amendment 10 with attachments.pdf

(x)

F11SOL10032

x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

OCON

Washington DC 20013-7012

MRC 1200

P.O. BOX 37012

OCON

OCON

Washington DC 20013-7012

MRC 1200

P.O. BOX 37012

SMITHSONIAN INSTITUTION

06/08/2011000010

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

06/08/2011

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This is amendment number ten to Solicitation Number F11SOL10032.

I. Request for Proposal F11SOL10032 is hereby amended as Follows:

A. The following Clause is hereby added:

H.23.2 Grant Agreement Information

In addition to the requirements outlined in Section H.23.1, Contractor shall be required to complete or assist, as the case may be, in the completion of the following documents (note that some of these requirements are in addition to similar requirements outlined herein.

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

Dorothy A. Leffler

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 42

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

F11SOL10032/000010

Smithsonian, in its own discretion may adopt the

Grant related documents in lieu of its own required documents (e.g. Pay Applications and

Bonding documents) However, at the drafting of this Contract, Contractor shall be expected to complete all documents required):

1. Performance Bond (See J.17);

2. Payment Bond (See J.18);

3. Doing Business Data Form (See J.19);

4. Payment Requisition (See J.20);

5. Request for Approval of Subcontractor (See

J.21);

6. Division of Labor Services (See J.22); and

7. Cultural Capital Grant - M/WBE Participation

Goals and Status report (See J.23)

B. Section J shall be amended by the addition of the following attachments:

J.17. Performance Bond

J.18. Payment Bond

J.19. Doing Business Data Form

J.20. Payment Requisition

J.21. Request for Approval of Subcontractor

J.22 Division of Labor Services

J.23. Cultural Capital Grant - M/WBE

Participation Goals and Status report

II. All Oferrors shall be permitted until August

19, 2011 at 3:00PM to amend their proposals to address any changes caused by this Amendment. If no amendment is received, it shall be presumed that the previously submitted offer remains unchanged.

III. All remaining aspects of RFP F11SOL10032 shall remain unchanged.

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

NEW YORK CITY PERFORMANCE BOND GREATER THAN $5 MILLION

PERFORMANCE BOND

KNOWN ALL MEN BY THESE PRESENTS. That we,_______________________________________ hereinafter referred to as the "Principal," and,__________________________________________________ hereinafter referred to as the "Surety" ("Sureties") are held and firmly bound to THE CITY OF NEW YORK, hereinafter referred to as the "City" or to its successors and assigns in the penal sum of___________

($ ___________________ ) Dollars, lawful money of the United States for the payment of which said sum of money well and truly to be made, we, and each of us, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, The Principal is about to enter, or has entered, into a Contract in writing with the City for a copy of which Contract is annexed to and hereby made a part of this bond as though herein set forth in full;

NOW, THEREFORE, the conditions of this obligation are such that if the Principal, his or its representatives or assigns, shall well and faithfully perform the said Contract and all modifications, amendments, additions and alterations thereto that may hereafter be made, according to its terms and its true intent and meaning, including repair and or replacement of defective work and guarantees of maintenance for the periods stated in the Contract, and shall fully indemnify and save harmless the City from all cost and damage which it may suffer by reason of failure so to do, and shall fully reimburse and repay the City for all outlay and expense which the City may incur in making good any such default and

J.17 shall protect the said City of New York against, and pay any and all amounts, damages, cost and judgments which may or shall be recovered against said City or its officers or agents or which the said City of New York may be called upon to pay any person or corporation by reason of any damages arising or growing out of the doing of said work, or the repair or maintenance thereof, or the manner of doing the same, or the neglect of the said PRINCIPAL or his (their, its) agents or servants, or the improper performance of the said work by the said PRINCIPAL, or his (their, its) agents or servants, or the infringement of any patent or patent rights by reason of the use of any materials furnished or work done as aforesaid or otherwise, then this obligation shall be null and void, otherwise to remain in full force and effect.

The Surety (Sureties), for value received, hereby stipulates and agrees, if requested to do so by the City, to fully perform and complete the Work to be performed under the Contract, pursuant to the terms, conditions, and covenants thereof, if the City determines that the Principal, for any cause, has failed or neglected to fully perform and complete such Work. The Surety (Sureties) further agrees to commence and diligently perform the Work specified in the Contract, including physical site work, within twenty-five (25) business days after written notice thereof from the City and to complete all Work within such time as the City may fix. The Surety and the City reserve all rights and defenses each may have against the other; provided, however, that the Surety expressly agrees that its reservation of rights shall not provide a basis for non-performance of its obligation to commence and to complete all Work as provided herein.

