OPD-2026-27_CASCANS_LibraryofAttachments.pdf

Library of Attachments

RFP OPD-2026-27

CAS/CANS Functional Needs Assessment Services

OPD-2026-27 CAS/CANS Functional Needs Assessment Services

Attachment 1

Document Submission Checklist and Attestation

OPWDD reserves the right to disqualify any proposals that do not contain the mandatory items specified for this Solicitation and the resulting Contract. Bidders should use the following checklist as a guide when submitting proposals and include all required documents (mark the box to indicate inclusion of the document):

To Be Included with

Submission when Checked by OPWDD

Required Documents Type of Submission

Included with Submission (To Be

Checked by Bidder)

Attachment 1 Document Submission Checklist and Attestation

Provide completed and signed copy.

Attachment 2 Bid Quote Sheet / Cost Proposal

Provide completed copy.

Attachment 2A Prevailing Wage Information

N/A

Attachment 3 Contractor Information Sheet

Provide completed and signed copy upon award.

Attachment 4 Encouraging the Use of New York Subcontractors and Suppliers

Provide completed and signed copy.

Attachment 4A New York State Business Usage Form

Provide completed copy.

Attachment 5 Non-Collusive Bidding Certification Provide completed and signed copy.

Attachment 6 References N/A

Attachment 7 Vendor Responsibility Questionnaire Certification

Provide completed and signed copy.

Attachment 8 New York State Consultant Services Contractor's Planned Employment Form A

N/A

Attachment 9 Vendor Assurance of No Conflict of Interest or Detrimental Effect

Provide completed and signed copy.

Attachment 10 Procurement Lobbying Law Certification of Compliance

Provide completed and signed copy.

Attachment 11 Equal Employment Opportunity Staffing Plan

Provide completed and signed copy.

ATTESTATION:

By signing below, the Bidder hereby attests that they have read, understand, and are willing to comply with the scope and requirements of this Solicitation. The Bidder also affirms that, to the best of their knowledge, the contents of their submitted proposal are truthful and accurate, meeting all mandatory requirements as presented.

PRINTED NAME: _______________________________________

AUTHORIZED SIGNATURE: ____________________________________ DATE: _________________

Attachment 12 MWBE Utilization Plan Provide completed and signed copy.

Attachment 13 SDVOB Utilization Plan Provide completed and signed copy.

Attachment 14 Sexual Harassment Prevention Policy Certification

Provide completed and signed copy.

Attachment 15 Executive Order 177 Anti- Discrimination Certification

Provide completed and signed copy.

Attachment 16 Certification Under Executive Order No. 16

Provide completed and signed copy.

Attachment 17 Gender-Based Policy and the Workplace Certification

Provide completed and signed copy.

Attachment 18 Minimum Mandatory Requirements Provide completed copy as applicable.

Attachment 19 Technical Proposal Response Form

Provide responses to the requirements as outlined in the solicitation as applicable.

Attachment 20 Diversity Practices Questionnaire N/A

Attachment 4

Encouraging the Use of New York Subcontractors and Suppliers

New York State businesses have a substantial presence in State contracts and strongly contribute to the economies of the state and the nation. In recognition of their economic activity and leadership in doing business in New York State, Bidders for this contract for commodities, services or technology are strongly encouraged and expected to consider New York State businesses in the fulfillment of the requirements of the contract. Such partnering may be as subcontractors, suppliers, protégés or other supporting roles.

Bidders need to be aware that all authorized users of this contract will be strongly encouraged, to the maximum extent practical and consistent with legal requirements, to use responsible and responsive New York State businesses in purchasing commodities that are of equal quality and functionality and in utilizing services and technology. Furthermore, Bidders are reminded that they must continue to utilize small, minority and women-owned business, consistent with current State law.

Utilizing New York State businesses in State contracts will help create more private sector jobs, rebuild New York’s infrastructure, and maximize economic activity to the mutual benefit of the contractor and its New York State business partners. New York State businesses will promote the contractor’s optimal performance under the contract, thereby fully benefiting the public sector programs that are supported by associated procurements.

