3 Procurement Lobbying Act.pdf
PDF 174 KB Posted
- Solicitation number
- 2138980
- Issued by
- Albany County, Albany City, New York
About this file
This is a Procurement Lobbying Act Certification Form issued by the New York State Department of Transportation (NYSDOT) in connection with a road salt strategic reserves procurement solicitation for Regions 1, 3, 5, 7, and 9. The form requires offerers to disclose their entity name and address, and to certify compliance with New York State Finance Law 139-j regarding permissible contacts during the procurement process. Strategic reserves of road salt must be physically available on or before January 1, 2027, and shall be dedicated exclusively for NYSDOT use. The Department will begin placing orders for delivery from these reserves as needed to various NYSDOT locations within each region, with all road salt deliveries completed by the end of March 2027. Interested business entities should contact NYSDOT's Purchasing Office at Purch-Assist@dot.ny.gov or (518) 457-4401 to request the Invitation for Bids (IFB) package, which contains complete details regarding the solicitation, method of award, bidder qualifications, and scope of work.
The certification form requires offerers to disclose any prior government findings of non-responsibility within the previous four years, including determinations based on violations of State Finance Law 139-j or the intentional provision of false or incomplete information to a government entity. Offerers must also disclose any terminations or withholding of procurement contracts due to intentional provision of false or incomplete information. By signing the form, offerers affirm their understanding of and agreement to comply with NYSDOT procedures regarding permissible contacts as required by State Finance Law 139-j(3) and 139-j(6)(b). Due to statutory restrictions on procurement lobbying, no NYSDOT employee may disclose any material information related to this procurement to persons outside the agency prior to public release of the IFB.
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Text version
NEW YORK STATE DEPARTMENT OF TRANSPORTATION
PROCUREMENT LOBBYING ACT CERTIFICATION FORM
Offerer Disclosure of Prior Non-Responsibility Determina�ons and Understanding and Agreement to Comply
PART 1 - NAME AND ADDRESS OF INDIVIDUAL OR ENTITY SEEKING TO ENTER INTO THE PROCUREMENT CONTRACT
ENTITY NAME: ________________________________________
ADDRESS: ________________________________________
Part 2 – DISCLOSURE OF PRIOR NON-RESPONSIBILITY DETERMINATIONS
2. Has any government En�ty made a finding of non-responsibility regarding the individual or en�ty seeking to enter into the Procurement Contract in the previous four years?
If YES, please also answer ques�ons 2-4. If NO, skip to ques�on 6. Yes No
3. Was the basis for the finding of non-responsibility due to a viola�on of State Finance Law §139-j? Yes No
4. Was the basis for the finding of non-responsibility due to the inten�onal provision of false or incomplete informa�on to a Government En�ty? Yes No
5. If you answered YES to any of the above ques�ons, please provide details regarding the funding of non-responsibility below:
Government En�ty:
Date of Finding of Non-Responsibility:
Basis of Finding of Non-Responsibility:
(attach additional pages as necessary to provide sufficient detail)
6. Has any Governmental En�ty or other Governmental agency terminated or withheld a
Procurement Contract with the individual or en�ty seeking to enter into the Procurement Contract due to the inten�onal provision of false or incomplete informa�on? Yes No
7. If you answered YES to any of the above ques�ons, please provide details regarding the funding of non-responsibility below:
Government En�ty:
Date of Termina�on or Withholding of Contract::
Basis of Termina�on or Withholding:
(attach additional pages as necessary to provide sufficient detail)
Part 3 – AFFIRMATION of UNDERSTANDING and AGREEMENT TO COMPLY Offerer affirms this _____ day of _________________, 20__ that it understands and agrees to comply with the procedures of the Government En�ty rela�ve to permissible contacts as required by State Finance Law §139-j(3) and §139-j(6)9b).
Business En�ty Name and Address:
By (signature) ______________________________________________ Date: ___________________ Print Name and Title: _________________________________________________________________
Contract/Procurement #
| ContractProcurement: |
| Yes: Off |
| No: Off |
| Yes_2: Off |
| No_2: Off |
| Yes_3: Off |
| No_3: Off |
| Yes_4: Off |
| No_4: Off |
| day of: |
| Print Name and Title: |
| Date: |
| Text1: |
| Text2: |
| Text3: |
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