The Surety (Sureties), for values received, for itself and its successors and assigns, hereby stipulates and agrees that the obligation of said Surety (Sureties) and its bond shall be in no way impaired or affected by any extension of time, modification, omission, addition, or change in or to the said Contract or the Work to be performed thereunder, or by any payment thereunder before the time required therein, or by any waiver of any provisions thereof, or by any assignment, subletting or other transfer thereof or of any Work to be performed or any moneys due or to become due thereunder; and said Surety (Sureties) does hereby waive notice of any and all of such extensions, modifications, omissions, additions, changes, payments, waivers, assignments, subcontracts and transfers, and hereby expressly stipulates and agrees that any and all things done and omitted to be done by and in relation to assignees, subcontractors, and other transferees shall have the same effect as to said Surety (Sureties) as though done or omitted to be done by or in relation to said Principal.

IN WITNESS WHEREOF, The Principal and the Surety (Sureties) have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereunto affixed and these presents to be signed by their proper officers, this day of 20 .

(Seal) (L.S.)

Principal

By .

(Seal) Surety

By .

(Seal) Surety

Bond Premium Rate .

Bond Premium Cost .

If the Contractor (Principal) is a partnership, the bond should be signed by each of the individuals who are partners.

If the Contractor (Principal) is a corporation, the bond should be signed in its correct corporate name by a duly authorized officer, agent, or attorney-in-fact.

There should be executed an appropriate number of counterparts of the bond corresponding to the number of counterparts of the Contract.

ACKNOWLEDGMENT OF PRINCIPAL IF A CORPORATION

State of _________________________County of_______________________________ss:

On this__ day of 20 before me personally came___________________________ to me known, who, being by me duly sworn did depose and say that he/she resides at___________________ _____________________________________________that he/she is the ________________________of the corporation described in and which executed the foregoing instrument; that he knows the seal of said corporation; that one of the seals affixed to said instrument is such seal; that it was so affixed by order of the directors of said corporation, and that he signed his name thereto by like order.

Notary Public or Commissioner of Deeds.

ACKNOWLEDGMENT OF PRINCIPAL IF A PARTNERSHIP

State of _________________________County of_______________________________ss:

On this__ day of 20 before me personally came___________________________ to me known, who, being by me duly sworn did depose and say that he/she resides at___________________ _____________________________________________that he/she is the ________________________of the corporation described in and which executed the foregoing instrument; that he knows the seal of said corporation; that one of the seals affixed to said instrument is such seal; that it was so affixed by order of the directors of said corporation, and that he signed his name

ACKNOWLEDGMENT OF PRINCIPAL IF AN INDIVIDUAL

State of _________________________County of_______________________________ss:

On this__ day of 20 before me personally came___________________________ to me known, who, being by me duly sworn did depose and say that he/she resides at___________________

_____________________________________________that he/she is the ________________________of the corporation described in and which executed the foregoing instrument; that he knows the seal of said corporation; that one of the seals affixed to said instrument is such seal; that it was so affixed by order of the directors of said corporation, and that he signed his name

Affix Acknowledgments and justification of Sureties

PAYMENT BOND 1

PAYMENT BOND

KNOW ALL MEN BY THESE PRESENTS, That we, _______________________________ hereinafter referred to as the "Principal", and ______________________________________________ hereinafter referred to as the "Surety" ("Sureties") are held and firmly bound to THE CITY OF NEW YORK, hereinafter referred to as the "City" or to its successors and assigns, in the penal sum of

($____________) Dollars, lawful money of the United States, for the payment of which said sum of money well and truly to be made, we, and each of us, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the Principal is about to enter, or has entered, into a Contract in writing with the City for a copy of which Contract is annexed to and hereby made a part of this bond as though herein set forth in full;

J.18

PAYMENT BOND 2

NOW, THEREFORE, the conditions of this obligation are such that if the Principal, his or its representatives or assigns and other Subcontractors to whom Work under this Contract is sublet and his or their successors and assigns shall promptly pay or cause to be paid all lawful claims for:

(a) Wages and compensation for labor performed and services rendered by all persons engaged in the prosecution of the Work under said Contract, and any amendment or extension thereof or addition thereto, whether such persons be agents, servants or employees of the Principal or any such Subcontractor, including all persons so engaged who perform the work of laborers or mechanics at or in the vicinity of the site of the Project regardless of any contractual relationship between the Principal or such Subcontractors, or his or their successors or assigns, on the one hand and such laborers or mechanics on the other, but not including office employees not regularly stationed at the site of the Project; and

(b) Materials and supplies (whether incorporated in the permanent structure or not), as well as teams, fuels, oils, implements or machinery furnished, used or consumed by said Principal or any Subcontractor at or in the vicinity of the site of the Project in the prosecution of the Work under said Contract and any amendment or extension thereof or addition thereto; then this obligation shall be null and void, otherwise to remain in full force and effect.

This bond is subject to the following additional conditions, limitations and agreements:

(a) The Principal and Surety (Sureties) agree that this bond shall be for the benefit of any materialmen or laborer having a just claim, as well as the City itself.

(b) All persons who have performed labor, rendered services or furnished materials and supplies, as aforesaid, shall have a direct right of action against the Principal and his, its or their successors and assigns, and the Surety (Sureties) herein, or against either or both or any of them and their successors and assigns. Such persons may sue in their own name, and may prosecute the suit to judgment and execution without the necessity of joining with any other persons as party plaintiff.

