RFP 2023-13 - Chemical Hygiene Consultants_complete.pdf

Putnam|Northern Westchester

BOARD OF COOPERATIVE EDUCATIONAL SERVICES

200 BOCES Drive Yorktown Heights, NY 10598-4399

(914) 248-2398 FAX (914) 245-4540

E-MAIL: dmahler@pnwboces.org

Don Mahler Purchasing Agent

BEDFORD BREWSTER BRIARCLIFF CARMEL CHAPPAQUA CROTON-HARMON GARRISON HALDANE HENDRICK HUDSON

KATONAH-LEWISBORO LAKELAND MAHOPAC NORTH SALEM OSSINING PEEKSKILL PUTNAM VALLEY SOMERS YORKTOWN

NOTICE TO PROPOSERS

Putnam/Northern Westchester BOCES, (hereinafter PNW BOCES), hereby invites the submission of sealed proposal for Chemical Hygiene Consultants.

Chemical Hygiene Consultants

RFP # 2023-13

Proposal Due Date: July 6th, 2023 @11:30 a.m.

PNW BOCES

School Services Building - Purchasing 200 BOCES Drive

Yorktown Heights, NY 10598

At the above stated time and place all proposals will be publicly opened. Proposals will be opened on the stated date and will be publicly read aloud. There will be no discussion at the time of the opening of the proposals. The names of the proposing vendors shall be available following the proposal opening via formal request sent to the Purchasing Agent. Specification forms may be obtained from the same office or http://www.bidnetdirect.com

In the event that PNW BOCES Purchasing Office is closed the day of the proposals opening, the proposal(s) will be opened at the same time, on the next day that the PNW BOCES Purchasing Office is open. All proposals received after the date and time stated in the Notice to Providers will not be considered and will be returned to the proposing vendor.

PNW BOCES is not responsible for proposals opened prior to the time and date of the opening if the identifying information does not appear on the envelope. Proposals opened prior to the time and date of the opening are invalid. PNW BOCES, reserves the right to accept each proposal by individual item, by category, by groups of items or as a whole, or in its discretion, to reject all proposals. PNW BOCES also reserves the right to waive any informality in the proposal process if determined to be in the best interest of PNW BOCES.

Proposals opened and read shall remain irrevocable for the contract period. The award of contracts, if at all, shall be made as soon as practicable after the opening. Any quantities, if shown, are estimates and not guaranteed.

Don Mahler Purchasing Agent June 15, 2023

REQUEST FOR PROPOSAL #2023‐13

Chemical Hygiene Consultants

THIS RFP IS IN THREE SECTIONS:

SECTION A – Requirements Section

SECTION B – Information Section

SECTION C – Forms

TABLE OF CONTENTS

SECTION A – REQUIREMENTS SECTION

Purpose

Scope of Services

RFP Submission

RFP Format and Organization

SECTION B – INFORMATION SECTION

Proposal Scoring and Evaluation

Terms and Conditions

Summary of Key Information

Insurance Requirements

SECTION C – FORMS

Proposal Form

Proposal Certification

Non‐Discrimination Statement

General Municipal Law Section 103‐g statement

Bidder Certification

Bidder Info and References

Vendor Responsibility

Questionnaire

Indemnification Agreement

Hold Harmless Agreement

Non‐Collusive Certification

Iran Divestment Act

ACH Enrollment Form

W9 Form

SECTION A – REQUIREMENTS SECTION

The Putnam/Northern Westchester BOCES, hereinafter referred to as “PNW BOCES”, invites proposals for Chemical Hygiene Consultants in accordance with the requirements and provisions set forth within this Request for Proposal. A one‐year contract with the option of extension by mutual agreement for

Four (4) additional One‐year periods is contemplated, said term being subject to the annual review and recommendation of the cooperative’s Board of Trustees.

1. PURPOSE

P/NW BOCES and its subscribing school districts are seeking proposals from companies qualified to provide medical and pharmaceutical waste management and regulatory compliance services, including collection, transportation, treatment and disposal of all accepted regulated medical and pharmaceutical waste generated by the BOCES and/or school districts.

PNW BOCES expects to enter into contracts with several companies that will allow it to deploy resources quickly in the event of a Medical and/or Pharmaceutical waste management issue.

Selected firms would be expected to enter into a master consulting agreement that would be supplemented by statements of work detailing the specific requirements of each engagement.

2. SCOPE OF SERVICES

P/NW BOCES recognizes that firms may have differing expertise and therefore, P/NW BOCES is issuing this RFP in an attempt to pre‐qualify several firms that could provide medical and pharmaceutical waste management services on an as needed basis. Selected companies would be expected to enter into a master consulting agreement.

The scope of work includes, but is not limited to, the following:

1. Provide Medical/Pharmaceutical Waste management and regulatory compliance services a.) This also would Include Collection, transportation, treatment and disposal of all accepted

Regulated Medical/Pharmaceutical waste.

2. Provide Environmental Management services.

a.) This would also include, but not limited to, Emergency response, waste disposal and handling, chemical packaging, recycling services, and chemical spill response.

The services provided pursuant to this proposal shall be enforced in accordance with the standard of skill, ethics and practice required of persons providing such services in New York State. The company will, at all times, comply with all applicable laws and regulations governing the provision of such services, including, but not limited to, licensing, certification and educational requirements (as applicable).

