RFP 26-004 Library of Attachments.pdf

PROPOSAL SUBMISSION CHECKLIST

OMH reserves the right to disqualify any proposals that do not contain the mandatory items as specified for this Solicitation and the resulting Contract. Vendors 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

VOLUME 3 – ADMINISTRATIVE 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 and Experience

- System Specifications

- Training

- Dashboard and Reports

- Ongoing Support

Attachment L References Provide completed copy with up to 3 references.

Attachment O Supplier Diversity Questionnaire

Include the completed copy

Required document Type of Submission Included w/ Submission

Attachment C Cost Proposal Worksheet Include the completed copy

Required document Type of Submission Included w/ Submission

Attachment A Solicitation Cover Sheet

Provide completed and signed copy

Attachment D OMH Consultant Disclosure Reporting – Form A

Provide signed copy

Attachment E Non-Collusive Bidding Certification Provide a signed and notarized original

Cost Proposal Summary Create your own document

Ron Foster Line

Attachment F Substitute W-9 Provide a signed copy if applicable

Attachment I and/or I-1 MWBE/EEO Policy Statement, EEO Employment Opportunity Staffing Plan

Provide copies as applicable

Attachment J-1 Vendor’s Affirmation of Understanding of OMH Procurement Lobbying Guidelines

Provide completed and signed copy

Attachment J-2 Disclosure of Prior Non-Responsibility Determinations

Provide completed and signed copy

Attachment M Encouraging the Use of New York State Subcontractors and Suppliers

Provide copies as applicable

Attachment N New York State Business Usage Form

Provide copies as applicable

Attachment P Sexual Harassment Prevention Certification

Provide completed and signed copy

Attachment Q Gender-Based Violence and the Workplace Certification

Provide completed and signed copy

Attachment R Certification Under Executive Order 16

Provide completed and signed copy

Workers’ Compensation/NYS Disability Coverage required forms

If available, include verification of required coverage.

(will be required upon notice of award)

Liability Insurance Coverage If required, include verification of required coverage.

(will be required upon notice of award)

ST-220-CA:

Sales and Compensating Use Tax Certificate

Provide completed and signed copy

ATTACHMENT A

SOLICITATION COVER

SHEET Bid #: IFB 26-004

NAME OF FIRM

ADDRESS

PRINTED NAME/SIGNATURE

TITLE

EMAIL ADDRESS

PHONE #

FAX#

New York State Vendor ID

FEDERAL ID (FEIN) #

DUNS #

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:

Form submitted to show compliance with New York State Workers Compensation Insurance requirements:

CE-200 or C-105.2 or U-26.3 or SI-12 or GSI-105.2

Form submitted to show compliance with New York State Disability Benefits Insurance requirements:

CE-200 or DB-120.1 or DB-155

PLEASE CHECK THE APPROPRIATE BOX:

NYS Minority-owned Business (MBE)

NYS Women-owned Business (WBE)

NYS Small Business (SB)

Registration #

Registration #

NYS Disadvantaged Business Enterprise

(DBE)

NYS Service-Disabled Veteran Owned Business (SDVOB)

None of the above

(Note: Information provided on this form should match, when applicable, to information provided on Vendor Responsibility Questionnaire/ or on the online version of the document.)

Attachment D Consultant Disclosure Form A

OSC Use Only:

Reporting Code:

Category Code:

Date Contract Approved:

FORM A

State Consultant Services - Contractor's Planned Employment

From Contract Start Date Through The End Of The Contract Term

State Agency Name: Agency Code:

Contractor Name: Contract Number:

Contract Start Date: Contract End Date:

Employment Category1 Number of Employees

Number of hours to be worked

Amount Payable Under the Contract

Total this page 0 0

Grand Total

Name of person who prepared this report:

Title: Phone #:

Preparer's Signature:

Date Prepared:

(Use additional pages, if necessary) Page 1 of 1

1. (Note: Access the O*NET database, which is available through the US Department of Labor’s Employment and Training Administration, on-line at online.onetcenter.org to find a list of occupations.)

http://online.onetcenter.org/

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.

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(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

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 3 of 3)

Identifying Data Potential Contractor: ___________________________________________________________ Address: ___________________________________________________________

Street

City, Town, etc.

