Required Forms w_checklist~14.pdf

HOLYOKE COMMUNITY COLLEGE

303 Homestead Avenue

Holyoke, MA 01040

Request for Proposal - CHECKLIST OF FORMS

REQUIRED FORMS (to be completed and submitted with bid response)

Additional Environmentally Preferable Products/Practices

Business Reference Form

Commonwealth of Massachusetts Contractor Authorized Signatory Listing (notarized)

Commonwealth of Massachusetts Prompt Pay Discount Form (if applicable)

Commonwealth Terms and Conditions

Consultant Contractor Mandatory Submission Form (if applicable)

Holyoke Community College Standard Conditions and Terms for Bidding

Massachusetts Substitute W-9 Form – Request for Taxpayer Identification Number and Certification (DUNS number)

Noncollusive Affidavit (notarized)

Supplier Diversity Program Plan Form

INFORMATIONAL FORMS (must read and no action required at time of bid response)

Authorization for Electronic Funds Payment (EFT) (if applicable)

Operational Services Division – RFR-Required Specifications

Operational Services Division – RFR Required Specifications for Information Technology

Operational Services Division – RFR-Other Specifications (form used for Access to Security-Sensitive Information)

FORMS REQUIRED, IF CONTRACT IS AWARDED

Commonwealth of Massachusetts – Standard Contract Form

Commonwealth of Massachusetts Standard Contract Amendment Form (used if necessary)

Commonwealth of Massachusetts Change in Contractor Identity Form (used if necessary)

Executive Order 504 Contractor Certification Form

Submitted by: _____________________________________________________________

Company Name (please print)

Signature Date Submitted

Business Reference Form

Bidder: ______________________________________________________________________________________

RFR Name/Title: _______________________________________________________________________________

RFR Number: _________________________________________________________________________________

The bidder must provide (indicate a number) __________ business references.

Reference name:_____________________________________ Contact: ___________________________________

Address: ________________________________________________ Phone: # ( ) ________________________

Fax/Internet address: ____________________________________________________________________________

Description and date(s) of commodities and services provided: ___________________________________________

Reference name: _______________________________________Contact: _________________________________

Address: _______________________________________________ Phone: # ( ) ________________________

Fax/Internet address: ____________________________________________________________________________

Description and date(s) of commodities and services provided: ___________________________________________

Reference name: ______________________________________ Contact: __________________________________

Address: _______________________________________________ Phone: # ( ) ________________________

Fax/Internet address: ____________________________________________________________________________

Description and date(s) of commodities and services provided: ___________________________________________

References will be contacted to confirm the bidder’s abilities and qualifications as stated in the bidder’s response. The department may deem the bidder’s response unresponsive if a reference is not obtainable from a listed reference after reasonable attempts.

COMMONWEALTH OF MASSACHUSETTS

Prompt Pay Discount Form (Invoice discounts for receiving fast payments)

Revised 3/9/07

Bidder Name: .

Vendor Code (VCUST): .

Contract/RFR Number(s): .

Prompt Payment Discounts (PPD). All contractors/vendors doing business with the Commonwealth must provide a Prompt Payment Discount (PPD) for receiving early payments unless the Contractor/vendor can provide compelling proof that providing a prompt pay discount would be unduly burdensome. Contractors benefit from PPD by increased, usable cash flow as a result of fast and efficient payments for commodities or services rendered. Contractors who agree to accept Electronic Funds Transfer (EFT) increase the prompt pay benefit by ensuring that funds are paid directly to their designated bank accounts, thus eliminating the delay of check clearance policies and traditional mail lead time.

Payments processed through the state accounting system (MMARS) can be tracked and verified through the Comptroller’s Vendor Web system using the Vendor/Customer Code assigned to you by a Commonwealth department.

The Commonwealth benefits because contractors reduce the cost of products and services through the applied discount.

While Bidders/Contractors have flexibility in determining the actual % discount(s) offered to the Commonwealth, the discount(s) must be identified for 10, 15, 20 and/or 30 days for payment issuance in the column entitled “% Discount Off Proposed Price” below. The Commonwealth may use the prompt pay discounts submitted as a basis for selection and may negotiate discounts as deemed in the best interest of the Commonwealth. The requirement to offer PPD discounts may be waived by the Commonwealth on a case-by-case basis if participation in the program would be unduly burdensome, provided the specific reason for the hardship is outlined below.