Public procurements can drive and improve the State’s economic engine through promotion of the use of New York businesses by its contractors. The State therefore expects Bidders to provide maximum assistance to New York businesses in their use of the contract. The potential participation by all kinds of New York businesses will deliver great value to the State and its taxpayers.

Bidder can demonstrate their commitment to the use of New York state businesses by responding to the question below:

Will New York State Businesses be used in the performance of this contract? YES NO

If yes, complete Attachment 4A – New York State Business Usage Form to provide identifying information about New York State Businesses that will be used in the performance of this contract.

Contractor Name: _____________________________________________________________

Printed Name: _______________________________________________________

Title: _______________________________________________________________

Authorized Signature: _________________________________________________ Date: ___________

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

Attachment 4A

New York State Business Usage Form

Question Yes No

1. Will subcontractors be used in the performance of this contract?

2. Will New York State Businesses be used as subcontractors in the performance of the contract?

3. Will suppliers be used in the performance of the contract?

4. Will New York State Businesses be used as suppliers in the performance of the contract?

If you answered “Yes” to either questions 2 or 4, please provide identifying information below:

Subcontractor or

Supplier

Check applicable certification type:

Estimated Contract Amount and Brief Description of

Services/Commodity

Company Phone #

Location/Address where Services will be Performed

Name:

EIN:

☐NYS-Certified MBE ☐ NYS-Certified

WBE

☐ NYS-Certified

SDVOB

☐ None of the above

Estimated Amount: $_____

Description:

Name:

EIN:

☐NYS-Certified MBE ☐ NYS-Certified

WBE

☐ NYS-Certified

SDVOB

☐ None of the above

Estimated Amount: $_____

Description:

Name:

EIN:

☐NYS-Certified MBE ☐ NYS-Certified

WBE

☐ NYS-Certified

SDVOB

☐ None of the above

Estimated Amount: $_____

Description:

Name:

EIN:

☐NYS-Certified MBE ☐ NYS-Certified

WBE

☐ NYS-Certified

SDVOB

☐ None of the above

Estimated Amount: $_____

Description:

Name:

EIN:

☐NYS-Certified MBE ☐ NYS-Certified

WBE

☐ NYS-Certified

SDVOB

☐ None of the above

Estimated Amount: $_____

Description:

Attachment 5

Non-Collusive Bidding Certification Required by Section 139-D of the State Finance Law (Page 1 of 3)

SECTION 139-D, Statement of Non-Collusion in bids to the State:

BY SUBMISSION OF THIS BID, BIDDER AND EACH PERSON SIGNING ON BEHALF OF BIDDER

CERTIFIES, AND IN THE CASE OF JOINT BID, EACH PARTY THERETO CERTIFIES AS TO ITS OWN ORGANIZATION, UNDER PENALTY OF PERJURY, THAT TO THE BEST OF HIS/HER KNOWLEDGE AND

BELIEF:

[1] The prices of this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purposes 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 that 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.

A BID SHALL NOT BE CONSIDERED FOR AWARD NOR SHALL ANY AWARD BE MADE WHERE [1], [2], [3] ABOVE HAVE NOT BEEN COMPLIED WITH; PROVIDED HOWEVER, THAT IF IN ANY CASE THE

BIDDER(S) CANNOT MAKE THE FOREGOING CERTIFICATION, THE BIDDER SHALL SO STATE AND

SHALL FURNISH BELOW A SIGNED STATEMENT WHICH SETS FORTH IN DETAIL THE REASONS

THEREFORE:

[AFFIX ADDENDUM TO THIS PAGE IF SPACE IS REQUIRED FOR STATEMENT.]

Subscribed to under penalty of perjury under the laws of the State of New York, this _______ day of ___________, 20____ as the act and deed of said corporation of partnership.

