Q 25-95 Business _ Tax Forms.pdf

Sachem Central School District Administrative Offices

Purchasing Office 51 School Street

Lake Ronkonkoma, NY 11779

REQUEST FOR QUOTE

Q 25-95 Business & Tax Forms

Date of Opening: September 25, 2025 Time: 10:00 am

School Purchasing Agent: Alyssa Hull Phone: 631-471-1330 Email: ahull@sachem.edu

Vendor Name: ___________________________

Vendor Name ____________________________ Q 25-95 Business & Tax Forms

NOTICE TO VENDORS

Quotes will be received at the Sachem Central School District Administrative Offices Purchasing Office, 51 School Street Lake Ronkonkoma, New York at 10:00 am prevailing time on September 25, 2025 for the following:

Q 25-95 Business & Tax Forms

In the event that the Sachem Purchasing Office is closed the day of the Quote Opening, the quote(s) will be opened the next day that the Sachem Purchasing Office is open.

Quote responses can be submitted via email to ahull@sachem.edu and ccarbone@sachem.edu (Please e-mail to both e-mail addresses). Anyone wishing to drop off their quote response may do so in the Purchasing mailbox located in the front vestibule of the Sachem Administrative Offices, 51 School Street, Lake Ronkonkoma, NY 11779. If quote response will be shipped and/or mailed, vendors are strongly advised to ship quote responses via US Mail, Fed-Ex, UPS and/or any authorized carrier that is able to officially track proposer’s bid packet. It is further advised that arrangements be made for quote responses to be delivered prior to the quote opening date to avoid any issues with delivery delays on the date of opening.

Specifications and quote forms are available for download through the Empire State Purchasing Group:

www.bidnetdirect.com/new-york Telephone #: 800-835-4603

Copies of documents obtained from sources other than the Empire State Purchasing Group, or the Sachem Purchasing Office are not considered official copies. Only those vendors who obtain documents from either the Sachem Purchasing Office or the Empire State Purchasing Group are guaranteed to receive addendum information, if such information is issued. If you have obtained this document from a source other than the Sachem Purchasing Office or the Empire State Purchasing Group, the District will not guarantee the integrity of the document.

Inquiries regarding specifications can be addressed by contacting the Purchasing Office via email to:

ahull@sachem.edu

All Quote Proposal Forms should be completed as requested. Quote Proposals must be received with the following information clearly marked on the outside of the envelope or in the “subject” of the e-mail.:

QUOTE #, TITLE, DATE OF OPENING and VENDOR NAME

For your convenience, we have provided labels to be used when returning quotes. All required information provided by vendors must be legible. Illegible or vague quotes may be rejected.

PLEASE DO NOT SUBMIT A QUOTE UNLESS THE DEADLINES STATED CAN BE MET WITH ABSOLUTE CERTAINTY.

Please read the attached material carefully before submitting price quotes and verify that all pricing is correct. By submitting a quote response, vendor represents that they have read all of the Quote Documents and will provide items/services in accordance with the terms and conditions and at the prices stated in vendor’s response for the entire contract period.

Any modifications or changes made to this quote are in direct violation of the terms and conditions contained herein. All quotes are subject to termination at the time of discovery of any unauthorized modifications. Should said discovery be after award date, the District reserves the right to cancel the award upon written notice to the vendor.

Quantities listed in the quote specifications are estimated quantities only. There is no guarantee that the District will purchase any/all of the items listed. The District reserves the right to purchase product at the quoted price at any time during the contract period.

mailto:ahull@sachem.edu mailto:ccarbone@sachem.edu http://www.bidnetdirect.com/new-york

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INFORMATION AND INSTRUCTIONS FOR VENDORS

This quote proposal document describes the conditions and specifications that must be met by any person or firm receiving an award as a result of this quote request. All vendors must be prepared to comply with all instructions, conditions, stipulations, specifications and regulations included in this document and any and all addenda issued prior to the opening of quotes.

1. RECEIPT AND OPENING OF QUOTES

a. Quote Proposals shall be received by 10:00 am on September 25, 2025 at the Sachem Central School District Administrative Offices, Purchasing Office, 51 School Street, Lake Ronkonkoma, NY 11779.

