RFP Town of Salem Comprehensive Plan Technical Services.pdf

Notice to Professionals

Town of Salem Comprehensive Plan

Section 1. Introduction:

The Town of Salem, NY, is soliciting proposals for the services of a planning consultant and consultant team to work with the Lake Champlain Lake George Regional Planning Board (LCLGRPB) to develop a Smart Growth Comprehensive Plan (the “Project”). The Project is funded by the New York State Department of State Environmental Protection Fund Smart Growth Comprehensive Planning and Zoning Grant Program.

1.1 Overview and Background

The Town of Salem has been awarded a grant from the New York State Department of State to develop a Smart Growth Comprehensive Plan for the community. The selected firm will be coordinating with the Lake Champlain Lake George Regional Planning Board (LCLGRPB) to complete the tasks as outlined in the NYSDOS Work Plan.

The Village of Salem officially dissolved in March 2016, yet no comprehensive planning documents have since been created to guide the integration of the former Village and the broader Town of Salem. Over the past decade, the Town has experienced a population decline of approximately 4% (2010–2020), and about 70% of its land area lies within a designated Washington County Agricultural District.

The Town of Salem now seeks qualified consultants to assist in the development of a Comprehensive Plan that reflects current conditions, harnesses ongoing community investments, and outlines a forward-looking vision. This plan will serve as a strategic blueprint to guide land use, economic development, infrastructure, housing, and quality of life improvements in alignment with the values, needs, and aspirations of residents and stakeholders.

Section 2. Scope of Services.

The Town of Salem seeks to develop a Comprehensive Plan according to Town Law § 272-a and following the NYSDOS Smart Growth Comprehensive Plan work plan. The selected firm will work with LCLGRPB to complete this project.

The selected firm will be responsible for the tasks listed below, according to the NYSDOS Work Plan. LCLGRPB will be responsible for the remaining work plan tasks and will coordinate with the consultant as needed.

https://dos.ny.gov/generic-smart-growth-comprehensive-plan-workplan

NYSDOS Work Plan Task #

Task Description

1. Project Initiation Meeting

5. Comprehensive Planning Committee Meetings

6. Community Participation Plan

7. Community Survey and Stakeholder Interviews

8. Review of Local and Regional Planning Efforts

9. Community Profile (Mapping only)

10. Community Visioning Workshops

11. Draft Comprehensive Plan

12. Review by Municipal Board

13. SEQRA

14. County Planning Board Review

15. Final Plan

16. Public Hearings

2.1 Budget.

The budget for this project is no more than $61,500.

2.3 MWBE Goals

NYSDOS has set a goal for NYS-Certified Minority and Women-owned Business Enterprise (MWBE) participation at 30% of the grant award amount. The Town will prioritize responses to this RFP that contain meaningful participation by certified MWBE firms.

The following MWBE goals have been established for this contract by NYSDOS:

MBE Participation Goal: $10,800 (15%)

WBE Participation Goal: $10,800 (15%)

2.4 When responding to this request, please send appropriate information, such as resumes, a description of your company, and experience. Proposals must include the following information:

a. A description of services to be provided.

b. Description of firm/staff qualifications, including resumes and experience, and affirmation of staff capacity to complete the project within the identified timeline. Include the education of each person who will work on the project and information concerning membership in professional organizations relevant to this project. At least one primary staff contact should be identified as a project manager for the assigned work. The proposed project manager should be experienced with comprehensive planning and public engagement.

c. List of three references and description of related work completed.

d. The dollar cost bid should contain all pricing information relating to performing all work as described in this request for proposals. The total all-inclusive maximum price to be bid is to contain all direct and indirect costs, including all out-of-pocket expenses, OR an itemized cost proposal including hourly and/or task-specific rates feasible and relevant to the potential tasks listed above. Itemized cost proposals must include the title and hourly rate for any proposed staff, as well as any anticipated indirect and/or out-of-pocket expenses.

e. Applicants are encouraged to emphasize their relevant area of expertise within their respective proposals.

f. The Review Team will be looking for relevant, unique, or diverse skills as part of the selection process.

g. Demonstration of meaningful NYS-Certified M/WBE participation will also yield a competitive advantage for applicants during the selection process.