3. RFP Submission:

Proposals must be clearly labeled:

“RFP# 2023‐13 – Chemical Hygiene Consultants”, when they are submitted to 200 BOCES Drive, Purchasing Office, Yorktown Heights, NY 10598, on or before 11:30 AM on July 6, 2023. There is no expressed or implied obligation for PNW BOCES to reimburse responding individuals or firms for any expenses incurred in preparing quotations, attending pre‐quotation conferences, or interview(s), in responding to this request. Proposals submitted after the stated time and date will not be considered and will be returned to the firm unopened.

There is no expressed or implied obligation for PNW BOCES to reimburse responding individuals or firms for any expenses incurred in preparing quotations, attending pre‐quotation conferences, or interview(s) in responding to this request. Proposals submitted after the stated time and date will not be considered and will be returned to the firm unopened.

Anticipated Proposal Timeline

Request for Proposals Issued Friday, June 16, 2023 Proposal Questions Due to Be Posted on BidnetDirect.com Tuesday, June 20, 2023

Addendum with Answers to RFP Questions to Be Issued on

BidnetDirect.com Thursday, June 22, 2023

Due Date for Proposals Thursday July 6th 2023 @ 11:30 am

Bid Opening Thursday July 6th 2023 @ 11:30 am Grading of Proposals Thursday, June 13, 2023

Anticipated Award Date Tuesday, August 22, 2023

4. RFP Format and Organization

Proposal Package: Proposals will be received no later than the date and time stated above in the Notice to Proposers, on July 6, 2023 @ 11:30 am, at which time they will be publicly opened.

• Proposal Form

• Proposal Certification

• Non‐Discrimination Statement

• General Municipal Law Section 103‐g Statement

• Bidder Certification

• Bidder Information and References

• Vendor Responsibility Questionnaire

• Indemnification Agreement

• Hold Harmless Statement

• Non‐Collusive Statement

• Iran Divestment Statement

• ACH Information and Enrollment Form

• W9

In addition to the forms above, proposers must submit a description of your company’s experience and expertise providing Chemical Hygiene services, including any experience working with BOCES and

New York State school districts, language capabilities, name, professional qualifications, and years of experience of personnel who provide the services.

The contract period shall be from September 1, 2023 through August 31, 2024. PNW BOCES reserves the right to renew with Four additional One‐Year options if deemed in the best interest of PNW

BOCES/District.

Bidder may be required to submit evidence that they possess the necessary equipment, experience and means to satisfactorily perform and render the work and service herein described. PNW BOCES, in its sole discretion, shall determine the adequacy of equipment, experience, and means.

No interpretation of the meaning of the specifications or other contract document will be made to any

Contractor orally. Every request for such interpretation should be made in writing, via PNW BOCES’ solicitation on www.bidnetdirect.com by June 20, 2023 at 11:30 a.m. Answers will be posted as an addendum on www.bidnetdirect.com on June 22, 2023 at 12:00 p.m.

DISCREPANCIES: Discrepancies and questions related to the bid documents and specifications must be brought to the attention of the Purchasing Agent by means of a question posted on www.bidnetdirect.com before submission of the bid. Failure to obtain clarification in writing shall not relieve the Contractor of performing the normal good practice of the industry.

SECTION B – INFORMATION SECTION

Proposal Scoring and Evaluation

PNW BOCES will form a committee to evaluate the proposals using the following criteria:

CRITERIA POINTS

BOCES

The committee may invite the top two or three qualified Vendors for an interview, based on each

Vendor’s score from the evaluation criteria items above. The interview will be scored independently.

The committee reserves the right to decide, based solely on the interviews. The committee will make reasonable attempts to schedule each interview at a time that is agreeable to the Vendor. Failure of a

Vendor to report to an interview on the date scheduled may result in rejection of the Vendor’s Proposal.

Points for cost will be assigned on the basis of ratio from low to high, meaning the Vendor with the lowest cost will be assigned the highest point value; second lowest cost will be assigned a point value in descending order in relation to how many RFP submittals are received.

Terms and Conditions

ACCEPTANCE OF PROPOSALS

This RFP should not be construed as a contract to purchase goods or services. PNW BOCES is not bound to accept the lowest price or any proposal of those submitted.

LIABILITY OF ERRORS

While PNW BOCES has used considerable efforts to ensure an accurate representation of information in this RFP, all prospective proposers are urged to conduct their own investigations into the material facts and PNW BOCES shall not be held liable or accountable for any error or omission in any part of this RFP.

CONTRACT DIGRESSION –FAILURE TO PERFORM

The Proposer will not assign or transfer the Contract or any right or privilege granted pursuant to the

RFP, without prior written consent of PNW BOCES. If Contractor is adjudged bankrupt, or if a receiver is appointed to or for the Contractor, or if Contractor makes any assignment for the benefit of creditors, PNW BOCES may, at its option, terminate the Contract immediately without any prior notice to the

Contractor. Should the Contractor fail to perform as required by the specifications, PNW BOCES may cancel the order and/or contract. In such event, PNW BOCES will assume no responsibility for, nor will it reimburse the Contractor for any expense or loss to the contractor because of such termination or cancellation.