(c) The Principal and Surety (Sureties) agree that neither of them will hold the City liable for any judgment for costs or otherwise, obtained against either or both of them by a laborer or materialman in a suit brought by either a laborer or materialman under this bond for moneys allegedly due for performing work or furnishing material.

PAYMENT BOND 3

(d) The Surety (Sureties) or its successors and assigns shall not be liable for any compensation recoverable by an employee or laborer under the Workmen's Compensation Law.

(e) In no event shall the Surety (Sureties), or its successors or assigns, be liable for a greater sum than the penalty of this bond or be subject to any suit, action or proceeding hereon that is instituted by any person, firm, or corporation hereunder later than two years after the complete performance of said Contract and final settlement thereof.

The Principal, for himself and his successors and assigns, and the Surety (Sureties), for itself and its successors and assigns, do hereby expressly waive any objection that might be interposed as to the right of the City to require a bond containing the foregoing provisions, and they do hereby further expressly waive any defense which they or either of them might interpose to an action brought hereon by any person, firm or corporation, including Subcontractors, materialmen and third persons, for work, labor, services, supplies or material performed rendered, or furnished as aforesaid upon the ground that there is no law authorizing the City to require the foregoing provisions to be placed in this bond.

And the Surety (Sureties), for value received, for itself and its successors and assigns, hereby stipulates and agrees that the obligation of said Surety (Sureties) and its bond shall be in no way impaired or affected by any extension of time, modification, omission, addition, or change in or of the said Contract or the Work to be performed thereunder, or by any payment thereunder before the time required therein, or by any waiver of any provisions thereof, or by any assignment, subletting or other transfer thereof or of any part thereof, or of any Work to be performed, or any moneys due to become due thereunder; and said Surety (Sureties) does hereby waive notice of any and all of such extensions, modifications, omissions, additions, changes, payments, waivers, assignments, subcontracts and transfers, and hereby expressly stipulates and agrees that any and all things done and omitted to be done by and in relation to assignees, Subcontractors, and other transferees shall have the same effect as to said Surety (Sureties) as though done or omitted to be done or in relation to said Principal.

PAYMENT BOND 4

IN WITNESS WHEREOF, the Principal and the Surety (Sureties) have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereunto affixed and these presents to be signed by their proper officers, this _____________ day of ___________, (Seal) ______________________________(L.S.)

Principal

By:______________________________

(Seal) _________________________________

By: ______________________________

BOND PREMIUM RATE: __________________

BOND PREMIUM COST: __________________

If the Contractor (Principal) is a partnership, the bond should be signed by each of the individuals who are partners.

If the Contractor (Principal) is a corporation, the bond should be signed in its correct corporate name by a duly authorized officer, agent, or attorney-in-fact.

There should be executed an appropriate number of counterparts of the bond corresponding to the number of counterparts of the Contract.

PAYMENT BOND 5

ACKNOWLEDGMENT OF PRINCIPAL, IF A CORPORATION

State of __________________ County of ______________ ss:

On this ________ day of __________, before me personally came _______________________________ to me known, who, being by me duly sworn did depose and say that he resides at ___________________ ________________________________________that he is the _________________________________ of the corporation described in and which executed the foregoing instrument; that he knows the seal of said corporation; that one of the seals affixed to said instrument is such seal; that it was so affixed by order of the directors of said corporation, and that he signed his name thereto by like order.

Notary Public or Commissioner of Deeds

ACKNOWLEDGMENT OF PRINCIPAL, IF A PARTNERSHIP

On this _______ day of ____________, before me personally appeared ___________________________ to me known, and known to me to be one of the members of the firm of ___________________________ _________________________described in and who executed the foregoing instrument; and he acknowledged to me that he executed the same as and for the act and deed of said firm.

ACKNOWLEDGMENT OF PRINCIPAL, IF AN INDIVIDUAL

On this ________ day of ___________, before me personally appeared ___________________________ to me known, and known to me to be the person described in and who executed the foregoing instrument;

and acknowledged that he executed the same.

Each executed bond should be accompanied by: (a) appropriate acknowledgments of the respective parties; (b) appropriate duly certified copy of Power of Attorney or other certificate of authority where bond is executed by agent, officer or other representative of Principal or Surety; (c) a duly certified extract from By-Laws or resolutions of Surety under which Power of Attorney or other certificate of authority of its agent, officer or representative was issued, and (d) a duly certified copy of latest published financial statement of assets and liabilities of Surety.

Affix Acknowledgments and Justification of Sureties

DOING BUSINESS ACCOUNTABILITY PROJECT

QUESTIONS AND ANSWERS ABOUT THE DOING BUSINESS DATA FORM

What is the purpose of this Data Form?

