Mobi Mat RFQ complete.pdf

Request for Quote (RFQ) This is NOT an Order

(Updated 8/26)

Request for Quote Number NYSP06 Page 1

INSTRUCTIONS FOR OPRHP BUYERS

DELETE THIS PAGE BEFORE RELEASING

This RFQ should NOT be used when a RFQ or Mini-Bid is required by an OGS Centralized Contract.

This RFQ is to be used for Open Market procurements up to $85,000.

PRIOR to releasing your RFQ, complete and submit the 2023 MWBE SDVOB Pre-Assessment. Add all vendors identified to your email bidders list. Failure to follow this step may result in having to start your process over from the beginning.

This OPRHP RFQ document:

1. Should be used for all procurements of commodities and/or services when it is anticipated the cost will be near $15,000.

2. Includes the statutory forms which are required to be submitted if procurement cost is at or above $15,000.

Lobbying Law Certification Non-Collusive Bidding Certification Public Officer’s Law Certification Under Executive Order No. 16 Prohibiting State Agencies and Authorities from

Contracting with Businesses Conducting Business in Russia NYS Finance Law §139-L and Executive Order No. 177 Certification

Consider the following:

1. Procurements over the $50,000 statutory threshold MUST be advertised on the Contract Reporter.

• Is the procurement’s total cost anticipated to be near $35,000?

o If yes, the RFQ is to be posted in the NYS Contract Reporter.

(If quotes come back over $50,000, and you did not advertise, you will have to start the process over)

2. Procurements over the $85,000 statutory threshold MUST be completed by the Purchasing or Service Contracts team, as a formal IFB or RFP, and are subject to OSC review/approval.

• Is the procurement total cost estimated to be near $85,000? If yes, fill out a Procurement Request Form

(PRF) and submit to Purchasing or Service Contracts team.

o PRF can be found at following link:

https://nysemail.sharepoint.com/:w:/r/sites/OPRHP_Intranet/Finance_Bureau/Procurement_Service_Contracts_Unit/_ layouts/15/Doc.aspx?sourcedoc=%7B095DA97A-9BD9-4796-A16E- C9A790178675%7D&file=Procurement%20Request%2010-2023.docx&action=default&mobileredirect=true

3. Certain technology procurements require a Plan to Procure (PTP) to be submitted for review/approval prior to purchase.

• Does this procurement contain technology components? If so, check to see if a PTP is required.

o PTP information can be found at the following link:

https://nysemail.sharepoint.com/sites/OPRHP_Intranet/Business_Innovation_Bureau/SitePages/Plan-to-Procure--- PTP.aspx?csf=1&web=1&e=SaGpbf&CID=0deffab7-2e7b-4f2d-8e16-1aaa8f795fe7

Additional technology related questions for consideration:

• Can this be obtained via ITSM request?

• Can this be procured via OGS Centralized Contract?

4. Do any of the following apply. If yes, be sure to check the boxes in the applicable section.

• Prevailing Wage (obtain and include the procurement-specific PRC number prior to releasing the RFQ),

• DOL Contractor Registry,

• Public Buildings Law §8(6), and

• Insurance Coverage needs (required for any service).

Instructions for filling out the RFQ:

• Remove the row for Vendor Questions Due from the RFQ Timeline of Events if you are not allowing for a

Question and Answer period.

https://nysemail.sharepoint.com/:w:/r/sites/OPRHP_Intranet/Finance_Bureau/Procurement_Service_Contracts_Unit/_layouts/15/Doc.aspx?sourcedoc=%7B095DA97A-9BD9-4796-A16E-C9A790178675%7D&file=Procurement%20Request%2010-2023.docx&action=default&mobileredirect=true https://nysemail.sharepoint.com/:w:/r/sites/OPRHP_Intranet/Finance_Bureau/Procurement_Service_Contracts_Unit/_layouts/15/Doc.aspx?sourcedoc=%7B095DA97A-9BD9-4796-A16E-C9A790178675%7D&file=Procurement%20Request%2010-2023.docx&action=default&mobileredirect=true https://nysemail.sharepoint.com/:w:/r/sites/OPRHP_Intranet/Finance_Bureau/Procurement_Service_Contracts_Unit/_layouts/15/Doc.aspx?sourcedoc=%7B095DA97A-9BD9-4796-A16E-C9A790178675%7D&file=Procurement%20Request%2010-2023.docx&action=default&mobileredirect=true https://nysemail.sharepoint.com/sites/OPRHP_Intranet/Business_Innovation_Bureau/SitePages/Plan-to-Procure---PTP.aspx?csf=1&web=1&e=SaGpbf&CID=0deffab7-2e7b-4f2d-8e16-1aaa8f795fe7 https://nysemail.sharepoint.com/sites/OPRHP_Intranet/Business_Innovation_Bureau/SitePages/Plan-to-Procure---PTP.aspx?csf=1&web=1&e=SaGpbf&CID=0deffab7-2e7b-4f2d-8e16-1aaa8f795fe7