INDEMNIFICATION

To the fullest extent permitted by law, the Contractor shall defend (with counsel selected by PNW

BOCES and reasonably approved by the Contractor), indemnify and hold harmless PNW BOCES, its employees, agents, and representatives, from any and all liability, losses, costs, damages, and expenses

(including, but not limited to, reasonable attorneys’ fees and disbursements) from any claims, disputes, or causes of action of whatever nature arising, in whole or in part, from the performance of the

Contractor’s duties hereunder or the action of or the failure to act by the Contractor, its representatives, employees, or anyone for whose acts the Contractor may be liable. In the event that any legal proceeding shall be instituted or that any claim or demand with respect to the foregoing be asserted by any person in respect of which indemnification may be sought from the Contractor under the provisions of this paragraph, PNW BOCES shall promptly notify the Contractor of such suit, claim or demand, and give the Contractor an opportunity to defend same and settle same without any cost to PNW BOCES, and shall extend reasonable cooperation to the Contractor in connection with such defense, which shall be at the expense of the Contractor. In the event that the Contractor fails to defend the same within thirty (30) days of receipt of notice, PNW BOCES shall be entitled to assume the defense thereof, and the Contractor shall be liable to repay PNW BOCES for all its expenses reasonably incurred in connection with said defense (including reasonable attorneys’ fees, disbursements, expert witness fees and settlement payments). All of the provisions of this paragraph will survive expiration or sooner termination of the Contract.

AWARD OF CONTRACT

When award Occurs: Award of contract occurs when a formal contract has been finalized or other evidence of acceptance by PNW BOCES is provided to the Proposer. A Recommendation of Award does not constitute award of contract.

Award: If a contract is awarded, it shall be awarded to the responsive and responsible Proposer(s) whose offer conforming to the Request for Proposal will be most advantageous to PNW BOCES as set forth in the Evaluation Criteria.

COMPLIANCE WITH LAWS

The Contractor shall comply with all the provisions of laws in the State of New York and of the United

States of America which affect municipalities and municipal contracts, and provide at his expense, any and all permits, licenses and registrations required for the fulfillment of this agreement, and more particularly the Labor Law, the Immigration and Naturalization Laws and Regulation, the General

Municipal Law, the Workers’ Compensation Law, the Lien Law, Personal Property Law, State

Unemployment Insurance Law, Federal Social Security Law, State, Local and Municipal Health Laws, Rules and Regulation, and any and all regulations promulgated by the State of New York and of amendments and additions thereto, insofar as the same shall be applicable to any contract awarded hereunder with the same force and effect as if set forth at length herein.

Summary of Key Information

1. Interview

The award process may include an interview with administration and (the Board).

2. Financial Terms

PNW BOCES will bill the participating districts for the total costs for the services provided by the company, as applicable, based on the district’s specific needs using the RFP awarded pricing. Upon district approval, PNW BOCES will pay the company 100% of their agreed upon fees and bill the district.

3. Termination of Contract

Any contract agreed to under this Request for Proposal is subject to termination by either party with sixty (60) days written notice. In the event of termination of the contract, PNW BOCES’ responsibility shall be to pay for unpaid services performed and authorized costs incurred.

4. Right to Reject Requests for Proposal

PNW BOCES reserves the right to reject without prejudice any and all quotations received under this

Request for Proposal.

5. Cooperation

The parties agree to cooperate with each other in connection with any internal investigations by the company or PNW BOCES, of possible violation of their respective policies and any third‐party litigation.

6. Fingerprinting

The company acknowledges and agrees that it’s employees may be subject to fingerprinting and criminal history check as may be required by the Education Law of the State of New York (i.e., more than five student contact days). In such event, the company agrees to cooperation with the PNW

BOCES and school districts and complete any and all necessary forms or procedure, all at no cost or expense to the district of PNW BOCES.

7. Confidentiality During the course of performance of the service(s), PNW BOCES may be given access to information that relates to the company’s past, present and future research, development, business activities, products, services, technical knowledge and employee information. All of such information shall be deemed to be “Confidential Information” unless otherwise indicated by the company in writing at or after the time of disclosure. PNW BOCES may use the Confidential Information only in connection with the specific duties authorized pursuant to this Agreement. Access to the Confidential Information shall be restricted to those of P/NW BOCES personnel and representatives on a need to know basis solely in connection with P/NW BOCES internal business. P/NW BOCES further agrees that it will (i) take all necessary steps to inform any of its personnel, representatives to whom Confidential Information may be disclosed of their obligations hereunder and (ii) cause said personnel, representatives to agree to be bound by the terms of this Agreement. P/NW BOCES agrees to protect the confidentiality of the

Confidential Information in the same manner that they protect the confidentiality of their own proprietary and confidential information of like kind, but in no event less than a reasonable manner.

PNW BOCES agrees to notify the company of any unauthorized use or disclosure of Confidential

Information and to take all actions reasonably necessary to prevent further unauthorized use or disclosure thereof. During the course of performance of the services(s), The company may be given access to information that relates to PNW BOCES or its affiliates, including its activities, products, services, employee and/or student information. All of such information shall be deemed to be

“Confidential Information” unless otherwise indicated by P/NW BOCES in writing at or after the time of disclosure. The company may use the Confidential Information only in connection with the specific duties authorized pursuant to this Agreement. Access to the Confidential Information shall be restricted to those of the company personnel and representatives with a legitimate interest to know solely in connection with the company internal business and the services to be provided hereunder.