All discounts offered will be taken in cases where the payment issue date is within the specified number of days listed below and in accordance with the Commonwealth’s Bill Paying Policy. Payment days will be measured from the date goods are received and accepted / performance was completed OR the date an invoice is received by the Commonwealth, whichever is later to the date the payment is issued as an EFT (preferred method) or mailed by the State Treasurer. The date of payment “issue” is the date a payment is considered “paid” not the date a payment is “received” by a Contractor.

If internal Bidder/Contractor systems require an alternate method of measuring payment issue dates, the

Bidder/Contractor must note the issues below or on an attached page if necessary to be considered by the PMT. In cases where the Bidder/Contractor considers that offering a Prompt Payment Discount would be a hardship, the Bidder must clearly define the issues and reasons for said hardship. Providing volume discounts or other discounts on prices is not considered a hardship, since the PPD provides the additional benefit of early cash flow for the Contractor.

Enter the Prompt Payment Discount percentage (%) off the invoice payment, for each of the payment issue dates listed, if the payment is issued within the specified Payment Issue days. For example:

5% - 10 Days 4% - 15 Days 3% - 20 Days 2% - 30 Days

If no discount is offered enter 0%

Prompt Payment Discount % Payment Issue Date w/in

% 10 Days

% 15 Days

% 20 Days

% 30 Days

The Contractor is unable to provide a prompt payment discount due to the following hardship:

Contractor/Bidder Authorized Signature _________________________________ Date: ____________ Contractor/ Bidder Authorized Signatory Print Name and Title: __________________________________ https://massfinance.state.ma.us/VendorWeb/vendor.asp

CCOOMMMMOONNWWEEAALLTTHH TTEERRMMSS AANNDD CCOONNDDIITTIIOONNSS

This Commonwealth Terms and Conditions form is jointly issued by the Executive Office for

Administration and Finance (ANF), the Office of the

Comptroller (CTR) and the Operational Services Division (OSD) for use by all Commonwealth of

Massachusetts (“State”) Departments and

Contractors. Any changes or electronic alterations by either the Department or the Contractor to the official version of this form, as jointly published by ANF, CTR and OSD, shall be void. Upon execution of these Commonwealth Terms and Conditions by the Contractor and filing as prescribed by the Office of the Comptroller, these Commonwealth Terms and Conditions will be incorporated by reference into any Contract for Commodities and Services executed by the Contractor and any State Department, in the absence of a superseding law or regulation requiring a different Contract form. Performance shall include services rendered, obligations due, costs incurred, commodities and deliverables provided and accepted by the Department, programs provided or other commitments authorized under a Contract. A deliverable shall include any tangible product to be delivered as an element of performance under a Contract. The Commonwealth is entitled to ownership and possession of all deliverables purchased or developed with State funds. Contract shall mean the

Standard Contract Form issued jointly by ANF, CTR and OSD.

1. Contract Effective Start Date. Notwithstanding verbal or other representations by the parties, or an earlier start date indicated in a Contract, the effective start date of performance under a Contract shall be the date a Contract has been executed by an authorized signatory of the Contractor, the

Department, a later date specified in the Contract or the date of any approvals required by law or regulation, whichever is later.

2. Payments And Compensation. The Contractor shall only be compensated for performance delivered and accepted by the Department in accordance with the specific terms and conditions of a Contract. All Contract payments are subject to appropriation pursuant to M.G.L. C. 29, §26, or the availability of sufficient non-appropriated funds for the purposes of a Contract, and shall be subject to intercept pursuant to M.G.L. C. 7A, §3 and 815 CMR 9.00.

Overpayments shall be reimbursed by the Contractor or may be offset by the

Department from future payments in accordance with state finance law.

Acceptance by the Contractor of any payment or partial payment, without any written objection by the Contractor, shall in each instance operate as a release and discharge of the State from all claims, liabilities or other obligations relating to the performance of a Contract.

3. Contractor Payment Mechanism. All Contractors will be paid using the

Payment Voucher System unless a different payment mechanism is required.

The Contractor shall timely submit invoices (Payment Vouchers - Form PV) and supporting documentation as prescribed in a Contract. The Department shall review and return rejected invoices within fifteen (15) days of receipt with a written explanation for rejection. Payments shall be made in accordance with the bill paying policy issued by the Office of the Comptroller and 815 CMR 4.00, provided that payment periods listed in a Contract of less than forty-five (45) days from the date of receipt of an invoice shall be effective only to enable a Department to take advantage of early payment incentives and shall not subject any payment made within the forty-five (45) day period to a penalty. The Contractor Payroll System, shall be used only for

"Individual Contractors" who have been determined to be "Contract

Employees" as a result of the Department's completion of an Internal Revenue Service SS-8 form in accordance with the Omnibus Budget Reconciliation Act

(OBRA) 1990, and shall automatically process all state and federal mandated payroll, tax and retirement deductions.

