Jefferson County Soil and Water Conservation District

On Behalf of the Jefferson County Stormwater Coalition

Request for Proposal (RFP)

RFP No. 2026-001

PROFESSIONAL SERVICES FOR MS4 STORMWATER SYSTEM MAPPING

Proposals Due: AUGUST 28, 2026, at 3:30 p.m. EST

SECTION 1. INTRODUCTION

1. Project Location The project encompasses the designated and additionally designated MS4-regulated areas within Jefferson County, New York, specifically covering eight (8) participating coalition members: the villages of Black River, Brownville, Carthage, and West Carthage; the towns of LeRay, Rutland, and Watertown; and Jefferson County itself.

2. Project Description The Jefferson County Soil and Water Conservation District (JCSWCD), on behalf of the Jefferson County Stormwater Coalition, is seeking proposals from qualified engineering and environmental consulting firms (Consultant) to perform GIS mapping services. The selected consultant will coordinate with participating MS4 Operators to compile existing information, identify data gaps, perform field surveys and verifications as necessary, and develop standardized GIS datasets for all participating municipalities. This workflow ensures full compliance with Year 3 and Year 5 mapping requirements outlined in the SPDES General Permit for Stormwater Discharges from Municipal Separate Storm Sewer Systems (MS4s) (GP-0-24-001).

The coalition members possess varying levels of existing stormwater data, spanning preliminary GIS layers, digital records, paper maps, or institutional knowledge. The objective of this project is to create map layers with all permit-required attributes and publish them in both ESRI and Diamond Maps configurations. Diamond Maps will serve as the simplified mapping platform to allow local DPW and highway staff to easily access, maintain, and update mapping data in the future.

3. Project Funding This project is funded through New York State Department of Environmental Conservation’s (NYSDEC’s) Non-Agricultural Nonpoint Source Planning and MS4 Mapping Grant (NPG) program. Coalition members will fulfill a 10% match requirement through in-kind services, including assigning DPW and highway staff to support field survey elements directly.

This grant will fund multiple project components, including consultant services, grant administration, and other eligible project costs. Through this RFP, the District is seeking proposals for the consultant services described herein.

For this NYSDEC-funded contract, the State has established rigorous participation goals applicable to the full project budget:

M/WBE Participation Goal (30%): Equivalent to $120,000 total. The split requires a 15% MBE participation goal ($60,000) and a 15% WBE participation goal ($60,000).

SDVOB Participation Goal (6%): Equivalent to $24,000 total allocation.

The Consultant shall be responsible for coordinating and complying with all project funding-related documentation and tracking metrics.

4. Project Contract Administration The JCSWCD project management team will be responsible for contract administration, general management of the project scope, coordination of multi-municipal coalitions, and formal reporting compliance with the NYSDEC.

5. Project Schedule The target date for contractor selection is August 31, 2026. Preliminary data collection for Year 3 permit mapping milestones must be completed before December 31, 2026. Year 5 permit mapping requirements must be completed by December 31, 2027, with the full integrated Diamond Maps interfaces deployed and complete by March 31, 2028.

SECTION 2. SCOPE OF SERVICES & DELIVERABLES

In responding to this RFP, the selected Consultant will assist the Coalition in executing a comprehensive, phased stormwater mapping program that meets all regulatory obligations under the grant contract with the NYSDEC. The Consultant shall not commence work on a subsequent phase of the project without the written authorization of JCSWCD.

Phase 1:

Task 1: Project Kickoff & Work Schedule Activities: Hold initial kickoff meeting(s) with JCSWCD and Coalition representatives to review protocols, transfer existing municipal records, and establish operational communication lines. The Consultant shall distribute a brief meeting summary outlining agreements and understandings reached.

Performance Measure: Completed kickoff meeting(s), written summary of distributed responsibilities, and an estimated timeline for achieving Phase 1 and 2 mapping goals.

Task 2: Data Compiling & Gaps Analysis Activities: Review and compile all existing GIS layers, digital logs, Excel inventories, and paper records across the 8 municipalities to pinpoint missing required attributes under permit GP-0-24-001.

Performance Measure: All existing records compiled and digitized for each participating municipality to guide field collection deployments.

Task 3: Field Mapping & Data Deployment

Timeline: Preliminary field data collected before December 31, 2026; formatted data accessible to JCSWCD by February 12, 2027, to facilitate coalition annual reports.

Deliverables: Standalone GIS layers with complete attribute tables containing:

• MS4 Outfalls & Interconnections: Receiving waterbody name, type of monitoring location, type of conveyance, material, shape, submerged in water (y/n), submerged in sediment (y/n), latitude, longitude, ID, prioritization (high/low), land use in drainage area, dimensions, name of MS4 Operator's municipal facility if located at a municipal facility, name of MS4 operator or private storm system receiving discharge (if interconnection), owner, inspection data, receiving waterbody class, and WI/PWL Segment ID.

• Municipal Facility Interconnections: ID, lat/long, owner, prioritization (high/low), monitoring location type, name of municipal facility, receiving waterbody name, class, and WI/PWL Segment ID.

