(legal entity)

By:

(signature) __________________________________________________________________________________

Name: _________________________________________________________________

Title: ___________________________________________________________________

Date: __________________________________________________________________

Exhibit D-1

Underline