Telephone: __________________________ Title__________________________

If applicable, Responsible Corporate Officer:

Name: ______________________________ Title__________________________

Signature: _______________________________________________________________

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

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

By: _____________________________ ______________________________ Name Name

Title Title

Address: _________________________ Address: _________________________ Street Street

City, State City, State

AC 3237-S (Rev. 1/17)

NEW YORK STATE OFFICE OF THE STATE COMPTROLLER

SUBSTITUTE FORM W-9:

REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION

TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION.

Part I: Vendor Information

1. Legal Business Name: 2. Business name/disregarded entity name, if different from Legal Business Name:

3. Entity Type (Check one only):

Individual Sole Proprietor Partnership Limited Liability Co. Corporation Not For Profit

Trusts/Estates Federal, State or Local Government Public Authority Disregarded Entity

Other _______________________________

Exempt

…….Payee

Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type

1. Enter your TIN here: (DO NOT USE DASHES) See instructions.

2. Taxpayer Identification Type (check appropriate box):

Employer ID No. (EIN) Social Security No. (SSN) Individual Taxpayer ID No. (ITIN) N/A (Non-United States Business Entity)

Part III: Address

1. Remittance Address: 2. Ordering Address:

Number, Street, and Apartment or Suite Number Number, Street, and Apartment or Suite Number

City, State, and Nine Digit Zip Code or Country City, State, and Nine Digit Zip Code or Country

Email Address

Part IV: Vendor Primary Contact Information – Executive Authorized to Represent the Vendor

Primary Contact Name: ________________________________________________ Title:__________________________________________

Email Address: _______________________________________________________ Phone Number: ________________________

Part V: Certification and Exemption from Backup Withholding

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (TIN), and

2. I am a U.S. citizen or other U.S. person, and

3. (Check one only):

I am not subject to backup withholding. I am (a) exempt from back up withholding, or (b) I have not been notified by the

Internal Revenue Service (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),or

I am subject to backup withholding. I have been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends, and I have not been notified by the IRS that I am no longer subject to back withholding.

Sign Here:

Signature Title Date

Print Preparer's Name Phone Number Email Address

DO NOT SUBMIT FORM TO IRS – SUBMIT FORM TO NYS ONLY AS DIRECTED

Attachment F: W9 Form

AC 3237-S (Rev. 1/17)

NYS Office of the State Comptroller

Instructions for Completing Substitute Form W-9

New York State (NYS) must obtain your correct Taxpayer Identification Number (TIN) to report income paid to you or your organization. NYS Office of the State Comptroller uses the Substitute Form W-9 to obtain certification of your TIN in order to ensure accuracy of information contained in its payee/vendor database and to avoid backup withholding.1 We ask for the information on the Substitute Form W-9 to carry out the Internal Revenue laws of the United States. You are required to give us the information.

Any payee/vendor who wishes to do business with New York State must complete the Substitute Form W-9. Substitute Form W-9 is the only acceptable documentation. We will not accept IRS Form W-9.

Part I: Vendor Information

1. Legal Business Name: For individuals, enter the name of the person who will do business with NYS as it appears on the Social Security card or other required Federal tax documents. An organization should enter the name shown on its charter or other legal documents that created the organization. Do not abbreviate names.

2. Business name/disregarded entity name, if different from Legal Business Name: Enter your DBA name or another name your entity is known by.

3. Entity Type: Check the Entity Type doing business with New York State.

Part II: Taxpayer Identification Number (TIN) and Taxpayer Identification Type

The TIN provided must match the name in the “Legal Business Name” box to avoid backup withholding.

For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, refers to IRS W-9 instructions for additional information. For other entities, it is your employer identification number (EIN). If you do not have a number or if the account is in more than one name, refer to IRS W-9 instructions for additional information.

1. Taxpayer Identification Number: Enter your nine-digit Social Security Number, Individual Taxpayer Identification Number (ITIN) or Employer Identification Number (EIN).

2. Taxpayer Identification Type: Check the type of identification number provided.

Part III: Address

1. Remittance Address: Enter the address where payments, 1099s, if applicable, and official correspondence should be mailed. This will become the default address.

2. Ordering Address: Enter the address where purchase orders should be sent. Please note that purchase orders will be sent via email by default.