• Locations Receiving Stormwater from Another MS4/Private System: ID, lat/long, owner, name and contact info for upstream MS4 operator or private storm system, receiving waterbody name, class, and WI/PWL Segment ID.

• Public Stormwater Management Practices (SMPs): Address, tax parcel, lat/long, type, installation date, ownership, maintenance responsible party & contact, O&M/legal document locations, inspection frequency, installation reason, contributing drainage area (if known), date of last inspection, ID, inspection results, corrective actions identified/completed, receiving waterbody name, class, and WI/PWL Segment ID.

• Municipal Facilities Inventory: Confirm that existing municipal facility data sets contain all municipal facilities within each MS4 Operator's designated and additionally designated MS4 areas and are complete. Final dataset must include:

Address, lat/long, name, facility type, priority (high/low), contact info, responsible department, blank column for link to/ location of future specific SWPPP (year 5 requirement), onsite activities list, acreage, last assessment date, BMPs identified, next assessment date, ID, owner, SPDES/No-Exposure ID (if applicable), receiving waterbody name, class, and WI/PWL Segment ID.

• Construction Site Inventory: Verify and update existing municipal Excel logs, capture missing data, and map parameters including address/parcel, lat/long, owner contact, SWPPP approval date, priority (high/low), SPDES ID number, receiving waterbody name, receiving waterbody class, receiving waterbody WI/PWL Segment ID, current status of construction site (active, temporarily shut down, complete), and full inspection rating histories.

• Focus Areas Mapping: Generate and update layers designating onsite wastewater systems, discharges to high-class waters (AA-s, A-S, AA, A, B, SA, and SB), construction boundaries, tax/zoning classifications (residential, commercial, and industrial), stormwater hotspots, and areas with a history of illicit discharges.

Phase 2:

Task 4: Field Mapping & System Connectivity

Timeline: Mapped and completed by December 31, 2027.

Deliverables: Fully integrated structural network maps containing:

• Storm Sewer Conveyance System: Continuous mapping of open and closed drainage networks across the entire designated MS4 areas, including pipes and open ditches, detailing type, lat/long, material, shape, dimensions, direction of flow, ID, owner, receiving waterbody name, class, and WI/PWL Segment ID.

• Storm Sewer Structures: Type (drop inlet, catch basin, or manhole), number of connections to and from feature, latitude, longitude, date of last inspection, approx.

level of trash, sediment, and/ or debris captured at time of cleanout in catch basin, depth of structure (for catch basins and manholes), depth of sump (for catch basin), ID, owner, receiving waterbody name, class, and WI/PWL Segment ID

• Private Stormwater Management Practices (SMPs) (mapped town/village-wide):

Full attribute profiles identical to public SMP requirements, capturing privately owned and managed infrastructure.

• Sewershed Boundary Refinements: Dynamically update and delineate preliminary storm-sewershed boundaries to align with newly finalized structural features and network paths.

Task 5: Diamond Maps System Integration & Staff Training Timeline: Finalized and fully operational by March 31, 2028.

Activities: Format, translate, and successfully publish all verified GIS layers, attribute tables, metadata, and supporting legal records into the Diamond Maps platform.

Coordinate with the Diamond Maps team to establish user permissions and access rights for new municipal entries. Host hands-on training sessions for local highway and DPW personnel to guarantee comfortable long-term utilization and updating of the datasets. All deliverables and associated files shall become the property of JCSWCD and the participating coalition members.

SECTION 3. PROPOSAL REQUIREMENTS

Proposals must be submitted electronically in PDF format with consecutively numbered pages. Submissions shall be single-spaced, using a clear font size of no less than 12-point.

Cover letters, fee models, matrices, and professional resumes must be bundled within the unified submission file. Incomplete packages failing to address every core section will be rejected from consideration.

Submissions must be organized strictly into the following distinct tabs/sections:

1. Executive Summary: Provide an organizational overview of the firm, highlight the strategic approach to the multi-municipal scope, outline the plan to hit M/WBE and SDVOB utilization goals, and name the core authorized contact.

2. Project Experience & Capacity: Detail the firm's historical performance on similar multi-municipal scale stormwater mapping projects, expertise regarding GP-0-24-001 permit structures, and capacity to handle large state-grant-funded projects

3. Key Personnel: Provide an organizational chart identifying all key personnel and subconsultants assigned to specific tasks, accompanied by professional resumes, licensing indicators, and certifications.

4. Approach and Methodology: Deliver a straightforward work plan demonstrating an explicit understanding of the coalition's localized needs. Detail field validation strategies, data translation compatibility with Diamond Maps and ESRI ArcGIS, and specific tasks designated to certified M/WBE and SDVOB partners.

5. Cost Proposal: Consultants shall provide a clear fixed cost for each deliverable item listed under Section 2. Accompanying each deliverable, consultants must provide a staffing matrix showing specific roles, corresponding hourly or daily billing rates, and the estimated hour allocation per task. The maximum master budget cannot exceed $400,000.