4. Contract Termination Or Suspension. A Contract shall terminate on the date specified in a Contract, unless this date is properly amended in accordance with all applicable laws and regulations prior to this date, or unless terminated or suspended under this Section upon prior written notice to the Contractor. The Department may terminate a Contract without cause and without penalty, or may terminate or suspend a Contract if the Contractor breaches any material term or condition or fails to perform or fulfill any material obligation required by a Contract, or in the event of an elimination of an appropriation or availability of sufficient funds for the purposes of a Contract, or in the event of an unforeseen public emergency mandating immediate Department action. Upon immediate notification to the other party, neither the Department nor the Contractor shall be deemed to be in breach for failure or delay in performance due to Acts of God or other causes factually beyond their control and without their fault or negligence. Subcontractor failure to perform or price increases due to market fluctuations or product availability will not be deemed factually beyond the Contractor's control.

5. Written Notice. Any notice shall be deemed delivered and received when submitted in writing in person or when delivered by any other appropriate method evidencing actual receipt by the Department or the Contractor. Any written notice of termination or suspension delivered to the Contractor shall state the effective date and period of the notice, the reasons for the termination or suspension, if applicable, any alleged breach or failure to perform, a reasonable period to cure any alleged breach or failure to perform, if applicable, and any instructions or restrictions concerning allowable activities, costs or expenditures by the Contractor during the notice period.

6. Confidentiality. The Contractor shall comply with M.G.L. C. 66A if the Contractor becomes a "holder" of "personal data". The Contractor shall also protect the physical security and restrict any access to personal or other

Department data in the Contractor's possession, or used by the Contractor in the performance of a Contract, which shall include, but is not limited to the

Department's public records, documents, files, software, equipment or systems.

7. Record-keeping And Retention, Inspection Of Records. The Contractor shall maintain records, books, files and other data as specified in a Contract and in such detail as shall properly substantiate claims for payment under a Contract, for a minimum retention period of seven (7) years beginning on the first day after the final payment under a Contract, or such longer period as is necessary for the resolution of any litigation, claim, negotiation, audit or other inquiry involving a Contract. The Department shall have access, as well as any parties identified under Executive Order 195, during the Contractor’s regular business hours and upon reasonable prior notice, to such records, including on-site reviews and reproduction of such records at a reasonable expense.

8. Assignment. The Contractor may not assign or delegate, in whole or in part, or otherwise transfer any liability, responsibility, obligation, duty or interest under a Contract, with the exception that the Contractor shall be authorized to assign present and prospective claims for money due to the Contractor pursuant to a Contract in accordance with M.G.L. C. 106, §9-318. The

Contractor must provide sufficient notice of assignment and supporting documentation to enable the Department to verify and implement the assignment. Payments to third party assignees will be processed as if such payments were being made directly to the Contractor and these payments will be subject to intercept, offset, counter claims or any other Department rights which are available to the Department or the State against the Contractor.

9. Subcontracting By Contractor. Any subcontract entered into by the

Contractor for the purposes of fulfilling the obligations under a Contract must be in writing, authorized in advance by the Department and shall be consistent with and subject to the provisions of these Commonwealth Terms and

Conditions and a Contract. Subcontracts will not relieve or discharge the Contractor from any duty, obligation, responsibility or liability arising under a

Contract. The Department is entitled to copies of all subcontracts and shall not be bound by any provisions contained in a subcontract to which it is not a party.

10. Affirmative Action, Non-Discrimination In Hiring And Employment.

The Contractor shall comply with all federal and state laws, rules and regulations promoting fair employment practices or prohibiting employment discrimination and unfair labor practices and shall not discriminate in the hiring of any applicant for employment nor shall any qualified employee be demoted, discharged or otherwise subject to discrimination in the tenure, position, promotional opportunities, wages, benefits or terms and conditions of their employment because of race, color, national origin, ancestry, age, sex, religion, disability, handicap, sexual orientation or for exercising any rights afforded by law. The Contractor commits to purchasing supplies and services from certified minority or women-owned businesses, small businesses or businesses owned by socially or economically disadvantaged persons or persons with disabilities.