Vendors are strongly advised to email quote responses to ahull@sachem.edu and ccarbone@sachem.edu (Please e-mail to both email addresses). Anyone wishing to drop off their quote response may do so in the Purchasing mailbox located in the front vestibule of the Sachem Administrative Offices, 51 School Street, Lake Ronkonkoma, NY 11779. If quote response will be shipped and/or mailed, vendors are strongly advised to ship quote responses via US Mail, Fed-Ex, UPS and/or any authorized carrier that is able to officially track proposer’s bid packet. It is further advised that arrangements be made for quote responses to be delivered prior to the quote opening date to avoid any issues with delivery delays on the date of opening.

b. In the event that the Sachem Purchasing Office is closed the day of the Quote Opening, the quote(s) will be opened the next day that the Sachem Purchasing Office is open.

c. This quote document describes the conditions and specifications that must be met by any person or firm receiving an award as a result of this quote. All vendors must be prepared to comply with all instructions, conditions, stipulations, specifications and regulations included in this document and any and all addenda issued prior to the opening of quotes.

2. Pricing – All pricing must include shipping, handling, freight and inside delivery. THERE SHALL

BE NO CHARGES IN EXCESS OF THOSE QUOTED, INCLUDING FUEL SURCHARGES.

3. Quotes stipulating minimum order requirements will not be considered.

4. The awarded quote will be utilized at the discretion of the District. Consequently, there is no guarantee that the specified minimum amount of materials, supplies, labor or equipment will be purchased. In the event the lowest apparent vendor has been awarded only a small portion of the quote, the District reserves the right to award to the second lowest vendor. The School District reserves the right to purchase any goods or services included as part of this quote from any means legally available to it at any time. Conversely, the quantities purchased may exceed the estimated quantities listed within this quote proposal.

5. Services rendered and/or materials provided must be as per the enclosed specifications. All invoices submitted must reflect pricing as per the enclosed quote proposal pages in order for payment to be rendered (i.e., hourly rate, initial price, discount, final price, etc.).

mailto:ccarbone@sachem.edu

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6.. Vendors are to pay particular attention to the way each item is requested to be priced.

Example: $ Price each or lot/ounce/case/per hour.

7. NO ITEMS ARE TO BE SHIPPED OR DELIVERED UNTIL RECEIPT OF AN AUTHORIZED PURCHASE

ORDER FROM SACHEM CENTRAL SCHOOL DISTRICT.

8. HOW TO COMPLETE FORMS:

a) Print complete Quote Packet, including General Terms and Conditions and any other posted documents from Empire State Bid System website and complete required forms. General Terms and Conditions should be retained for your records.

b) All Quote Proposal Forms should be completed as requested. Please refer to General Terms and Conditions for pricing requirements. Quote prices submitted shall be all-inclusive. Vendor name should be filled in on all Quote Proposal Forms.

c) The Vendor shall make no changes to the forms. Quote prices and all information required shall be typewritten or written legibly in ink. All quotes shall be hand signed, and the signer’s name shall also be typed or printed next to or under the signature, together with his/her title or designation. Failure to properly complete the quote may result in the bid being disqualified. It is understood that upon award, all prices, bid terms and conditions as represented in this quote and all addenda thereto shall become part and parcel of the awarded contract.

d) Price lines should not be left blank. Incomplete quote responses may be rejected, in whole or in part, at the discretion of the District. All pricing and any additional information must appear on pricing lines provided. The District will not accept any arrows or ditto marks.

1. “No Quote” – contractor not wishing to quote on an item and/or service must clearly indicate “No Quote” for that item and/or service.

2. “No Charge” Quote Item – contractor desiring to quote “no charge” on an item and/or service must clearly indicate such by either writing “No Charge” or indicating 0 dollars.

3. “No Discount” Quote item – contractor offering no discount off list price must clearly indicate zero percent (0%) as discount offered.

e) All required information provided by vendors must be legible. All quotes submitted must be either typed or written legibly in ink. Quotes written in PENCIL will not be considered. Illegible or vague quotes may be rejected at the discretion of the District. All signatures must be the original written signatures in INK. Facsimile printed or typewritten signatures are not acceptable. Incomplete submissions may not be considered for award. Vendor may be deemed non-responsive if responses are not received in required format as indicated herein. It is the responsibility of the vendor to return all required pages of this contract.

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SPECIFICATIONS

(I) Purpose:

It is the intent of the District to obtain a qualified vendor to supply business and tax forms for the Sachem Central School District.

This document describes the conditions and specifications that must be met by any person or firm receiving a contract as a result of this bid. All vendors must be prepared to comply with all instructions, general terms and conditions, stipulations, specifications and regulations included in this document and any and all addenda issued prior to the opening of quotes.

(II) Contract Period: Upon approval through June 30, 2026 Vendor will be responsible for supplying items in this quote proposal at the price quoted at any time during the entire contract period.

