Appendix SDVOB-3 - Application for Waiver of SDVOB Participation Goal.pdf
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This is an Application for Waiver of SDVOB Participation Goal form issued by the New York State Department of Labor's Purchase & Contracts Division and SDVOB Administrator office, located at the Harriman State Office Campus in Albany, New York. The form is designed for contractors to request a waiver of the Service-Disabled Veteran-Owned Business (SDVOB) participation goal, which is set at 6 percent for applicable contracts. Contractors may request either a full or partial waiver of the SDVOB participation requirement and must provide the solicitation or contract number and basic company information, including the contractor's legal name, Federal Identification Number, street address, email address, city, state, zip code, and telephone number.
To support a waiver application, contractors must submit comprehensive supporting documentation demonstrating good faith efforts to meet SDVOB goals, including copies of solicitations sent to certified SDVOBs and any responses received, detailed explanations for why each responding SDVOB was not selected, dates of any pre-bid or pre-award meetings attended with certified SDVOBs identified by the Department of Labor as capable of fulfilling contract goals, descriptions of specific steps taken to structure the contract scope of work to facilitate subcontracting with or obtaining supplies from certified SDVOBs, and any other relevant information supporting the request. The contractor's authorized representative must certify by signature that good faith efforts have been made to promote SDVOB participation. The Department of Labor reviews the application and issues a determination granting a full waiver, granting a partial waiver with a revised SDVOB goal percentage, or denying the waiver request. Failure to submit complete and accurate information may result in findings of noncompliance, non-responsibility, and suspension or termination of the contract.
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Text version
SDVOB 200 (10/20) Page 1 of 2
Purchase & Contracts, SDVOB Administrator Harriman State Office Campus, Building 12, Room 465 Albany, NY 12240 Phone: (518) 474-2678 | Labor.sm.SDVOBAdmin@labor.ny.gov
Application for Waiver of SDVOB Participation Goal
Section 1: Basic Information
Contractor’s Name: Federal Identification No.:
Street Address: E-mail address:
City, State, Zip Code: Telephone No.: ( ) -
Solicitation/Contract No.: SDVOB Contract Goals
6%
Section 2: Type of Waiver Requested
Total Partial If partial waiver, please enter the revised SDVOB percentage: %
Please explain the reason for the waiver request:
Section 3: Supporting Documentation
Provide the following documentation as evidence of your good faith efforts to meet the SDVOB goals set forth in the contract and in support of your waiver application:
Attachment A. Copies of solicitation to certified SDVOB and any responses thereto.
Attachment B. Explanation of the specific reasons each SDVOB that responded to Bidders/Contractors’ solicitation was not selected.
Attachment C Dates of any pre-bid, pre-award or other meetings attended by Contractor, if any, scheduled by the Department of Labor with certified SDVOBs whom the Department of Labor determined were capable of fulfilling the SDVOB goals set in the contract.
Attachment D. Information describing the specific steps undertaken to reasonably structure the contract scope of work for the purposes of subcontracting with, or obtaining supplies from certified SDVOBs.
Attachment E. Other information deemed relevant to the request.
Section 4: Signature and Contact Information
By signing and submitting this form, the contractor certifies that a good faith effort has been made to promote SDVOB participation pursuant to the SDVOB requirements set forth under the solicitation or Contract. Failure to submit complete and accurate information may result in a finding of noncompliance, non-responsibility, and a suspension or termination of the contract.
Prepared by (signature): Date:
Name and title of preparer (print):
For Department of Labor Use Only
Solicitation/Contract No.:
Appendix SDVOB-3
SDVOB 200 (10/20) Page 2 of 2
Reviewed By: Date:
Decision:
Full SDVOB waiver Granted
Partial SDVOB waiver Granted; revised SDVOB goal: %
SDVOB waiver Denied
Approved By: Date:
Date Notice of Determination Sent:
Comments:
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