3-Disclosure and Certification with respect to State Finance Law ��139-j and 139-k.pdf
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- Solicitation number
- RFP-RCC-2026-002
- Issued by
- Rockland County, New York
About this file
This is a Disclosure and Certification Form C related to New York State Finance Law 139-j and 139-k requirements for the Food Service Program contract opportunity at SUNY Rockland/Rockland Community College administered by the County of Rockland Purchasing Division. The form serves as a compliance document for offerers to disclose any prior determinations of non-responsibility or contract terminations by governmental entities within the previous four years that were based on violations of State Finance Law 139-j or the intentional provision of false or incomplete information. Offerers must certify the completeness, truthfulness, and accuracy of all information provided regarding their compliance with applicable state finance laws.
The form requires offerers to respond to two primary disclosure questions: whether a governmental entity has made a determination of non-responsibility against the offerer in the previous four years, and whether a governmental entity has terminated or withheld a procurement contract due to violations of State Finance Law 139-j or provision of false information. For any affirmative responses, offerers must provide specific details including the name of the governmental entity, date of the finding or termination, and basis for the action. Completion and signature of this certification form is mandatory for offerers submitting proposals for the food service program contract.
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FORM C
Disclosure and Certification with respect to State Finance Law §§139-j and 139-k
Procurement Description/ID No._______________________
1. Has a Governmental Entity, as defined in State Finance Law §139-j(1)(a), made a determination of non-responsibility with respect to the Offerer within the previous four years where such finding was due to a violation of State Finance Law §139-j or the intentional provision of false or incomplete information with respect to previous determinations of non-responsibility?
No ___ Yes ___
If yes, provide the following details:
Governmental Entity which made the finding:
Date of finding:
Basis of finding:
2. Has a Governmental Entity terminated or withheld a procurement contract with the Offer because of violations of State Finance Law §139-j or the intentional provision of false or incomplete information with respect to previous determinations of non-responsibility?
No ___ Yes ___
If yes, identify the following:
Governmental Entity which terminated the contract:
Date of contract termination or withholding:
Identify the related procurement contract:
Offerer CERTIFIES that all information provided by Offerer with respect to its compliance with State Finance Law §§139-j and 139-k is complete, true and accurate.
Name of Offerer:
Address:
Signature of Person Submitting Form: _________________________________ Name:
Title:
Date:
3/16/26, 9:25 AM Disclosure and Certification with respect to State Finance Law ��139-j and 139-k https://www.suny.edu/sunypp/documents.cfm?doc_id=283 1/1 https://www.suny.edu/sunypp/index.cfm https://www.suny.edu/sunypp/index.cfm javascript:window.print() javascript:window.print() javascript:window.close() javascript:window.close() https://www.suny.edu/SUNYPP/pdf.cfm?doc_id=283 https://www.suny.edu/SUNYPP/pdf.cfm?doc_id=283
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