Non-Collusive Bidding Certification Required by Section 139-D of the State Finance Law (Page 2 of 3)

IF BIDDER IS A PARTNERSHIP, COMPLETE THE FOLLOWING:

NAMES OF PARTNERS OR PRINCIPALS LEGAL RESIDENCE

IF BIDDER IS A CORPORATION, COMPLETE THE FOLLOWING:

NAME LEGAL RESIDENCE

President:

Secretary:

Treasurer:

President:

Secretary:

Treasurer:

IF BIDDER IS A LIMITED LIABILITY COMPANY (LLC), COMPLETE THE FOLLOWING:

NAMES OF MEMBERS LEGAL RESIDENCE

Non-Collusive Bidding Certification Required by Section 139-D of the State Finance Law (Page 3 of 3)

Identifying Data

Potential Contractor: ___________________________________________________________

Address: ___________________________________________________________ Street

City, Town, etc.

Telephone: __________________________ Title__________________________

If applicable, Responsible Corporate Officer:

Name: ______________________________ Title__________________________

Signature: _______________________________________________________________

Joint or combined bids by companies or firms must be certified on behalf of each participant.

Legal name of person, firm or corporation Legal name of person, firm or corporation

By: _____________________________ ______________________________ Name Name

Title Title

Signature Signature

Address: _________________________ Address: _________________________ Street Street

City, State City, State

Attachment 7

Vendor Responsibility Questionnaire Certification

Vendors are encouraged to file the required Vendor Responsibility Questionnaire online via the New York State VendRep System. To enroll in and use the New York State VendRep System, see the VendRep System Instructions available at https://www.osc.ny.gov/state-vendors/vendrep/vendrep-system or go directly to the VendRep System online at https://onlineservices.osc.state.ny.us. For direct VendRep System user assistance, the Office of the State Comptroller Help Desk may be reached at 866-370-4672 or 518-408-4672 or at https://www.osc.ny.gov/online-services/get-help.Vendors may opt to file a paper questionnaire; the appropriate questionnaire form can be obtained from the VendRep https://www.osc.ny.gov/state-vendors/vendrep/vendor-responsibility-forms, or vendors may contact the authorized contact at OPWDD or the Office of the State Comptroller Help Desk for a copy of the paper form.

Vendors enrolled in the online VendRep System are also reminded to recertify existing questionnaires every six months or whenever changes that affect their business entity occur.

Vendor Responsibility Certification

Please check the appropriate box indicating what mechanism has been utilized to submit the Vendor Responsibility Questionnaire; the Questionnaire is to be submitted/certified prior to the bid due date.

Bidder is to indicate the format utilized by checking the appropriate box:

On-Line Certified Format (Preferred) or Hard Copy, Paper Format

Note: If utilizing a hard copy, paper format, that hard copy must be included with the bid quote submission. If utilizing the online format, the Vendor Responsibility Questionnaire must be certified by the bid due date. Failure to provide the required Vendor Responsibility Questionnaire may result in the bid being rejected for not meeting the minimum mandatory requirement.

Vendor Registration Requirement

The New York State Vendor Management Unit (VMU) relies on State Business Units to obtain a completed Substitute Form W-9 for any vendor not already registered. Any vendor that wants to do business with New York State must complete a Substitute Form W-9, which may be accessed on the NYS Office of the State Comptroller’s Web site at the following link: https://www.osc..ny.gov/vendors/forms/ac3237s_fe.pdf.

Submit the completed form with the required bid documentation. For more information about NYS Vendor Management, please access the NYS Office of State Comptroller's website using the following link:

http://www.osc..ny.gov/state-vendors.

https://www.osc.ny.gov/state-vendors/vendrep/vendrep-system https://onlineservices.osc.state.ny.us/ https://www.osc.ny.gov/online-services/get-help https://www.osc.ny.gov/state-vendors/vendrep/vendor-responsibility-forms https://www.osc.ny.gov/state-vendors/vendrep/vendor-responsibility-forms http://www.osc.state.ny.us/vendor_management/index.htm

Attachment 9

Vendor Assurance of No Conflict of Interest or Detrimental Effect

The Firm offering to provide services pursuant to this Contract, as a contractor, joint venture contractor, subcontractor or consultant, attests that its performance of the services outlined in this Contract does not and will not create a conflict of interest with nor position the Firm to breach any other contract currently in force with the State of New York.