The company further agrees that it will (i) take all necessary steps to inform any of its personnel and representatives to whom Confidential Information may be disclosed of their obligations hereunder and

(ii) cause said personnel and representatives to agree to be bound by the terms of this Agreement. The company agrees to protect the confidentiality of the Confidential Information in the same manner that they protect the confidentiality of their own proprietary and confidential information of like kind, but in no event less than in a reasonable and prudent manner. The company agrees to notify P/NW BOCES of any unauthorized use or disclosure of Confidential Information and to take all actions reasonably necessary to prevent further unauthorized use or disclosure thereof. The terms of this Section shall survive the expiration or termination of this Agreement.

8. Independent Contractor

This agreement does not create an employee/employer relationship between the parties. The awarded vendor will be an independent contractor and not a PNW BOCES employee for all purposes. The awarded vendor will retain sole and absolute discretion in the judgement of the manner and means of carrying out the services, activities and responsibilities. PNW BOCES does not engage the company exclusively, nor does it restrict the company from engaging in regular business with anyone of its choosing. PNW BOCES shall not be liable for any obligations incurred by the company or for any damages to person or property of the company.

9. Conflict of Interest

The awarded vendor represents and warrants that: (a) it has no obligation, legal or otherwise, inconsistent with the terms of this Agreement; (b) the performance of the services to be provided in this Agreement does not and will not violate any applicable law, rule or regulation or any proprietary or other right of any third party; (c) it has not entered into or will not enter into any agreement, oral or written, in conflict with this Agreement; and (d) it, including its officers, employees and agents, do not possess any personal or professional relationship with the PNW BOCES, its officers and employees that would constitute a conflict of interest relative to performing this Agreement.

INSURANCE REQUIREMENTS

1. Notwithstanding any terms, conditions or provisions, in any other writing between the parties, the professional consultant hereby agrees to effectuate the naming of Putnam‐Northern Westchester BOCES as an Additional Insured on the professional consultant's insurance policies, except for workers' compensation and N.Y. State Disability insurance.

2. The policy naming Putnam‐Northern Westchester BOCES as an Additional Insured shall:

a. Be an insurance policy from an A.M. Best A‐ rated or better insurer, licensed to conduct business in New York State. A New York licensed and admitted insurer is strongly preferred.

The decision to accept non‐licensed and non‐admitted carriers lies exclusively with Putnam‐ Northern Westchester BOCES and may create significant vulnerability and costs for the

BOCES.

b. State that the organization's coverage shall be primary and non‐contributory coverage for Putnam‐Northern Westchester BOCES, its Board, employees and volunteers with a waiver of subrogation in favor of Putnam‐Northern Westchester BOCES for all coverages, including Workers Compensation.

c. Additional insured status for General Liability coverage shall be provided by standard or other endorsements that extend coverage to Putnam‐Northern Westchester BOCES (CG 20 26) or equivalent. The decision to accept an endorsement rests solely with Putnam‐Northern Westchester BOCES. A completed copy of the endorsements must be attached to the Certificate of Insurance to include General Liability, Auto Liability (where applicable) and Umbrella/Excess coverages.

3. a. The certificate of insurance must describe the services provided by the professional consultant that are covered by the liability policies.

b. At Putnam‐Northern Westchester BOCES’ request, the professional consultant shall provide a copy of the declaration page of the liability and umbrella/excess policies with a list of endorsements and forms. If requested, the professional consultant will provide a copy of the policy endorsements and forms.

4. The professional consultant agrees to indemnify Putnam‐Northern Westchester BOCES for applicable deductibles and self‐insured retentions.

5. Minimum Required Insurance:

a. Commercial General Liability Insurance $1,000,000 per Occurrence/ $2,000,000 Aggregate $2,000,000 Products and Completed Operations $1,000,000 Personal and Advertising Injury $100,000 Fire Damage $10,000 Medical Expense

b. Automobile Liability $1,000,000 combined single limit for owned, hired, borrowed and non‐owned motor vehicles.

c. Workers' Compensation and NYS Disability Insurance Statutory Workers' Compensation (C‐105.2 or U‐26.3); and NYS Disability Insurance (DB‐ 120.1) for all employees. Proof of coverage must be on the approved specific form, as required by the New York State Workers’ Compensation Board. ACORD certificates are not acceptable. A person seeking an exemption must file a CE‐200 Form with the state. The form can be completed and submitted directly to the WC Board online.

d. Professional Errors and Omissions Insurance $2,000,000 per occurrence/$2,000,000 aggregate for the professional acts of the consultant performed under the contract for Putnam‐Northern Westchester BOCES. If written on a “claims‐made” basis, the effective date must pre‐date the inception of the contract or agreement. Coverage shall remain in effect for three years following the completion of work.

e. Umbrella/Excess Insurance $3,000,000 each Occurrence and Aggregate. Umbrella/Excess coverage shall be on a follow‐form basis or provide broader coverage over the required Auto Liability (where applicable), General Liability and Professional Liability coverages.

