NYS OFFICE OF MENTAL HEALTH

RFQ# 26-001

Record Retention and Management Services

INITIAL SUBMISSION CHECKLIST

Document Type of Submission

Attachment B Intent to Bid

Complete, sign & submit by August 10, 2026 at 3pm ET

Attachment B-1 Mandatory Pre-Bid Conference (Webex) Registration Form

Must be submitted to participate in the Webex presentation; only those Vendors participating in the Mandatory Pre-Bid Conference via Webex are eligible to submit a Proposal in response to this

RFP.

Complete, sign & submit by August 10, 2026 at 3pm ET

Attachment B-2 No-Bid Explanation

If not submitting a Proposal, complete & submit by September 30, 2026 at 3pm ET

PROPOSAL SUBMISSION CHECKLIST

(page 1 of 2)

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

VOLUME 1 - TECHNICAL PROPOSAL

VOLUME 2 – COST PROPOSAL

Required document Type of Submission Included w/ Submission

Proposal Technical Responses

Include all narrative responses to the requirements as outlined in Section 7.3 of the RFP, including:

- Executive Summary

- Qualifications & Experience

- Technical Capability

- Physical Facility

- Samples

Attachment C Business References

Provide completed copy with 3 references.

Required document Type of Submission Included w/ Submission

Attachment F-1 Cost Proposal Worksheet – CNYPC-CBOs

Include completed & signed copy

Attachment F-2 Cost Proposal Worksheet – STARC-OV

Include completed & signed copy

Attachment F-3 Cost Proposal Worksheet – STARC-BV

Include completed & signed copy

PROPOSAL SUBMISSION CHECKLIST

(page 2 of 2)

VOLUME 3 – ADMINISTRATIVE PROPOSAL

Required document Type of Submission Included w/ Submission

Attachment A Solicitation Cover Sheet

Include completed & signed copy

Attachment D-1 Offeror’s Affirmation etc re OMH Procurement Lobbying Guidelines

Include completed & signed copy

Attachment D-2 Offeror’s Disclosure of Prior Non-Responsibility Determinations

Include completed & signed copy

Attachment E (3 pages) Non-Collusive Bidding Certification

Include completed & signed copy

Attachment I (2 pages) MWBE-EEO Policy Statement

Include completed & signed copy

Attachment I-1 EEO Staffing Plan

Include completed & signed copy

Attachment M Encouraging the Use of New York Subcontractors and Suppliers

Include completed & signed copy

Attachment N New York State Business Usage Form

Include completed & signed copy

Attachment P Sexual Harassment Prevention Certification

Include completed & signed copy

Attachment Q Gender-Based Violence and the Workplace Certification

Include completed & signed copy

Attachment R Certification Under Executive Order No. 16 Prohibiting State Agencies and Authorities from Contracting with Businesses Conducting Business in Russia

Include completed & signed copy

ST-220-CA (2 pages) Contractor Certification to Covered Agency Note: A fillable webform is also available here.

Include completed, signed & notarized copy

NYS Workers’ Compensation Insurance Coverage

If available, include verification of required coverage.

(will be required upon notice of award)

NYS Disability Benefits Insurance Coverage

Liability Insurance Coverage https://www.tax.ny.gov/pdf/current_forms/st/st220ca_fill_in.pdf

ATTACHMENT A

SOLICITATION COVER SHEET

RFP# 26-001

NAME OF FIRM

ADDRESS

PRINTED NAME

TITLE

EMAIL ADDRESS

PHONE #

FAX#

NYS VENDOR ID

FEDERAL ID (FEIN) #

IF THE COMPANY USES, OR HAS USED IN THE PAST TEN (10) YEARS, ANY OTHER BUSINESS NAME, FEIN, OR D/B/A PLEASE PROVIDE

Number of Years in Business: ____ Number of Years of Experience Providing Solicited Service: ____

PLEASE CHECK THE APPROPRIATE BOX:

NYS Minority-owned Business (MBE) Registration #

NYS Women-owned Business (WBE) Registration #

NYS Small Business (SB) Registration #

NYS Disadvantaged Business Enterprise

(DBE) Registration #

NYS Service-Disabled Veteran Owned

Enterprise (SDVOB) Registration #

None of the above

ATTESTATION:

By signature below, the Offeror hereby attest that they have read, understand, and are willing to comply the scope and requirements of this Request for Proposal. The Offeror also affirms that, to the best of their knowledge, the contents of their submitted proposal are truthful and accurate, meeting all mandatory requirements as presented.

