Exhibit A - Form of Offerer Disclosure.docx
DOCX document 36 KB Posted
- Solicitation number
- 1669A
- Issued by
- Suffolk County, New York
About this file
Exhibit A is a Form of Offerer Disclosure document from the Suffolk County Water Authority (SCWA) in New York, related to a Radio Frequency (RF) Consulting Services contract (RFP No. 1669A). The procurement seeks a consultant to design and field test a new wireless communications network for the existing SCADA system throughout Suffolk County. Key submission details include an electronic bid deadline of December 16, 2025, at 11:00 a.m. EST via www.BidNetDirect.com/new-york, and a mandatory pre-bid conference on November 19, 2025, at 10:00 a.m. at the SCWA Production Control building in Bayshore, NY. Attendance at the pre-bid conference is critical, with non-attendance potentially resulting in bid disqualification.
The document emphasizes that Disadvantaged Business Enterprises (DBEs) are encouraged to participate in the bidding process. While specific budget details are not provided, the project appears to be a significant technology investment requiring specialized expertise in radio frequency design, wireless network engineering, and integration with existing water authority communication systems. The RFP is issued directly by Jeffrey W. Szabo, CEO of SCWA, and indicates a formal procurement process for critical infrastructure technology. Bidders must demonstrate technical proficiency in RF consulting, wireless network design, and the ability to field test and implement complex communication systems for municipal water infrastructure.
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Other files
| File | Type | Posted |
|---|---|---|
| Appendix A - Pump Stations.pdf | ||
| EXHIBIT A1 - SCWA Disclosure Form.docx | DOCX document | |
| EXHIBIT E - 1669A.docx | DOCX document | |
| RFP 1669A - Appendix A - Pump Station and Tank Database R1.xlsx | XLSX spreadsheet | |
| Request for Proposal.pdf | ||
| Subcontractor Insurance Agreement (If Applicable).docx | DOCX document | |
| Appendix A - Tanks and Towers.pdf | ||
| EXHIBIT B - Affirmation of Understanding and Compliance.docx | DOCX document | |
| EXHIBIT C - Insurance Carriers or Agents Acknowledgment Form.docx | DOCX document | |
| EXHIBIT D - Contact Information.docx | DOCX document | |
| Exhibit F - Proposer Acknowledgment Form.docx | DOCX document | |
| RFP 1669 - Appendix B - Combined Drawings.pdf | ||
| RFP 1669A - Appendix C - FCC Licenses.xlsx | XLSX spreadsheet |
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Text version
EXHIBIT A
FORM OF OFFERER DISCLOSURE OF
PRIOR NON-RESPONSIBILITY DETERMINATION
Contract No. _______
Name of Individual or Entity Seeking to Enter into the Procurement Contract:
Address:
Name and Title of Person Submitting this Form:
Contract Procurement Number:
Date:
1. Has any Government Entity made a finding of non-responsibility regarding the individual or entity seeking to enter into the Procurement Contract in the previous four years?
(Please circle): No Yes
If yes, please answer questions 2 thru 4.
2. Was the basis for the finding of non-responsibility due to a violation of State Finance Law 139-j?
(Please circle): No Yes
3. Was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a Government Entity?
(Please circle): No Yes
4. If you answered yes to any of the above questions, please provide details regarding the finding of non-responsibility below.
Governmental Entity:
Date of Finding of Non-Responsibility:
Basis of Finding of Non-Responsibility:
(Add additional information on reverse if necessary) All question must be answered.
| 5. | Has any Governmental Entity or other governmental agency terminated or withheld a Procurement Contract with the above-named individual or entity due to the intentional provision of false or incomplete information? | |
| (Please circle): | No | Yes |
If yes, please provide details below:
Governmental Entity:
Date of Termination or Withholding of Contract:
Basis of Termination or Withholding:
(Add additional information on reverse as necessary)
6. Has any agency, including, but not limited to, the New York State Department of Labor, found you to be in violation of, or are you currently under investigation for, failure or the alleged failure to comply with the laws, rules or regulations requiring you to pay prevailing wage and supplements for any public work you or your firm has performed, for the failure or the alleged failure to comply with the laws, rules or regulations concerning the employment of children, or the failure or alleged failure to pay wages, or unemployment insurance tax payments within the past five years?
(Please Circle) No Yes
7. Has any agency, such as a local or state government entity or the federal government debarred your firm?
(Please Circle) No Yes
If yes, please provide details concerning the disbarment.
Offerer certifies that all information provided to the Suffolk County Water Authority with respect to State Finance Law 139-k is complete, true, and accurate.
By: Date:
Signature:
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