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Request for Quote Number NYSP06 Page 2

• Be clear and concise when explaining what you are looking to procure in the “Detailed Scope of What is Needed” section. Provide as much detail as possible to help the vendors understand exactly what you are trying to achieve though this RFQ.

o Attach any referenced documents as necessary e.g., reports, drawings, detailed specifications, including but not limited to, quantities, delivery locations, etc.

• Ensure that each Description/Specification entered has an associated Unit of Measure and Quantity.

o Lump Sum quotes are not acceptable.

• Have a colleague review your RFQ to determine if it’s clear as to what you are trying to procure and for grammatical errors; revise as necessary.

• Be sure to fill out all sections and check all boxes applicable to your procurement.

• To “check” a checkbox in Microsoft Word:

o Double-click on the desired checkbox to be marked/unmarked.

o Change the Default Value to “Not checked” or “Checked” as appropriate.

o Select OK to confirm your modification.

• Once the RFQ is completed, reviewed, and finalized, convert it into PDF before soliciting/posting for the public.

o This is for accessibility and readability, and mitigates any erroneous changes to the document.

END OF INSTRUCTIONS FOR OPRHP BUYERS – DELETE BEFORE RELEASING

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Request for Quote Number NYSP06 Page 3

Instructions to Vendors Complete all yellow-shaded areas and provide documentation if indicated as “Applicable” in the check box.

Responses must be submitted on this RFQ document, or the quote may be deemed non-responsive and disqualified from consideration.

If the quote exceeds $15,000, fill out and return the additional forms provided within this RFQ document to the Designated Contact by the due date and time indicated below.

Note: For the purposes of this RFQ, the terms “Vendor”, “Contractor” and “Bidder” are used interchangeably.

RFQ Number Description NYSP06 Heavy duty roll up beach access mat.

Region Designated Contact Phone Submit E-Mail Responses to Niagara Kate Hahn 716 349-0799 Katheen.hahn@parks.ny.gov Delivery Location(s) Physical Address(es) County

Niagara Maintance Center 1410 Buffalo Ave Niagara Falls NY 14303 Niagara

RFQ Timeline of Events Event Date Time

RFQ Release 9/25/2026 N/A

Vendor Questions Due 10/2/2026 3:00 PM ET Questions Response 10/7/2026 N/A

RFQ Due 10/14/2026 3:00 PM ET

MWBE Goals Applicable Not Applicable

Minority Business Enterprise Participation __%

Women’s Business Enterprise Participation __%

Service Disable Veterans Owned Business __%

Detailed Scope of What is Needed: Commodity Services The Office of Parks, Recreation and Historic Preservation (OPRHP) is seeking quotes for…

Heavy duty roll up beach access mat w/stripe down the middle.

Qty 5 @ 45 degree multi angled Qty 3 @ 10' x 16.5' Qty 2 @ 5' x 16.5' Qty 3 @ 10' x 50'

Service Term: Applicable Not Applicable One Time Service Ongoing: Start Date: End Date:

mailto:Katheen.hahn@parks.ny.gov

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Request for Quote Number NYSP06 Page 4

Minimum Bidder Qualification(s): Applicable Not Applicable Required by* Agency Law Agency Law Agency Law

Minimum qualifications will be evaluated on a pass/fail basis. If the bidder fails to meet a minimum qualification, they will be deemed non-responsive and will not be considered for award.

*If required by law, please include supporting documentation citing the law/legislation.

Method of Award In the sole discretion of OPRHP, award of this RFQ will be made to a responsive, responsible and qualified bidder who offers the lowest quote meeting all specifications as outlined in this RFQ. A bidder will be found non-responsive if OPRHP finds that they do not have sufficient resources to provide the commodity and/or service as outlined in this RFQ.

NYS Office of Parks, Recreation and Historic Preservation’s Terms and Conditions

All RFQ responses must be valid for at least 90 days.