Part IV: Vendor Primary Contact Information Please provide the contact information for an executive at your organization. This individual should be the person who makes legal and financial decisions for your organization. Name, phone number and email address are required.

Part V: Certification and Exemption from Backup Withholding Check the appropriate box indicating your exemption status from backup withholding. Individuals and sole proprietors are not exempt from backup withholding. Corporations are exempt from backup withholding for certain types of payments. Refer to IRS Form W-9 instructions for additional information. The signature should be provided by the individual, owner, officer, legal representative, or other authorized person of the entity listed on the form. Certain exceptions to the signature requirement are listed in the IRS instructions for form W-9.

1 According to IRS Regulations, OSC must withhold 28% of all payments if a payee/vendor fails to provide OSC its certified TIN. The Substitute Form W-9 certifies a payee/vendor’s TIN.

Attachment F: W9 Form

ATTACHMENT I

CONTRACTOR REQUIREMENTS AND PROCEDURES FOR BUSINESS PARTICIPATION OPPORTUNITIES FOR

VENDORS CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

NEW YORK STATE LAW

Pursuant to New York State Executive Law Article 15-A and 5 NYCRR 140-145 OMH recognizes its obligation under the law to promote opportunities for maximum feasible participation of certified minority-and women-owned business enterprises and the employment of minority group members and women in the performance of OMH contracts.

In 2006, the State of New York commissioned a disparity study to evaluate whether minority and women-owned business enterprises had a full and fair opportunity to participate in state contracting. The findings of the study were published on April 29, 2010, under the title "The State of Minority and Women-Owned Business Enterprises:

Evidence from New York" (“Disparity Study”). The report found evidence of statistically significant disparities between the level of participation of minority-and women-owned business enterprises in state procurement contracting versus the number of minority-and women-owned business enterprises that were ready, willing and able to participate in state procurements. As a result of these findings, the Disparity Study made recommendations concerning the implementation and operation of the statewide certified minority- and women-owned business enterprises program. The recommendations from the Disparity Study culminated in the enactment and the implementation of New York State Executive Law Article 15-A, which requires, among other things, that OMH establishes goals for maximum feasible participation of New York State Certified minority- and women – owned business enterprises (“MWBE”) and the employment of minority groups members and women in the performance of New York State contracts.

Business Participation Opportunities for MWBEs

For purposes of this procurement, OMH hereby establishes an overall goal of 30% for MWBE participation, 16% for New York State certified minority-owned business enterprises (“MBE”) participation and 14% for New York State certified women-owned business enterprises (“WBE”) participation (based on the current availability of qualified MBEs and WBEs). A contractor (“Contractor”) on the subject contract (“Contract”) must document its good faith efforts to provide meaningful participation by MWBEs as subcontractors or suppliers in the performance of the Contract and the Contractor agrees that OMH may withhold payment pending receipt of the required MWBE documentation. The directory of MWBEs can be viewed at: https://ny.newnycontracts.com. For guidance on how OMH will determine a Contractor’s “good faith efforts,” refer to 5 NYCRR §142.8.

In accordance with 5 NYCRR §142.13, the Contractor acknowledges that if it is found to have willfully and intentionally failed to comply with the MWBE participation goals set forth in the Contract, such finding constitutes a breach of Contract and OMH may withhold payment from the Contractor as liquidated damages.

Such liquidated damages shall be calculated as an amount equaling the difference between: (1) all sums identified for payment to MWBEs had the Contractor achieved the contractual MWBE goals; and (2) all sums actually paid to MWBEs for work performed or materials supplied under the Contract.

By submitting a bid or proposal, a bidder on the Contract (“Bidder”) agrees to demonstrate its good faith efforts to achieve its goals for the utilization of MWBEs by submitting evidence thereof through the New York State Contract System (“NYSCS”), which can be viewed at https://ny.newnycontracts.com, provided, however, that a Bidder may arrange to provide such evidence via a non-electronic method by contacting the Agency contact.

Please note that the NYSCS is a one stop solution for all of your MWBE and Article 15-A contract requirements.

For additional information on the use of the NYSCS to meet Bidder’s MWBE requirements please see the attached MWBE guidance, “Your MWBE Utilization and Reporting Responsibilities Under Article 15-A.”

