CNY BID FORM.doc

Central New York DDSO- Bid Form

BID FORM

COMPLETE AND RETURN THIS FORM

Central New York Developmental Disabilities Services Office

BID FORM FOR: 7557 ROME-ORISKANY IRA SLAB

THE STATE RESERVES THE RIGHT TO REJECT ANY OR ALL BIDS.

The Undersigned agrees to complete the Work within the time stated in the Specifications.

By Submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his/her knowledge and belief:

1. The prices in this bid have been arrived at independently without collusion, consultation, communication, or agreement, for the purpose of restricting competition as to any matter relating to such prices with any other bidder or with a competitor.

2. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder prior to openings, directly or indirectly or any other bidder or any competitor; and,

3. No attempt has been made or will be made by the bidder to induce any other person, partnership, or corporation to submit or not to submit a bid for the purpose of restricting competition.

4. This contract shall not cause or result in a violation of Section 73(4) of the Public Officers Law which states: “No officer or employee of a state agency, member of the legislature or legislative employee or firm or association of which such person is a member, or corporation, ten percent or more of the stock of which is owned or controlled directly or indirectly by such person, shall sell any goods or services having a value in excess of $25 to any state agency unless pursuant to an award or contract let after public notice and competitive bidding”.

5. This contract shall not cause or result in a violation of Section 74(3)(e) of the Public Officers Law which states: “No officer or employee of a state agency, member of the legislature or legislative employee should engage in any transaction as representative or agency of the State with any business entity in which he has a direct or indirect financial interest that might reasonably tend to conflict with the proper discharge of his official duties”.

6. Executive Order #1 prohibits Central New York DSO employees from any hiring or contracting decisions involving a family member. CNYDSO employees who have a family member hired to complete work for the DSO must formally recuse themselves from all decision making specific to the contract work. Please complete and return the attached Vendor Survey Disclosure Statement with your bid.

BID FORM

BID FORM FOR: 7557 ROME-ORISKANY IRA SLAB

BID AMOUNT: $

Sign Bid Here

(Authorized Signature)

Print Name

Title

Official Company Name

EIN No.:

SSN:

If incorporated)

(if individually owned)

Mailing Address

(Street)

(City)

(State)

(Zip Code)

Telephone:

Fax:

Cell:

NON-COLLUSIVE BIDDING CERTIFICATION

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his knowledge and belief:

1.

The prices in this bid have been arrived at independently without collusion, consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other bidder, or with any competitor.

2.

Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder, and will not knowingly be disclosed by the bidder prior to opening, directly, or indirectly, to any other bidder or to any competitor; and

3.

No attempt has been made or will be made by the bidder to induce any other person, partnership, or corporation to submit or not to submit a bid for the purpose of restricting competition.

I hereby affirm under the penalties of perjury that the foregoing statement is true.

I also acknowledge notice that a false statement made in the foregoing is punishable under Article 20 of the Penal Law.

SIGN HERE:

(Contractor's Signature)

COMPANY NAME:

VENDOR SURVEY DISCLOSURE STATEMENT

Executive Order #1, issued by Governor Spitzer, prohibits Central New York DSO employees from taking part in any hiring decisions or contracting decisions involving a family member. In that regard, any Central New York DSO employee who has a family member hired to complete work for the DSO must formally recuse themselves from all decision making specific to that contract work.

In an effort to ensure that the central New York DSO is able to comply with Executive Order #1 and protect the interest of our employees and contractors, please disclose below the names of any and all family members currently employed by the Central New York DSO. If this does not apply to you, please write “NONE”.

Name

Address

Relationship

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