11. Indemnification. Unless otherwise exempted by law, the Contractor shall indemnify and hold harmless the State, including the Department, its agents, officers and employees against any and all claims, liabilities and costs for any personal injury or property damages, patent or copyright infringement or other damages that the State may sustain which arise out of or in connection with the Contractor's performance of a Contract, including but not limited to the negligence, reckless or intentional conduct of the Contractor, its agents, officers, employees or subcontractors. The Contractor shall at no time be considered an agent or representative of the Department or the State. After prompt notification of a claim by the State, the Contractor shall have an opportunity to participate in the defense of such claim and any negotiated settlement agreement or judgment. The State shall not be liable for any costs incurred by the Contractor arising under this paragraph. Any indemnification of the Contractor shall be subject to appropriation and applicable law.

12. Waivers. Forbearance or indulgence in any form or manner by a party shall not be construed as a waiver, nor in any way limit the legal or equitable remedies available to that party. No waiver by either party of any default or breach shall constitute a waiver of any subsequent default or breach.

13. Risk Of Loss. The Contractor shall bear the risk of loss for any Contractor materials used for a Contract and for all deliverables, Department personal or other data which is in the possession of the Contractor or used by the Contractor in the performance of a Contract until possession, ownership and full legal title to the deliverables are transferred to and accepted by the Department.

14. Forum, Choice of Law And Mediation. Any actions arising out of a

Contract shall be governed by the laws of Massachusetts, and shall be brought and maintained in a State or federal court in Massachusetts which shall have exclusive jurisdiction thereof. The Department, with the approval of the

Attorney General's Office, and the Contractor may agree to voluntary mediation through the Massachusetts Office of Dispute Resolution (MODR) of any Contract dispute and will share the costs of such mediation. No legal or equitable rights of the parties shall be limited by this Section.

15. Contract Boilerplate Interpretation, Severability, Conflicts With Law, Integration. Any amendment or attachment to any Contract which contains conflicting language or has the affect of a deleting, replacing or modifying any printed language of these Commonwealth Terms and Conditions, as officially published by ANF, CTR and OSD, shall be interpreted as superseded by the official printed language. If any provision of a Contract is found to be superseded by state or federal law or regulation, in whole or in part, then both parties shall be relieved of all obligations under that provision only to the extent necessary to comply with the superseding law, provided however, that the remaining provisions of the Contract, or portions thereof, shall be enforced to the fullest extent permitted by law. All amendments must be executed by the parties in accordance with Section 1. of these

Commonwealth Terms and Conditions and filed with the original record copy of a Contract as prescribed by CTR. The printed language of the Standard Contract Form, as officially published by ANF, CTR and OSD, which incorporates by reference these Commonwealth Terms and Conditions, shall supersede any conflicting verbal or written agreements relating to the performance of a Contract, or attached thereto, including contract forms, purchase orders or invoices of the Contractor. The order of priority of documents to interpret a Contract shall be as follows: the printed language of the Commonwealth Terms and Conditions, the Standard Contract Form, the

Department's Request for Response (RFR) solicitation document and the

Contractor’s Response to the RFR solicitation, excluding any language stricken by a Department as unacceptable and including any negotiated terms and conditions allowable pursuant to law or regulation.

IN WITNESS WHEREOF, The Contractor certify under the pains and penalties of perjury that it shall comply with these Commonwealth Terms and Conditions for any applicable Contract executed with the

Commonwealth as certified by their authorized signatory below:

CONTRACTOR AUTHORIZED SIGNATORY: _________________________________________________________________(signature)

Print Name:

Title:

Date:

(Check One): ____ Organization ____ Individual

Full Legal Organization or Individual Name:

Doing Business As: Name (If Different):

Tax Identification Number:

Address:

Telephone: FAX:

INSTRUCTIONS FOR FILING THE COMMONWEALTH TERMS AND CONDITIONS

A “Request for Verification of Taxation Reporting Information” form (Massachusetts Substitute W-9 Format), that contains the Contractor's correct

TIN, name and legal address information, must be on file with the Office of the Comptroller. If the Contractor has not previously filed this form with the Comptroller, or if the information contained on a previously filed form has changed, please fill out a W- 9 form and return it attached to the executed COMMONWEALTH TERMS AND CONDITIONS.