Additionally, a Bidder will be required to submit the following documents and information as evidence of compliance with the foregoing:

A. An MWBE Utilization Plan with their bid or proposal. Any modifications or changes to the MWBE Utilization Plan after the Contract award and during the term of the Contract must be reported on a revised MWBE Utilization Plan and submitted to OMH.

OMH will review the submitted MWBE Utilization Plan and advise the Bidder of OMH acceptance or issue a notice of deficiency within 30 days of receipt.

https://ny.newnycontracts.com/ https://ny.newnycontracts.com/

CONTRACTOR REQUIREMENTS AND PROCEDURES FOR BUSINESS PARTICIPATION OPPORTUNITIES FOR VENDORS

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

B. If a notice of deficiency is issued, the Bidder will be required to respond to the notice of deficiency within seven (7) business days of receipt by submitting to cbomwbe@omh.ny.gov a written remedy in response to the notice of deficiency. If the written remedy that is submitted is not timely or is found by OMH to be inadequate, OMH shall notify the Bidder and direct the Bidder to submit, within five (5) business days, a request for a partial or total waiver of MWBE participation goals. Failure to file the waiver form in a timely manner may be grounds for disqualification of the bid or proposal.

OMH may disqualify a Bidder as being non-responsive under the following circumstances:

a) If a Bidder fails to submit a MWBE Utilization Plan;

b) If a Bidder fails to submit a written remedy to a notice of deficiency;

c) If a Bidder fails to submit a request for waiver; or

d) If OMH determines that the Bidder has failed to document good faith efforts.

The Contractor will be required to attempt to utilize, in good faith, any MBE or WBE identified within its MWBE Utilization Plan, during the performance of the Contract. Requests for a partial or total waiver of established goal requirements made subsequent to Contract Award may be made at any time during the term of the Contract to OMH, but must be made no later than prior to the submission of a request for final payment on the Contract.

The Contractor will be required to submit a Contractor’s Quarterly M/WBE Contractor Compliance & Payment Report to the OMH, by the 10th day following each end of quarter over the term of the Contract documenting the progress made toward achievement of the MWBE goals of the Contract.

Equal Employment Opportunity Requirements

By submission of a bid or proposal in response to this solicitation, the Bidder/Contractor agrees with all of the terms and conditions of Appendix A – Standard Clauses for All New York State Contracts including Clause 12 - Equal Employment Opportunities for Minorities and Women. The Contractor is required to ensure that it and any subcontractors awarded a subcontract over $25,000 for the construction, demolition, replacement, major repair, renovation, planning or design of real property and improvements thereon (the "Work"), except where the Work is for the beneficial use of the Contractor, undertake or continue programs to ensure that minority group members and women are afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. For these purposes, equal opportunity shall apply in the areas of recruitment, employment, job assignment, promotion, upgrading, demotion, transfer, layoff, termination, and rates of pay or other forms of compensation. This requirement does not apply to: (i) work, goods, or services unrelated to the Contract; or (ii) employment outside New York State.

The Bidder will be required to submit a Minority and Women-Owned Business Enterprises and Equal Employment Opportunity Policy Statement, ATTACHMENT I-1, to OMH with their bid or proposal.

Pursuant to Executive Order #162, contractors and subcontractors will also be required to report the gross wages paid to each of their employees for the work performed by such employees on the contract utilizing the Workforce Utilization Report on a quarterly basis.

Further, pursuant to Article 15 of the Executive Law (the “Human Rights Law”), all other State and Federal statutory and constitutional non-discrimination provisions, the Contractor and sub-contractors will 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.

Please Note: Failure to comply with the foregoing requirements may result in a finding of non-responsiveness, non-responsibility and/or a breach of the Contract, leading to the withholding of funds, suspension or termination of the Contract or such other actions or enforcement proceedings as allowed by the Contract.

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

PARTICIPATION OPPORTUNITIES FOR NEW YORK STATE CERTIFIED SERVICE-DISABLED VETERAN

OWNED BUSINESSES

Article 17-B of the New York State Executive Law provides for more meaningful participation in public procurement by certified Service-Disabled Veteran-Owned Businesses (“SDVOB”), thereby further integrating such businesses into New York State’s economy. OMH recognizes the need to promote the employment of service-disabled veterans and to ensure that certified service-disabled veteran-owned businesses have opportunities for maximum feasible participation in the performance of OMH contracts.