6. The Professional Consultant acknowledges that failure to obtain such insurance on behalf of Putnam‐ Northern Westchester BOCES constitutes a material breach of contract and subjects it to liability for damages, indemnification and all legal remedies available to Putnam‐Northern Westchester BOCES. The professional consultant is to provide Putnam‐Northern Westchester BOCES with a certificate of insurance, evidencing the above requirements have been met, prior to the provision of services. The failure of Putnam‐Northern Westchester BOCES to object to the contents of the certificate or the absence of same shall not be deemed a waiver of any fights held by Putnam‐Northern Westchester

BOCES.

Putnam|Northern Westchester

BOARD OF COOPERATIVE EDUCATIONAL SERVICES

200 BOCES Drive Yorktown Heights, NY 10598-4399

(914) 248-2398 FAX (914) 245-4540

E-MAIL: dmahler@pnwboces.org

Don Mahler Purchasing Agent

BEDFORD BREWSTER BRIARCLIFF CARMEL CHAPPAQUA CROTON-HARMON GARRISON HALDANE HENDRICK HUDSON

KATONAH-LEWISBORO LAKELAND MAHOPAC NORTH SALEM OSSINING PEEKSKILL PUTNAM VALLEY SOMERS YORKTOWN

PIGGYBACKING

The contractor acknowledges that, pursuant to New York General Municipal Law Section 103 (16), Putnam Northern Westchester BOCES, intends to allow all political subdivisions in the State of New York to participate in the contract.

These political subdivisions include, but are not limited to, local governments (villages, towns, etc.), public authorities, public school and fire districts, public and non-profit libraries, and certain other nonpublic/nonprofit organizations.

Such political subdivisions shall participate in this contract by entering into their own separate contracts with the contractor that are based upon, incorporate and honor the terms, conditions, specifications and prices of this bid and contract.

Please Initial Only ONE of the following:

I Agree to Participate in Piggybacking:_______

I Do Not Agree to Participate in Piggybacking: ______

(Person or Business Name) Authorized Signature

Date

Sworn to me on this ___, Day of ___, 22__

Notary Public signature

PUTNAM NORTHERN WESTCHESTER BOCES

200 BOCES Drive

Yorktown Heights, NY 10598

BIDDER CERTIFICATION

PLEASE COMPLETE AND RETURN WITH YOUR BID:

THE BIDDER DECLARES AND CERTIFIES:

THAT THE SAID BIDDER HAS CAREFULLY EXAMINED THE INSTRUCTIONS TO

BIDDERS, SCHEDULES AND SPECIFICATIONS PREPARED UNDER THE DIRECTION OF

THE BOARD OF EDUCATION, AND WILL, IF SUCCESSFUL IN THIS BID, FURNISH AND

DELIVER AT THE PRICES BID AND WITHIN THE TIME STATE, ALL THE MATERIALS,

EQUIPMENT OR SERVICES FOR WHICH THIS BID IS MADE.

THE FULL NAMES AND TITLES OF ALL PERSONS INTERESTED IN THIS BID AS PRINCIPALS ARE AS

FOLLOWS:

DATE: ________________________________________ PHONE NUMBER: __________________________

FIRM: _________________________________________ FAX NUMBER: _______________________________

ADDRESS: _____________________________________

___________________________________________________ NAME: ________________________________________

(CONTACT PERSON FOR BID INQUIRIES)

(IF SAME AS AUTHORIZED, LEAVE BLANK)

AUTHORIZED

SIGNATURE: _____________________________________________________________________________________

TITLE: ____________________________________________________________________________________________

Yorktown Heights, NY 10598

BIDDER INFORMATION AND REFERENCE

Please provide the full name and corporate address of your organization.

Corporation Name:

Corporate Address:

Contact Person: Title:

Phone: Fax:

Email: Website:

REFERENCES: MUST BE PROVIDED FOR BID TO BE CONSIDERED

Contracting firm and its principal officer must be able to prove (5) years of continuous work experience, immediately preceding this quote, in the performance of work substantially equivalent to the scope of this project. References must be from companies in which you have provided same type of product/service.

Company Name: ________________________________________________________________________________________________________

Address: _________________________________________________________________________________________________________________________ Contact Person: _________________________________________________________________________________________________________________ Telephone: ____________________________________________ Email: __________________________________________________________________ Dates of Contract(s): ___________________________________________

Company Name: _________________________________________________________________________________________________________

Address: _________________________________________________________________________________________________________________________ Contact Person: _________________________________________________________________________________________________________________ Telephone: ______________________________________________ Email: ________________________________________________________________ Dates of Contract(s): ___________________________________________

Company Name: _________________________________________________________________________________________________________

Address: ________________________________________________________________________________________________________________________ Contact Person: _________________________________________________________________________________________________________________ Telephone: _______________________________________________ Email: _______________________________________________________________ Dates of Contract(s): ___________________________________________