(III) Scope of Work:

Vendor shall be responsible to supply items specified in this document as required by the District.

This quote shall establish pricing for all orders placed within the stated contract period.

(IV) Award:

Award (s) will be made to the lowest responsible proposer as will best promote the public interest. If bid security is required, awards will be made to the lowest responsible bidder furnishing the required security as will best promote the public interest.

The Board of Education reserves the right before making an award to conduct investigations as to whether or not the items, qualifications or facilities offered by the vendor meet the requirements set forth in the Quote Proposal and Specifications and are sufficient to insure the proper performance of the contract. The Board of Education reserves the right to request additional information from the vendor for this purpose.

(V) Insurance Requirements:

Certificates of Insurance are required as per the attached General Terms and Conditions and must be filed with the Business office within ten (10) days after receipt of award notification. Insurance information must be provided prior to the commencement of work.

(VI) Non-Assignment:

a. The successful vendor will give its personal attention to the faithful performance of this Contract. It will not assign, transfer, convey, sublet, use brokers, engage subcontractors, hire others to perform all or part of this Contract, or otherwise dispose of this Contract or any part hereof without prior written consent of the District.

b. In accordance with New York State General Municipal Law 109, at no time during the duration of the Contract, shall the Successful vendor be allowed to assign any portion of this Contract to a third party without prior written consent of the District.

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(VII) Pricing:

All pricing must include shipping, handling, freight & inside delivery. THERE SHALL BE NO CHARGES

IN EXCESS OF THOSE QUOTED, INCLUDING FUEL SURCHARGES.

No increases in the prices charged will be permitted for the full term of this contract.

This quote will be awarded either in whole or in part, whichever is in the best interest of the District.

All work must be performed in accordance with all applicable Federal, State, Local, OSHA and District laws, rules and/or regulations.

Extension of Contract to Political Subdivisions - The Sachem Central School District reserves the right to allow all municipal, not-for-profit and political subdivisions authorized under the General Municipal Laws of the State of New York, to purchase any goods and/or services awarded as a result of this quote in accordance with the latest amendments to NYS GML 100 through 104. However, it is understood that the extension of such contracts are at the discretion of the vendor and the vendor is only bound to any contract between the Sachem Central School District and the vendor. Additionally, the School District reserves the right to purchase any goods or services included as a part of this quote from any means legally available to it at any time.

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QUOTE PROPOSAL FORM

Quote # and Title: Q 25-95 Business & Tax Forms

Time: 10:00 am Contract Period: Upon approval through June 30, 2026

Name Of Company: ___________________________________________________

Address: ___________________________________________________

Telephone Number: ___________________________________________________

Fax Number: ___________________________________________________

Email Address: ___________________________________________________

Federal Employer Id #: ___________________________________________________

Company Representative: ___________________________________________________

Title: ___________________________________________________

THE VENDOR WHOSE SIGNATURE APPEARS ON THIS QUOTE PROPOSAL FORM DECLARES AND CERTIFIES THAT:

1. Vendor is of lawful age and the only one interested in this bid, and that no one other than said vendor has any interest herein;

2. No member of the Board of Education of Sachem Central School District nor any officer or employee or person whose salary is payable in whole or in part from the treasury of said Board of Education is directly or indirectly interested in this proposal or in the supplies, materials, equipment, work or services to which it related, or in any portion of the profits thereof;

3. Vendor has carefully examined the General Instructions and Specifications prepared under the direction of the Board of Education, and will, if successful in this quote proposal, furnish and deliver at the prices submitted and within the time stated, all the materials, supplies, apparatus, goods, wares and merchandise, services or labor for which this quote proposal is made in accordance with the terms and conditions of the specifications;

4. Vendor is in compliance with the requirements of Section 201-G of the NYS labor law regarding sexual harassment.

5. Vendor has examined, understands and agrees to the terms and conditions of the agreement as set forth in the bid specifications.

6. Vendor has submitted accurate pricing for required items and/or services.

By submitting a quote response, the undersigned, as a duly authorized representative of the vendor, represents that they have read all Quote Documents and will provide items and/or services in accordance with the terms and conditions and at the prices stated in vendor’s response for the entire contract period.

Company Representative: __________________________________________________________

Signature: __________________________________________________________

Title: __________________________________________________________

Sworn to before me this _______day of ________________, 20___

NOTARY PUBLIC

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Time: 10:00 am Contract Period: Upon approval through June 30, 2026

Quotes stipulating minimum order requirements will not be considered. There shall be no charges in excess of those quoted. No contract becomes binding until the necessary funds have been approved for the fiscal year during which the contract is in effect.