If the Contractor is responding to a Request for Response (RFR), the COMMONWEALTH TERMS AND CONDITIONS must be submitted with the Response to RFR or as specified in the RFR. Otherwise, Departments or Contractors must timely submit the completed and properly executed

COMMONWEALTH TERMS AND CONDITIONS (and the W-9 form if applicable) to the: Payee and Payments Unit, Office of the Comptroller, 9th Floor, One Ashburton Place, Boston, MA 02108 in order to record the filing of this form on the MMARS Vendor File. Contractors are required to execute and file this form only once.

Page 2.of 2.

CONSULTANT CONTRACTOR MANDATORY SUBMISSION FORM

COMPLETE THE FOLLOWING ONLY FOR CONSULTANT CONTRACTS

(Within HH and NN and UU Object Classes)

Bidder: ________________________________________________________________________

RFR Name/Title: ________________________________________________________________

RFR Number: # _________________________________________________________________

Additional Income Disclosure. Pursuant to the provisions of M.G.L. c. 29, s. 29A, the following amounts represent any contracts, grants or other income due from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of a contract. You may attach additional sheets as necessary.

Please check if N/A.

Disclosure of Persons with Financial Interest (other than the bidder). Pursuant to the provisions of M.G.L. c. 29, s 29A and c. 7A,

s. 6, the following individuals have a financial interest in a contract and/or with more than one percent (1%) interest in the capital stock of the contractor. You may attach additional sheets as necessary.

Key Personnel. Attach a resume or statement of qualifications for all key personnel specifically named in bidder's response to be assigned to the performance of a contract.

The information submitted herein is certified by the bidder to be accurate under the pains and penalties of perjury.

Signature of Authorized Signatory for Bidder: __________________________________________________

Title of Authorized Signatory for Bidder: _____________________________________________________

Date: __________________________________________________________

HOLYOKE COMMUNITY COLLEGE

Standard Conditions and Terms for Bidding

All bids must be submitted on the accompanying form or equivalent proposal form. No bid will be entertained unless so made. Late bids will not be considered. Bids must be in the Purchasing Department before the date and time specified on the front of the proposal. Post marks are not considered in determining late bids. The right is reserved to reject any and all bids, to omit an item or items, or to accept any proposal deemed best for the College. Awards may be made on an item by item basis. If a split award is not acceptable, it must be stated prominently on the bid.

Proprietary names are quoted for information only, not to limit competition. If bid is based on similar products deemed to be similar/equal to those quoted, give full information in the bid or in a letter. Bids on items which differ from specifications will, at the discretion of the Purchasing Agent, be rejected unless the manufacturer's name and catalogue number, together with literature and cuts, are furnished with bid proposals.

Please state warranty if applicable.

A vendor winning this award, if the amount is over $20,000, may be required to enter into a formal contract with the

Commonwealth.

BID PRICING

All prices must be submitted on a net basis. Cash, trade, and quantity discounts must be figured in net prices submitted.

BID DELIVERY

Delivery is to be free of charge unless specified elsewhere on this bid.

Materials ordered must be delivered at the places designated for their reception. Deliveries must be strongly packed and marked according to the direction for shipment, without charge therefor, or for cases, crates, baling or sacks.

Inspection will be made at the point of delivery. If material is not in accordance with specifications, it will be returned at vendor's expense.

STATE TAX COMPLIANCE

Bidder must complete and sign the attached statement of state tax compliance. No bid will be awarded without an original signed copy of the tax compliance form attached to bid document. Vendor code number must be filled in, otherwise invoice(s) cannot be processed. Be sure to list all 13 digits of your Massachusetts vendor code number. If you have not been issued a vendor number, enter the nine character federal employer identification number you were issued by the IRS if you employ more than two people. If you employ two or less people, use your personal social security number.

VERIFICATION OF COMPLIANCE

The Governor or his designee, the Secretary of Administration and Finance, and the State Auditor or his designee, shall have the right at reasonable times and upon reasonable notice to examine the books, records, and other compilations of data of (vendor) which pertain to the performance of the provisions and requirements of this contract or agreement.

REQUIREMENTS FOR SAMPLES

If items' specifications of later terms and conditions call for a sample to be submitted, the award will be made on the basis of the sample. The sample will set the standard of grade and quality to which all deliveries must conform. When the weight or quantity of the sample to be submitted is not stated, the sample may be submitted in the smallest container which accurately represents the article the bidder is proposing to furnish. Only one sample of each article called for under any proposal may be submitted. Any bidder, at his request, will be furnished with the analysis of the sample submitted by him.