OPRHP reserves the right to purchase some, all, more or none of the items requested in this RFQ.

Quotes containing extraneous terms and conditions may be deemed non-responsive.

By submitting a quote, the Bidder agrees not to make any claim for, or have any right to, damages because of any misinterpretation or misunderstanding of the specifications, or because of any misinformation or lack of information.

OPRHP reserve the right to exercise the following:

• Change any of the scheduled dates herein;

• Amend RFQ Requirement(s) and so notify all potential Bidders;

• Withdraw the RFQ, at its sole discretion without any obligation or liability to any vendor;

• Eliminate any mandatory, non-material requirement that cannot be complied with by all of the prospective Bidders;

• Accept and/or reject any and all bids, in whole or in part, and to waive technicalities, irregularities, and omissions if, in OPRHP’s judgement, the best interests of OPRHP will be served.

• In the event compliant bids are not received, OPRHP reserves the right to consider late or non-conforming bids as offers;

• Require the Bidder to demonstrate, to the satisfaction of OPRHP, any information presented as part of their proposal;

• Require clarification at any time during the procurement process and/or require correction of arithmetic errors;

• Disqualify any Bidder whose conduct and/or bid fails to conform to the requirements of the solicitation;

• Prior to the bid opening, determine a tie breaking mechanism for award of the Contract to serve the best interests of OPRHP and the State of New York;

• Negotiate with the successful Bidder within the scope of the RFQ to serve the best interests of OPRHP and the

State of New York;

• Make an award under the RFQ in whole or in part; and

• Seek revisions of bids.

By responding to this RFQ, Vendor certifies its acceptance of the terms and conditions of Appendix A. In the event of a conflict between the purchase order document and any referenced documents contained within the purchase order, the order of precedence shall be as follows:

1) Appendix A Standard Clauses for New York State Contracts,

2) Purchase Order / Contract,

3) Appendix B General Specification for OPRHP Contracts,

4) This RFQ,

5) Vendor’s offer / Proposal.

Prevailing Wage: Applicable Not Applicable PRC Number https://ogs.ny.gov/procurement/appendix https://parks.ny.gov/sites/default/files/2026-08/AppendixB_General_SpecificationsOPRHPContracts.pdf

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Request for Quote NumberNYSP06 Page 5

The work under this RFQ has been determined to be a public work pursuant to Article 8 (Construction) / 9 (Building Services in excess of $1,500) of the New York Labor Law which requires prevailing wages to be paid. A willful violation of such may result in civil penalties and debarment from public contracting in the State of New York.

https://dol.ny.gov/public-work-and-prevailing-wage

Add PRC# Here

Contractor Registry Requirement Applicable Not Applicable Labor Law Article 8 subsection 220-I requires contractors and subcontractors to register with the Bureau of Public Work and Prevailing Wage Enforcement. This registration must be completed prior to bidding on public work projects or commencing work on public work projects or covered private projects that are subject to the prevailing wage pursuant to Sections 224-a, 224-d, & 224-e. The effective date of the registration requirement is December 30, 2024.

If Applicable, a Certificate of Registration must be submitted at the time of bid.

For additional information, please refer to this website: https://dol.ny.gov/public-work-contractor-and-subcontractor-registry-landing The registration page can be found here: https://mpwr-public.labor.ny.gov/en/login

Public Building Law § 8(6): Applicable Not Applicable Pursuant to Public Building Law § 8(6), any contracts over $5,000 for the work of construction, reconstruction, alteration, repair, or improvement of any State building, a responsible and reliable NYS-certified Minority or Women-Owned Business Enterprise that submits a bid within ten percent of the lowest bid will be deemed the apparent low bidder provided that the bid is $1,737,918 or less (maximum amount has been adjusted for inflation effective January 1, 2026). If more than one responsible and reliable MWBE firm meets the requirements, the MWBE firm with lowest bid will be deemed the apparent low bidder.