Price lines should not be left blank. Incomplete quote responses may be rejected, in whole or in part, at the discretion of the District.

a. “No Quote” – contractor not wishing to quote on an item and/or service must clearly indicate “No Quote” for that item and/or service.

b. “No Charge” Item – contractor desiring to quote “no charge” on an item and/or service must clearly indicate such by either writing “No Charge” or indicating 0 dollars.

c. “No Discount” item – contractor offering no discount off list price must clearly indicate zero percent (0%) as discount offered.

d. All quotes & invoices must reflect prices and discounts according to bid.

e. ALL PRICING AND ANY ADDITIONAL INFORMATION MUST APPEAR ON PRICING LINES

PROVIDED. THE DISTRICT WILL NOT ACCEPT ANY ARROWS OR DITTO MARKS.

ITEM# DESCRIPTION QUANTITY UNIT PRICE TOTAL PRICE

BF-00050

Press Pin Feed Labels, 2 ¾” x 1 15/16”, one across, 3 ½” carrier width. 5,000 labels/ box

1 box

$ /each box

$ /1 box

BF-00060

Press on Pin Feed Labels, 3 ½” x 15/16”, 3 across, fanfold, 15,000 forms/ box

3 boxes

$ /3 boxes

Q 25-95 Business & Tax Forms Date of Opening: September 25, 2025

Contract Period: Upon approval through June 30, 2026

ITEM# DESCRIPTION QUANTITY EACH PRICE TOTAL PRICE

BF-00100

Attendance Office Card, 7” x 4”, side perforations, white index stock, black ink, printed on one side.

1000 continuous cards / lot

1 lot

$ /each lot

$ /1 lot

BF-00110

Emergency Information Card, 7” x 4”, side perforations, buff index stock, printed on one side, 5,000 continuous cards /box

4 boxes

$ /4 boxes

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BF-00120

Pressure Seal Form, white, E-Z fold, 1000 forms/ lot

2 lots

$ /2 lots

BF-00130

Blank Schedule, 9 ½” x 5 ½”, ½” side perforations, 2-part, fold at 11”. 1000 forms/ lot

3 lots

$ /3 lots

BF-00140

½” side perforations, 1-part, fold at 11”. 1000 forms/ lot

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BF-

00150

½” side perforations, 32# white ledger 1-part, fold at 11”. 1,000 forms/ lot

BF-00170

W2 Pressure seal E-Z Fold, 5-up horizontal, blank face, instructions on back, 8 ½” x 14”, 1000 forms / box

3 boxes

$ /3 boxes

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BF-00180

1099-M, 8 ½” x 11” Z-fold, backer with instructions, pressure seal, 500 forms / pack

1 pack

$ /each pack

$ /1 pack

BF-00210

1099, Blank, 3-up, 8 1/2” x 11”. 50 forms / pack

BF-00220

1099-R, 100 forms / pack

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BF-00240

1099-NEC, 50 forms / pack

BF-00260

1099-MISC, 100 forms / pack

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BF-00280

1096, 5 forms / pack

TOTAL AMOUNT OF QUOTE- ALL FORMS

Authorized Signature: ___________________________________________________

Print Name: ___________________________________________________

Title: ___________________________________________________

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CONTRACTOR NOTIFICATION FORM

Please take notice that asbestos exists in various locations in school district facilities.

Exposure to asbestos fibers can be hazardous to your health, and therefore, precautions must be taken to prevent the disturbance of asbestos-containing building materials.

Information on specific locations where asbestos containing building materials exists is available for each building at the Facilities Office. Areas containing asbestos materials are conspicuously labeled.

Please proceed with caution.

I hereby acknowledge this notification regarding the locations of asbestos containing building materials in the building/buildings in which I am to perform work.

All workers in my employ (if applicable) will also be informed of this notification and will take adequate measures to prevent disturbance of asbestos fibers to the extent possible.

All workers in my employ are trained in asbestos awareness.

Contractor will indemnify and save the school district harmless from any and all claims of loss or damage, including reasonable attorney fees, which the school district may sustain by reason of the injury to any person through the negligent act or acts of the contractor, its sub-contractors, employees or agents in the performance of said contract.