PRINTED NAME: _____________________________

AUTHORIZED SIGNATURE: ____________________________ DATE: ____________

ATTACHMENT B

NOTICE OF INTENT TO BID

This notice acknowledges that the undersigned prospective Offeror has read and understands the terms and conditions set forth in this solicitation and intends to submit a formal Proposal response by the Due Date and Time indicated for consideration of contract award.

Furthermore, the Bidder acknowledges that any contract(s) resulting from this solicitation will be substantially in accordance with the standard OMH and New York State terms and conditions, as set forth in the associated OMH Contract Boilerplate and this solicitation.

FIRM NAME:

CONTACT NAME:

CONTACT TITLE:

MAILING ADDRESS:

EMAIL:

PHONE:

AUTHORIZED SIGNATURE: ___________________________________________

NAME: _________________________________ DATE:__________________

ATTACHMENT B-1

PRE-BID CONFERENCE REGISTRATION FORM

A Mandatory Pre-Bid Conference is scheduled on Wednesday, August 12, 2026 at 11:00am ET. Format shall be an informational PowerPoint presentation via Webex.

Vendors must attend the Mandatory Pre-Bid Conference via Webex in order to be eligible to submit a Proposal in response to this RFP.

Return this form to the contact below to complete registration no later than Monday, August 10, 2026 at 3:00 pm ET

OMH CONTACT:

Peter A. Rogers

Contract Management Specialist 1

NYS Office of Mental Health peter.rogers@omh.ny.gov

FIRM NAME:

REPRESENTATIVE NAME:

TITLE:

TELEPHONE NUMBER:

EMAIL ADDRESS(ES):

If multiple attendees, please include all addresses.

mailto:peter.rogers@omh.ny.gov

ATTACHMENT B-2

NO BID EXPLANATION

Please return no later than: Wednesday, September 30, 2026 at 3:00pm ET

TO: Error! Reference source not found.

Contract Management Specialist I peter.rogers@omh.ny.gov

NYS Office of Mental Health Bureau of Procurement Enterprise Services

FROM: ________________________________/____________________________

(Print Company Representative Name) Signature

COMPANY NAME: ______________________

(PRINT)

ADDRESS: ______________________

(PRINT)

Email address for designated point of contact: _____________________________

I do not wish to submit a bid for the above solicitation due to:

ATTACHMENT C

BUSINESS REFERENCES

REFERENCE #1

Company Name

Address

City/State/Zip Code

Contact Name

Contact Phone

Contact E-mail

Dates Work Performed for Reference

REFERENCE #2

Address

City/State/Zip Code

Contact Name

Contact Phone

Contact E-mail

REFERENCE #3

Address

City/State/Zip Code

Contact Name

Contact Phone

Contact E-mail

ATTACHMENT D

NEW YORK STATE OFFICE OF MENTAL HEALTH

Summary of OMH Procurement Lobbying Guidelines

OMH has issued Guidelines pursuant to the New York State Finance Law Sections 139-j and 139-k, which prohibit lobbying on procurement contracts. For purposes of the law, procurement contracts include most contracts/Purchase Orders with an estimated annual expenditure in excess of $15,000 per year, as well as amendments and modifications to such contracts which were not contemplated by the original contract and represent a material change in the scope of the contract.

The law provides that, during the Restricted Period of an agency procurement for goods or services, vendors (or Offerors) may only contact the agency’s designated contact person(s), and all contacts, whether permissible or impermissible, shall be recorded:

Vendor Requirements

• Must limit communications with OMH during the Restricted Period of each procurement to the OMH-designated point(s) of contact o The Restricted Period is the period from the date of the earliest method by which an agency solicits a response from vendors to a contract opportunity until the date the contract is awarded and, if applicable, approved by the Comptroller’s Office.

• Must affirm in writing vendor’s understanding of, and agreement, to comply with the OMH Procurement Guidelines

• Must certify whether vendor has been found non-responsible within the previous four years by any Governmental Entity for failure to comply with State Finance Law 139-k or for the intentional provision of false or incomplete information regarding its procurement lobbying law compliance.

