Enclosure H - Exhibit G-6 Supplier Compliance and Payment Report.pdf
PDF 435 KB Posted
- Attached to
- Construction Manager as Advisor Federal contract opportunity
- Solicitation number
- 459544
- Issued by
- Department of Energy Office of Science
About this file
This is a compliance and payment reporting form (Exhibit G-6) for the New York State Empire State Development's Office of Contractor and Supplier Diversity (OCSD) to track payments made to Minority and Women-Owned Business Enterprises (MWBE) and Service-Disabled Veteran-Owned Businesses (SDVOB) subcontractors.
The form requires contractors to report payment details either monthly or quarterly, including prime contract amounts, subcontractor information, certification status (MBE/WBE/SDVOB), description of services, contract amounts, and payment history. Supporting documentation such as executed contracts, wire transfers, and canceled checks must be attached. The form must be certified by a company officer and submitted to OCSD at 633 Third Avenue in New York or via email to ocsd@esd.ny.gov. The document includes contact information for regional compliance managers who oversee different geographic areas and ESD subsidiaries throughout New York State.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions and Answers RFQ 459544 3_24_2025.pdf | ||
| Questions and Answers RFQ 459544 3_17_2025.pdf | ||
| Questions and Answers RFQ 459544.pdf | ||
| Enclosure C - Quotation Pricing Sheet.docx | DOCX document | |
| Attachment B - BNL-QA-101 459544.pdf | ||
| RFQ Letter 459544.pdf | ||
| Enclosure A - Draft Contract.pdf | ||
| Enclosure B - AMS-FORM-050 - Reps and Certs.pdf | ||
| Enclosure D - ACH Authorization Form.pdf | ||
| Enclosure G - Exhibit G-4 Supplier Utilization Plan.pdf | ||
| Attachment A - Statement of Work 459544.pdf | ||
| Enclosure C - Quotation Pricing Sheet.docx | DOCX document | |
| Enclosure E - Form W-9.pdf | ||
| Enclosure F - Exhibit G-2 Staffing Plan.pdf |
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Text version
OFFICE OF CONTRACTOR AND SUPPLIER DIVERSITY
Exhibit G-6 MWBE AND SDVOB COMPLIANCE AND PAYMENT REPORT
CONTRACTOR/GRANTEE:
ADDRESS:
TOWN/COUNTY/ZIP:
CONTACT PERSON:
TELEPHONE:
EMAIL:
ESD OCSD REPRESENTATIVE:
CONTRACT/PROJECT NAME:
CONTRACT/PROJECT #:
PROJECT START DATE:
PERCENT COMPLETE:
ACTUAL COMPLETION DATE:
REPORTING PERIOD: Monthly for the Month of: (Month) (Year) Quarterly (Check Applicable): Quarter 1 (4/1-6/30) | Quarter 2 (7/1-9/30) | Quarter 3 (10/1-12/31) | Quarter 4 (1/1-3/31)
Attach MWBE and SDVOB executed contracts, wire transfer confirmations and cancelled checks as proof of payment to the identified MWBEs and SDVOBs. This report should be completed and signed by an officer of the Reporting Company. Attach additional sheets if necessary.
PRIME CONTRACTOR, if different from above
(Name, Address, Contact Person, Title and Phone # with area code)
PRIME
CONTRACT
AMOUNT
MWBE or SDVOB
SUBCONTRACTOR
(Name, Address, Contact Person, Title and Phone
# with area code)
NYS
CERTIFICATION
(Check One)
DESCRIPTION OF
SERVICES
CONTRACT
AMOUNT
PAYMENTS
PREVIOUSLY
REPORTED
PAYMENTS
ON
CURRENT
REPORT
TOTAL
PAYMENTS
TO DATE
MBE WBE
SDVOB
CERTIFICATION: I, (Print Name), the (Title) of the Reporting Company above, do certify that (i) I have read this Compliance Report and (ii) to the best of my knowledge, information and belief, the information contained herein is complete and accurate.
SIGNATURE: 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.
OFFICE OF CONTRACTOR AND SUPPLIER DIVERSITY
Exhibit G-6 MWBE AND SDVOB COMPLIANCE AND PAYMENT REPORT
SUBMIT REPORT TO: Office of Contractor and Supplier Diversity Empire State Development 633 Third Avenue, 35th Floor New York, NY 10017
Completed forms may be emailed directly to OCSD at ocsd@esd.ny.gov. All email submissions must include ESD’s project/contract number(s), and the name and contact information of the individual or firm submitting the information.
QUESTIONS? Please contact the OCSD’s Compliance Managers or email the office at ocsd@esd.ny.gov.
Danielle Adams Danah Alexander Geraldine Ford Denise Ross Jordan Lopez Jazmin Thomas
(518) 292-5187 (212) 803-3244 (716) 846-8205 (212) 803-3226 (212) 803-3109 (212) 803-3571 Danielle.Adams@esd.ny.gov Danah.Alexander@esd.ny.gov Geraldine.Ford@esd.ny.gov Denise.Ross@esd.ny.gov Jordan.Lopez@esd.ny.gov Jazmin.Thomas@esd.ny.gov
R E G I O N S :
Capital District North Country Finger Lakes Mid-Hudson Central NY ESD Procurement Mohawk Valley NYC- Brooklyn, Bronx, Western New York NYC- Manhattan, Southern Tier Contracts SUNY Poly Portfolio Queens ESD Subsidiaries – Staten Island ESD Subsidiary – ESD Subsidiaries – CCDC, Department of Economic Development
Long Island ESD Subsidiaries – HCDC, MSDC
ECHDC, USA Niagara AYCDC QWDC, LMDC, ESNMC mailto:ocsd@esd.ny.gov mailto:ocsd@esd.ny.gov mailto:Danielle.Adams@esd.ny.gov mailto:Danah.Alexander@esd.ny.gov mailto:Geraldine.Ford@esd.ny.gov mailto:Denise.Ross@esd.ny.gov mailto:Jordan.Lopez@esd.ny.gov mailto:Jazmin.Thomas@esd.ny.gov
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