(Printed Name of Contractor Representative)

(Signature) (Date)

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VENDOR REFERENCE FORM

**REFERENCES MUST BE COMPANIES OTHER THAN SACHEM*

Company Name: ___________________________________________

Address: ___________________________________________

Contact Person: ___________________________________________

Telephone: ( ) ___________________________________________

Email: ___________________________________________

Dates of Contract(s) ___________________________________________

Contact Person: ___________________________________________

Telephone: ( ) ___________________________________________

Contact Person: ___________________________________________

Telephone: ( ) ___________________________________________

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NON-COLLUSIVE QUOTE PROPOSAL CERTIFICATION

Firm Name _________________________________________________________________________ Business Address _______________________________________Telephone Number ( ) ___________________ I. General Quote Certification The vendor certifies that he will furnish, at the prices herein quoted, the materials, equipment and/or services as proposed on this quote.

II. Non-Collusive Quote Certification

1. The undersigned (does) (do) declare the (he has) (they have) examined the Notice to Vendors, Specifications, and Information for Vendors (all of which are acknowledged as being part of the Contract), as well as all laws, ordinances, and regulations governing the work and (he proposes) (they propose) to provide all materials, labor and related items necessary for the satisfactory completion of the work strictly in accordance with the documents listed above under the head of Section 103-d of the General Municipal Law as follows:

Statement of non-collusion in bids and proposals to political subdivision of the state. Every bid or proposal hereafter made to a political subdivision of the state or any public department, agency or official thereof where competitive bidding is required by statute, rule, regulation, or local law, for work or services performed or to be performed or goods sold or to be sold, shall contain the following statement subscribed by the vendor and affirmed by such vendor as true under the penalties of perjury: Non-collusive bidding certification.

(a) By submission of this quote, each vendor and each person signing on behalf of any vendor certifies, and in the case of a joint quote each party thereto certifies as to its own organization, under penalty of perjury, that to the best of knowledge and belief:

(1) The prices in this quote have been arrived at independently without collusion, consultation, communication or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other vendor or with any competitor;

(2) Unless otherwise required by law, the prices which have been quoted in this quote have not been knowingly disclosed by the vendor and will not knowingly be disclosed by the vendor prior to opening, directly or indirectly, to any other vendor or to any competitor; and

(3) No attempt has been made or will be made by the vendor to induce any other person, partnership or corporation to submit or not to submit a quote for the purpose of restricting competition.”

(b) A quote shall not be considered for award nor shall any award be made when (a) (1) (2) and (3) above have not been complied with; provided: however, that if in any case the vendor cannot make the foregoing certification, the vendor shall so state and shall furnish with the quote a signed statement which sets forth in detail the reasons therefore. Where (a) (1) (2) and (3) above have not been complied with, the quote shall not be considered for award nor shall any award be made unless the head of the purchasing unit of the political subdivision, public department, agency or official thereof to which the quote is made, or his designee, determines that such disclosure was not made for the purpose of restricting competition.

The fact that a vendor (a) has published price lists, rates, or tariffs covering items being procured, (b) has informed prospective customers of proposed or pending publication of new or revised price lists for such items, or (c) has sold the same items to other customers at the same prices being quoted, does not constitute, without more, a disclosure within the meaning subparagraph one (a).

2. Any bid or proposal hereafter made to any political subdivision of the state or any public department, agency or official thereof by a corporate vendor for work or services performed or to be performed or goods sold or to be sold, where competitive bidding is required by statute, rule, regulation, or local law, and where such bid or quote proposal contains the certification referred to in subdivision one of the section, shall be deemed to have been authorized by the board of directors of the vendor, and such authorization shall be deemed to include the signing and submission of the bid or quote and the inclusion therein of the certificate as to non-collusion as the act and deed of the corporation.

3. The successful vendor shall agree to defend, indemnify and hold harmless the Sachem Central School District, its Board of Education, the Board’s agents, officers, trustees, attorneys and employees, all in their individual and corporate capacities, for all loss, costs, damage and expense, including but not limited to attorney’s fees, arising out of or resulting from the performance of the Agreement. In addition, an applicable Insurance Endorsement, naming the District as an additional insured, with no responsibility to the District for payment of premium, shall be submitted by the successful vendor, to the District’s Business Office, within ten (10) days after the award of the quote to the successful vendor.

Signature (Authorized) _________________________________Title _________________________

Please Print Name ________________________________________

Sworn to before me this ______________ Day of _____________, 20___

Notary Public

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AFFIDAVIT OF COMPLIANCE

STATE OF_______________

COUNTY OF_____________

___________________________________________, being duly sworn, deposes and says:

1) That (s)he is an officer or representative of ___________________________________ and that (s)he has the authority to sign this affidavit.