OMH Requirements

• Must include a summary of OMH’s procurement lobbying guidelines in each initial solicitation document

• Must designate a single point or points of contact for each procurement

• Must require OMH staff to record all Contacts from Offerors during the Restricted Period of each procurement o A Contact is any communication with OMH under circumstances where a reasonable person would infer that the communication was intended to influence the procurement

• Must refer all impermissible Contacts for investigation by OMH

• Must make a responsibility determination with regard to State Finance Law Section 139-j and 139-k compliance prior to award of the contract

• Must include a provision in all procurement contracts which allows OMH to terminate the contract if the vendor’s certification is found to be intentionally false or intentionally incomplete.

An electronic copy of the complete OMH Procurement Lobbying Law Guidelines is located at:

http://www.omh.ny.gov/omhweb/procurementguidelines/ http://www.omh.ny.gov/omhweb/procurementguidelines/

ATTACHMENT D-1

OFFEROR’S AFFIRMATION OF, UNDERSTANDING OF, AGREEMENT TO, AND COMPLIANCE WITH

OMH PROCUREMENT LOBBYING GUIDELINES

New York State Finance Law 139-j(6)(b) provides that OMH shall seek written affirmation from all Offerors on their understanding of and agreement to comply with OMH’s procedures relating to permissible contacts during each procurement pursuant to State Finance Law 139-j(3). OMH is expanding on that requirement, requiring that

(1) Offerors affirm they have complied with the OMH Guidelines throughout the procurement process, and (2) Offerors agree that OMH shall have the right to terminate any contract, purchase order or purchase authorization resulting from the procurement in the event that the affirmation is found to be intentionally false or intentionally incomplete.

Solicitation # and/or OMH descriptive name of solicitation:

RFP # 26-001 - Record Retention and Management Services

I hereby affirm that I have read and understand the OMH Procurement Lobbying Guidelines, and agree to comply with the OMH procedures relating to permissible contacts during this New York State governmental procurement pursuant to State Finance Law 139-j(3). Unless I provide notice otherwise, my execution of this affirmation shall be an ongoing representation that I have complied with, and continue to be in compliance with, the OMH Guidelines.

I understand and agree that: 1) OMH shall have the right to terminate the contract, purchase order or purchase authorization resulting from this solicitation in the event that this affirmation is found to be intentionally false or intentionally incomplete; and 2) upon such finding, OMH may exercise its termination right by providing written notification.

Date:___________ 20__

Signature of Offeror’s Authorized Representative _______________________________

Printed Name and Title ___________________________________________________

Name of Offeror_________________________________________________________

Offeror’s Address: ______________________________________________________

ATTACHMENT D-2

NEW YORK STATE OFFICE OF MENTAL HEALTH

OMH OFFEROR DISCLOSURE OF

PRIOR NON-RESPONSIBILITY DETERMINATIONS

New York State Finance Law 139-k requires Offerors to disclose findings of non-responsibility within the last four years by a governmental entity where such prior finding of non-responsibility was due to unlawful contacts during a procurement as stated under State Finance Law §139-j or the intentional provision of false or incomplete information to a governmental entity.

Failure to submit this form, the submission of a form with false, misleading or incomplete information, or failure to update this form when required may result in a determination of non-responsiveness and disqualification of the bid, proposal or offer. If the failure to comply is discovered after the contracting process has been completed, it may result in termination of the contract.

Solicitation # and/or OMH descriptive name of solicitation:

RFP # 26-001 - Record Retention and Management Services

(1) Has any New York State agency or authority made a finding of non-responsibility regarding the Offeror in the last four years? (Please circle): No Yes

If yes, what was the basis for the finding of the Offeror’s non-responsibility?

Please check all that apply:

__ Unlawful Contacts during a procurement contract (State Finance Law §139-j) __ The intentional provision of false or incomplete information

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

New York State Agency or Authority: ____________________________________ Year of Finding of Non-Responsibility:____________________________________ Facts Underlying Finding of Non-Responsibility:_____________________________

Add additional sheets if necessary

(2) Has any New York State agency or authority terminated or withheld a procurement contract with the Offeror due to the intentional provision of false or incomplete information? (Please circle): No Yes

If yes, please provide details regarding the termination/withholding below:

New York State Agency or Authority: _____________________________________ Date of Termination/Withholding of Contract:____________Contract #: __________

Facts Underlying Termination: __________________________________________

Add additional sheets if necessary

Offeror certifies that all information provided to OMH with respect to State Finance Law 139-k is complete, true and accurate.