Yorktown Heights, NY 10598

VENDOR RESPONSIBILITY QUESTIONNAIRE

1. VENDOR IS:

PRIME CONTRACTOR

2. VENDOR’S LEGAL BUSINESS NAME 3. IDENTIFICATION NUMBERS

a) FEIN #

b) DUNS #

4. D/B/A – Doing Business As (if applicable) & COUNTY FIELD: 5. WEBSITE ADDRESS (if applicable)

6. ADDRESS OF PRIMARY PLACE OF BUSINESS/EXECUTIVE OFFICE 7. TELEPHONE NUMBER 8. FAX NUMBER

9. ADDRESS OF PRIMARY PLACE OF BUSINESS/EXECCUTIVE OFFICE

IN NEW YORK STATE, if different from above

10. TELEPHONE NUMBER 11. FAX NUMBER

12. AUTHORIZED CONTACT FOR THIE

QUESTIONNAIRE Name

Title Telephone

Number Fax

Number e-mail

13. LIST ALL OF THE VENDOR’S PRINCIPAL OWNERS.

a) NAME TITLE b) NAME TITLE

c) NAME TITLE d) NAME TITLE

A DETAILED EXPLANATION IS REQUIRED FOR EACH QUESTION ANSWERED WITH A “YES,” AND MUST BE PROVIDED AS AN ATTACHMENT TO THE COMPLETED QUESTIONNAIRE. YOU MUST PROVIDE ADEQUATE DETAILS OR DOCUMENTS TO AID THE COUNTY IN MAKING A DETERMINATION OF VENDOR RESPONSIBILITY. PLEASE NUMBER EACH RESPONSE TO MATCH THE QUESTION NUMBER.

14. DOES THE VENDOR USE, OR HAS IT USED IN THE PAST FIVE (5) YEARS, ANY OTHER BUSINESS Yes No NAME, FEIN, or D/B/A OTHER THAN THOSE LISTED IN ITEMS 2-4 ABOVE? List all other business name(s), Federal Employer Identification Number(s) or any D/B/A names and the dates that these names or numbers were/are in use. Explain the relationship to the vendor.

15. WITHIN THE PAST (5) YEARS, HAS THE VENDOR, ANY INDIVIDUALS SERVING IN

MANAGERIAL OR CONSULTING CAPACITY, PRINCIPAL OWNERS, OFFICERS, MAJOR

STOCKHOLDER(S) (10% OR MORE OF THE VOTING SHARES FOR PUBLICLY TRADED

COMPANIES, 25% OR MORE OF THE SHARES FOR ALL OTHER COMPANIES), AFFLITIATE OR

ANY PERSON INVOLVED IN THE BIDDING OR CONTRACTING PROCESS:

a) 1. been suspended, debarred or terminated by a local, state or federal authority in connection with a contract or contracting process;

2. been disqualified for cause as a bidder on any permit, license, concession franchise or lease;

3. entered into an agreement to a voluntary exclusion from bidding/contracting;

4. had a bid rejected on an Putnam County contract for failure to comply with the MacBride Fair Employment Principles;

5. had a low bid rejected on a local, state or federal contract for failure to meet statutory affirmative action or M/WBE requirements on a previously held contract;

6. had status as a Women’s Business Enterprise, Minority Business Enterprise or Disadvantaged Business Enterprise, de-certified, revoked or forfeited;

7. been subject to an administrative proceeding or civil action seeking specific performance or restitution in connection with any local, state or federal government contract;

8. been denied an award of a local, state or federal government contract, had a contract suspended or had a contract terminated for non-responsibility; or

9. had a local, state or federal government contract suspended or terminated for cause prior to the completion of the term of the contract.

b) been indicted, convicted, received a judgment against them or a grant of immunity for any business- related conduct constituting a crime under local, state or federal law including but not limited to, fraud extortion, bribery, racketeering, price-fixing, bid collusion or any crime related to truthfulness and/or business conduct?

Yes

Yes

Yes

No

No

No

16. IN THE PAST THREE (3) YEARS, HAS THE VENDOR OR ITS AFFILIATES 1 HAD ANY CLAIMS, JUDGMENTS, INJUNCTIONS, LIENS, FINES OR PENALTIES SECURED BY ANY

GOVERNMENTAL AGENCY?

Indicate if this is applicable to the submitting vendor or affiliate. State whether the situation(s) was a claim, judgment, injunction, lien or other with an explanation. Provide the name(s) and address(es) of the agency, the amount of the original obligation and outstanding balance. If any of these items are open, unsatisfied, indicate the status of each item as “open” or “unsatisfied.”

Yes No

17. DURING THE PAST THREE (3) YEARS, HAS THE VENDOR FAILED TO:

a) file returns or pay any applicable federal, state or city taxes?

Identify the taxing jurisdiction, type of tax, liability year(s), and tax liability amount the vendor failed to file/pay and the current status of the liability.

b) file returns or pay New York State unemployment insurance?

Indicate the years the vendor failed to file/pay the insurance and the current status of the liability.

c) Property Tax Indicate the years the vendor failed to file.

Yes

Yes

Yes

No

No

No

18. HAVE ANY BANKRUPTCY PROCEEDINGS BEEN INITIATED BY OR AGAINST THE VENDOR OR Yes No ITS AFFILIATES 1 WITHIN THE PAST SEVEN (7) YEARS (WHETHER OR NOT CLOSED) OR IS ANY

BANKRUPTCY PROCEEDING PENDING BY OR AGAINST THE VENDOR OR ITS AFFILIATES

REGARDLESS OR THE DATE OF FILING?

Provide the court name, address and docket number. Indicate if the proceedings have been initiated, remain pending or have been closed. If closed, provide the date closed.