To collect accurate, up-to-date identification information about entities that have business dealings with the City of New York in order to comply with Local Law 34 of 2007 (LL 34), the recently passed campaign finance reform law. LL 34 limits municipal campaign contributions from principal officers, owners and senior managers of these entities and mandates the creation of a Doing Business Database to allow the City to enforce the law. The information requested in this Data Form must be provided, regardless of whether the entity or the people associated with it make or intend to make campaign contributions. No sensitive personal information collected will be disclosed to the public.

Why have I received this Data Form?

The contract, franchise, concession, grant or economic development agreement you are proposing on, applying for or have already been awarded is considered a business dealing with the City under LL 34. No proposal or application will be considered and no award will be made unless this Data Form is completed.

Most transactions valued at more than $5,000 are considered business dealings and require completion of the Data Form. Exceptions include transactions awarded on an emergency basis or by publicly advertised, non-pre-qualified competitive sealed bid. Other types of transactions that are considered business dealings include real property and land use actions with the City.

What entities will be included in the Doing Business Database?

Entities that hold $100,000 or more in grants, contracts for goods or services, franchises or concessions ($500,000 or more for construction contracts), along with entities that hold any economic development agreements or pension fund investment contracts, are considered to be doing business with the City for the purposes of LL 34 and will be included in the Doing Business Database. Because all of the business that an entity does or proposes to do with the City will be added together, the Data Form must be completed for all covered transactions even if an entity does not currently do enough business with the City to be listed in the Database.

What individuals will be included in the Doing Business Database?

The principal officers, owners and certain senior managers of entities listed in the Doing Business Database are themselves considered to be doing business with the City and will also be included in the Database.

• Principal Officers are the Chief Executive Officer (CEO), Chief Financial Officer (CFO) and Chief

Operating Officer (COO), or their functional equivalents. See the Data Form for examples of titles that apply.

• Principal Owners are individuals who own or control 10% of more of the entity. This includes stockholders, partners and anyone else with an ownership or controlling interest in the entity.

• Senior Managers include anyone who, either by job title or actual duties, has substantial discretion and high-level oversight regarding the solicitation, letting or administration of any contract, concession, franchise, grant or economic development agreement with the City. At least one Senior Manager must be listed or the Data Form will be considered incomplete.

I provided some of this information on the VENDEX Questionnaire; do I have to provide it again?

Although the Doing Business Data Form and the VENDEX Questionnaire request some of the same information, they serve entirely different purposes. In addition, the Data Form requests information concerning senior managers, which is not part of the VENDEX Questionnaire.

My organization is proposing on a contract with another firm as a Joint Venture that does not exist yet;

how should the Data Form be completed?

A joint venture that does not yet exist must submit Data Forms from each of its component firms. If the joint venture receives the award, it must then complete a form in the name of the joint venture.

Printed on paper containing 30% post-consumer material

Will the information on this Data Form be available to the public?

The names and titles of the officers, owners and senior managers reported on the Data Form will be made available to the public, as will information about the entity itself. However, personal identifying information, such as home address, home phone and date of birth, will not be disclosed to the public, and home address and phone number information will not be used for communication purposes.

No one in my organization plans to contribute to a candidate; do I have to fill out this Data Form?

Yes. All entities are required to return this Data Form with complete and accurate information, regardless of the history or intention of the entity or its officers, owners or senior managers to make campaign contributions. The Doing Business Database must be complete so that the Campaign Finance Board can verify whether future contributions are in compliance with the law.

I have already completed a Doing Business Data Form; do I have to submit another one?

Yes. An entity is required to submit a Doing Business Data Form each time it proposes on or enters a transaction considered business dealings with the City. However, the Data Form has both a No Change option, which only requires an entity to report its EIN and sign the last page, and a Change option, which allows an entity to only fill in applicable information that has changed since the previous completion of the Data Form. No entity should have to fill out the entire Data Form more than once.

How does a person remove him/herself from the Doing Business Database?

Any person who believes that s/he should not be listed may apply for removal from the Database by submitting a Request for Removal. Reasons that a person would be removed include his/her no longer being the principal officer, owner or senior manger of the entity, or the entity no longer being in business.

Entities may also update their database information by submitting an update form. Both of these forms are available online at www.nyc.gov/mocs (once there, click MOCS Programs) or by calling 212-788-8104.

How long will an entity and its officers, owners and senior managers remain listed on the Doing Business Database?

• Contract, Concession and Economic Development Agreement holders: generally for the term of the transaction, plus one year.

• Franchise and Grant holders: from the commencement or renewal of the transaction, plus one year.

• Pension investment contracts: from the time of presentation on an investment opportunity or the submission of a proposal, whichever is earlier, until the end of the contract, plus one year.

• Line item and discretionary appropriations: from the date of budget adoption until the end of the contract, plus one year.

• Contract proposers: for one year from the proposal date or date of public advertisement of the solicitation, whichever is later.

• Franchise and Concession proposers: for one year from the proposal submission date.

For information on other transaction types, contact the Doing Business Accountability Project.

What are the new campaign contribution limits for people doing business with the City?