6. Project Timeline: A detailed project schedule mapping out field data collection phases, verification intervals, draft data delivery windows, and training sessions aligned with the Year 3 and Year 5 milestones.

7. References: Provide up to five (5) distinct references from past projects of a similar municipal scope, including client contact names, project construction/consulting costs, and active phone numbers.

8. Gender-Based Violence Form: 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. A completed Gender-Based Violence and the Workplace form is required with your proposal submission (Appendix A).

SECTION 4. INSURANCE REQUIREMENTS

Upon notice of intent to award, the successful proposer must furnish certified insurance indicators within five (5) business days. All policies must be provided by insurance companies licensed to do business in the State of New York.

The Consultant and all subconsultants shall maintain the following minimum thresholds throughout the contract lifespan and for a three-year tail period following project closeout:

Commercial General Liability

• Commercial General Liability with Limits of Insurance not less than $1,000,000 each Occurrence and $2,000,000 Aggregate with a $2,000,000 Products & Completed Operations Aggregate.

• The Aggregate must apply on a Per Project basis.

• Liability Coverage shall apply to Premises, Operations, Independent Contractors, Products & Completed Operations, and Personal & Advertising Injury.

• The Owner and all other parties required by contract are to be listed as Additional

Insureds on a Primary and Non-Contributory Basis. A copy of the Endorsement(s) must be provided.

• General Contractor and all subcontractors shall maintain coverage for itself and all Additional Insureds for the duration of the project and maintain Completed Operations for itself and all Additional Insureds for at least 3 years after final acceptance of the work. The additional insured endorsement on the CGL policy shall be provided under Insurance Services Office, Inc., form CG 20 10 11 85 for ongoing operations and CG 20 37 07 04 completed operations and their equivalent.

• No Endorsements Excluding or limiting coverage for Labor Law Liability or any limitations on Bodily Injury or death of Employees or Subcontractors will be allowed

Professional Liability

• If Contractor will provide or furnish professional services under this Contract, through a delegation of professional design services or otherwise, then Contractor shall be responsible for purchasing and maintaining applicable professional liability insurance. This insurance must cover negligent acts, errors, or omissions in the performance of professional design or related services by the insured or others for whom the insured is legally liable.

• Contractor shall purchase and maintain a policy covering Professional Liability with limits no less than $2,000,000 per each Claim, $2,000,000 Annual Aggregate. The retroactive date on the policy must pre-date the commencement of furnishing services on the Project. The Claims Made policy must remain in effect for at least three years after completion of the project or provide a three-year Extended Reporting Period (tail).

• All deductibles or other forms of retention are the responsibility of the contractor. All deductibles or other forms of retention are subject to the approval of the Owner.

Contractor will disclose to the Owner in writing the amounts of any deductibles or self-insured retentions on the insurance required under this contract.

Automobile Liability

• Business Auto Liability with limits or at least $1,000,000 Combined Single Limit

• Business Auto Liability must coverage all owned, non-owned and hired/borrowed automobiles

• The Jefferson County Soil and Water Conservation District, the Jefferson County

Stormwater Coalition (including all 8 individual municipalities), and the New York State Department of Environmental Conservation (NYSDEC) are to be listed as Additional Insureds on a Primary and Non-Contributory Basis. A copy of the Endorsement(s) must be provided.

Workers Compensation/Employers Liability

• Workers Compensation and Employers Liability should be maintained for the State of New York for all employees of the Subcontractor with the Statutory Limits of Insurance

• The Contractor must obtain ONE of the following forms as proof of Workers’ Compensation coverage:

o Form C-105.2 – Certificate of Workers’ Compensation Insurance issued by private insurance carriers, or Form U-26.3 issued by the State Insurance Fund; or o Form SI-12– Certificate of Workers’ Compensation Self-Insurance; or Form GSI-105.2 Certificate of Participation in Workers’ Compensation Group Self-Insurance; or o CE-200– Certificate of Attestation of Exemption from NYS Workers’ Compensation and/or Disability Benefits Coverage.

NYS Disability/Paid Family Leave

• Statutory Coverage

• The Contractor must obtain ONE of the following forms as proof of Disability/PFL coverage:

o Form DB-120.1 - Certificate of Disability Benefits Insurance; or o Form DB-155 - Certificate of Disability Benefits Self-Insurance; or o CE-200 – Certificate of Attestation of Exemption from New York State

Workers’ Compensation and/or Disability Benefits Coverage

Commercial Umbrella Policy

• Umbrella Limits $5,000,000 each Occurrence and $5,000,000 Aggregate

• Umbrella policy must follow form on the General Liability, Auto Liability and

Employers Liability

• The Jefferson County Soil and Water Conservation District, the Jefferson County

Stormwater Coalition (including all 8 individual municipalities), and the New York State Department of Environmental Conservation (NYSDEC) are to be listed as Additional Insureds on a Primary and Non-Contributory Basis on the Umbrella. A copy of the Endorsement(s) must be provided.

Certificate of Insurance

• A Certificate of Insurance must be issued to the Owner and must include the owner and all other parties required by contract as Additional Insureds on a Primary and Non-Contributory Basis.