19. IS THE VENDOR CURRENTLY INSOLVENT, OR DOES VENDOR CURRENTLY HAVE REASON

TO BELIEVE THAT AN INVOLUNTARY BANKRUPTCY PROCEEDING MAY BE BROUGHT

AGAINST

IT? Provide financial information to support the vendor’s current position, for example, Current Ration, Debt Ration, Age of Accounts Payable, Cash Flow and any documents that will provide the agency with an understanding of the vendor’s situation.

Yes No

20. IN THE PAST FIVE (5) YEARS, HAS THE VENDOR OR ANY AFFILIATES1 :

a) defaulted or been terminated on, or had its surety called upon to complete, any contract (public or private) awarded;

Indicate if this is applicable to the submitting vendor or affiliate. Detail the situation(s) that gave rise to the negative action, any corrective action taken by the vendor and the name of the contracting agency.

Yes No

1 “Affiliate” meaning: (a) any entity in which the vendor owns more than 50% of the voting stock; (b) any individual, entity or group of principal owners or officers who own more than 50% of the voting stock of the vendor;

or (c) any entity whose voting stock is more than 50% owned by the same individual, entity or group described in clause (b). In addition, if a vendor owns less than 50% of the voting stock of another entity, but directs or has the right to direct such entities daily operations, that entity will be an “affiliate” for purposes of this questionnaire.

Yorktown Heights, NY 10598

INDEMNIFICATION AGREEMENT

The Contractor agrees:

(a) that except for the amount, if any, of damage contributed to, caused by or resulting from the negligence of PNW BOCES, the Contractor agrees to indemnify and hold harmless the Putnam/Northern Westchester BOCES, its officers, employees and agents from and against any and all liability, damage, claims, demands, costs, judgments, fees, attorney's fees or loss arising directly or indirectly out of the performance or failure to perform hereunder by the Consultant or third parties under the direction or control of the Consultant; and

(b) to provide defense for and defend, at its sole expense, any and all claims, demands or causes of action directly or indirectly arising out of the Agreement and to bear all other costs and expenses related thereto.

AUTHORIZED SIGNATURE

DATE

NOTARY PUBLIC

DATE

Yorktown Heights, NY 10598

HOLD HARMLESS AGREEMENT

The addition of the following Hold Harmless Agreement to this Certificate of Insurance does not amend, extend or alter the coverage afforded by the listed policy.

This “Hold Harmless Clause” must be signed by an officer of your organization dated and witnessed.

The Contractor agrees to protect, defend, indemnify and hold PNW BOCES, and its employees free and harmless from and against any and all losses, claims, liens, demands and causes of action of every kind and character including, but not limited to, the amount of judgements, penalties, interest, court costs and legal fees incurred by PNW BOCES, death or damages to property, (including property of PNW BOCES) and without limitation by enumeration, all other claims or demands of every character occurring or in any way incident to, in connection with or arising directly or indirectly out of work performed or to be performed by the Contractor. The Contractor agrees to investigate, handle, respond to, provide defense for and defend any such claims, demands or suit as its sole expense and agrees to bear all other costs and expenses related thereto, even if it (claims, etc.) is groundless, false or fraudulent.

AUTHORIZED SIGNATURE

DATE

WITNESS SIGNATURE

DATE

Yorktown Heights, NY 10598

NON COLLUSIVE CERTIFICATION

Firm Name _________________________________________________________________________________________

Business Address ____________________________________________________________________________________

Telephone Number ________________________________________ Date of Bid _____________________________

By submission of this bid proposal, the bidder certifies that he is complying with 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 bidder and affirmed by such bidder as true under the penalties of perjury: Non-collusive bidding specification.

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

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

(2) Unless otherwise requested by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly by disclosed by the bidder prior to opening, directly or indirectly, to any other bidder or to any competitor; and –

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

(B) A bid shall not be considered for award nor shall any award be made where (A) (1) (2) and (3) above have not been complied with; provided, however, that if in any case the bidder cannot make the foregoing certification, the bidder shall so state and shall furnish with the bid a signed statement which sets forth in detail the reasons therefore. Where (A) (1)(2) and (3) above have not been completed with, the bid 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 of official thereof to which the bid is made, or his designee, determines that such disclosure was not made for the purpose of restricting competition.

(1) The fact that a bidder (2) has (a) published price lists, rates, or tariffs covering items being procured, (b) had 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 bid, does not constitute, without more, a disclosure within the meaning subparagraph one (A).

(2)Any bid hereafter made to any political subdivision of the state or any public department, agency or official thereof by a corporate bidder 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 contains the certification referred to in subdivision one of the section, shall be deemed to have been authorized by the board of directors to the bidder, and such authorization shall be deemed to include the signing and submission of the bid and the inclusion therein of the certificates to non-collusion as the act and deed of the corporation.

Signature ____________________________________________________ Title______________________________________________________

Yorktown Heights, NY 10598

IRAN DIVESTMENT ACT CERTIFICATION

The Iran Divestment Act of 2012 (“Act”), Chapter 1 of the 2012 Laws of New York, added State Finance Law (SFL), §165-a and General Municipal Law §103-g, effective April 12, 2012. Under the Act, the Commissioner of the New York State Office of General Services (“OGS”) developed a list (“Prohibited Entities List”) of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law). In accordance with SFL §165-a(3), the Prohibited Entities List may be found of the OGS website at:

http://www.ogs.ny.gov/about/regs/docs/ListofEntities.pdf .