Date:___________ 200_ _________________________________________________

Signature of Offeror’s Authorized Representative

Printed Name and Title of Authorized Representative

Name and Address of Offeror

ATTACHMENT E

NON-COLLUSIVE BIDDING CERTIFICATION

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 1 of 3)

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

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

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

BELIEF:

[1] The prices of this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purposes of restricting competition, as to any matter relating to such prices with any other Bidder or with any competitor;

[2] Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the Bidder and will not knowingly be disclosed by the Bidder prior to opening, directly or indirectly, to any other Bidder or to any competitor; and

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

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

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

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

THEREFORE:

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

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

(Page 2 of 3)

IF BIDDER(S) (ARE) A PARTNERSHIP, COMPLETE THE FOLLOWING:

NAMES OF PARTNERS OR PRINCIPALS LEGAL RESIDENCE

IF BIDDER(S) (ARE) A CORPORATION, COMPLETE THE FOLLOWING:

NAME LEGAL RESIDENCE

President:

Secretary:

Treasurer:

President:

Secretary:

Treasurer:

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

NAMES OF MEMBERS LEGAL RESIDENCE

(Page 3 of 3)

Identifying Data Potential Contractor: ___________________________________________________________ Address: ___________________________________________________________

Street

City, Town, etc.

Telephone: __________________________ Title__________________________

If applicable, Responsible Corporate Officer:

Name: ______________________________ Title__________________________

Signature: _______________________________________________________________

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

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

By: _____________________________ ______________________________

Name Name

Title Title

Address: _________________________ Address: _________________________

Street Street

City, State City, State

ATTACHMENT I

(page 1 of 2)

MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES – EQUAL EMPLOYMENT

OPPORTUNITY POLICY STATEMENT

I, _________________________, the awardee/contractor, agree to adopt the following policies with respect to the project being developed or services rendered for the Office of Mental Health (OMH)

This organization will and will cause its contractors and subcontractors to take good faith actions to achieve the M/WBE contract participations goals set by the State for that area in which the State-funded project is located, by taking the following steps:

(1) Actively and affirmatively solicit bids for contracts and subcontracts from qualified State certified MBEs or WBEs, including solicitations to M/WBE contractor associations.

(2) Request a list of State-certified M/WBEs from OMH and solicit bids from them directly.

(3) Ensure that plans, specifications, request for proposals and other documents used to secure bids will be made available in sufficient time for review by prospective M/WBEs.

(4) Where feasible, divide the work into smaller portions to enhanced participations by M/WBEs and encourage the formation of joint venture and other partnerships among M/WBE contractors to enhance their participation.

(5) Document and maintain records of bid solicitation, including those to M/WBEs and the results thereof.

Contractor will also maintain records of actions that its subcontractors have taken toward meeting M/WBE contract participation goals.

(6) Ensure that progress payments to M/WBEs are made on a timely basis so that undue financial hardship is avoided, and that bonding and other credit requirements are waived or appropriate alternatives developed to encourage M/WBE participation.

M/WBE

(a) This organization will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, sex, age, disability or marital status, will undertake or continue existing programs of affirmative action to ensure that minority group members are afforded equal employment opportunities without discrimination, and shall make and document its conscientious and active efforts to employ and utilize minority group members and women in its work force on state contracts.

(b)This organization shall state in all solicitation or advertisements for employees that in the performance of the State contract all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex disability or marital status.

(c) At the request of the contracting agency, this organization shall request each employment agency, labor union, or authorized representative will not discriminate on the basis of race, creed, color, national origin, sex, age, disability or marital status and that such union or representative will affirmatively cooperate in the implementation of this organization’s obligations herein.

(d) Contractor shall comply with the provisions of the Human Rights Law, all other State and Federal statutory and constitutional non-discrimination provisions.

Contractor and subcontractors shall not discriminate against any employee or applicant for employment because of race, creed (religion), color, sex, national origin, sexual orientation, military status, age, disability, predisposing genetic characteristic, marital status or domestic violence victim status, and shall also follow the requirements of the Human Rights Law with regard to non-discrimination on the basis of prior criminal conviction and prior arrest.

(e) This organization will include the provisions of sections

(a) through (d) of this agreement in every subcontract in such a manner that the requirements of the subdivisions will be binding upon each subcontractor as to work in connection with the State contract.

EEO

ATTACHMENT I

(page 2 of 2)

MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES – EQUAL EMPLOYMENT

OPPORTUNITY POLICY STATEMENT

Agreed to this _______ day of ____________________, 2___________

By __________________________________________ Print: _____________________________________ Title: _____________________________

_________________________________is designated as the Minority Business Enterprise Liaison (Name of Designated Liaison) responsible for administering the Minority and Women-Owned Business Enterprises- Equal Employment Opportunity (M/WBE-EEO) program.

M/WBE Contract Goals

0 % Minority and Women’s Business Enterprise Participation

0 % Minority Business Enterprise Participation

0 % Women’s Business Enterprise Participation

(Authorized Representative)

Title: ________________________________________ Date:__________________

ATTACHMENT I-1

Equal Employment Opportunity Staffing Plan

Solicitation/Program Name:

RFQ 26-001 – Record Retention and Management Services

Report includes:

□ Work force to be utilized on this contract

□ Contractor/Subcontractor’s total work force

Offeror’s Name: Reporting Entity:

□ Contractor

□ Subcontractor

Subcontractor’s name Offeror’s Address:

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

EEO-Job Category

Total Work force

Work force by Gender

Work force by Race/Ethnic Identification

Total Male (M)

Total Female

(F)

White

(M) (F)

Black

Hispanic

Asian

Native American

Disabled

Veteran

Officials/Administrators

Professionals

Technicians

Service Maintenance Workers

Office/Clerical

Skilled Craft Workers

Paraprofessionals

Protective Service Workers

Totals

PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type):

SUBMIT COMPLETED WITH BID OR PROPOSAL

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

Instructions for completing:

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

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

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

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

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

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

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

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

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

RACE/ETHNIC IDENTIFICATION

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

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

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

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

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

ISLANDER

NATIVE INDIAN (NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal

AMERICAN/ ALASKAN affiliation or community recognition.

NATIVE)

OTHER CATEGORIES

DISABLED INDIVIDUAL any person who: -has a physical or mental impairment that substantially limits one or more major life activity(ies)

-has a record of such an impairment; or

-is regarded as having such an impairment.

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

ATTACHMENT M

Encouraging the Use of New York Subcontractors and Suppliers

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

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

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

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

Will New York State Businesses be used in the performance of this contract?

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

Name of Firm: _______________________________________________________

Printed Name: _______________________________________________________

Authorized Signature: _________________________________________________ Date: ____________

YES NO

ATTACHMENT N

New York State Business Usage Form

Question Yes No

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

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

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

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

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

NYS Business

Subcontractor or

Supplier Company Name Company Address

Company Phone #

Company

FEIN

Estimated Amt to NYS Business in the performance of this contract

Name of Firm: ____________________________________________________

Printed Name: ____________________________________________________

Authorized Signature: _______________________________________________ Date: _______________

ATTACHMENT P

Sexual Harassment Prevention Certification

State Finance Law §139-l requires bidders on state procurements to certify that they have a written policy addressing sexual harassment prevention in the workplace and provide annual sexual harassment training (that meets the Department of Labor’s model policy and training standards) to all its employees.

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies its own organization, under penalty of perjury, that the bidder has and has implemented a written policy addressing sexual harassment prevention in the workplace and provides annual sexual harassment prevention training to all of its employees. Such policy shall, at a minimum, meet the requirements of section two hundred one-g of the labor law.

I hereby affirm that ______________________________ (Offerer’s Name) has implemented a written policy addressing sexual harassment prevention in the workplace and provides annual sexual harassment prevention training to all of its employees. Such policy, at a minimum, meets the requirements of section two hundred one-g of the labor law. Unless I provide notice otherwise, my execution of this affirmation shall be an ongoing representation that I have complied with, and continue to be in compliance with State Finance Law §139-l.

I understand and agree that: 1) OMH shall have the right to terminate the contract, purchase order or purchase authorization resulting from this solicitation in the event that this affirmation is found to be intentionally false or intentionally incomplete; and 2) upon such finding, OMH may exercise its termination right by providing written notification.

Date____________________ 20___

Signature of Offerer’s Authorized Representative _______________________________

Printed Name and Title ___________________________________________________

Name of Offerer_________________________________________________________

Offerer’s Address________________________________________________________

ATTACHMENT Q

Gender-Based Violence and the Workplace Certification

New York State Finance Law §139-M requires bidders on competitive state procurements to certify that they have a written policy addressing gender-based violence and the workplace and that such policy meets the following minimum requirements:

● Share Information: Employers must provide information regarding gender-based violence where employees can see and access it, including displaying the NYS Domestic and Sexual Violence Hotline information and a gender-based violence and the workplace poster.

● Refer Employee-Survivors to Services: The policy must require that the employer refer employees who disclose current or past victim status to the NYS Domestic and Sexual Violence Hotline and/or a local service provider. For bidders outside of New York State, referrals should be made to a local provider or statewide hotline. While referrals are required to be provided by the employer, it is not required for the employee to access services.

● Prohibit Retaliation: The policy must clearly state that discrimination or retaliation against employees who identify as victims or survivors of gender-based violence is prohibited.

● Comply with Laws: Ensure your policy follows State law. For employers based in New York State, this means that the policy must follow the SAFE Leave Act, New York State Human Rights Law, and any other relevant laws and regulations.

● Offer Implementation Support: OPDV is able to assist employers in developing and implementing this policy. Employers must provide information to supervisors and human resources, where available, about this technical assistance from OPDV. OPDV can be contacted at workplace@opdv.ny.gov.

By submission of this certification, each person signing on behalf of any organization certifies, and in the case of a joint submission each party thereto certifies its own organization, under penalty of perjury, that they have and have implemented a written policy addressing gender-based violence and the workplace.

Organization’s signature below certifies its compliance with State Finance Law §139-M.

Organization: __________________________________________ By (signature): ____________________________________

Name (Please Print): _______________________________ Title: ____________________________________________ Date: ____________________

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

If the organization cannot make the above certification, they must provide a statement with their bid detailing the reasons therefor:

mailto:workplace@opdv.ny.gov

ATTACHMENT R

Certification Under Executive Order No. 16

Prohibiting State Agencies and Authorities from Contracting with Businesses Conducting Business in Russia

Executive Order No. 16 provides that “all Affected State Entities are directed to refrain from entering into any new contract or renewing any existing contract with an entity conducting business operations in Russia.” The complete text of Executive Order No. 16 can be found here.

The Executive Order remains in effect while sanctions imposed by the federal government are in effect. Accordingly, vendors who may be excluded from award because of current business operations in Russia are nevertheless encouraged to respond to solicitations to preserve their contracting opportunities in case the sanctions are lifted during a solicitation or even after award in the case of some solicitations.

As defined in Executive Order No. 16, an “entity conducting business operations in Russia” means an institution or company, wherever located, conducting any commercial activity in Russia or transacting business with the Russian

Government or with commercial entities headquartered in Russia or with their principal place of business in Russia in the form of contracting, sales, purchasing, investment, or any business partnership.

Is Vendor an entity conducting business operations in Russia, as defined above? Please answer by checking one of the following boxes:

1. No, Vendor does not conduct business operations in Russia within the meaning of

Executive Order No. 16.

2. a. Yes, Vendor conducts business operations in Russia within the meaning of Executive

Order No. 16 but has taken steps to wind down business operations in Russia or is in the process of winding down business operations in Russia. (Please provide a detailed description of the wind down process and a schedule for completion.)

2.b. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order

No. 16 but only to the extent necessary to provide vital health and safety services within

Russia or to comply with federal law, regulations, executive orders, or directives. (Please provide a detailed description of the services being provided or the relevant laws, regulations, etc.)

3. Yes, Vendor conducts business operations in Russia within the meaning of Executive

Order No. 16.

The undersigned certifies under penalties of perjury that they are knowledgeable about the Vendor’s business and operations and that the answer provided herein is true to the best of their knowledge and belief.

Vendor Name:

(legal entity) By:

(signature) __________________________________________________________________________________

Name: _________________________________________________________________

Title: ___________________________________________________________________

Date: _________________________________________________________________ https://www.governor.ny.gov/executive-order/no-16-prohibiting-state-agencies-and-authorities-contracting-businesses-conducting