Furthermore, the Firm attests that it will not act in any manner that is detrimental to any State project on which the Firm is rendering services. Specifically, the Firm attests that:

1. The fulfillment of obligations by the Firm, as proposed in the response, does not violate any existing contracts or agreements between the Firm and the State.

2. The fulfillment of obligations by the Firm, as proposed in the response, does not and will not create any conflict of interest, or perception thereof, with any current role or responsibility that the Firm has with regard to any existing contracts or agreements between the Firm and the State.

3. The fulfillment of obligations by the Firm, as proposed in the response, does not and will not compromise the Firm’s ability to carry out its obligations under any existing contracts between the Firm and the State.

4. The fulfillment of any other contractual obligations that the Firm has with the State will not affect or influence its ability to perform under any contract with the State.

5. During the negotiation and execution of any contract, the Firm will not knowingly take any action or make any decision which creates a potential for conflict of interest or might cause a detrimental impact to the State as a while including, but not limited to any action or decision to divert resources from one State project to another.

6. In fulfilling obligations under each of its State contracts, the Firm will act in accordance with the terms of each of its State contracts and will not knowingly take any action or make any decision which might cause a detrimental impact to the State as a whole, including but not limited to any action or decision to divert resources from one State project to another.

7. No former officer or employee of the State who is now employed by the Firm, nor any former officer or employee of the Firm who is now employed by the State, has played a role with regard to the administration of this contract procurement in a manner that may violate Section 73(8)(a) of the State Ethics Law; and

8. The Firm has not and shall not offer to any employee, member or director of the State any gift, whether in the form of money, service, loan, travel, entertainment, hospitality, thing or promise, or in any other form, under circumstances in which it could reasonably be inferred that the gift was intended to influence said employee, member or director, or could reasonably be expected to influence said employee, member or director, in the performance of the official duty of said employee, member or director, or was intended as a reward for any official action on the part of said employee, member or director.

Firms should note that the State recognizes that conflicts may occur in the future because a Firm may have existing or new relationships. The State will review the nature of any such new relationship and reserves the right to terminate the contract for cause if, in its judgment, a real or potential conflict of interest cannot be cured.

Legal Entity Name:

By (signature):

Name (print/type):

Title:

Date:

Attachment 10

Procurement Lobbying Law Certification of Compliance

1. CONTACTS – Contractor affirms that it understands and agrees to comply with the procedures on procurement lobbying restrictions regarding permissible contacts in the restricted period for a procurement contract in accordance with State Finance Law §§ 139-j and 139-k. I agree

2. BIDDER/OFFERER DISCLOSURE OF PRIOR NON-RESPONSIBILITY DETERMINATIONS – Pursuant to Procurement Lobbying Law, State Finance Law § 139-j.

(a) Has any Governmental Entity made a finding of non-responsibility regarding the individual or entity seeking to enter into a procurement contract in the previous four years? Yes No

If yes, please answer the following questions:

i. Was the basis for the finding of non-responsibility due to a violation of State Finance Law § 139-j?

Yes No

ii. Was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a governmental entity? Yes No

If yes, please provide details regarding the finding of non-responsibility:

Governmental Entity: ____________________________________________________________________________

Date of Finding of Non-Responsibility: ______________________________________________________________

Basis of Finding of Non-Responsibility: ______________________________________________________________

(b) Has any 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? Yes No

If yes, please provide details below:

Governmental Entity: ____________________________________________________________________________ Date of Termination or Withholding of Contract: _______________________________________________________ Basis of Termination of Withholding: ________________________________________________________________

3. TERMINATION CLAUSE – Contractor certifies that all information provided to the Agency with respect to State Finance Law §§ 139-j and 139-k is complete, true and accurate. If found to be in violation of State Finance law §§ 139-j and 139-k, the contract will result in termination. I agree

Legal Entity Name: _______________________________________________________________________________

Contractor Address: ______________________________________________________________________________

By (signature): _______________________________________________________________________________________________________ I understand that my signature represents that I am signing and responding to both certifications listed above.

