Appendix SDVOB-2 - SDVOB Monthly Compliance Report.pdf

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Attached to
Statewide Workforce Lifecycle Tracking System for Infrastructure Projects (NY Builds)
Solicitation number
2140589
Issued by
New York

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This is an SDVOB Monthly Compliance Report form issued by the New York State Department of Labor, Purchase and Contracts division, SDVOB Administrator. The form serves as a template for contractors to report their monthly compliance with Service-Disabled Veteran-Owned Business (SDVOB) utilization goals on state contracts. The report is due on the 10th day of each month and documents the preceding month's activity as evidence of progress toward achieving contractual SDVOB goals. Contractors must complete the form with their company information, contract number, and project description, along with the percentage SDVOB goal established for their specific contract.

The compliance report requires contractors to list all SDVOB firms engaged during the reporting period, including firm name, address, phone number, federal identification number, description of work or supplies provided, the designation type (sub, broker, joint venture, written contract, supplier team, or other), and payment amounts. Contractors must indicate whether each SDVOB firm has a written contract and report payment made that month and total contract amounts. Submission of the completed and accurate form is mandatory, and failure to provide complete information may result in findings of noncompliance, non-responsibility determination, contract suspension, or termination. The form includes certification language requiring the contractor's authorized representative to sign and date the submission.

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SDVOB 101 (01/18) Page 1 of 1

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

465 Albany, NY 12226 Phone: (518) 474-2678 | Fax: (518) 457-0620

Labor.sm.SDVOBAdmin@labor.ny.gov

SDVOB Monthly Compliance Report Contract No.

The SDVOB Monthly Compliance Report is due on the 10th day of each month for the preceding month’s activity as evidence towards achievement of the SDVOB goals on the contract. Submit the completed form to the address above.

Contractor/Vendor Name, Address and Phone No.:

Contractor/Vendor Federal ID No.: SDVOB Goals Reporting Period Description of Project:

Month Year

Firm Name, Address and Phone Number (List All Firms)

Description of Work or Supplies Provided Designation Payment This Month Contract Amount

SDVOB

Sub Broker Joint Venture Written Contract

Supplier Team Other No Written Contract

Federal ID No.: No Payment This Month

SDVOB

Sub Broker Joint Venture Written Contract

Supplier Team Other No Written Contract

Federal ID No.: No Payment This Month

SDVOB

Sub Broker Joint Venture Written Contract

Supplier Team Other No Written Contract

Federal ID No.: No Payment This Month

Signature Print Name and Title Date Submission of this form constitutes the Contractor’s acknowledgement as to the accuracy of the information contained herein. Failure to submit complete and accurate information may result in a finding of noncompliance, non-responsibility, suspension and/or termination of the Contract.

For Department of Labor Use Only Reviewed By: Date:

Appendix SDVOB-2

File details come from the government source that posted it. Updated .