In recognition of the service and sacrifices made by service-disabled veterans and in recognition of their economic activity in doing business in New York State, Bidders are expected to consider SDVOBs in the fulfillment of the requirements of the Contract. Such participation may be as subcontractors or suppliers, as protégés, or in other partnering or supporting roles.

I. Contract Goals

A. OMH hereby establishes an overall goal of 6% for SDVOB participation, based on the current availability of qualified SDVOBs. For purposes of providing meaningful participation by SDVOBs, the Bidder/Contractor should reference the directory of New York State Certified SDVOBs found at:

https://ogs.ny.gov/veterans/Docs/CertifiedNYS_SDVOB.pdf. Questions regarding compliance with SDVOB participation goals should be directed to the cbomwbe@omh.ny.gov. Additionally, following Contract execution, Contractor is encouraged to contact the Office of General Services’ Division of Service-Disabled Veterans’ Business Development at 518-474-2015 or VeteransDevelopment@ogs.ny.gov to discuss additional methods of maximizing participation by SDVOBs on the Contract.

B. Contractor must document “good faith efforts” to provide meaningful participation by SDVOBs as subcontractors or suppliers in the performance of the Contract (see clause IV below).

II. SDVOB Utilization Plan

A. In accordance with 9 NYCRR § 252.2(i), Bidders are required to submit a completed SDVOB Utilization Plan on Form SDVOB 100 with their bid.

B. The Utilization Plan shall list the SDVOBs that the Bidder intends to use to perform the Contract, a description of the work that the Bidder intends the SDVOB to perform to meet the goals on the Contract, the estimated dollar amounts to be paid to an SDVOB, or, if not known, an estimate of the percentage of Contract work the SDVOB will perform. By signing the Utilization Plan, the Bidder acknowledges that making false representations or providing information that shows a lack of good faith as part of, or in conjunction with, the submission of a Utilization Plan is prohibited by law and may result in penalties including, but not limited to, termination of a contract for cause, loss of eligibility to submit future bids, and/or withholding of payments. Any modifications or changes to the agreed participation by SDVOBs after the Contract award and during the term of the Contract must be reported on a revised SDVOB Utilization Plan and submitted to OMH.

C. OMH will review the submitted SDVOB Utilization Plan and advise the Bidder/Contractor of OMH acceptance or issue a notice of deficiency within 20 days of receipt.

D. If a notice of deficiency is issued, Bidder/Contractor agrees that it shall respond to the notice of deficiency, within seven business days of receipt, by submitting to OMH a written remedy in response to the notice of deficiency. If the written remedy that is submitted is not timely or is found by OMH to be inadequate, OMH shall notify the Bidder/Contractor and direct the Bidder/Contractor to submit, within five business days of notification by OMH, a request for a partial or total waiver of SDVOB participation goals on SDVOB 200. Failure to file the waiver form in a timely manner may be grounds for disqualification of the bid or proposal.

https://ogs.ny.gov/veterans/Docs/CertifiedNYS_SDVOB.pdf mailto:VeteransDevelopment@ogs.ny.gov

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

E. OMH may disqualify a Bidder’s bid or proposal as being non-responsive under the following circumstances:

(1) If a Bidder fails to submit an SDVOB Utilization Plan;

(2) If a Bidder fails to submit a written remedy to a notice of deficiency;

(3) If a Bidder fails to submit a request for waiver; or

(4) If OMH determines that the Bidder has failed to document good faith efforts.

F. If awarded a Contract, Contractor certifies that it will follow the submitted SDVOB Utilization Plan for the performance of SDVOBs on the Contract pursuant to the prescribed SDVOB contract goals set forth above.

G. Contractor further agrees that a failure to use SDVOBs as agreed in the Utilization Plan shall constitute a material breach of the terms of the Contract. Upon the occurrence of such a material breach, OMH shall be entitled to any remedy provided herein, including but not limited to, a finding of Contractor non-responsibility.

III. Request for Waiver

A. Prior to submission of a request for a partial or total waiver, Bidder/Contractor shall speak to the Agency contact(s) at OMH for guidance.

B. In accordance with 9 NYCRR § 252.2(m), a Bidder/Contractor that is able to document good faith efforts to meet the goal requirements, as set forth in clause IV below, may submit a request for a partial or total waiver on Form SDVOB 200, accompanied by supporting documentation. A Bidder may submit the request for waiver at the same time it submits its SDVOB Utilization Plan. If a request for waiver is submitted with the SDVOB Utilization Plan and is not accepted by OMH at that time, the provisions of clauses II (C), (D) & (E) will apply. If the documentation included with the Bidder’s/Contractor’s waiver request is complete, OMH shall evaluate the request and issue a written notice of acceptance or denial within 20 days of receipt.

C. Contractor shall attempt to utilize, in good faith, the SDVOBs identified within its SDVOB Utilization Plan, during the performance of the Contract. Requests for a partial or total waiver of established goal requirements made subsequent to Contract award may be made at any time during the term of the Contract to OMH, but must be made no later than prior to the submission of a request for final payment on the Contract.

D. If OMH, upon review of the SDVOB Utilization Plan and Monthly SDVOB Compliance Report (SDVOB

101) determines that Contractor is failing or refusing to comply with the contract goals and no waiver has been issued in regard to such non-compliance, OMH may issue a notice of deficiency to the Contractor.

The Contractor must respond to the notice of deficiency within seven business days of receipt. Such response may include a request for partial or total waiver of SDVOB contract goals.

Waiver requests should be sent to OMH.

IV. Required Good Faith Efforts

In accordance with 9 NYCRR § 252.2(n), Contractors must document their good faith efforts toward utilizing SDVOBs on the Contract. Evidence of required good faith efforts shall include, but not be limited to, the following:

(1) Copies of solicitations to SDVOBs and any responses thereto.

(2) Explanation of the specific reasons each SDVOB that responded to Bidders/Contractors’ solicitation was not selected.

(3) Dates of any pre-bid, pre-award or other meetings attended by Contractor, if any, scheduled by OMH with certified SDVOBs whom OMH determined were capable of fulfilling the SDVOB goals set in the Contract.

(4) Information describing the specific steps undertaken to reasonably structure the Contract scope of work for the purpose of subcontracting with, or obtaining supplies from, certified SDVOBs.

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

(5) Other information deemed relevant to the waiver request.

V. Monthly SDVOB Contractor Compliance Report

In accordance with 9 NYCRR § 252.2(q), Contractor is required to report Monthly SDVOB Contractor Compliance to OMH during the term of the Contract for the preceding month’s activity, documenting progress made towards achieving the Contract SDVOB goals. This information must be submitted using form SDVOB 101 (Exhibit 6) and should be completed by the Contractor and submitted to OMH, by the 10th day of each month during the term of the Contract, for the preceding month’s activity to: cbomwbe@omh.ny.gov

VI. Breach of Contract and Damages

In accordance with 9 NYCRR § 252.2(s), any Contractor found to have willfully and intentionally failed to comply with the SDVOB participation goals set forth in the Contract, shall be found to have breached the contract and Contractor shall pay damages as set forth therein.

ALL FORMS ARE AVAILABLE AT: https://ogs.ny.gov/veterans/

THIS SPACE INTENTIONALLY LEFT BLANK

https://ogs.ny.gov/veterans/

ATTACHM ENT I

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

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 ________ % Minority and Women’s Business Enterprise Participation ________% Minority Business Enterprise Participation ________% Women’s Business Enterprise Participation

(Authorized Representative)

Title: ________________________________________ Date:__________________

ATTACHMENT I-1

Equal Employment Opportunity Staffing Plan

Solicitation/Program Name: Error! Reference source not found. 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

(M) (F) Hispanic

(M) (F) Asian

(M) (F)

Native American

(M) (F) Disabled

(M) (F) Veteran

(M) (F)

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.

GENDER

ATTACHMENT J-1

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 J-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 25-009, Comprehensive Energy Efficiency Program ______________________________________________________________________

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 J-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 26-004 /Electronic Patient Observation System

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 L

REFERENCES

Business References for RFP # 26-004

REFERENCE #1

Company Name Address City/State/Zip Code Contact Name Contact Phone Contact E-mail Dates Work Performed for Reference

REFERENCE #2

Company Name Address City/State/Zip Code Contact Name Contact Phone Contact E-mail Dates Work Performed for Reference

REFERENCE #3

Company Name Address City/State/Zip Code Contact Name Contact Phone Contact E-mail Dates Work Performed for Reference

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…