Insurance: Applicable Not Applicable Commercial General Liability - Insurance shall be endorsed to name the “State of New York, Office of Parks, Recreation, and Historic Preservation, and their officers, employees, and agents” as an additional insured. Said policy shall cover the liability of the Contractor for bodily injury, property damage, premises liability and personal/advertising injury from all work and operations under any contract resulting from this solicitation. The limits under such policy shall not be less than the following:

• Each Occurrence limit $1,000,000.00

• General Aggregate $2,000,000.00

• Products/Completed Operations $2,000,000.00

• Personal Advertising Injury $1,000,000.00

• Damage to Rented Premises $50,000.00

• Medical Expense $5,000.00

The following ISO forms must be endorsed to the policy:

a. CG 20 10 12 19 or an equivalent – Commercial General Liability Coverage Form

b. CG 20 37 12 19 or an equivalent – Additional Insured – Owner, Lessees or Contractors (Form B)

c. Waiver of Subrogation

Comprehensive Business Automobile Liability Insurance. Such policy shall have a combined single limit for Bodily Injury and Property Damage of at least $1,000,000 each accident. Said policy shall cover liability arising out of any automobile used in connection with performance under this Agreement including owned, leased, hired, and non-owned automobiles bearing or, under the circumstances under which they are being used, required by the Motor Vehicles Law of the State of New York to bear license plates.

If the Contractor does not own, lease, or hire any automobiles used in connection with performance under this Agreement, the Contractor is not required to obtain Comprehensive Business Automobile Liability Insurance.

Workers’ Compensation and Disability Benefits Insurance - Provide OPRHP with proof of Workers’ Compensation Insurance and Disability Benefits Insurance. The following are the only acceptable means of proof; ACORD forms are NOT https://dol.ny.gov/public-work-and-prevailing-wage https://dol.ny.gov/public-work-contractor-and-subcontractor-registry-landing https://dol.ny.gov/public-work-contractor-and-subcontractor-registry-landing https://mpwr-public.labor.ny.gov/en/login

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Request for Quote Number NYSP06 Page 6 acceptable proof of coverage. For more information about Workers’ Compensation and Disability insurance, log onto the Workers Compensation Board website at www.wcb.ny.gov or call them toll-free at 1-877-632-4996.

Acceptable Proof of Workers’ Compensation CE-200 Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage C-105.2 Certificate of Workers’ Compensation Insurance U-26.3 NYS Insurance Fund Certificate GSI-105.2 Certificate of Participation in Workers' Compensation Group Board - approved self-insurance SI-12 Certificate of Workers’ Compensation Self-Insurance

Acceptable Proof of Disability Benefits CE-200 Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage DB-120.1 Certificate of Disability Benefits Insurance DB-120.2 Certificate of Participation in Disability Benefits Group Self Insurance DB-155 Certificate of Disability Benefits Self-Insurance

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Request for Quote Number NYSP06 Page 7

Bid Form Method of Award is based on the lowest Grand Total Cost to OPRHP from a responsive and responsible vendor. The figures shown below represent OPRHP’s best estimate, included for bidding purposes. OPRHP guarantees no minimum or maximum amount of product and/or work. Payment to awarded contractor will reflect only produce received and/or work completed.

All ancillary costs must be included in rates bid.

To submit a bid, please enter your price(s) below, being mindful of any required mathematical extensions (e.g. multiplied by quantities/frequency, etc.). All figures must be rounded to two decimal places.

Provide Pricing for Each Item Listed Below Lump sum pricing is not acceptable

# Description / Specification Unit of

Measure Part or SKU # (if applicable)

𝑨𝑨 𝑩𝑩 𝐀𝐀 × 𝐁𝐁

Quantity Price Total Cost

Guaranteed Delivery Days After Receipt of Order RFQ Total

Vendor Certification The RFQ Response must be fully and properly executed by an authorized representative. By signing you certify your express authority to sign on behalf of yourself, your company, or other entity and full knowledge and acceptance of this RFQ, OPRHP’s requirements, including NYS Appendix A (https://ogs.ny.gov/procurement/appendix) and if awarded a Purchase order, agrees to provide the requested items or services at the bid price offered.

Company Name: SFS ID No.: NYS Contract No.:

NYS Small Business*1 NYS Certified Minority- Owned Business

NYS Certified Women- Owned Business

NYS Service-Disabled Veteran Owned Business # Employees

Address: City State Zip Code

Name of Official Title E-Mail Telephone

Signature Date

1 A “New York State Small Business” is defined as a company that is a resident to New York State, independently owned and operated, with 100 or fewer employees, and not dominant in its field. There is no certification process to be considered a New York State Small Business.

https://ogs.ny.gov/procurement/appendix

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Request for Quote Number NYSP06 Page 8

No Bid Form If your firm has chosen not to bid on this procurement opportunity, please use the space below to briefly explain why and return this form to:

Bids.Purchasing@parks.ny.gov

Reason(s) for Not Bidding

Certification Company Name:

Doing Business As:

Address: City

State Zip Code

Name of Official: Title E-Mail Telephone:

mailto:Bids.Purchasing@parks.ny.gov

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Request for Quote Number NYSP06 Page 9

Additional Forms The following Forms are only required if the response to this RFQ is $15,000 or more.

1. Lobbying Law Certification

2. Non-Collusive Bidding Certification

3. Public Officer’s Law

4. Certification Under Executive Order No. 16. Certification Under Executive Order

No. 16 Prohibiting State Agencies and Authorities from Contracting with Businesses Conducting Business in Russia

5. NYS Finance Law §139-L and Executive Order No. 177 Certification

6. Gender-Based Violence and the Workplace Certification

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Request for Quote Number NYSP06 Page 10

Lobbying Law Certification Pursuant to State Finance Law §§139-j and 139-k, this solicitation includes and imposes certain restrictions on communications between a Governmental Entity and an Offerer/bidder during the procurement process. An Offerer/bidder is restricted from making contacts from the earliest posting, on a Governmental Entity’s website, in a newspaper of general circulation, or in the procurement opportunities newsletter in accordance with article four-C of the economic development law of written notice, advertisement or solicitation of a request for proposal, invitation for bids, or solicitation of proposals, or any other method provided for by law or regulation for soliciting a response from Offerers intending to result in a Procurement Contract with a Governmental Entity through final award and approval of the Procurement Contract by the Governmental Entity and, if applicable, the Office of the State Comptroller (“Restricted Period”) to other than the Designated Contacts for the Governmental Procurement unless it is a Contact that is included among certain statutory exceptions set forth in State Finance Law §139-j(3)(a). The Designated Contact(s) for this Governmental Procurement, as of the date hereof, are identified on the first page of this solicitation. Governmental Entity employees are also required to obtain certain information when Contacted during the Restricted Period and make a determination of the responsibility of the Offerer/bidder pursuant to these two statutes. Certain findings of non-responsibility can result in rejection for contract award and in the event of two findings within a 4-year period, the Offerer/bidder is debarred from obtaining governmental Procurement Contracts. Further information about these requirements can be found at https://ogs.ny.gov/acpl.

Offerer Disclosure of Prior Non-Responsibility Determinations

New York State Finance Law §139-k(2) obligates a Governmental Entity to obtain specific information regarding prior non-responsibility determinations with respect to State Finance Law §139-j. This information must be collected in addition to the information that is separately obtained pursuant to State Finance Law §163(9). In accordance with State Finance Law §139-k, an Offerer must be asked to disclose whether there has been a finding of non-responsibility made within the previous four (4) years by any Governmental Entity due to: (a) a violation of State Finance Law §139-j or (b) the intentional provision of false or incomplete information to a Governmental Entity. The terms “Offerer” and “Governmental Entity” are defined in State Finance Law § 139-k(1). State Finance Law §139-j sets forth detailed requirements about the restrictions on Contacts during the procurement process. A violation of State Finance Law §139-j includes, but is not limited to, an impermissible Contact during the restricted period (for example, contacting a person or entity other than the designated contact person, when such Contact does not fall within one of the exemptions).

As part of its responsibility determination, State Finance Law §139-k(3) mandates consideration of whether an Offerer fails to timely disclose accurate or complete information regarding the above non-responsibility determination. In accordance with law, no Procurement Contract shall be awarded to any Offerer that fails to timely disclose accurate or complete information under this section, unless a finding is made that the award of the Procurement Contract to the Offerer is necessary to protect public property or public health safety, and that the Offerer is the only source capable of supplying the required Article of Procurement within the necessary timeframe. See State Finance Law §§139-j (10)(b) and 139-k(3).

Instructions

The Governmental Entity reserves the right to terminate this contract in the event it is found that the certification filed by the Offerer in accordance with New York State Finance Law §139-k was intentionally false or intentionally incomplete. Upon such finding, the Governmental Entity may exercise its termination right by providing written notification to the Offerer in accordance with the written notification terms of this contract.

The Office of State Parks, Recreation and Historic Preservation (OPRHP) includes this disclosure request regarding prior non-responsibility determinations in accordance with State Finance Law §139-k in its solicitation of proposals or bid documents or specifications or contract documents, as applicable, for procurement contracts. The attached form is to be completed and submitted by the individual or entity seeking to enter into a Procurement Contract. It shall be submitted to OPRHP unit conducting the Governmental Procurement.

1. Has any Governmental 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 mark):

No Yes - If yes, please answer the next questions:

2. Was the basis for the finding of non-responsibility due to a violation of State Finance Law §139-j (Please mark):

No Yes

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Request for Quote Number NYSP06 Page 11

3. Was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a Governmental Entity? (Please mark):

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

(attach additional pages as necessary)

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 mark):

No Yes - If yes, please provide details below.

Governmental Entity Date of Finding of Non-Responsibility

Basis of Finding of Non-Responsibility

(attach additional pages as necessary)

Lobbying Affirmation and Vendor Certification Offerer affirms that it understands and agrees to comply with the procedures of the OPRHP relative to permissible Contacts as required by State Finance Law §139-j(3) and §139-j(6)(b). Offerer certifies that all information provided to the Governmental Entity with respect to State Finance Law §139-k, §139-j(3) and §139-j(6)(b), §139-k(5) is complete, true and accurate.

Company Name:

Doing Business As:

Address: City

State

Zip Code

Name of Official: Title

E-Mail Telephone:

Signature Date

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Request for Quote Number NYSP06 Page 12

Non-Collusive Bidding Certification By submission of this bid, each bidder and each person signing on behalf of any other bidder certifies, and in the case of a joint bid, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his or her knowledge and belief:

1. The prices of 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 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.

Vendor Certification Company Name:

Doing Business As:

Address:

City

State

Zip Code

Name of Official: Title

E-Mail Telephone:

May 2025

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Request for Quote Number NYSP06 Page 13

Public Officers Law The following prohibitions pertain to the sale of goods and services by State employees to New York State Agencies pursuant to the NYS Public Officer’s Law § 73(4).

Current State Employees - Current employees of New York State cannot sell goods or services valued at $25 or more to any state agency, either as a private contractor or through a company in which that employee holds ownership of at least 10%, unless the procurement opportunity is first advertised in the NYS Contract Reporter and competitively bid.

Former OPRHP State Employees - Former employees of the New York State Office of Parks, Recreation and Historic Preservation (OPRHP) cannot sell goods or services to OPRHP under any circumstance for two (2) years following the date they leave OPRHP’s employ. This applies only to OPRHP and OPRHP’s employees, and does not preclude a former employee of another state agency from selling goods or services to OPRHP within two years following the last date of that person's state employment.

Please check (X) as appropriate, sign and date.

I am currently a state employee, and:

am a private contractor own at least 10% of the company that is being asked to provide goods or services to OPRHP.

I am a former OPRHP employee, and my service with OPRHP ended less than two (2) years prior to the date of my signature below.

None of the above apply.

Vendor Certification Company Name:

Doing Business As:

Name of Official: Title

E-Mail Telephone:

July 2021

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Request for Quote Number NYSP06 Page 14

Certification Under Executive Order No. 16 Prohibiting State Agencies and Authorities from Contracting with

Businesses Conducting Business in Russia https://ogs.ny.gov/EO-16 Executive Order No. 16 provides that “all Affected State Entities are directed to refrain from entering into any new contract or renewing any existing contract with an entity conducting business operations in Russia.”

The complete text of Executive Order No. 16 can be found here.

The Executive Order remains in effect while sanctions imposed by the federal government are in effect. Accordingly, vendors who may be excluded from award because of current business operations in Russia are nevertheless encouraged to respond to solicitations to preserve their contracting opportunities in case the sanctions are lifted during a solicitation or even after award in the case of some solicitations.

As defined in Executive Order No. 16, an “entity conducting business operations in Russia” means an institution or company, wherever located, conducting any commercial activity in Russia or transacting business with the Russian Government or with commercial entities headquartered in Russia or with their principal place of business in Russia in the form of contracting, sales, purchasing, investment, or any business partnership.

Is Vendor an entity conducting business operations in Russia, as defined above? Please answer by checking one of the following boxes:

1. No, Vendor does not conduct business operations in Russia within the meaning of Executive Order No. 16.

2.a. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order No. 16 but has taken steps to wind down business operations in Russia or is in the process of winding down business operations in Russia.

(Please provide a detailed description of the wind down process and a schedule for completion.)

2.b. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order No. 16 but only to the extent necessary to provide vital health and safety services within Russia or to comply with federal law, regulations, executive orders, or directives. (Please provide a detailed description of the services being provided or the relevant laws, regulations, etc.)

3. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order No. 16.

The undersigned certifies under penalties of perjury that they are knowledgeable about the Vendor’s business and operations and that the answer provided herein is true to the best of their knowledge and belief.

Vendor Certification Company Name:

Doing Business As:

Name of Official: Title

E-Mail Telephone:

Signature Date

June 2022 https://ogs.ny.gov/EO-16

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Request for Quote Number NYSP06 Page 15

NYS Finance Law §139-L and Executive Order No. 177 Certification

State Finance Law § 139-L Certification By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid 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 in the workplace and provides annual 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.

Executive Order No. 177 Certification The New York State Human Rights Law, Article 15 of the Executive Law, prohibits discrimination and harassment based on age, race, creed, color, national origin, sex, pregnancy or pregnancy-related conditions, sexual orientation, gender identity, disability, marital status, familial status, domestic violence victim status, prior arrest or conviction record, military status or predisposing genetic characteristics. The Human Rights Law may also require reasonable accommodation for persons with disabilities and pregnancy-related conditions. A reasonable accommodation is an adjustment to a job or work environment that enables a person with a disability to perform the essential functions of a job in a reasonable manner. The Human Rights Law may also require reasonable accommodation in employment on the basis of Sabbath observance or religious practices.

Generally, the Human Rights Law applies to:

• all employers of four or more people, employment agencies, labor organizations and apprenticeship training programs in all instances of discrimination or harassment;

• employers with fewer than four employees in all cases involving sexual harassment; and,

• any employer of domestic workers in cases involving sexual harassment or harassment based on gender, race, religion or national origin.

In accordance with Executive Order No. 177, the Bidder hereby certifies that it does not have institutional policies or practices that fail to address the harassment and discrimination of individuals on the basis of their age, race, creed, color, national origin, sex, sexual orientation, gender identity, disability, marital status, military status, or other protected status under the Human Rights Law.

Executive Order No. 177 and this certification do not affect institutional policies or practices that are protected by existing law, including but not limited to the First Amendment of the United States Constitution, Article 1, Section 3 of the New York State Constitution, and Section 296(11) of the New York State Human Rights Law.

Vendor Certification By signing, you certify your express authority to sign on behalf of yourself, your company, or other entity and full knowledge and acceptance of the above certifications and that all information provided is complete, true and accurate.

Company Name:

Doing Business As:

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Name of Official: Title

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Revised August 2022

(Updated 8/26)

Request for Quote Number NYSP06 Page 16

Gender-Based Violence and the Workplace Certification Vendor Name:

New York State Finance Law §139-M requires bidders on competitive state procurements to certify that they have a written policy addressing gender-based violence and the workplace and that such policy meets the following minimum requirements:

● Share Information: Employers must provide information regarding gender-based violence where employees can see and access it, including displaying the NYS Domestic and Sexual Violence Hotline information and a gender-based violence and the workplace poster.

● Refer Employee-Survivors to Services: The policy must require that the employer refer employees who disclose current or past victim status to the NYS Domestic and Sexual Violence Hotline and/or a local service provider. For bidders outside of New York State, referrals should be made to a local provider or statewide hotline. While referrals are required to be provided by the employer, it is not required for the employee to access services.

● Prohibit Retaliation: The policy must clearly state that discrimination or retaliation against employees who identify as victims or survivors of gender-based violence is prohibited.

● Comply with Laws: Ensure your policy follows State law. For employers based in New York State, this means that the policy must follow the New York State Human Rights Law, and any other relevant laws and regulations, which may include the SAFE Leave Act.

● Offer Implementation Support: OPDV is able to assist employers in developing and implementing this policy.

Employers must provide information to supervisors and human resources, where available, about this technical assistance from OPDV. OPDV can be contacted at workplace@opdv.ny.gov.

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that the bidder has and has implemented a written policy addressing gender-based violence and the workplace and has provided such policy to all of its employees, directors and board members. Such policy shall, at a minimum, meet the requirements of subdivision 11 of section five hundred seventy-five of the executive law.

Organization’s signature below certifies its compliance with State Finance Law §139-M.

Vendor Certification Company Name:

Doing Business As:

Name of Official: Title

E-Mail Telephone:

Signature Date

This form must be signed by an authorized executive or legal representative.

If the organization cannot make the above certification, they must attach a signed statement with their bid detailing the reasons therefor.

mailto:workplace@opdv.ny.gov