Pursuant to General Municipal Law §103-g, by signing below, Bidder certifies as true under the penalties of perjury that: By submission of this proposal each Bidder and each person signing on behalf of any Bidder certifies, and in the case of a joint proposal each party thereto certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and belief that each Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of section 165-a of the State Finance Law.

A proposal shall not be considered for award nor shall any award be made where the certification has not been made, provided, however, that if in any case the Bidder cannot make the certification, the Bidder shall so sate and shall furnish with the proposal a signed statement which sets forth in detail the reasons therefor.

The Pearl River School District (“District”) may award a contract to a Bidder who cannot make the required certification on a case-by-case basis if:

1) The investment activities in Iran were made before April 12, 2012, the investment activities in Iran have not been expanded or renewed after April 12, 2012, and the person has adopted, publicized, and is implementing formal plan to cease the investment activities in Iran and to refrain from engaging in any new investments in Iran: or

2) The District makes a determination that the goods and services are necessary for the District to perform its functions and that, absent such exemption, the political subdivision would be unable to obtain the goods or services for which the contract is offered. Such determination shall be made in writing and shall be a public document.

During the term of the Contract, should the District receive information that a person is in violation of the above-referenced certifications, the District will offer the person an opportunity to respond. If the person fails to demonstrate that it has ceased its engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then the District shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking compliance, recovering damages, or declaring the contractor in default.

The District reserves the right to reject any bid, proposal, contract or request for assignment for an entity that appears on the Prohibited Entities List prior to the award or execution of a contract or any renewal thereof, as applicable, and to pursue a responsibility review with respect to any entity that is awarded a contract and appears on the Prohibited Entities List after contract award.

DATE SIGNATURE

BUSINESS NAME PRINTED NAME

200 BOCES Drive

Yorktown Heights, NY 10598

NON-DISCRIMINATION STATEMENT

To the extent required by Article 15 of the Executive Law (also known as the Human Rights Law) and all other State and Federal statutory and constitutional non-discrimination provisions, the Contractor will not discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, sexual orientation, age, disability, genetic predisposition or carrier status, military status, domestic violence victim status, or marital status. Furthermore, in accordance with Section 220-e of the Labor Law, if this is a contract for the construction, alteration or repair of any public building or public work or for the manufacture, sale or distribution of materials, equipment or supplies, and to the extent that this contract shall be performed within the State of New York, Contractor agrees that neither it nor its subcontractors shall, by reason of race, creed, color, disability, sex, or national origin: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. If this is a building service contract as defined in Section 230 of the Labor Law, then, in accordance with Section 239 thereof, Contractor agrees that neither it nor its subcontractor shall by reason of race, creed, color, national origin, age, sex or disability: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. Contract is subject to fines of $50.00 per person per day for any violation of Section 220-e or Section 239 as well as possible termination of this contract and forfeiture of all moneys due for a second or any subsequent violation.

BY:

Signature

Print Name and Title of Signatory

DATE:

Yorktown Heights, NY 10598

GENERAL MUNICIPAL LAW SECTION 103-g STATEMENT

The below signed bidder affirms the following as true under penalties of perjury:

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and belief that each bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of New York State Finance Law.

Corporate or Company Name

By: _ Signature

Title

Sworn to before me this

Day of , 20

Notary Public

Putnam/Northern Westchester

BOARD OF COOPERATIVE EDUCATIONAL SERVICES

200 BOCES Drive, Yorktown Heights, NY 10598-4399

(914) 248-2326 FAX (914) 245-4540

E-MAIL:ap@pnwboces.org

ACH ENROLLMENT FORM

Putnam/Northern Westchester BOCES has begun making ACH vendor payments. This electronic banking method will expedite the payment process and provide email payment notification…at no additional cost to you!

Please complete the information required below, and attach a voided check. Should you have any questions, please don’t hesitate to contact me.

Return Completed Forms To: Accounts Payable 200 BOCES Drive Yorktown Heights, NY 10598

ACH Information and Authorization Form

Company/Individual Name EIN # or SS #

Company/Individual Address (Remit To) - Please submit one form for each Remit To address.

Payment Contact Name Phone Number Email Address

Name of Financial Institution for Deposit

Bank Transit/Routing (ABA) Number (checking only) Bank Account #(attach voided check)

I (we) attest that the information provided is accurate and hereby authorize Putnam/Northern Westchester BOCES to credit the account listed using ACH payments. I (we) understand that this authorization will remain in full force and effect until I (we) notify Putnam/Northern Westchester BOCES in writing that I (we) wish to revoke or change this information. To change or cancel this authorization, I (we) will provide Putnam/Northern Westchester BOCES with at least 15 business days’ notice.

Authorized Signature Printed Name and Title of Signer Date

Service and Innovation Through Partnership

BEDFORD BREWSTER BRIARCLIFF CARMEL CHAPPAQUA CROTON-HARMON GARRISON HALDANE HENDRICK HUDSON KATONAH-LEWISBORO LAKELAND MAHOPAC NORTH SALEM OSSINING PEEKSKILL PUTNAM VALLEY SOMERS YORKTOWN mailto:EMelagrano@pnwboces.org

Form W-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number…