Enclosure H - Exhibit G-6 Supplier Compliance and Payment Report.pdf
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- Attached to
- Construction Manager as Advisor
- Solicitation number
- 2119585
- Issued by
- New York
About this file
This is a Minority and Women-Owned Business Enterprise (MWBE) and Service-Disabled Veteran-Owned Business (SDVOB) Compliance and Payment Report form issued by the New York State Office of Contractor and Supplier Diversity (OCSD) under Empire State Development (ESD). The form is designed for contractors and grantees to document their compliance with MWBE and SDVOB subcontracting requirements on state-funded projects. Contractors must complete the report on a monthly or quarterly basis, with quarterly periods defined as Quarter 1 (April 1–June 30), Quarter 2 (July 1–September 30), Quarter 3 (October 1–December 31), and Quarter 4 (January 1–March 31). The form requires submission of executed contracts, wire transfer confirmations, and cancelled checks as proof of payment to identified MWBEs and SDVOBs, and must be certified by an officer of the reporting company as complete and accurate.
The report captures essential payment data including prime contract amounts, subcontractor names and certifications (MBE, WBE, or SDVOB), descriptions of services provided, contract amounts, payments previously reported, current period payments, and cumulative payment totals. Completed forms must be submitted to the OCSD at the Empire State Development office located at 633 Third Avenue, 35th Floor, New York, NY 10017, with submissions accepted via email at ocsd@esd.ny.gov. The OCSD maintains compliance managers across multiple New York regions and can be reached at phone numbers and email addresses specific to regional assignments. Failure to submit complete and accurate information may result in findings of noncompliance, non-responsibility, contract suspension, or termination.
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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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