• A copy of the Additional Insured Endorsement for the Commercial General Liability, Contractors Pollution Liability, Commercial Auto and Umbrella policy must be attached to the certificate of insurance.

Waiver of Subrogation

• A Waiver of Subrogation applies in favor of the Owner and all other parties required by contract for recovery of damages to the extent these damages are covered by General Liability, Commercial Auto Liability, Property/Inland Marine, Installation Floater/Builders Risk or Workers Compensation or Employers Liability.

Cancellation

No insurance policies may be canceled, allowed to expire or reduced in coverage and the policies must provide at least 30 days prior written notice to the Owner before any of the foregoing occurs. In the event that coverage is canceled, reduced or allowed to expire, then the Owner will have the right to secure the necessary coverage and charge back the premiums to the Contractor, or reimburse itself from payments otherwise due Contractor.

SECTION 5. PROPOSAL CONDITIONS

Conditions Governing Proposals: JCSWCD reserves the right to accept or reject any or all proposals, waive minor irregularities, amend specification parameters post-release with equal notification to all bidders, or award contracts for only select portions of the tasks to maximize value. Proposers make submissions with no expectation of reimbursement for preparation costs.

Freedom of Information Law (FOIL): All submission materials become the property of the District and are subject to public disclosure under NYS Public Officers Law. Portions containing legitimate trade secrets or proprietary data must be explicitly highlighted in writing with a statement of cause for exemption request.

Liability Limitation: The District is not liable for any costs incurred by a firm during proposal preparation, localized field reconnaissance, or software familiarization. All such costs are borne entirely by the proposer.

SECTION 6. M/WBE AND TITLE VI POLICY

M/WBE Compliance NYSDEC grant enforcement protocols govern this project. A strict 30% M/WBE utilization goal applies to the master budget. Proposers must outline explicit subcontracts with NYS-certified Minority and Women-owned Businesses totaling no less than $120,000 (split evenly as 15% / $60,000 MBE and 15% / $60,000 WBE). If goals cannot be entirely met, comprehensive documentation demonstrating verified Good Faith Efforts must be supplied.

SDVOB Compliance A 6% Service-Disabled Veteran-Owned Business participation goal ($24,000) applies to the contract allocation. Contractors possessing active partnerships with certified firms located in Northern New York are highly preferred.

Title VI Nondiscrimination Assurance Pursuant to Title VI of the Civil Rights Act of 1964, no entity will be excluded from participation in, denied the benefits of, or subjected to discrimination under this procurement on the grounds of race, color, or national origin.

SECTION 7. SUBMISSION REQUIREMENTS & DEADLINE

Proposals must be received electronically via email in a single consolidated PDF file no later than August 28, 2026, at 3:30 p.m. EST.

To: Sarah Trick (ERS@JeffersonCountySWCD.org) & George Birth (ERE@JeffersonCountySWCD.org)

Subject Line: `RFP Submission: No. 2026-001 - MS4 Stormwater System Mapping`

Late submissions received after the designated date and time will be automatically rejected, with no exceptions.

SECTION 8. QUESTIONS

All technical or procedural clarifications regarding this RFP must be submitted via email to the authorized procurement contact points:

Contacts: Sarah Trick & George Birth Email: Sarah Trick (ERS@JeffersonCountySWCD.org) & George Birth (ERE@JeffersonCountySWCD.org) Subject Line: ‘Questions: RFP No. 2026-001 - MS4 Stormwater System Mapping’ Deadline for Questions: August 14, 2026, by 3:30 p.m. EST.

mailto:ERS@JeffersonCountySWCD.org mailto:ERE@JeffersonCountySWCD.org mailto:ERS@JeffersonCountySWCD.org mailto:ERE@JeffersonCountySWCD.org

Answers will be compiled and distributed to all registered interested parties simultaneously via an official addendum on August 19, 2026. Direct contact with individual municipality personnel or coalition member staff regarding this project during the active bidding session is strictly prohibited and constitutes grounds for immediate disqualification.

SECTION 9. PROPOSAL EVALUATION

The Coalition's mapping grant review committee will score submissions based on a 100-point rubric. JCSWCD may choose to conduct interviews with a competitive shortlist of firms to finalize selection.

| Evaluation Criteria | Maximum Points |

| Relevant experience and demonstrated municipal mapping expertise| 30 |

| Proposed timeline and critical path milestone planning| 20 |

| Understanding of project technical objectives | 15 |

| M/WBE & SDVOB Utilization Plan and past regional partnerships| 15 |

| Cost Proposal and staff resource breakdown cost-effectiveness| 10 |

| Quality of past work and reference metrics| 10 |

| TOTAL POSSIBLE SCORE| 100 |

SECTION 10. CONDITIONS OF CONTRACT

Subcontractor Bound Terms: All subcontractors/consultants are bound directly to the same terms, insurance requirements, and non-discrimination riders as the prime consultant. Prime consultants must pay subconsultants within seven (7) calendar days of receipt of payment from JCSWCD.