All goods must be of the best quality of the grade required. All items coming within the National Pure Food and Drug Act, approved June 30, 1906, must comply with the Act. All goods are subject to inspection at the College and to analysis and comparison with the standard sample at a laboratory of the Commonwealth of Massachusetts. Deliveries will be subject to any regulations or standards established under Federal or Massachusetts laws. Any article which in any way fails to conform to the specifications or to the standard sample upon which the award was made may, at the option of the

Purchasing Agent, be rejected and returned to the shipper at his expense, in which case the College shall have the privilege of purchasing in the open market, or otherwise, at the then prevailing price until a satisfactory delivery is made.

Any excess in price shall be borne by the bidder securing the contract. In the event that the material has been passed upon by the Purchasing Agent, a penalty will be exacted.

PENALTIES FOR NON-PERFORMANCE

Whenever it is found that the vendor is unable to deliver the quantity called for by the College, the College shall have the privilege of purchasing in the open market, or otherwise, at the then prevailing price, until a satisfactory delivery is made, and any excess in price shall be borne by the bidder securing the contract. In case the work shall not be completed or the goods delivered by the time appointed, the vendor shall pay the College liquidated damages in full compensation for such delay. The sum of fifty dollars ($50) for each day beyond the time specified for completion of the work or delivery of the goods shall be the amount of the assessment; until said work shall be completed provided that the assessment of liquidated damages or a portion thereof may be waived by the College if the vendor submits evidence satisfactory to the

College that work has not be completed by time appointed because of conditions beyond the control of the vendor.

DUTIES OF VENDORS ON NON-DISCRIMINATION

The vendor will comply with the provisions of the Governor's Code of Fair Practices dated January 12, 1966 and Chapter

151B as amended of the non-discrimination laws of the Commonwealth which are herein incorporated by reference and made part of this contract.

The vendor, in the performance of all work after award and prior to completion of the contract work, will not discriminate on grounds of race, color, religion, national origin, age or sex in employment practices or in the selection or retention of subcontractors, and in the procurement of materials and rental of equipment. The vendor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice advising the said labor union of workers' representative or the vendor's commitments under this section and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

The vendor will provide all information and reports required by Holyoke Community College or the Massachusetts

Commission Against Discrimination on order or instructions issued by them and will permit access to its books, records, accounts and other sources of information and its facilities as may be determined by the Massachusetts Commission

Against Discrimination to be pertinent to ascertain compliance with such orders or instructions. Where the information required is in the exclusive possession of another who fails or refuses to furnish this information, the vendor shall so certify to Holyoke Community College and shall set forth what efforts he has made to obtain the information.

SANCTIONS FOR NON-COMPLIANCE

In the event of the vendor's non-compliance with the nondiscrimination provisions of this contract, the College shall impose such contract sanctions as it may determine to be appropriate including, but not limited to

a. Withholding of payments to the vendor under the contract until the vendor complies, and/or

b. cancellation, termination or suspension of the contract in whole or in part.

SECURITY

Holyoke Community College can neither accept nor assume responsibility for the security of the vendor's material nor equipment; which is lost, stolen, or vandalized. The vendor is advised to exert caution in placement and storage of his equipment and material while in use at the College.

OTHER CONDITIONS - THE VENDOR

- May subcontract work only with the approval of the College;

- will fully indemnify and save harmless the College, its officers and employees for his wrongful or negligent acts or those of his employees or subcontractors and from all claims relating to labor performed or material furnished;

- will comply with all laws, ordinances, rules, orders and regulations, national, state and local in his work and give all notices, take out all permits, pay charges, fees, water, and other rates therefor;

- will pay to the College all expenses, losses, and damages incurred in consequence of any defect, omission or mistake of the vendor, his employees or subcontractors;

- will provide only new and good quality materials and warrant that he has full title to all materials, supplies, and equipment used by him in the work;

- will maintain and leave the work site in a clean and orderly condition;

- will at the time of bid, indicate expected time of commencement and completion of work after receipt of purchase order;

- will at the time of bid, submit descriptive literature of proposed item(s);

- will provide Worker's Compensation in accordance with the provisions of Chapter 438, Acts of 1938 during life of contract.

STATEMENT OF STATE TAX COMPLIANCE

Bid Number

Pursuant to Chapter 233 of the Acts of 1983, section 49A(b), I, ____________________________________, authorized signatory for (Name and Title)

_____________________________________, whose principal place of (vendor) business is at ______________________________________________ (Address) do hereby certify under the pains and penalties of perjury that

____________________________________ has complied with all laws (vendor) of the Commonwealth relating to taxes.

Authorized Signature

Date

Vendor Code Number

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Services (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. I am an U.S. person (including an U.S. resident alien).