Name (print/type): _______________________________________________________________________________

Title: Date: Email Address: _________________________________________________________________________

Attachment 11

Equal Employment Opportunity Staffing Plan

Solicitation/Program Name: Report includes:

□ Work force to be utilized on this contract

□ Total work force

Bidder Name: Reporting Entity:

□ Contractor

□ Subcontractor

Subcontractor’s name: ________________________________ Bidder Address:

Enter the total number of employees for each classification in each of the EEO-Job Categories identified

EEO-Job Category Total Work force

Work force by Gender Work force by Race/Ethnic Identification Veteran Status Total Male (M)

Total Female

(F)

Total X

(X)

Whit e

(M) (F) (X)

Blac k

(M) (F) (X)

Hispanic

(M) (F) (X)

Asia n

(M) (F) (X)

Native American

(M) (F) (X)

Disabled

(M) (F) (X)

Veteran

(M) (F) (X)

Officials/ Administrators Professionals

Technicians

Sales Workers

Office/Clerical

Craft Workers

Laborers

Service Workers Temporary Apprentices

Totals PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type): SUBMIT COMPLETED WITH BID OR PROPOSAL

General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (04-10) and submit it as part of the bid or proposal package. Where the work force to be utilized in the performance of the State contract can be separated out from the contractor’s or subcontractor’s total work force, the Bidder shall complete this form only for the anticipated work force to be utilized on the State contract. Where the work force to be utilized in the performance of the State contract cannot be separated out from the contractor’s or subcontractor’s total work force, the Bidder shall complete this form for the contractor’s or subcontractor’s total work force.

Instructions for completing:

1. Enter the Solicitation number or RFP number that this report applies to along with the name and address of the Bidder.

2. Check off the appropriate box to indicate if the Bidder completing the report is the contractor or a subcontractor.

3. Check off the appropriate box to indicate if the work force being reported is just for the contract or the Bidder’s total work force.

4. Enter the total work force by EEO job category.

5. Break down the total work force by gender and enter under the heading ‘Work force by Gender’

6. Break down the total work force by race/ethnic background and enter under the heading ‘Work force by Race/Ethnic Identification’. Contact the

Designated Contact(s) for the solicitation if you have any questions.

7. Enter information on disabled or veterans included in the work force under the appropriate headings.

8. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes.

RACE/ETHNIC IDENTIFICATION

Race/ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. For the purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one race/ethnic group. The race/ethnic categories for this survey are:

• WHITE (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

• BLACK a person, not of Hispanic origin, who has origins in any of the black racial groups of the original peoples of Africa.

• HISPANIC/LATINO a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

• ASIAN & PACIFIC ISLANDER a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific

Islands.

• NATIVE AMERICAN/ALASKAN NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.

OTHER CATEGORIES

• DISABLED INDIVIDUAL any person who:

o has a physical or mental impairment that substantially limits one or more major life activity(ies) o has a record of such an impairment; or o is regarded as having such an impairment.

• VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975.

• GENDER Male, Female, or X

Attachment 12

MWBE UTILIZATION

PLAN Initial Plan Revised plan Solicitation#

INSTRUCTIONS: This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each NYS Certified Minority and Women-owned Business Enterprises (MWBE) under the contract. By submission of this Plan, the Bidder/Contractor commits to good faith efforts in the utilization of MWBE subcontractors and suppliers as required by the MBE/WBE goals contained in the

Solicitation/Contract. Making false representations or including information evidencing a lack of good faith as part of, or in conjunction with, the submission of a Utilization Plan is prohibited by law and may result in penalties including, but not limited to, termination of a contract for cause, loss of eligibility to submit future bids, and/or withholding of payments. Firms that do not perform commercially useful functions may not be counted toward MWBE utilization. Attach additional sheets if necessary.