Any primary or secondary contractors/ consultants working on this project should be registered in the New York State VendRep System. DEC requires all contractors and subcontractors receiving $100,000 or more of grant funding to complete a Vendor Responsibility Questionnaire, which can be completed online through the state’s VendRep System or as a notarized document (See Appendix B). We would prefer that primary and subcontractors file the required Vendor Responsibility Questionnaire online via the

New York State VendRep System and provide JCSWCD with a copy of the “system certification” for us to provide NYSDEC.

Before work can be conducted, the selected primary consultant and any subcontractors will be required to sign and submit the following forms:

• Sexual Harassment Certification Form (Appendix C)

• Executive Order No. 16 Certification Form (Appendix D)

Payment Requisitions & Claims: Invoices must be submitted quarterly, broken down by task, and accompanied by certified timesheets showing role hourly rates, along with standard claim vouchers, and other appropriate supporting documentation as requested by JCSWCD. JCSWCD standard payment turnarounds run 30 to 60 days following voucher verification.

Grant Retainage: In compliance with state grant funding safeguards, ten percent (10%) of the total contract amount will be withheld from monthly progress allocations until all digital map layers and final summary reporting items are fully approved by the NYSDEC.

SECTION 11. TIMELINE FOR PROCUREMENT

Release of RFP: August 3, 2026

Deadline for Technical Questions: August 14, 2026, at 4:00 p.m. EST

Issuance of Clarifying Addendum: August 19, 2026

Deadline for Proposal Submission: August 28, 2026, at 3:30 p.m. EST

Target Consultant Selection Notification: August 31, 2026

Anticipated Contract Execution & Kickoff: September 11, 2026

SECTION 12. APPENDIX REFERENCES

Appendix A: Gender-Based Violence and the Workplace Form

Appendix B: Vendor Responsibility Questionnaire

Appendix C: Sexual Harassment Certification Form

Appendix D: Executive Order No. 16 Certification Form

Gender-Based Violence and the Workplace Certification 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 SAFE Leave Act, New York State Human Rights Law, and any other relevant laws and regulations.

● 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.

Organization: __________________________________________

By (signature): ____________________________________

Name (Please Print): _______________________________

Title: ____________________________________________

Date: ____________________

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

If the organization cannot make the above certification, they must provide an attached statement with their bid detailing the reasons therefor.

Appendix A mailto:workplace@opdv.ny.gov

AC 3290-S (Rev. 03/2022)

Link to state website: https://www.osc.ny.gov/state-vendors/vendrep/file-your-vendor-responsibility-questionnaire?redirect=legacy

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

You have selected the For-Profit Non-Construction questionnaire which may be printed and completed in this format or, for your convenience, may be completed online using the New York State VendRep System.

COMPLETION & CERTIFICATION

The person(s) completing the questionnaire must be knowledgeable about the vendor’s business and operations. An owner or owner’s official representative authorized to legally bind the Reporting Entity must certify the truth of the questionnaire answers.

NEW YORK STATE VENDOR IDENTIFICATION NUMBER (VENDOR ID)

The Vendor ID is a ten-digit identifier issued by New York State when the vendor is registered on the Statewide Vendor File. This number must now be included on the questionnaire. If the business entity has not obtained a Vendor ID, contact the IT Service Desk at ITServiceDesk@osc.state.ny.us or call 866-370-4672.

DEFINITIONS

All underlined terms are defined in the “New York State Vendor Responsibility Definitions List,” found at https://www.osc.state.ny.us/files/vendors/2017-11/vendor-questionnaire-definitions.pdf. These terms may not have their ordinary, common or traditional meanings. Each vendor must read the respective definitions for any and all underlined terms. By submitting this questionnaire, the vendor agrees to be bound by the terms as defined in the "New York State Vendor Responsibility Definitions List" existing at the time of certification.

RESPONSES

Every question must be answered fully. Each response must provide all relevant information to appropriately explain the answer. If you have concerns as to the legal requirements behind your answers, please seek clarification from your counsel. However, information regarding a determination or finding made in error which was subsequently corrected or overturned, and/or was withdrawn by the issuing government entity is not required to be identified. Individuals and Sole Proprietors may use a Social Security Number but are encouraged to obtain and use a federal Employer Identification Number (EIN).

REPORTING ENTITY

Each vendor must indicate if the questionnaire is filed on behalf of the entire Legal Business Entity or an Organizational Unit within or operating under the authority of the Legal Business Entity and having the same EIN. Generally, the Organizational Unit option may be appropriate for a vendor that meets the definition of “Reporting Entity” but due to the size and complexity of the Legal Business Entity, is best able to provide the required information for the Organizational Unit, while providing more limited information for other parts of the Legal Business Entity and Associated Entities.

ASSOCIATED ENTITY

An Associated Entity is one that owns or controls the Reporting Entity, or any entity owned or controlled by the Reporting Entity.