Contributions to City Council candidates are limited to $250 per election cycle; $320 to Borough President candidates; and $400 to candidates for citywide office. Please contact the NYC Campaign Finance Board for more information at www.nyccfb.info, or 212-306-7100.

The Data Form is to be returned to the contracting agency.

If you have any questions about the Data Form please contact the Doing Business Accountability Project at 212-788-8104 or DoingBusiness@cityhall.nyc.gov.

5/16/08 http://www.nyc.gov/mocs http://www.nyccfb.info/ mailto:DoingBusiness@cityhall.nyc.gov

CCG FORM H Payment Requisition FINAL NOV 10 2009

DEPARTMENT OF DESIGN + CONSTRUCTION

30-30 Thomson Avenue Long Island City, NY 11101

Capital Cultural Grant Payment Requisition Format

Note: Definitions for the defined terms used in this form may be found in the Capital Grant Agreement.

A payment requisition may be submitted to the Dept. of Design and Construction every thirty (30) days. It should be submitted in duplicate. It should contain the information listed below. The documents should be formatted per the attached sample documents. Payments will be made to the Grantee (electronically when available).

The payment requisition package must include the following documents:

- Cover letter (signed by an authorized representative of the cultural organization);

- Summary Spreadsheet of Costs to be reimbursed (signed by CM or Architect);

- Certification of Prevailing Wage compliance (signed by each contractor);

- Current project budget; and

- Copies of invoice(s)

The requisition should either include or affirm prior submission to DDC of the following:

Proof of current insurance (per Exhibit C of the Agreement)

VENDEX clearance for 1st tier contractors or consultants

Proof of release of liens on property (as applicable)

Proof of payment bonds (as applicable)

M/WBE or EBE Participation Goal and Status Report

Note: Please use the forms, as provided; please do not substitute any other forms.

J.20

Requisition Cover Letter (on Grantee Letterhead)

[Date]

[DDC Project Manager] Dept. of Design and Construction 30-30 Thomson Avenue, 5th Floor Long Island City, NY 11101

Re: Request for Reimbursement – [Title of Grant Agreement] Requisition Number [___] Contract Registration No. _____________ FMS ID: ___________

Dear [DDC Project Manager]:

This is the [Grantee]’s [Requisition Number] request for capital reimbursement from the New York City Department of Design and Construction (DDC). This requisition, in the amount of [Total Requisition Amount] covers the period from ___/___/_____ to ___/___/_____.

The attached spreadsheet lists the name of each contractor/consultant, the amount requested in this invoice, and the overall amount requested and incurred by [Grantee] in carrying out the approved work scope under the terms of the Capital Grant Agreement dated __/__/____. The [Grantee] is not seeking reimbursement for any Eligible Project Costs that were previously reimbursed by DDC to [Grantee]. Invoices/receipts are attached.

In summary:

TOTAL AMOUNT OF THIS REQUISITION

LESS RETAINAGE (AS PER CAPITAL GRANT AGREEMENT ___%)

CURRENT AMOUNT REQUESTED FOR DDC DISBURSEMENT

The Grantee affirms that by submitting this Requisition, Grantee is in compliance with all terms and conditions of the Grant, and has submitted or is submitting (check all that apply):

Attached Submitted/date

________ Proof of current insurance (per Exhibit C of the Agreement)

________ VENDEX clearance for 1st tier contractors or consultants

________ Proof of release of liens on property (check here if not applicable )

________ Proof of payment bonds (check here if not applicable )

________ M/WBE or EBE Participation Goal and Status Report

If you have any questions, please contact [Grantee Contact] directly at [Contact phone and e-mail].

Sincerely, [Signature of CEO/Executive Director/Authorized Representative] Name/Title

Attach.

Cc: [names]

DEPARTMENT OF DESIGN AND CONSTRUCTION

CAPITAL CULTURAL GRANT

Payment Requisition

Title of Grant Agreement: __________________________________________________

Grant Registration No. ____________________________ FMS ID: __________

Estimate for Payment No. ___

(Organization or CM to complete Lines 1-8)

1. ORIGINAL REGISTERED GRANT AGREEMENT AMOUNT ………………………………………… $

2. ANY NET CHANGE …………………………………………………………………………………..…… $

3. GRANT AGREEMENT AMOUNT TO DATE (1 + or - 2) ……………………………………………… $

4. TOTAL COMPLETED & STORED (Column G on Summary Spreadsheet) ………………………. $

5. RETAINAGE / STORED MATERIALS WITHHOLDING

A. ________% of Completed Work (Columns D + E on Summary Spreadsheet) .….. $ B. __ % of Stored Material (Column F on Summary Spreadsheet) .............…. $ Total Retainage / Withldg (Lines 5A/B or Total Column I in Summary Spreadsheet) .. $

6. TOTAL EARNED LESS RETAINAGE / STORED MAT’L WITH’LDNG (Line 4 less Line 5 Total) … $

7. LESS TOTAL OF ALL PREVIOUSLY APPROVED PAYMENT REQUISITIONS ......................…… $

(Total of all Line 14 amounts from all prior Grant Agreement Requisitions)

8. CURRENT PAYMENT DUE (Line 6 less Line 7) ………………………………………..……………… $

9. AMOUNT WITHHELD BY RE/PM ……………………………………………………………..…………

REASONS:

10. PAYMENT DUE THIS ESTIMATE (Line 8 less Line 9) ...............................…………................... $

11. AMOUNT WITHHELD BY EAO .......................................................................................…………

12. PAYMENT AMOUNT APPROVED BY EAO (Line 10 less Line 11) ..............................…………. $

13. AMOUNT WITHHELD BY CFO .......................................................................................…………

14. PAYMENT AMOUNT APPROVED BY CFO (Line 12 less Line 13) ………………………………… $

Grant Agreement Time ____________ ccds Time Consumed to Date ____________ ccds Time elapsed ____________________ % Work completed __________________ %

SUMMARY SPREADSHEET OF COSTS TO BE REIMBURSED

TITLE OF GRANT: NAME OF ORGANIZATION:

Grant Registration No. ____________________ FMS ID _________ Grant Registration Date ____________ Grant Completion Date ___________

Requisition No. ___ For Work: From __________ To__________ Original Grant Amount $

Payment Type: Partial Substantial Final Release of Retainage

A B C D E F G H I

ITEM

NO.

DESCRIPTION

TOTAL

SCHEDULED

VALUE

WORK COMPLETED

MATERIALS

CURRENTLY

STORED

( not in D or E )

TOTAL TO

DATE

(Completed

+ Stored) ( D + E + F )

G C

BALANCE

TO FINISH

RETAINAGE

FROM PREVIOUS

APPLICATIONS

THIS PERIOD

[list contracts] [contract amt]

Subtotals (this sheet) Totals (last sheet) Add more sheets if necessary.

Certificate of Eligible Project Costs The undersigned certifies that all items, units, quantities and prices of work and material shown on this requisition are correct; that all work completed to date has been performed and material supplied in full accordance with the terms and conditions of the Grant between _______________ and ___________________, and all authorized changes thereto; that all outstanding claims for labor, materials and equipment for the performance of said Grant have been paid in full in accordance with the requirements of said Grant, except the outstanding claims listed in the attached sheet, “Certificate of Contractor Prevailing Wage Compliance;” that all applicable laws have been complied with; that the above is true and correct statement of the account up to and including the last day of the period covered by this requisition and that no part of the “Current Payment Due” has been received.

Signature __________________________________________________ Date _______________

Name/Title (print) ____________________________________________ Federal Taxpayer ID __________________________

Certificate of Contractor Prevailing Wage Compliance

Under the provisions of Section 220-a of the Labor Law of the State of New York, and the terms and conditions of the Grant between _______[Grantee]________ and the Departments of Design and Construction and Cultural Affairs of the City of New York, the undersigned hereby certifies that the following is a true and correct statement of the amounts now due from the said contractor to laborers for daily or weekly wages on account of labor performed upon the work under the aforementioned contract, and the material and/or supplies delivered for use on the work , and for which payment is due to wit:

Amounts Due For:

Names Labor Material & Supplies

(Note: If no money is due to any laborers, state above “None due to laborers.” If no money is due to other persons for material and/or supplies delivered for use on the work, state above “None due to material-persons and supply-persons.”)

That the following is true and correct list of all subcontractors who have employed laborers and/or used materials and/or supplies for work performed under said contract:

Names of Subcontractors Work Subcontracted

I/We have complied with all provisions of Section 220 of the New York state Labor Law. (Note: If no subcontractors are employed, state above “None.”)

Contractor Signature

Print Name/Title

STATE OF NEW YORK,

COUNTY OF __________________

__________________________________, being duly sworn, deposes and says that he/she is the ___________________ of _____________________________, the CONTRACTOR named in and who executed the foregoing; that he/she has read the foregoing statement subscribed by him/her and knows the contents thereof, and that the same is true of his/her own knowledge and is executed under the provisions of Section 220-a of the Labor Law of the State of New York, and the terms and conditions of contract with __________________________________.

Contractor Signature Sworn to before me this __________ day of _________________, 20_____.

Notary Public, County of ____________________ Note: A County Clerk’s notarial certificate must accompany this document if it is executed outside the State of New York.

FUNDING DISBURSEMENT CHART

Please provide a summary of the project budget indicating the City-funded disbursements and balances in the following format:

Grant Registration No. ____________ Title of Grant: ______________________________________________________

FMS ID: ___________

Requisition No. ____ Grantee: ______________________________________________________ Final Payment? (Y/N) Address: ______________________________________________________ Requisition Amount $_____________ Period (From ---/---/------ to ---/---/------)

1 2 3 4 5 6 7

Project Scope

PROJECT

BUDGET

(Total Cost) City Funded Previous

Applications Stored

Materials Amount this Requisition

Contract Balance After this Requisition

CONSTRUCTION

Construction Items by Trade

Construction Items by Trade Subtotal Other Construction Costs General Conditions Construction Escalation Construction Contingency Other (Identify by category)

Other Construction Costs Subtotal Construction Total

DESIGN AND CONSTRUCTION

MANAGEMENT

Design Architectural Engineering (identify by type) Other Design Consultants (identify by type)

Design Subtotal Design Contingency

Design Total Construction Manager CM Fee (include pre-construction fees) Total Design and CM Costs

OTHER SOFT COSTS

CM & Subcontractor Bonds Insurance (Itemize by category) Other (identify by category) Total Other Soft Costs

TOTAL PROJECT COSTS

DEPARTMENT OF DESIGN AND CONSTRUCTION

REQUEST FOR APPROVAL OF SUBCONTRACTOR

(For Pass-Through Contracts Only)

CONTRACTOR PROJECT INFORMATION

NAME: Cooper-Hewitt, National Design Museum, Smithsonian Institution CAPIS (PROJECT) NO.:PV467COOP

STREET: 2 East 91st Street_____ COMPTROLLER REG. NO.:20111418542

CITY: New York STATE: NY ZIP: 10128 LOCATION: SAME _____________________

TEL: 212-849-8322 FAX: _212-849-8367 _______

Contact: Name: Julie Barnes___Tel: _As Above__email:_barnesjulie@si.edu____ [ ] CM Project Name of CM Contractor:

SUBCONTRACTOR DESCRIPTION OF SUBCONTRACT WORK

NAME: _______________________

STREET: [ ] Supplier

CITY: STATE: _____ZIP: SUBCONTRACT AMOUNT:

TEL#: FAX: SUBCONTRACTOR EIN: ______________

[ ] Subcontractor is part of LBE Util. Plan [ ] Addition to LBE Util. Plan [ ] Non-LBE Subcontractor

SUBCONTRACTOR SIGNATURE: DATE: / /

I hereby certify that the above named subcontractor maintains a permanent place of business; has adequate equipment to do the work expeditiously; has suitable financial status to meet obligations incident to the job; has appropriate technical experience; certifies that all operations are covered by a sufficient amount of insurance; and that the applicable provisions of the general contract, as set forth in said contract, will govern the work to which the subcontract relates.

I hereby certify that the amount of work subcontracted for does not exceed the limits allowed under the contract.

Contractor Officer Name (Print):

Signature: Date: / / ______ For DDC Use Only [ ] The above subcontractor is the lowest, responsive, responsible bidder.

(If subcontractor is other than the lowest responsive, responsible bidder and/or less than three bids have been received, approval of waiver must be attached.)

Division Representative/Project Manager Approval:

[ ] Granted [ ] Denied: Date: / / (Please Check off one) Signature Print Name of PM or Resident Engineer: Hilda Schneider Tel: 718-391-1018 Location:

Sat Unsat Initials Comments

1. Employment Report (Dollar Value>$750K) [ ] [ ] _________ ___________________

2. MBE/WBE Compliance [ ] [ ] _________ ___________________

3. VENDEX Compliance [ ] [ ] _________ ___________________

Additional Documentation Required: Date Requested: / /

Deputy ACCO Approval:

[ ] Granted [ ] Denied Date: / / (Please Check off one) Signature

11/1/97

J.21

Internal Procedures and Special Instructions Request for Approval of Subcontractors (RFAS form)

Contractors that permit subcontractors to start work under any DDC pass-through contracts prior to approval by DDC, as described below, assume the risk that the City will not pay for work done by that subcontractor unless and until such approval has been obtained.

The RFAS form submittal and approval process is as follows:

• The passs-through contractor shall submit a Request for Approval of Subcontractor to the DDC Project

Manager for each subcontractor whose work must be paid for through the pass-through contract. Such form(s) should be submitted at least 30 days prior to the date the subcontract work is scheduled to start.

• The DDC Project Manager will review the Request for Approval of Subcontractor to determine (a) whether the subcontractor was selected in accordance with the terms of the pass-through contract, and (b) whether the subcontractor has the technical experience and skills for the work being subcontracted. In the case where the request for approval is not granted by the DDC Project Manager upon completion of this review, it is the DDC Project Manager’s responsibility to inform the pass-through Contractor of the disapproval of the proposed subcontractor within a reasonable time.

• Where the DDC Project Manager has approved the proposed subcontractor, the DDC Project Manager shall then submit the original Request to the Office of the Deputy ACCO for a “responsibility” review to take place. The Office of the Deputy ACCO will run a check on the subcontractor to ascertain: (1) subcontractor’s compliance with equal employment opportunity laws; (2) acceptability pursuant to VENDEX requirements; and (3) evidence of satisfactory performance evaluations. At the same time, the Office of the Deputy ACCO will also review the contract file to check on the extent of the pass-through contractor’s effort to date in achieving the M/WBE participation percentage agreed to in the contract. A non-MWBE subcontractor which is otherwise acceptable may be disapproved if the pass-through contractor has not submitted evidence of satisfactory compliance with the contract’s MWBE requirement.

• Upon approval, the Deputy ACCO’s office will return the approved and signed original Request for

Approval of Subcontractor to the DDC Project Manager. The Project Manager will notify the prime of DDC approval by returning the signed original.

Additional Documents Required by the Office of the Deputy ACCO

• Where a City funded subcontract is equal to or exceeds $750,000, the subcontractor must complete a

Division of Labor Services (DLS) Employment Report. Where the City funded subcontract is less than that amount, subcontractors need to complete the “Less than $750,000 Subcontractor Certificate.” (Copies of the Employment Report, the Certificate, and instructions may be obtained by contacting the Deputy ACCO’s office).

• A VENDEX Subcontractor Questionnaire must be attached to the Request for Approval of Subcontractor where the subcontract dollar amount is equal to or exceeds $100,000. Where the subcontract is less than that amount, the Deputy ACCO’s office will request that a VENDEX Subcontractor Questionnaire be submitted only upon a finding that the subcontractor’s aggregate business with the City during the preceding twelve (12) months plus the amount of this request would exceed $100,000.

These documents are required from the subcontractor regardless of whether the contractor negotiated a first or second tier subcontract.

J.21

FOR OFFICIAL USE ONLY: File No. _________________________________________ Revised 11/09

Page 1 of 15 NYC Dept. of Small Business Services, Division of Labor Services, Contract Compliance Unit, 110 William Street, NY, NY 10038 Phone: (212) 513 – 6323 Fax: (212) 618 – 8879

CONSTRUCTION EMPLOYMENT REPORT

GENERAL INFORMATION

1. Your contractual relationship in this contract is: Prime Contractor ________ Subcontractor ___________

1a. Are M/WBE goals attached to this project? Yes ______ No _________

2. Would your company like information on how to certify with the City of New York as a:

______ Minority Owned Business Enterprise ______ Locally based Business Enterprise

______ Women Owned Business Enterprise ______ Emerging Business Enterprise

______ Disadvantaged

3. Please indicate if you would like assistance from SBS in identify certified M/WBEs for contracting opportunities: Yes ____ No ____

4. Is this project subject to a Project labor Agreement? Yes _____ No _____

PART I: CONTRACTOR/SUBCONTRACTOR INFORMATION

5. _________________________________________________

Employer Identification Number or Federal Tax I.D.

6. _________________________________________________________________________ Company Name

7. ______________________ ________________________ ______ __________________

Street Address City State Zip Code

8. _____________________________ ____________________________ __________________ __________________ (Chief Operating Officer) First Name Last Name Telephone Number Fax Number

9. ___________________________________________________________________ __________________

Designated Equal Opportunity Compliance Officer (if same as Item #8, write “Same”) Telephone Number

10. ______________________________________________________________________________________ Name of Prime Contractor and Contact Person (if same as item #6, write “Same”)

11. Number of employees in your company: ____________________________

12. Contract information:

(a) ______________________________________________ (b) _____________________________________________ Contracting Agency (City Agency) Contract Amount

(c) ______________________________________________ (d) _____________________________________________ Procurement Identification Number (PIN) Contract Registration Number (CT#)

(e) ______________________________________________ (f) ______________________________________________ Project Commence Date Projected Completion Date

Division of Labor Services

J.22

Page 2 of 15 NYC Dept. of Small Business Services, Division of Labor Services, Contract Compliance Unit, 110 William Street, NY, NY 10038

(g) Description and location of proposed contract::

13. Has your firm been reviewed by the Division of Labor Services (DLS) within the past 36 months and issued a Certificate of Approval? Yes ____ No ____.

If Yes, attach a copy of the certificate.

14. Has DLS within the past month reviewed an Employment Report submission for your company and issued a

Conditional Certificate of Approval? Yes _____ No _____

If Yes, attach a copy of the certificate.

15. Has an Employment Report already been submitted for a different contract (not covered by this Employment Report) for which you have not yet received compliance certificate? Yes ______ No ______

If Yes, Date submitted: _____________________ Agency to which submitted: _____________________________________________

Name of Agency Person: First Name _____________________________ Last Name __________________________________

Contract No. : __________________________________ Telephone: __________________________________________

16. Has your company in the past 36 months been audited by the United States Department of Labor, Office of Federal Contract Compliance

Programs (OFCCP)? Yes _________ No __________

If Yes,

(a) Name and address of OFCCP office: ________________________________________________________

(b) Was a Certificate of Equal Employment Compliance issued within the past 24 months? Yes _____ No _____

If Yes, attach a copy of such certificate.

(c) Were any corrective actions required or agreed to? Yes ______ No ______

If Yes, attach a copy of such requirements or agreements.

(d) Were any deficiencies found? Yes ______ No ______

If Yes, attach a copy of such findings.

17. Is your company or its affiliates a member or members of an employers’ trade association which is responsible for negotiating collective bargaining agreements (CBA) which affect construction site hiring? Yes ______ No ______ If Yes, attach a list of such associations and all applicable CBA’s.

NOTE: DLS…