BIDDER/CONTRACTOR INFORMATION MWBE Goals In

Contract Bidder/Contractor Name: NYS Vendor ID: MBE %

Bidder/Contractor Address (Street, City, State and Zip Code): WBE %

Bidder/Contractor Telephone Number: Contract Work Location/Region:

Contract Description/Title:

CONTRACTOR INFORMATION

Prepared by (Signature): Name and Title of Preparer: Telephone

Number:

Date:

Email Address:

IF UNABLE TO MEET THE MBE AND WBE GOALS SET FORTH IN THE SOLICITATION/CONTRACT

BIDDER/CONTRACTOR MUST SUBMIT A REQUEST FOR WAIVER (FORM BDC 333)

MWBE Subcontractor/Supplier

Name:

MWBE Certification: MBE WBE (If firm is dual certified please select one only)

Please identify the person you contacted: Federal Identification No.:

Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or %

MWBE Subcontractor/Supplier Name:

MWBE Certification: MBE WBE (If firm is dual certified, please select one only)

Please identify the person you contacted: Federal Identification No.:

Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or %

Submit Completed Plan To: NYS Office for People With Developmental Disabilities Division of Fiscal Policy and Management

44 Holland Ave, 5th Floor Albany NY 12229 email: mwbe@opwdd.ny.gov mailto:mwbe@opwdd.ny.gov

ADDITIONAL SHEET

Bidder/Contractor Name: Solicitation#

MWBE Subcontractor/Supplier Name: MWBE Certification: MBE WBE (If firm is dual certified please select one only) Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or % MWBE Subcontractor/Supplier Name: MWBE Certification: MBE WBE (If firm is dual certified please select one only) Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or % MWBE Subcontractor/Supplier Name: MWBE Certification: MBE WBE (If firm is dual certified please select one only) Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or % MWBE Subcontractor/Supplier Name: MWBE Certification: MBE WBE (If firm is dual certified please select one only) Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or % MWBE Subcontractor/Supplier Name: MWBE Certification: MBE WBE (If firm is dual certified please select one only) Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be determined put estimated % of work under the contract or value TBD based on contractual spending): $ or %

Attachment 13 SDVOB Contractor Utilization Plan

SDVOB UTILIZATION PLAN Initial Plan Revised plan Solicitation#

INSTRUCTIONS: This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each NYS Certified Service-Disabled Veteran-Owned Business (SDVOB) under the contract. By submission of this Plan, the Bidder/Contractor commits to making good faith efforts in the utilization of SDVOB subcontractors and suppliers as required by the SDVOB goals contained in the Solicitation/Contract. Making false representations or providing information that shows a lack of good faith as part of, or in conjunction with, the submission of a Utilization Plan is prohibited by law and may result in penalties including, but not limited to, termination of a contract for cause, loss of eligibility to submit future bids, and/or withholding of payments. Firms that do not perform commercially useful functions may not be counted toward SDVOB utilization. Attach additional sheets if necessary.

BIDDER/CONTRACTOR INFORMATION SDVOB Goals In Contract Bidder/Contractor Name: NYS Vendor ID: % Bidder/Contractor Address (Street, City, State and Zip Code):

Bidder/Contractor Telephone Number: Contract Work Location/Region:

Contract Description/Title:

CONTRACTOR INFORMATION

Prepared by (Signature): Name and Title of Preparer: Telephone Number: Date:

Email Address:

If unable to meet the SDVOB goals set forth in the solicitation/contract, bidder/contractor must submit a request for waiver on the SDVOB Waiver Form.