2) This affidavit is offered as an inducement to the Sachem School District to award to

_________________________________________________such purchase contracts for goods or services as directed by the Board of Education, in accordance with New York State law and with District policy.

3) That no Officer, Employee or Stockholder of the above referenced vendor is an Employee, in any position, Administrator or Board Member at the Sachem Central School District other than as disclosed below.

4) That no Officer, Employee or Stockholder of the above-referenced vendor is related to an employee in any position, administrator or Board Member, at the Sachem Central School District other than as disclosed below:

Vendor: List Officer, Employee or Stockholder’s Name

Position with Vendor Sachem Employee, Administrator or Board Member Name

Relationship between parties

Signed Date

Sworn to before me this ______________ Day of _____________, 20__

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SEXUAL HARASSMENT PREVENTION CERTIFICATION FORM

By submission of this quote, the person signing on behalf of the vendor certifies, under penalty of perjury, that: the vendor has and has implemented a written policy addressing sexual harassment prevention in the workplace; the vendor provides annual sexual harassment prevention training to all of its employees; and that the principal(s) and all employees of the vendor have completed the sexual harassment prevention training in the last twelve (12) months. Such policy shall, at a minimum, meet the requirements of Section 201-g of the Labor Law.

Vendor Name: _______________________________________________________________________

Vendor Address: _____________________________________________________________________

Print Name and Title: _________________________________________________________________

Signature:____________________________________________________________________________

Date: _____________________

Sworn to before me this ________ day of ________________, 20____

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IRAN DIVESTMENT ACT COMPLIANCE

FORM 1 - CERTIFICATION OF COMPLIANCE WITH THE IRAN DIVESTMENT ACT

As a result of the Iran Divestment Act of 2012 (the “Act”), Chapter 1 of the 2012 Laws of New York, a new provision has been added to State Finance Law (SFL) § 165-a and New York General Municipal Law § 103-g, both effective April 12, 2012.

Under the Act, the Commissioner of the Office of General Services (OGS) will be developing a list of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law) (the “Prohibited Entities List"). Pursuant to SFL § 165-a(3)(b), the initial list is expected to be issued no later than 120 days after the Act’s effective date at which time it will be posted on the OGS website.

By submitting a quote in response to this solicitation or by assuming the responsibility of a Contract awarded hereunder, each Vendor/Contractor, any person signing on behalf of any Vendor/Contractor and any assignee or subcontractor and, in the case of a joint quote, each party thereto, certifies, under penalty of perjury, that once the Prohibited Entities List is posted on the OGS website, that to the best of its knowledge and belief, that each Vendor/Contractor and any subcontractor or assignee is not identified on the Prohibited Entities List created pursuant to SFL § 165-a(3)(b).

Additionally, Vendor/Contractor is advised that once the Prohibited Entities List is posted on the OGS Website, any Vendor/Contractor seeking to renew or extend a Contract or assume the responsibility of a Contract awarded in response to this solicitation must certify at the time the Contract is renewed, extended or assigned that it is not included on the Prohibited Entities List.

During the term of the Contract, should the School District receive information that a Vendor/Contractor is in violation of the above-referenced certification, the School District will offer the person or entity an opportunity to respond. If the person or entity fails to demonstrate that he/she/it has ceased engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then the School District shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking compliance, recovering damages or declaring the Vendor/Contractor in default. The School District reserves the right to reject any quote or request for assignment for a Vendor/Contractor that appears on the Prohibited Entities List prior to the award of a contract and to pursue a responsibility review with respect to any Vendor/Contractor that is awarded a contract and subsequently appears on the Prohibited Entities List.

I, ___________________________________________, being duly sworn, deposes and says that he/she is the ___________________________ of the __________________________________ Corporation and that neither the Vendor/ Contractor nor any proposed subcontractor is identified on the Prohibited Entities List.

SIGNED

Sworn to before me this ______________ Day of _____________, 20__

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IRAN DIVESTMENT ACT COMPLIANCE

FORM 2 - DECLARATION OF INABILITY TO PROVIDE CERTIFICATION OF COMPLIANCE WITH THE IRAN

DIVESTMENT ACT

Vendors shall complete this form if they cannot certify that the vendor /contractor or any proposed subcontractor is not identified on the Prohibited Entities List. The District reserves the right to undertake any investigation into the information provided herein or to request additional information from the vendor.

Name of the Vendor: ______________________________________________________________

Address of Vendor: ______________________________________________________________

Has vendor been involved in investment activities in Iran?

Describe the type of activities including but not limited to the amounts and the nature of the investments (e.g. banking, energy, real estate)

If so, when did the first investment activity occur?

Have the investment activities ended?

If so, what was the date of the last investment activity?

If not, have the investment activities increased or expanded since April 12, 2012?

Has the vendor adopted, publicized, or implemented a formal plan to cease the investment activities in Iran and to refrain from engaging in any new investments in Iran?

If so, provide the date of the adoption of the plan by the vendor and proof of the adopted resolution, if any and a copy of the formal plan.

In detail, state the reasons why the vendor cannot provide the Certification of Compliance with the Iran Divestment Act below (additional pages may be attached):

I, ___________________________________________, being duly sworn, deposes and says that he/she is the ___________________________ of the __________________________________ Corporation and that neither the Vendor/ Contractor nor any proposed subcontractor is identified on the Prohibited Entities List.

SIGNED

SWORN to before me this

_______________ day of _______________20__

Notary Public: _________________________

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STATEMENT OF VENDOR’S QUALIFICATIONS

1. Name of Vendor ________________________________________________

2. Type of Business Entity: _________________________________________

3. If the vendor is a corporation, state the date and place of incorporation of the corporation.

4. For how many years has the vendor done business under its present name?

5. List the persons who are directors, officers, owners, managerial employees or partners in the vendor’s business.

6a. Have any of the persons listed in Number 5 owned/operated/been shareholders in any other companies? If so, please state name of owned/operated/been shareholders and names of other companies:

6b. If the answer to number 6a is in the affirmative, list said persons and the names of their previous affiliations.

7. Has any director, officer, owner or managerial employee had any professional license suspended or revoked? If the answer to this question is yes, list the name of the individual, the professional license he/she formerly held, whether said license was revoked or suspended and the date of the revocation or suspension.

8. During the five-year period preceding the submission of this quote, has the vendor been found guilty of any OSHA Violations? If the answer to this question is yes, describe the nature of the OSHA violation, an explanation of the remediation or other steps taken regarding such violation(s).

9. During the five-year period preceding the submission of this quote, has the vendor been charged with any claims pertaining to unlawful intimidation or discrimination against any employee by reason of race, creed, color, disability, sex or natural origin and/or violations of an employee’s civil rights or equal employment opportunities? If the answer to this question is yes, list the person making such claim against the vendor, a description of the claim, the status of the claim, and what disposition (if any) has been made regarding such claim.

Q 25-95 Business & Tax Forms

10. During the five-year period preceding the submissions of this quote, has the vendor been named as a party in any lawsuit in an action involving a claim for personal injury or wrongful death arising from performance of work related to any project in which it has been engaged? If the answer to this question is yes, list all such lawsuits, the index number associated with said suit and the status of the lawsuit at the time of the submission of this quote.

11. During the five-year period preceding the submission of this quote, has the vendor been the subject of an investigation and/or proceedings before the Department of Labor for alleged violations of the Labor Law as it related to the payment of prevailing wages and/or supplemental payment requirements? If the answer to this question is yes, please list each such instance of the commencement of a Department of Labor proceeding, for which project such proceeding was commenced, and the status of the proceeding at the time of the submission of this quote.

12. During the five-year period preceding the submission of this quote, has the vendor been the subject of an investigation and/or proceeding before any law enforcement agency, including, but not limited to any District Attorney’s Office? If the answer to this question is yes, please list each such instance, the law enforcement agency, the nature of the proceeding, the project for which such proceeding was commenced, if applicable to a project, and the status of the proceeding at the time of the submission of this quote.

13. During the five-year period preceding the vendor’s submission of this quote, has the vendor been the subject of proceedings involving allegations that it violated the Workers’ Compensation Law including but not limited to the failure to provide proof of worker’s compensation or disability coverage and/or any lapses thereof. If the answer to this question is yes, list each such instance of violation and the status of the claimed violation at the time of the submissions of this quote.

14. Has the vendor, its officers, directors, owner and/or managerial employees been convicted of a crime or been the subject of a criminal indictment during the five years preceding the submission of this quote? If the answer to this question is yes, list the name of the individual convicted or indicted, the charge against the individual and the date of disposition of the charge.

Q 25-95 Business & Tax Forms

15. During the five-year period preceding the vendor’s submission of this quote, has the vendor been charged with and/or found guilty of any violations of federal, state or municipal environmental and/or health laws, codes, rules and/or regulations? If the answer to this question is yes, list the nature of the charge against the vendor, the date of the charge, and the status of the charge at the time of the submission of this quote.

16. Has the vendor bid on any projects during the five-year period preceding the vendor’s submission of this quote? If the answer to this question is yes, list the projects bid on, whether said bid was awarded to the vendor and the expected date of commencement of the work for said project. For those projects listed, if the vendor was not awarded the contract, state whether the vendor was the lowest monetary vendor.

17. Does the vendor have any projects ongoing at the time of the submission of this quote? If the answer to this question is yes, list the projects on which the vendor is currently working, the percentage complete and the expected date of completion of said project.

18. Has your firm, in its current or any previous names, ever been declared a non-responsible vendor? If yes, please explain.

19. Has your firm, in its current or any previous names, ever failed to complete any contract awarded to you? If yes, please explain.

20. Has the vendor ever been terminated from a Project by the Owner? If the answer to this question is yes, list the projects on which the vendor was terminated, the nature of the termination (convenience, suspension, for cause), and the date of said termination.

I hereby certify that all statements above are true and accurate.

BY: _________________________________ DATE: _________________

(Signature) (Print Name and Title)

Q 25-95 Business & Tax Forms

QUOTE PROPOSAL CHECKLIST

The forms listed below must be completed and included with Quote response on flash drive and hard copy as applicable:

1. QUOTE PROPOSAL FORMS – Fill in all required vendor information, signatures and notaries.

2. VENDOR PRICE LIST FORM – Submit as per instructions in “How to Complete Forms”.

3. CONTRACTOR NOTIFICATION FORM – Print name, sign, date as required.

Fill in Vendor name on bottom of page.

4. VENDOR REFERENCE FORM – references must be other than Sachem. Fill in Vendor name bottom of page.

5. NON-COLLUSIVE CERTIFICATION – Fill in all requested vendor info on top and bottom of page.

6. AFFIDAVIT OF COMPLIANCE – Fill in all required vendor info, sign in INK (no pencil permitted), signature must be notarized.

7. SEXUAL HARASSMENT PREVENTION CERTIFICATION FORM – Fill in all required vendor info, sign in INK (no pencil permitted), signature must be notarized.

8. IRAN DIVESTMENT ACT COMPLIANCE FORMS -Fill in Form 1 if certifying compliance. Fill in Form 2 if non-compliant. Chosen form must be filled out completely, signed in ink and notarized.

9. STATEMENT OF VENDOR’S QUALIFICATIONS – All questions must be answered. Statement must be signed, name printed, date and vendor name filled in on bottom of page.

10. ELECTRONIC COPY (FLASH DRIVE) – Included with quote response

11. ADDENDA (when applicable – indicate receipt of addenda as requested on form)

12. ADDITIONAL FORMS (if included and required) Additional forms may be included and required for this quote. It is the responsibility of the Vendor to return all required pages of this contract.

13. QUOTE PROPOSAL CHECKLIST – fill in vendor name on bottom of form

14. NO QUOTE RESPONSE FORM – fill out and return if not submitting a quote.

Q 25-95 Business & Tax Forms

“NO QUOTE” RESPONSE FORM

Quote #: Q 25-95

Title: Business & Tax Forms

Vendor Name: ______________________________

TO ALL VENDORS:

In an effort to best serve the taxpayer, Sachem Central School District requests that a no quote response be returned with an explanation for the vendor’s decision not to submit a proposal. Therefore, please provide information below.

We have elected not to submit a quote due to the following reason(s): (Please check all that apply)

Do not offer this product/service __________ Unable to meet specifications __________ Unable to meet service requirements __________ Workload does not allow us to quote __________ Specifications unclear or too restrictive __________ Insufficient time to respond __________ Other (Please specify):

We have not submitted a quote in response to this solicitation. However, we wish to remain on the vendor list for future solicitations. Yes ______ No ______

Failure to submit either a quote proposal or a “no quote” response form may result in your company name being removed from our active vendor list.

We appreciate your cooperation and value your comments.

Alyssa Hull School Purchasing Agent

Authorized Signature: _____________________________________________

Please print name & Title: __________________________________________

Date: ______________

Q 25-95 Business & Tax Forms

ENVELOPE LABELS:

For your convenience, we have provided labels to be used when returning quotes.

ADDRESS LABEL:

Administrative Offices Purchasing Office 51 School Street

Lake Ronkonkoma, NY 11779

QUOTE LABEL TO BE PLACED ON LOWER LEFT CORNER OF OUTSIDE ENVELOPE:

VENDOR NAME: ________________________

QUOTE ENCLOSED – DATED MATERIAL

QUOTE #: Q 25-95 Business & Tax Forms DATE OF OPENING: September 25, 2025 TIME: 10:00 am