However, the term Associated Entity does not include “sibling organizations” (i.e., entities owned or controlled by a parent company that owns or controls the Reporting Entity), unless such sibling entity has a direct relationship with or impact on the Reporting Entity. Please refer to the Definitions List for the complete definition.

STRUCTURE OF THE QUESTIONNAIRE

The questionnaire is organized into eleven sections. Section I is to be completed for the Legal Business Entity. Section II requires the vendor to specify the Reporting Entity for the questionnaire. Section III refers to the individuals of the Reporting Entity, while Sections IV-VIII require information about the Reporting Entity. Section IX pertains to any Associated Entities, with one question about their Officials/Owners. Section X relates to disclosure under the Freedom of Information Law (FOIL). Section XI requires an authorized contact for the questionnaire information.

Appendix B

NYS Vendor ID: 000000000 http://www.osc.state.ny.us/vendrep/ mailto:ITServiceDesk@osc.state.ny.us https://www.osc.state.ny.us/files/vendors/2017-11/vendor-questionnaire-definitions.pdf https://www.osc.ny.gov/state-vendors/vendrep/file-your-vendor-responsibility-questionnaire?redirect=legacy

AC 3290-S (Rev. 03/2022) NYS Vendor ID: 000000000

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

I. LEGAL BUSINESS ENTITY INFORMATION

Legal Business Entity Name* EIN

Address of the Principal Place of Business (street, city, state, zip code) New York State Vendor Identification Number

Telephone Ext.

Fax

Email Website

Additional Legal Business Entity Identities: If applicable, list any other DBA, Trade Name, Former Name, Other Identity, or EIN used in the last five (5) years and the status (active or inactive).

Type Name EIN Status

1.0 Legal Business Entity Type – Check appropriate box and provide additional information:

Corporation (including PC) Date of Incorporation

Limited Liability Company (LLC or PLLC) Date of Organization

Partnership (including LLP, LP or General) Date of Registration or Establishment

Sole Proprietor How many years in business?

Other Date Established

If Other, explain:

1.1 Was the Legal Business Entity formed or incorporated in New York State? Yes No

If ‘No,’ indicate jurisdiction where Legal Business Entity was formed or incorporated and attach a Certificate of Good Standing from the applicable jurisdiction or provide an explanation if a Certificate of Good Standing is not available.

United States State

Other Country

Explain, if not available:

1.2 Is the Legal Business Entity publicly traded? Yes No

If “Yes,” provide CIK Code or Ticker Symbol

1.3 Does the Legal Business Entity have a DUNS Number? Yes No

If “Yes,” Enter DUNS Number

*All underlined terms are defined in the “New York State Vendor Responsibility Definitions List,” which can be found at

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

I. LEGAL BUSINESS ENTITY INFORMATION

1.4 If the Legal Business Entity’s Principal Place of Business is not in New York State, does the Legal Business Entity maintain an office in New York State?

(Select “N/A,” if Principal Place of Business is in New York State.)

Yes No N/A

If “Yes,” provide the address and telephone number for one office located in New York State.

1.5 Is the Legal Business Entity a New York State certified Minority-Owned Business Enterprise (MBE), Women-Owned Business Enterprise (WBE), Service-Disabled Veteran-Owned Business (SDVOB), New York State Small Business (SB) or a federally certified Disadvantaged Business Enterprise (DBE)?

If “Yes,” check all that apply:

New York State certified Minority-Owned Business Enterprise (MBE) New York State certified Women-Owned Business Enterprise (WBE) New York State certified Service-Disabled Veteran-Owned Business (SDVOB) New York State Small Business (SB) Federally certified Disadvantaged Business Enterprise (DBE)

Yes No

1.6 Identify Officials and Principal Owners of the Reporting Entity, if applicable. For each person, include name, title, date of birth, and percentage of ownership. For each Business Entity that is a Principal Owner, include name, address, EIN, and percentage ownership. Identify all Business Entities owning 25% or more of the Reporting Entity and include name, address, EIN and percentage of ownership. Attach additional pages if necessary. If applicable, reference to relevant SEC filing(s) containing the required information is optional. Each Business Entity identified as a Principal Owner must also submit a vendor responsibility questionnaire.

If there is no person or Business Entity that owns 25% or more of the Reporting Entity (or 10% or more if the Reporting Entity is publicly traded), check here.

Name of Officials and Principal Owners (for each person, please include a middle initial)

Title Date of Birth Percentage Ownership (Enter 0% if not applicable)

Name of each Business Entity owning 25% or more of Reporting Entity

Address EIN Percentage Ownership

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

II. REPORTING ENTITY INFORMATION

2.0 The Reporting Entity for this questionnaire is:

Note: Select only one.

Legal Business Entity Note: If selecting this option, “Reporting Entity” refers to the entire Legal Business Entity for the remainder of the questionnaire. (SKIP THE REMAINDER OF SECTION II AND PROCEED WITH SECTION III.)

Organizational Unit within and operating under the authority of the Legal Business Entity

SEE DEFINITIONS OF “REPORTING ENTITY” AND “ORGANIZATIONAL UNIT” FOR ADDITIONAL

INFORMATION ON CRITERIA TO QUALIFY FOR THIS SELECTION.

Note: If selecting this option, “Reporting Entity” refers to the Organizational Unit within the Legal Business Entity for the remainder of the questionnaire. (COMPLETE THE REMAINDER OF SECTION II AND ALL REMAINING

SECTIONS OF THIS QUESTIONNAIRE.)

IDENTIFYING INFORMATION

a) Reporting Entity Name

Address of the Primary Place of Business (street, city, state, zip code) Telephone ext.

b) Describe the relationship of the Reporting Entity to the Legal Business Entity

c) Attach an organizational chart

d) Does the Reporting Entity have a DUNS Number? Yes No

If “Yes,” enter DUNS Number

e) Identify the designated manager(s) responsible for the business of the Reporting Entity.

For each person, include name and title. Attach additional pages if necessary.

Name Title

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

INSTRUCTIONS FOR SECTIONS III THROUGH VII

For each “Yes,” provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). For each “Other,” provide an explanation which provides the basis for not definitively responding “Yes” or “No.” Provide the explanation at the end of the section or attach additional sheets with numbered responses, including the Reporting Entity name at the top of any attached pages.

III. LEADERSHIP INTEGRITY

Within the past five (5) years, has any current or former reporting entity official or any individual currently or formerly having the authority to sign, execute or approve bids, proposals, contracts or supporting documentation on behalf of the reporting entity with any government entity been:

3.0 Sanctioned relative to any business or professional permit and/or license? Yes No Other

3.1 Suspended, debarred, or disqualified from any government contracting process? Yes No Other

3.2 The subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation for any business-related conduct?

Yes No Other

3.3 Charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime or subject to a judgment for:

a) Any business-related activity; or

b) Any crime, whether or not business-related, the underlying conduct of which was related to truthfulness?

Yes No Other

For each “Yes” or “Other” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

IV. INTEGRITY – CONTRACT BIDDING

Within the past five (5) years, has the reporting entity:

4.0 Been suspended or debarred from any government contracting process or been disqualified on any government procurement, permit, license, concession, franchise or lease, including, but not limited to, debarment for a violation of New York State Workers’ Compensation or Prevailing Wage laws or New York State Procurement Lobbying Law?

Yes No

4.1 Been subject to a denial or revocation of a government prequalification? Yes No

4.2 Been denied a contract award or had a bid rejected based upon a non-responsibility finding by a government entity?

Yes No

4.3 Had a bid rejected on a government contract for failure to make good faith efforts on any Minority- Owned Business Enterprise, Women-Owned Business Enterprise, Service-Disabled Veteran-Owned Business or Disadvantaged Business Enterprise goal or statutory affirmative action requirements on a previously held contract?

Yes No

4.4 Agreed to a voluntary exclusion from bidding/contracting with a government entity? Yes No

4.5 Initiated a request to withdraw a bid submitted to a government entity in lieu of responding to an information request or subsequent to a formal request to appear before the government entity?

Yes No

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

V. INTEGRITY – CONTRACT AWARD

Within the past five (5) years, has the reporting entity:

5.0 Been suspended, cancelled or terminated for cause on any government contract including, but not limited to, a non-responsibility finding?

Yes No

5.1 Been subject to an administrative proceeding or civil action seeking specific performance or restitution in connection with any government contract?

Yes No

5.2 Entered into a formal monitoring agreement as a condition of a contract award from a government entity? Yes No

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

VI. CERTIFICATIONS/LICENSES

6.0 Had a revocation, suspension or disbarment of any business or professional permit and/or license? Yes No

6.1 Had a denial, decertification, revocation or forfeiture of New York State certification of Minority-Owned Business Enterprise, Women-Owned Business Enterprise, Service-Disabled Veteran-Owned Business or federal certification of Disadvantaged Business Enterprise status for other than a change of ownership?

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

VII. LEGAL PROCEEDINGS

7.0 Been the subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation?

Yes No

7.1 Been the subject of an indictment, grant of immunity, judgment or conviction (including entering into a plea bargain) for conduct constituting a crime?

Yes No

7.2 Received any OSHA citation and Notification of Penalty containing a violation classified as serious or willful?

Yes No

7.3 Had a government entity find a willful prevailing wage or supplemental payment violation or any other willful violation of New York State Labor Law?

Yes No

7.4 Entered into a consent order with the New York State Department of Environmental Conservation, or received an enforcement determination by any government entity involving a violation of federal, state or local environmental laws?

Yes No

7.5 Other than previously disclosed:

a) Been subject to fines or penalties imposed by government entities which in the aggregate total

$25,000 or more; or

b) Been convicted of a criminal offense pursuant to any administrative and/or regulatory action taken by any government entity?

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered response if necessary:

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

VIII. FINANCIAL AND ORGANIZATIONAL CAPACITY

8.0 Within the past five (5) years, has the Reporting Entity received any formal unsatisfactory performance assessment(s) from any government entity on any contract?

Yes No

If “Yes,” provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

8.1 Within the past five (5) years, has the Reporting Entity had any liquidated damages assessed over $25,000 for any reason, including failure to meet Minority-Owned Business Enterprise, Women-Owned Business Enterprise, Service-Disabled Veteran-Owned Business, or Disadvantaged Business Enterprise goals?

Yes No

If “Yes,” provide an explanation of the issue(s), relevant dates, contracting party involved, the amount assessed and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

8.2 Within the past five (5) years, have any liens, claims or judgments (not including UCC filings) over $25,000 been filed against the Reporting Entity which remain undischarged?

Yes No

If “Yes,” provide an explanation of the issue(s), relevant dates, the Lien holder or Claimant’s name(s), the amount of the lien(s), the current status of the issue(s), and the balance of the lien or judgment not yet paid. Provide answer below or attach additional sheets with numbered responses.

8.3 In the last seven (7) years, has the Reporting Entity initiated or been the subject of any bankruptcy proceedings, whether or not closed, or is any bankruptcy proceeding pending?

Yes No

If “Yes,” provide the bankruptcy chapter number, the court name and the docket number. Indicate the current status of the proceedings as “Initiated,” “Pending” or “Closed.” Provide answer below or attach additional sheets with numbered responses.

8.4 During the past three (3) years, has the Reporting Entity failed to file or pay any tax returns required by federal, state or local tax laws?

Yes No

If “Yes,” provide the taxing jurisdiction, the type of tax, the liability year(s), the tax liability amount the Reporting Entity failed to file/pay and the current status of the tax liability. Provide answer below or attach additional sheets with numbered responses.

8.5 During the past three (3) years, has the Reporting Entity failed to file or pay any New York State unemployment insurance returns?

Yes No

If “Yes,” provide the years the Reporting Entity failed to file/pay the insurance, explain the situation and any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

8.6 During the past three (3) years, has the Reporting Entity had any government audit(s) completed? Yes No

a) If “Yes,” did any audit of the Reporting Entity identify any reported significant deficiencies in internal control, fraud, illegal acts, significant violations of provisions of contract or grant agreements, significant abuse or any material disallowance?

Yes No

If “Yes” to 8.6 a), provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

IX. ASSOCIATED ENTITIES

This section pertains to any entity(ies) that either controls or is controlled by the reporting entity.

(See definition of “associated entity” for additional information to complete this section.)

9.0 Does the Reporting Entity have any Associated Entities?

Note: All questions in this section must be answered if the Reporting Entity is either:

− An Organizational Unit; or − The entire Legal Business Entity which controls, or is controlled by, any other entity(ies).

If “No,” SKIP THE REMAINDER OF SECTION IX AND PROCEED WITH SECTION X.

If “Yes,” provide the name, address and EIN of each Associated Entity and its relationship to the Reporting Entity.

Yes No

9.1 Within the past five (5) years, has any Associated Entity Official or Principal Owner been charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime or subject to a judgment for:

a) Any business-related activity; or

b) Any crime, whether or not business-related, the underlying conduct of which was related to truthfulness?

Yes No

If “Yes,” provide an explanation of the issue(s), the individual involved, their title and role in the Associated Entity, identify the Associated Entity’s name(s), EIN(s), primary business activity, the individual’s relationship to the Reporting Entity, relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s).

9.2 Does any Associated Entity have any currently undischarged federal, New York State, New York City or New York local government liens or judgments (not including UCC filings) over $50,000?

Yes No

If “Yes,” provide an explanation of the issue(s), identify the Associated Entity’s name(s), EIN(s), primary business activity, relationship to the Reporting Entity, relevant dates, the Lien holder or Claimant’s name(s), the amount of the lien(s) and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

9.3 Within the past five (5) years, has any Associated Entity:

a) Been disqualified, suspended or debarred from any federal, New York State, New York City or other New York local government contracting process?

Yes No

b) Been denied a contract award or had a bid rejected based upon a non-responsibility finding by any federal, New York State, New York City, or New York local government entity?

Yes No

c) Been suspended, cancelled or terminated for cause (including for non-responsibility) on any federal, New York State, New York City or New York local government contract?

Yes No

d) Been the subject of an investigation, whether open or closed, by any federal, New York State, New York City, or New York local government entity for a civil or criminal violation with a penalty in excess of $500,000?

Yes No

e) Been the subject of an indictment, grant of immunity, judgment, or conviction (including entering into a plea bargain) for conduct constituting a crime?

Yes No

f) Been convicted of a criminal offense pursuant to any administrative and/or regulatory action taken by any federal, New York State, New York City, or New York local government entity?

Yes No

g) Initiated or been the subject of any bankruptcy proceedings, whether or not closed, or is any bankruptcy proceeding pending?

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

IX. ASSOCIATED ENTITIES

This section pertains to any entity(ies) that either controls or is controlled by the reporting entity.

(See definition of “associated entity” for additional information to complete this section.)

For each “Yes,” provide an explanation of the issue(s), identify the Associated Entity’s name(s), EIN(s), primary business activity, relationship to the Reporting Entity, relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current…