4. I am currently a Commonwealth of Massachusetts’s state employee: (check one): No____ Yes _____ If yes, in compliance with the State Ethics Commission requirements.

Certification instructions: You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.

Sign Here

Authorized Signature ► Date ►

Purpose of Form A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or debt, or contributions you made to an IRA.

Use Form W-9 only if you are a U.S. person (including a resident alien), to give your correct TIN to the person requesting it (the requester) and , when applicable, to:

1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued).

2. Certify you are not subject to backup withholding

If you are a foreign person, use the appropriate Form W-8. See Pub 515, Withholding of Tax on Nonresident Aliens and Foreign Corporations.

What is backup withholding? Persons making certain payments to you must withhold a designated percentage, currently 28% and pay to the IRS of such payments under certain conditions. This is called “backup withholding.”

Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive will not be subject to backup withholding. Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester, or

2. You do not certify your TIN when required (see the Part II instructions on page 2 for details), or

3. The IRS tells the requester that you furnished an incorrect TIN, or

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See the Part II instructions on page 2.

Penalties

Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information.

Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of Federal law, the requester may be subject to civil and criminal penalties.

Form W-9

(Massachusetts Substitute W-9 Form) Rev. April 2009

Request for Taxpayer Identification Number and Certification

Completed form should be given to the requesting department or the department you are currently doing business with.

Name ( List legal name, if joint names, list first & circle the name of the person whose TIN you enter in Part I-See Specific Instruction on page 2)

Business name, if different from above. (See Specific Instruction on page 2)

Check the appropriate box: □ Individual/Sole proprietor □ Corporation □ Partnership □ Other ►-----------------------------------------------

Legal Address: number, street, and apt. or suite no.

Remittance Address: if different from legal address number, street, and apt. or suite no.

City, state and ZIP code

City, state and ZIP code

Phone # ( ) Fax # ( ) Email address:

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instruction on page 2. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 2.

Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number to enter.

Vendors:

Dunn and Bradstreet Universal Numbering System (DUNS))

Social security number

OR

Employer identification number

DUNS

f

Part II Certification

P le a s e p ri n t o r ty p e

What Name and Number to Give the Requester

For this type of account: Give name and SSN of:

1. Individual

2. Two or more individuals (joint account)

3. Custodian account of a minor (Uniform Gift to Minors Act)

4. a. The usual revocable savings trust (grantor is also trustee)

b. So-called trust account that is not a legal or valid trust under state law

5. Sole proprietorship

The individual The actual owner of the account or, if combined funds, the first individual on the account

The minor

The grantor-trustee

The actual owner

The owner

For this type of account: Give name and EIN of:

6. Sole proprietorship

7. A valid trust, estate, or pension trust

8. Corporate

9. Association, club, religious, charitable, educational, or other tax-exempt organization

10. Partnership

11. A broker or registered nominee

12. Account with the

Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments

The owner

Legal entity

The corporation The organization

The partnership The broker or nominee

The public entity

Specific Instructions

Name. If you are an individual, you must generally enter the name shown on your social security card. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name.

If the account is in joint names, list first and then circle the name of the person or entity whose number you enter in Part I of the form.

Sole proprietor. Enter your individual name as shown on your social security card on the “Name” line. You may enter your business, trade, or “doing business as (DBA)” name on the “Business name” line.

Limited liability company (LLC). If you are a single-member LLC (including a foreign LLC with a domestic owner) that is disregarded as an entity separate from its owner under Treasury regulations section 301.7701-3, enter the owner’s name on the “Name” line. Enter the LLC’s name on the “Business name” line.

Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8.

Other entities. Enter your business name as shown on required Federal tax documents on the “Name” line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the “Business name” line.

Part I - Taxpayer Identification

Number (TIN)

Enter your TIN in the appropriate box.

If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN.

If you are an LLC that is disregarded as an entity separate from its owner (see Limited liability company (LLC) above), and are owned by an individual, enter your SSN (or “pre-LLC” EIN, if desired). If the owner of a disregarded LLC is a corporation, partnership, etc., enter the owner’s EIN.

Note: See the chart on this page for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a

TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office. Get Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can get Forms W-7 and SS-4 from the IRS by calling 1-800-TAX-FORM (1-800-829- 3676) or from the IRS’s Internet Web Site www.irs.gov.

If you do not have a TIN, write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments.

The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note: Writing “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Part II - Certification

To establish to the paying agent that your TIN is correct or you are a U.S. person, or resident alien, sign Form W-9.

For a joint account, only the person whole TIN is shown in Part I should sign (when required).

Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

Dunn and Bradstreet Universal Numbering System (DUNS) number requirement – The United States Office of Management and Budget (OMB) requires all vendors that receive federal grant funds have their DUNS number recorded with and subsequently reported to the granting agency. If a contractor has multiple DUNS numbers the contractor should provide the primary number listed with the Federal government’s Central Contractor Registration (CCR) at /www.ccr.gov . Any entity that does not have a DUNS number can apply for one on-line at www.DNB.com under the DNB D-U-N Number Tab.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires you to give your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or MSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws

You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold a designated percentage, currently 28% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.

List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.

Circle the minor’s name and furnish the minor’s SSN.

You must show your individual name, but you may also enter your business or “DBA” name. You may use either your SSN or EIN (if you have one).

. List first and circle the name of the legal trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.)

Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

If you have questions on completing this form, please contact the Office of the State Comptroller.

(617) 973-2468.

Upon completion of this form, please send it to the Commonwealth of Massachusetts Department you are doing business with.

NONCOLLUSIVE AFFIDAVIT

Must be completed and included at Bid Opening

State of ___________________________

County of ___________________________

_________________________________, being first duly sworn deposed and says:

That he/she is a ( )Partner ( )Officer ( )Owner of firm of the party making the forgoing proposal or bid; that such proposal or bid is genuine and not collusive or sham, that said bidder has not clouded, conspired, connived or agreed directly or indirectly, with any bidder, or person, to put in a sham bid or to refrain from bidding and has not in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any person, to fix the bid price of offhand or of any other bidder, or to fix overhead profit or cost element of said bid price, or of that of any other bidder, or to secure any advantage against Holyoke Community College or any other person interested in the proposed contract; and that all statements in said proposal or bid are true.

________________________ Bidder

________________________ Title

Subscribed and sworn to before me this _______ day of _______________, 20____

____________________________ Notary Public

My Commission Expires __________________________

Supplier Diversity Program (SDP) Plan Form

Contract/RFR Document Number:

Sign Here:

Print Name ► Title ►

Authorized Signature ► ___________________________ Date ►

Instructions: Completing all parts of this form is mandatory. Please read instructions in the SDP section of the solicitation.

Complete one form for each Supplier Diversity Office (SDO) Certified M/WBE Partner Business.

For a complete list of certified vendors please go to http://www.somwba.state.ma.us/BusinessDirectory/BusinessDirectory.aspx .

Part I Bidder/Contractor Information Help with Part I Business Name:

Full Address: number, street, and apt. or suite no., city, state, zip

Contact Name:

Phone # ( ) - x Email address:

Check one of the following if applicable:

MBE WBE M/WBE M/W Non-Profit

Certification Expiration Date If Applicable (copy of the SDO certification letter must be attached):

Part II SDP Partner (Cannot be the same company as the Bidder/Contractor or an affiliate) Help with Part II

M/WBE Business Name:

Full Address: number, street, and apt. or suite no., city, state, zip

Phone # ( ) - x Email address:

Check one of the following if applicable:

MBE WBE M/WBE M/W Non-Profit

Certification Expiration Date If Applicable (copy of the SDO certification letter must be attached):

If not yet certified, check here if you have applied for Certification:

Part III Description of Business Relationship Help with Part III III

Check a minimum of one of these options that best describe the business relationship between Bidder/Contractor and SDP Partner:

Subcontract: include a copy of the written agreement between the Bidder and Subcontractor.

Ancillary: include a copy of the written agreement between the Bidder and Ancillary Partner.

Growth & Development: enclose plan for education, training, sponsorship, mentoring, resource sharing, and/or other initiatives.

Briefly describe the products and/or services the SDP Partner will provide your business:

Part IV Financial Commitment Help with Part IV Provide information on the committed amount (as a percentage of Bidder/Contractor gross revenue derived from this contract or as an exact dollar figure) to be spent with the certified SDP Partner as part of this relationship.

Annual Amount or Percentage or separately for each contract year

Year 1 Amount or Percentage

Year 2 Amount or Percentage

Year 3 Amount or Percentage

Year 4 Amount or Percentage

Year 5 Amount or Percentage

Part V Past Performance Help with Part V Have you had past…