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or % SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

FOR OPWDD USE ONLY

OPWDD Authorized Signature: Accepted Accepted as Noted Notice of Deficiency NAME (Please Print): SDVOB

Date Received: Date Processed:

Comments:

NYS CERTIFIED SDVOB SUBCONTRACTOR/SUPPLIER INFORMATION: The directory of New York State Certified SDVOBs can be viewed at: Division of Service-Disabled Veterans' Business Development (ny.gov) Note: All listed Subcontractors/Suppliers will be contacted and verified by OPWDD.

https://sdves.ogs.ny.gov/business-search

ADDITIONAL SHEET

Bidder/Contractor Name: Solicitation#

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or % SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or % SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or % SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform)): $ or % SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

Attachment 14 Sexual Harassment Prevention Policy Certification

State Finance Law § 139-l requires bidders on state procurements to certify that they have a written policy addressing sexual harassment prevention in the workplace and provide annual sexual harassment prevention training to all its employees and that such policy, at a minimum, meets the requirements of State Labor Law § 201-g.

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 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 its employees. Such policy shall, at a minimum, meet the requirements of State Labor Law § 201-g.

Please mark the applicable box (select one) below and complete the following sections, as required.

The Contractor certifies its compliance with State Finance Law § 139-I.

The Contractor cannot certify its compliance with State Finance Law § 139-I.

Legal Entity Name:

By (signature):

Name (print/type):

Title:

Date:

If the Contractor cannot make the above certification, the Contractor must provide a statement detailing the reasons:

Attachment 15

Executive Order 177 Anti-Discrimination Certification

The New York State Human Rights Law, Article 15 of the Executive Law, prohibits discrimination and harassment on the basis of 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 age, race, creed, color, national origin, sex, sexual orientation, gender identity, disability, marital 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.

Legal Entity Name:

By (signature):

Name (print/type):

Title:

Date:

Attachment 16

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

Businesses Conducting Business in Russia

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 at Executive Order 16 Prohibiting State Agencies and Authorities from Contracting with Businesses Conducting Business in Russia | Office of General Services (ny.gov).

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.

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 in 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 penalty 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 Name (Legal Entity): ________________________________________________________

By (signature): ___________________________________________________________________

Name (print/type): ________________________________________________________________

Title: ____________________________________________________________________

Date: __________________________________________

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

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

Attachment 17

Gender-Based Policy 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: The Office for the Prevention of Domestic Violence (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 certification, each person signing on behalf of any organization certifies, and in the case of a joint submission each party thereto certifies its own organization, under penalty of perjury, that they have and have implemented a written policy addressing gender-based violence and the workplace.

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 a statement with their bid detailing the reasons therefor:

mailto:workplace@opdv.ny.gov

OPWDD OPD-2026-27 CAS/CANS

Functional Needs Assessment

Services

Bidder Name:

By checking the boxes the Bidder is attesting to a minimum of five (5) years experience, as stated in Section 1.8, for the following:

1. Maintaining and supporting through managerial oversight (either directly or through a subcontracted vendor) of a workforce equaling at least 300 people with geographic distribution and ability to perform in person assessments across all of NYS, including New York City (NYC).

2. Maintaining and supporting a data management system that can capture person-level data elements for at least 200,000 people, and meets relevant state Office of Information Technology Services (ITS) and/or federal requirements for both Centers for Medicare and Medicaid Services (CMS)/ Medicaid and Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant data security and privacy standards.

3. Operating a telephony and scheduling system that can receive assignments, call people needing assessment, and provide appointment level confirmations (both digitally and in writing) 24/7 and 365 days a year.

4. Receiving and processing a minimum of 135,000 assessment assignments annually and completing assessments for conducting standardized functional needs assessment tools for people with developmental disabilities and other special needs.

*Experience acquired concurrently is considered acceptable. Failure to meet these Minimum Qualifications will result in a proposal being found non-responsive and eliminated from consideration.

Printed Name:

Authorized Signature:

Date:

OPWDD: Putting People First

Attachment 19

Technical Proposal Response Cover

Page

RFP OPD-2026-27

CASCANS Functional Needs Assessment

Services

Bidder: