Appendix SDVOB-1.pdf

SDVOB 100 (01/18) Page 1 of 2

Purchase & Contracts, SDVOB Administrator Harriman State Office Campus, Building 12, Room 465

Albany, NY 12240 Phone: (518) 474-2678 | Fax: (518) 457-0620

Labor.sm.SDVOBAdmin@labor.ny.gov

SDVOB UTILIZATION PLAN Initial Plan Revised plan Contract/Solicitation #

INSTRUCTIONS: This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each NYS Certified Service-Disabled Veteran-Owned Business (SDVOB) under the contract. By submission of this Plan, the Bidder/Contractor commits to making good faith efforts in the utilization of SDVOB subcontractors and suppliers as required by the SDVOB goals contained in the Solicitation/Contract. Making false representations or providing information that shows a lack of good faith as part of, or in conjunction with, the submission of a Utilization Plan is prohibited by law and may result in penalties including, but not limited to, termination of a contract for cause, loss of eligibility to submit future bids, and/or withholding of payments. Firms that do not perform commercially useful functions may not be counted toward SDVOB utilization. Attach additional sheets if necessary.

BIDDER/CONTRACTOR INFORMATION SDVOB Goals In Contract Bidder/Contractor Name: NYS Vendor ID: %

Bidder/Contractor Address (Street, City, State and Zip Code):

Bidder/Contractor Telephone Number: Contract Work Location/Region:

Contract Description/Title:

CONTRACTOR INFORMATION

Prepared by (Signature): Name and Title of Preparer: Telephone Number: Date:

Email Address:

If unable to meet the SDVOB goals set forth in the solicitation/contract, bidder/contractor must submit a request for waiver on the SDVOB Waiver Form.

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

NYS CERTIFIED SDVOB SUBCONTRACTOR/SUPPLIER INFORMATION: The directory of New York State Certified SDVOBs can be viewed at: https://online.ogs.ny.gov/SDVOB/search Note: All listed Subcontractors/Suppliers will be contacted and verified by the Department of Labor.

FOR Department of Labor USE ONLY

DOL Authorized Signature: Accepted Accepted as Noted Notice of Deficiency

Name (Please Print): SDVOB %/$ Date Received: Date Processed:

Comments:

Appendix SDVOB-1

SDVOB 100 (01/18) Extra Page Page 2 of 2

ADDITIONAL SHEET

Bidder/Contractor Name: Contract/Solicitation #

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform)): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %