REQUEST FOR PROPOSAL

No. 2026-01 Development of Marketing and Branding for Downtown Lyons Falls Date: June 10, 2026

To Whom It May Concern:

The Village of Lyons Falls is currently seeking a proposal for the development of marketing and branding for Downtown Lyons Falls.

All proposals to be mailed to:

Village of Lyons Falls Clerk 4059 Cherry Street Lyons Falls, New York 13368 or delivered in person between the hours of 2:00 PM to 5:00 PM on Mondays, or on Thursdays from 9:00 AM to 12:00 PM.

All proposals must be received on or before 11:00 AM on, Friday July 10, 2026. Late proposals will not be considered.

The Village of Lyons Falls reserves the right to forego any formalities and reject any or all proposals.

The Village of Lyons Falls is an Equal Opportunity Employer.

This RFP can be found on and downloaded from the Village Website:

https://lyonsfallsny.gov/

Sincerely, Donna Dolhof Mayor, Village of Lyons Falls 4059 Cherry Street Lyons Falls, NY 13368

Introduction

1.1 Purpose/Objective

The purpose of this Request for Proposals (RFP) is to solicit qualified consultants to develop a comprehensive marketing and branding program for the Downtown Lyons Falls NY Forward initiative. This effort is intended to establish a cohesive and recognizable identity that reflects the community’s character, enhances a sense of place, and supports long-term economic vitality.

The objective of this project is to design branding elements and marketing tools—including visual identity standards, wayfinding and interpretive signage, and digital and physical promotional materials—that reinforce downtown revitalization investments and improve navigation, visitor experience, and public engagement. All work shall be consistent with the NY Forward Strategic Investment Plan and comply with New York State Department of State (DOS) requirements.

The selected contractor will support the municipality in advancing a coordinated branding strategy that increases visibility, promotes local assets, and contributes to sustained economic development and community revitalization outcomes.

The Village intends to open the bid responses to this RFP on Friday July 10th, 2026, at 11:00 a.m., and to select a qualified firm, if any.

1.2 Inquiries

Any questions related to this RFP should be directed to Grace Metzler, Grant Manager for Lewis County Planning & Community Development, by email at gracemetzler@lewiscounty.ny.gov.

1.3 Minority, Women-owned Enterprises and Service-Disabled Veteran- Owned Businesses

The Village is committed to promoting opportunities for Minority- and Women-Owned Business Enterprises (MWBEs) in accordance with New York State Executive Law Article 15-A and applicable NYS Department of State (DOS) requirements.

The selected Consultant shall make good faith efforts to achieve a minimum participation goal of thirty percent (30%) of the total contract value for New York State–certified MWBEs. Participation may be achieved through the utilization of MWBE prime consultants, subcontractors, suppliers, or other authorized entities.

Requirements

• The Contractor shall submit an MWBE Utilization Plan (Form D or equivalent) with its proposal, identifying proposed MWBE firms, scope of work, and percentage of participation.

• The Contractor shall utilize only MWBE firms certified by Empire State Development (ESD) at the time of proposal submission and throughout the contract term.

• Any changes to the approved MWBE Utilization Plan must be submitted for review and approval prior to implementation.

mailto:gracemetzler@lewiscounty.ny.gov

1.4 Taxes

No charge will be allowed for federal, state, sales, and excise taxes from which the Village is exempt.

Exemption Certificates will be provided upon request.

General Description or Required Performance Outcomes:

2.1 Project Goals

The primary goal of this project is to establish a cohesive and recognizable downtown identity for Lyons Falls that enhances the overall visitor experience and supports long-term economic revitalization. This includes creating a unified brand identity that reflects the character, history, and assets of the downtown, while improving wayfinding and accessibility through the design of coordinated signage such as gateway, directional, and interpretive elements. The project also seeks to enhance the visibility and marketability of downtown businesses, destinations, and public spaces through strategic marketing tools and materials, and to strengthen the sense of place by integrating branding into the built environment. Collectively, these efforts are intended to support economic development and tourism by increasing awareness, visitation, and community engagement, while ensuring consistency with the NY Forward Strategic Investment Plan and compliance with all New York State Department of State requirements.

Scope of Work

The selected consultant shall provide comprehensive marketing and branding services to support the future implementation and visibility of this NY Forward–funded project. All work must comply with New York State Department of State (DOS; Department) requirements and applicable grant administration standards.

Task 1: Project Initiation Meeting The selected Contractor shall participate in a Project Initiation Meeting and, with the Village of Lyons Falls, shall identify and review project goals, schedule, scope of work, associated fees, responsible parties, a Project Advisory Committee (PAC), and expected deliverables. Additionally, the Project Initiation Meeting should include a determination of the scope and frequency of coordination meetings between the Contractor, Village, and project staff, progress reports, and invoices to keep the project progressing and on schedule. The Contractor shall establish a file-sharing platform to track the completion of Tasks and coordinate reviews. The Meeting shall also include a walk-through of downtown Lyons Falls, for which the project will address.

Deliverables:

☐Brief meeting summary documenting agreements/understandings reached at the initiation meeting, including frequency and method of project progress reports, coordination meetings, and invoices.

☐Identify a PAC ☐File sharing platform Task 2: Draft Design for Marketing and Branding Materials The Contractor shall work with the PAC and municipal staff, through methods such as focus groups, stakeholder interviews, public information sessions, or online surveys, to obtain input and feedback to prepare draft branding designs, draft brand guidelines (to include, but not limited to logos, color palettes, typography, and implementation guide), a draft plan for locating signage, draft designs of a series of wayfinding elements such as directional signs, gateway signs, interpretive signs consistent with the Strategic Investment Plan; and a downtown marketing strategy and draft design(s). The Contractor shall provide a presentation of the draft designs to the Board of Trustees. The draft design shall also be provided to the Lewis County Department of Planning and Community Development, Department of State (Department), and the public for review. Comments from these parties must be addressed to the satisfaction of the Village of Lyons Falls Department in subsequent revisions of the products and the final design.

The Contractor shall also prepare and execute a strategic marketing plan to promote funded projects, downtown revitalization efforts

Deliverables:

☐ Draft branding design with options and a draft style and implementation guide ☐ Draft location plan for wayfinding elements ☐ Draft design(s) or theme(s) for wayfinding elements ☐ Draft marketing strategy ☐ Draft design(s) and/or presentation for downtown marketing collateral ☐ Presentation(s) or other documents needed for engagement with the public and summaries from public engagement meetings ☐ A presentation(s) for the Board of Trustees and a summary from that meeting ☐ Revised draft design(s) in an Adobe Acrobat PDF format created using 300 dpi resolution

Task 3: Final Design for Marketing and Branding Materials Based upon the approved draft designs, the Contractor shall produce a final branding design and a style and implementation guide; a final plan for locating wayfinding elements and a final design for wayfinding elements; and a final marketing strategy and a final design or presentation for downtown marketing collateral. The final designs for all components shall be presented to the Village of Lyons Falls Board of Trustees. The final designs are subject to approval from DOS, and DOS comments must be addressed to the satisfaction of the Department.

Deliverables:

☐ Final brand and a final style and implementation guide ☐ Final location plan for wayfinding elements ☐ Cost estimate for fabrication and installation of wayfinding elements ☐ Final marketing strategy ☐ Final design for downtown marketing collateral ☐ A presentation for the Board of Trustees and summary from that meeting ☐ Final draft designs in an Adobe Acrobat PDF format created using 300 dpi resolution

Task 6: Completion of Project Following satisfaction of punch list items for the above scope elements, the Contractor shall submit a statement that the work has been completed in accordance with the contract. The Contractor shall submit copies of all branding, marketing, and wayfinding signage templates, associated style and/or implementation guides or strategies, and any specification developed as part of the Project. The

Contractor shall submit a copy of the completion statement to the Village and DOS. The Contractor shall not submit a final payment request to the Village until the Village concurs that the work is complete.

Deliverables:

☐ Completion statement certifying all work has been completed in accordance with the contract ☐ Copies of all branding, marketing, and wayfinding signage templates, associated style, and/or implementation guides, marketing strategy, and any specification developed as part of the Project

The Village recognizes that there are different approaches that can lead to the desired outcomes that have been noted in this RFP. If, based on the Contractor’s knowledge and experience, the Contractor believes the required scope of work should be changed in any way, the suggested changes should be outlined in their response. Respondents to the RFP are required to include a recommended project approach based on their expertise and experience with similar projects. The Village and DOS reserve the right to modify the above-mentioned scope of services based on project approaches that may be recommended by respondents, and all RFP document holders shall be notified of such changes.

SPECIFIC REQUIREMENTS:

3.1 The Contractor/ firm agrees to provide services to the Village as an independent contractor and not as an employee, as those terms are understood for New York and Federal law purposes. The Contractor/Firm agrees to provide for, secure, and/or be solely responsible for any and all required fees, permits, Workers Compensation coverage, Unemployment Insurance, Disability Insurance, Social S e c u r i t y contributions , i n c o m e t a x w i t h h o l d i n g and a n y other i n s u r a n c e o r t a x e s , including but not limited to Federal and New York taxes, for any persons performing services pursuant to a subsequent agreement, including the Contractor, and any employees of the selected Firm. The Contractor agrees to indemnify the Village and hold the Village harmless from any claims, suits, losses, or damages, including reasonable attorney’s fees, resulting from any failure on the part of the contractor to satisfy its obligations as states herein.

3.2 The Contractor acknowledges and agrees to purchase, register, and insure any and all necessary equipment and vehicles to provide the scope of services identified. Automobile liability insurance must have a minimum limit for bodily injury and property damage of $1,000,000 /$2,000,000.

3.3 The Contractor acknowledges and agrees to purchase comprehensive general liability insurance with minimum liability limits of $1,000,000 / $2,000,000 for personal injury and property damage, and $2,000,000 aggregate to protect against claims brought against the Village, which may arise from the provision of services under a subsequent agreement. Contractor agrees to name the Village as an additional primary insured.

3.4 The Contractor agrees to indemnify the Village and hold the Village harmless from any claims (including but not limited to claims under Labor Law Section 240, if applicable), suits, losses, or damages resulting from or relating to any services provided by the Contractor and/or equipment or materials used by the Contractor, or any other person performing services pursuant to a subsequent agreement. The Contractor shall be liable to the Village for any loss, damage or destruction of any property, materials, goods, documents, or other items, including reasonable attorney’s fees, resulting from or related to the negligence, or other wrongful acts of the Contractor, the Contractor’s employees, or any other person performing services pursuant to a subsequent agreement. The amount of general liability insurance.

3.5 The Contractor may not assign, transfer, sublet or otherwise dispose of the Agreement without the prior written consent of the Village.

3.6 The Village reserves its right to require additional contractual provisions it deems appropriate to give effect to this Proposal.

ELIGIBLE APPLICANTS

4. To be deemed an eligible applicant, you must have at least three (3) years’ experience in marketing and branding and provide a minimum of three (3) customers as references.

For preparation/certification of final designs and construction documents, and for supervision of construction, a licensed professional engineer, architect or landscape architect licensed to practice in New York State is required.

PROPOSAL FORMAT

5. To be submitted on your own forms, but must include the bid page, the non-collusion form, anti-sexual harassment form, and corporate attestation form set forth at the end of this RFP.

BASIS OF AWARD:

6.1 All proposals will be evaluated to determine if they meet the requirements of the Request for Proposal. The Village may, as it deems necessary, conduct discussions with the contractor(s) it deems reasonably suspected of being selected for award, for the purpose of clarification and responsiveness to requirements. The Village has assigned the criteria below:

10% Quality and completeness of proposal 5% Approach to completing the scope of work 5% Qualification and relevant experience 10% Past performance on similar projects 70% Fee for this scope of work

6.2 Information gathered by the Village from the RFP, during any interviews, and any other information and factors deemed relevant by the Village may be considered in a final award. Some additional information and criteria the Village may consider includes but is not limited to the bidder’s commitment to the Village, reputation of the contractor, commitment to quality of services, responsiveness.

6.3 The Village reserves the right to accept or reject any and all Proposals.

6.4 The Award may be made to the most responsible bidder whose proposal is determined to be in the best interest of the Village and deemed to best serve the Village’s needs and requirements, based on the evaluation of all relevant criteria and information provided including an interview with Contractor and the Award Committee.

6.5 A successful bidder is encouraged by the Village to use in-county and/or local vendors, supply entities and labor force, if possible, in providing the services under the contract awarded for this project, but is not required to do so, nor is same a criteria in the award determination.

6.6 The Village reserves the right to reject any and all bids and to waive any informality in bids received whenever such rejection or waiver is in the interest of the Village. Price will not necessarily be the determining factor in the award of the contract. Contract award will be made by resolution of the Board of Trustees.

6.7 Contractors will be notified in writing of the successful award after formal acceptance by the Village Board of Trustees.

CONTRACT PERIOD:

7.1 The intent of the Village is to award this contract on July 27,2026.

GENERAL INFORMATION:

8.1 Your proposal must include the following to be considered:

1. Letter of submittal. A short introduction, summary of the firm/contractor, and any subcontractors, along with a description of the disciplines included within the firm/team.

The letter shall also identify a single contact with a telephone number and email address

2. Team profile and qualifications. A description of the team members, including sub-consultants, and their role in the project and their relevant experience. This section should include an organizational chart for the project team, which identifies the Project Manager, who will be the primary contact person overseeing daily scope activities. Resumes for key personnel should also be included.

3. Scope of Work. A detailed work program outlining the consultant’s approach to performing, at a minimum, the tasks within the Scope of Work as noted earlier in this RFP, including a timeline for each task. Based on the Consultant’s past experience and expertise, respondents may add additional tasks they deem necessary to achieve the project goals but must explain why necessary to achieve project goals.

For each task, include:

a. A brief narrative describing what is included within the task,

b. Key milestones to be met,

c. Key deliverables to the Village,

d. An estimated timeframe for completing the task.

4. Proposed budget, including:

a. A not-to-exceed fee for all services to be provided by the respondent/consultant team required to fulfill the deliverables described herein and within their proposal.

Include this total on the bid proposal page provided as part of this RFP.

b. Breakdown for fee proposal by each task and by prime Contractor and any sub-consultants

c. Breakdown of any proposed reimbursables for travel, printing, and/or other anticipated charges

d. Fees for any optional and/or additional services for out-of-scope work products that the Contractor feels necessary to achieve the goals of the project.

5. Project Experience. A description of similar projects completed by the proposer.

6. Work Sample(s). A representative work sample similar to the work being requested. A sample may be provided digitally as a PDF, or a link can be provided. A minimum of two (2) samples is required.

7. References. A minimum of three (3) professional references for similar project work completed within the past five (5) years. Provide the name, phone number, and email address of each professional contact.

8.2 PROPOSAL REQUIREMENTS:

a) Proposals must be accompanied by a signed Proposal Form, Signed Non-Collusion

Statement, Signed Anti-Sexual Harassment statement, and signed Attestation of Good Standing if corporate entity. These forms can be found at the end of these specifications.

b) Provider must submit their written proposal on their own forms and must include the project schedule.

c) One original and one copy of the proposal must be provided.

d) Read all documents contained in the proposal package.

e) Proposals must be submitted to:

Village of Lyons Falls Clerk 4059 Cherry Street Lyons Falls, New York 13368

To be considered, the proposal must be received no later than 1 1 : 0 0 A M on July 10, 2026.

No proposals will be accepted after the designated time. Bid packages will be opened on said date and time in the Village of Lyons Falls Office, 4059 Cherry Street, Lyons Falls, NY 13368.

Providers shall indicate on the outside of their sealed proposal the following information:

• Title of Proposal and Proposal Number, if any

• Date and Time of Proposal Opening

• Company Name / Bidders Name

Failure to do so may result in the rejection of the proposal as being unresponsive.

No Bidder may withdraw their proposal within ninety (90) days after the actual date of opening thereof.

8.3 LATE PROPOSALS:

Proposals received in the Village Clerk's Office after the date and time prescribed shall not be considered for contract award and shall be returned, unopened, to the Contractor.

NOTE: Any delay due to traffic, weather, mail or express delivery is not an exception to the deadline for receipt of proposals. Please plan accordingly.

8.4 NON-COLLUSION STATEMENT; SEXUAL HARASSMENT POLICY

STATEMENT:

Non-Collusion Statement and Sexual harassment compliance statements shall be returned with your proposal.

8.5 PROPOSAL CONTENT:

All information required by these specifications must accompany the proposal or the provider may be disqualified.

8.6 ADDENDA:

Addenda are written instruments issued by the Village prior to the date for receipt of offers which modify or interpret the specification document by addition, deletion, clarification or correction. The addenda will be e-mailed to all who are known by the Village to have received a complete set of specification documents. The addenda will also be posted on the Village website, https://lyonsfallsny.gov/.

No addendum will be issued later than forty-eight (48) hours prior to the date and time for the receipt of offers, except an addendum withdrawing the RFP, or an addendum including postponement.

8.7 PROPOSAL RECEIPT BY A THIRD PARTY:

Any Contractor submitting a proposal based on incomplete or inaccurate information resulting from documentation received from any third party shall not have cause for relief from award or completion of a contract in accordance with the official documents on file with the Village of Lyons Falls. It is STRONGLY suggested that all Contractors interested in participating in this proposal, contact the Lewis County Planning & Community Development Department directly to assure they have received the most accurate and up to date material concerning this contract. The Village does not offer or supply anyone the list of people that have obtained a copy of these RFP specifications for the project prior to the opening of the RFP. NO EXCEPTIONS ARE MADE TO THIS POLICY.

8.8 FREEDOM OF INFORMATION LAW (FOIL)

All material submitted in response to this Bid becomes the property of the Village, with same being considered public records after the award of the contract, subject to confidentiality and exemptions set forth in the Public Officers Law. Proposals will not be shared with any competing offerors during the selection phase of this procurement, however, after award of the contract to the successful offeror, proposals and/or lawful parts of proposals received in response to this RFP may be subject to disclosure under the Freedom of Information Act. Information in proposals that is clearly identified as proprietary will not be disclosed at any time. Blanket statements that all contents of the proposal are confidential and proprietary will not be honored by the Village. The New York State Freedom of Information Law (FOIL), as set forth in Article 6 of the Public Officers Law mandates public access to certain government records. Generally, proposals submitted in response to this Bid may constitute government records subject to FOIL.

Proposals may contain, among other things, certain technical, financial, or other data and information that constitute trade secrets if publicly disclosed. To protect this information from disclosure under FOIL, Proposers should specifically identify the pages of the proposal that contain such information by properly marking the top of the applicable pages with “ with the notation:

“CONFIDENTIAL” and inserting the following statement in the front of its proposal: “The information or data on pages of this proposal, identified on the top thereof as “CONFIDENTIAL”, contain financial, technical, or other information which constitute government records subject to FOIL.” Bidder should explain, among other things, certain technical, financial, or other data and information that constitute trade secrets, if publicly disclosed, that could cause substantial injury to the commercial enterprise’s competitive position, and request that the Village use such information only for the evaluation of this proposal.

Bidder must understand that the Village is required to comply with the provisions of the New York State Freedom of Information Law (FOIL), and that public disclosure of the information contained in this proposal whether or not marked as “CONFIDENTIAL” may be required. Bidder shall make no claim for any damages as a result of any such disclosure by the Village pursuant to FOIL. In the event the Village receives a FOIL request for disclosure of information marked as “CONFIDENTIAL”, the Proposer/Bidder shall be notified of the request and may expeditiously submit a detailed statement and explanation indicating the reasons it has for believing that the information requested is exempt from disclosure under the law. This detailed statement and explanation shall be used by the Village in making its determination as to whether disclosure is required under the law.

9. CONFLICTING TERMS

9.1 The requirements provided in the “specification” portion of these documents shall govern in any conflict with any other language provided in the general “Terms and Conditions” or any other boilerplate type information. Any conflict between the specification language and any boilerplate language will be resolved in favor of the specification language.

10. EXECUTORY CLAUSE:

10.1 Any contract offered in response to this RFP shall contain the following clause: “This Contract shall be deemed executory only to the extent of funds appropriated by the Village of Lyons Falls Board of Trustees and available for the purposes of this Agreement; and no liability on account thereof shall be incurred by Lyons Falls beyond the amount of such funds.”

11. NO JOINT BIDS

11.1 Joint Bids will not be accepted. For purposes of the specifications, the term joint Bid shall include, but is not limited to, any Bid submitted jointly by two or more Contractors in the name of partnership, joint venture or other legal entity formed for the purpose of submitting such a Bid or to be formed for the purpose of entering into a contract pursuant to such Bid/RFP.

12. PAYMENTS UNDER CONTRACT AWARD:

12.1 Payment for services shall be following receipt of vendor claims and invoices in accordance with Lyons Falls accounting/payment practices. Any claim against the contractor may be deducted by the Village from any money due him in the same or other transactions. In any case where a question of non-performance of a contract arises, payment may be withheld in whole or in part at the discretion of the Village as compensation for any loss, damage, or cost incurred by the Village as a result of said non-performance.

13. CONFLICTS OF INTEREST

13.1 In executing and submitting this Bid, the bidder represents and warrants that no person who is an elected official, officer, or employee of Lyons Falls, nor any person whose salary is payable, in whole or in part, by the Village, or any corporation, partnership or association in which such official, officer or employee is directly interested, shall have a direct financial interest, in the contract to be awarded hereunder or in the proceeds thereof.

YOU MUST RETURN THIS SHEET WITH YOUR PROPOSAL

BID PROPOSAL PAGE

REQUEST FOR PROPOSAL

Development of Marketing and Branding for Downtown Lyons Falls

Lump Sum Price for Development of Marketing and Branding for Downtown Lyons Falls

Company Name:

Authorized Signature:

Date:

SIGNATURE PAGE

REQUEST FOR PROPOSAL

TO: Village of Lyons Falls Clerk

THE UNDERSIGNED PROPOSES TO PROVIDE THE GOODS AND SERVICES required as set forth in the referenced Request for Proposal. If successful, the Bidder hereby agrees t o f u r n i s h t h e goods a n d s e r v i c e s i n a c c o r d a n c e w i t h a l l t e r m s , c o n d i t i o n s a n d specifications contained within referenced Request for Proposal, at prices submitted in referenced specifications. I certify that I am authorized to sign this proposal, myself or on behalf of the company or firm I represent, and to enter into a binding contract with the Village of Lyons Falls. This signed proposal will become part of a binding contract after award by the Village of Lyons Falls Board of Trustees to the successful bidder.

NOTE: By signing and submitting the proposal form for consideration by the Lyons Falls Board of Trustees, the Contractor acknowledges they have read, understood, and agree to all aspects of the specifications as presented without reservation or alteration.

Legal name of person/firm/corporation Authorized Signature/ Position

Address Typed Name

City/State/Zip Title

Date Telephone No. Fax No.

E-mail address

NON-COLLUSION FORM

REQUEST FOR PROPOSAL

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, as to its own organization, under penalty or perjury, that to the best of his or 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 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.

4. No person, broker or selling agent has been employed or retained by the bidder to solicit or secure this award upon an agreement or upon an understanding for a commission, percentage, a brokerage fee, contingent fee or any other compensation. The bidder further represents and warrants that no payment, gift or thing of value has been made, given or promised to obtain this or any other agreement between the parties.

In compliance with this invitation for bids, and subject to the conditions thereof, the undersigned offers and agrees, if this bid is accepted within forty-five (45) days from the date of opening, to furnish any and all of the items upon which prices are submitted.

Legal name of firm/corporation Authorized Signature

AFFIRMATION STATEMENT ON SEXUAL HARASSMENT

REQUEST FOR PROPOSAL

In compliance with State Finance Law § 139-l, the undersigned bidder hereby certifies and affirms under penalty of perjury:

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bide each party thereto certifies as to its own organization, under penalty of perjury, that the bidder has and has implemented a written policy addressing sexual harassment prevention training to all of its employees. Such policy shall, at a minimum, meet the requirements of section two hundred one-g of the labor law.

Note: Pursuant to State Finance Law §139-l 3, if the Bidder cannot make the foregoing certification and, such bidder shall so state and shall furnish with the bid a signed statement which sets forth in detail the reasons, therefore.

YOU MUST RETURN THIS SHEET WITH YOUR BID

CORPORATE APPLICANT/ENTITY ATTESTATION OF

GOOD STANDING

REQUEST FOR PROPOSAL

As a duly authorized official of the Applicant Entity identified below, I certify and attest that the following conditions are true and accurate:

The applicant is not currently the subject of an enforcement action related to an investigation by a State or Federal agency.

The applicant corporate entity is in good standing and is in compliance with required corporate filings.

RECEIPT OF ADDENDUM ACKNOWLEDGMENT

ADDENDUM NO.

Please acknowledge the receipt of the above ADDENDUM issued by the Village of Lyons Falls, by signature and recording the date of receipt below.

Bidder:

Authorized Signatory: Date:

**NOTE: This form must be included in your bid documents if any Addendum is issued

Rev. 06/2021

NEW YORK STATE – DEPARTMENT OF STATE (DOS)

M/WBE UTILIZATION PLAN - FORM D

Offeror/Grantee’s Name: Village of Lyons Falls Federal Identification No.:

Address: 4059 Cherry Street Project/Contract No.: C1003034

City, State, Zip Code: Lyons Falls, NY 13368 Telephone No.: 315-348-5081 M/WBE Goals in the Contract: MBE 15% WBE 15%

Region/Location of Work: North Country

1. Certified M/WBE Subcontractors/Suppliers Name, Address, Email Address, Telephone No.

2. Classification

3. Federal ID No.

4. Detailed Description of Work

(Attach additional sheets, if necessary)

5. Dollar Value of Subcontracts/ Supplies/Services and intended performance dates of each component of the contract.

A.

NYS ESD CERTIFIED

MBE

WBE

B. NYS ESD CERTIFIED

MBE

WBE

6. IF UNABLE TO FULLY MEET THE MBE AND WBE GOALS SET FORTH IN THE CONTRACT, OFFEROR/GRANTEE MUST SUBMIT A REQUEST FOR WAIVER FORM E.

PREPARED BY (Signature):

DATE:

NAME AND TITLE OF PREPARER (Print or Type):

SUBMISSION OF THIS FORM CONSTITUTES THE OFFEROR/GRANTEE’S ACKNOWLEDGEMENT AND

AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A, 5 NYCRR PART 143, AND THE ABOVE-REFERENCED SOLICITATION. FAILURE TO SUBMIT

COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND

POSSIBLE TERMINATION OF YOUR CONTRACT.

TELEPHONE NO.:

EMAIL ADDRESS:

FOR M/WBE USE ONLY

REVIEWED BY:

DATE:

UTILIZATION PLAN APPROVED: YES NO Date:

Contract No.: Project No. (if applicable):

Contract Award Date: Estimated Date of Completion:

Contract Execution Date:

Contract Amount:

Amount Obligated Under the Contract:

Total Planned MWBE Utilization Amount:

Description of Work:

NOTICE OF DEFICIENCY ISSUED: YES NO Date:______________ NOTICE OF ACCEPTANCE ISSUED: YES NO Date:_____________

FOR M/WBE USE ONLY

Comments:

Rev. 06/2021

General Instructions:

• This form (Form D) or a compliance certification letter (Form D-1) must be submitted within ten (10) business days after the respondent/awardee receives notice from the Department of State that the contract/grant is being awarded.

• In case a compliance certification letter (Form D-1) was submitted at the time of the award notification, the awardee must submit this form D within two (2) weeks following the procurement of any MWBE-applicable purchase or contractual service undertaken in furtherance of the Contract.

• This form D must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (MWBE) that will actually be utilized under the DOS contract. Attach additional sheets if necessary.

• In case of changes to an approved utilization plan, the awardee must submit a revised Form D to the DOS MWBE Program at dos.sm.mwbe@dos.ny.gov

• Any Form D submitted to DOS for review must be completed and signed by the entity in contract with DOS.

• Contact your DOS Program/Project Analyst or the DOS MWBE Program at dos.sm.mwbe@dos.ny.gov, if you have any questions.

Instructions for completing:

The Offeror/Grantee’s section on top of the form must contain information on the entity in contract with the Department of State (DOS).

1. Enter the name, address, email address and phone number of each NYS certified MWBE that will actually be utilized under the DOS contract (Look up certified MWBEs in the directory at https://ny.newnycontracts.com/)

2. Check off the box to indicate the certification class (MBE or WBE). If the MWBE has both MBE & WBE certifications, check off the appropriate certification class toward which the utilization should count.

3. Enter the federal ID number of each NYS certified MWBE to be utilized.

4. Enter detailed description of the supplies and/or services to be provided by each certified MWBE. Also, enter detailed information on any tier subcontracts, if applicable.

5. Enter the dollar value of subcontracts/supplies/services and intended performance dates of each component of the contract with each certified MWBE. Also, enter detailed information on any tier subcontracts, if applicable.

mailto:dos.sm.mwbe@dos.ny.gov mailto:dos.sm.mwbe@dos.ny.gov https://ny.newnycontracts.com/