• Please provide a description of how you will be utilizing any M/WBE firms, along with the intended firm’s NYS Tax ID #.

h. Cost and past performance will be considered, along with any other qualifications as determined by the Town.

3. Submission Instructions

3.1 Questions. Please submit all questions by email to Allison Gaddy at Allison.gaddy@lclgrpb.org by June 18, 2025, at Noon. All questions and answers will be posted to the Town of Salem and Lake Champlain Lake George Regional Planning Board’s website within five days.

3.1 Proposal Submissions. All responses to this RFP must be received no later than 4:00 PM on June 27, 2025. Proposals may be submitted either electronically or in hard copy, as outlined below:

Electronic Submissions:

Email proposals to: info@lclgrpb.org Subject line: “Village of Salem RFP – Attn: Allison Gaddy”

Hard Copy Submissions:

Mailed or hand-delivered proposals must be received by the deadline and addressed to:

Sue Clary, Supervisor Town of Salem PO Box 575 214 Main Street Salem, NY 12865

Hard copy submissions must include:

• Two (2) printed copies of the full proposal

• One (1) electronic copy saved to a USB flash drive

Late submissions will not be considered.

The Town of Salem Town Board is expected to award the contract to the selected firm at its July 9, 2025, meeting.

mailto:Allison.gaddy@lclgrpb.org mailto:info@lclgrpb.org

4.2 Safeguarding of Confidential Information - Any trade secrets or other data that the proposer does not wish to disclose to other than Town representatives involved in RFP evaluation or contract administration will be kept confidential if identified as follows: Each page shall be identified in boldface at the top and bottom as “Confidential”; and any section of the proposal, which is to remain confidential, should, in addition, be so marked in boldface on the title page of that section.

Net cost information may not be deemed confidential.

4.3 License to Practice in New York State – As necessary, an affirmative statement should be included that the firm and all assigned key professional staff are properly licensed to practice in New York State.

4.4 Certification of DBE/MBE/WBE/SDVOB Status – An affirmative statement should be included from all firms claiming to meet DBE/MBE/WBE/SDVOB status that the entity is properly registered as such in New York State and provide copies of certificates as part of the bid package (certifications issued by New York City do not count towards MWBE goals).

Section 5. RFP General Terms and Conditions:

A. The Consultant selected shall be required to furnish an engagement letter and/or execute an agreement. The terms of such engagement letter or agreement is subject to discussion and agreement but is anticipated to include the following:

1. Inclusion of a scope of services similar to that set forth in this Request for Proposals unless modified upon agreement by the Town.

2. A provision shall be included, which allows the Town of Salem to terminate services at any time upon thirty (30) days written notice or in the instance of non-performance as determined by the Town, immediately.

3. To the extent allowed under law or not prohibited by the contract, a credit of the fee payable shall be provided in the event that services are terminated and/or deleted.

4. Insurance coverage satisfactory to the Town. In order to be considered for selection to provide the services requested by this RFP, the Contractor submitting the proposal must agree to not limit professional, general or other liability to an amount less than the limits of the required insurance coverage.

5. A provision that requires all services performed under a contract awarded to the successful Contractor shall conform to prevailing professional or provider standards and to the requirements of the contract. Upon written notice of any defect from the Town, the Contractor will be expected to correct or re-perform any defective or nonconforming services at no cost to the Town. If the Contractor fails or refuses to correct or re-perform, the Town shall be entitled to any remedy that may be provided for under the contract, and in any event, that may be authorized by law.

6. A provision requiring the Contractor to defend, indemnify and hold harmless the Town with regard to any negligent acts or omissions or malfeasance with regard to the services performed or to be performed.

The successful Contractor shall indemnify and hold harmless the Town, their officers, directors, agents and employees from, and against any and all claims, notices of claim, demands or causes of action for injury or death to any person, including Contractor’s employees or damage to property (including all costs and reasonable attorney’s fees incurred in defending any claim, demand or cause of action), arising, directly or indirectly, out of or resulting from, the performance of the Contractor’s work or any negligent or wrongful acts, errors, omissions, negligence, incompetence, malfeasance and misfeasance by the Contractor, its employees, agents, materialmen, suppliers and/or subcontractors in the performance of its obligations under the agreement. The Town and the Contractor shall notify each other in writing within thirty (30) days of any such claims or demands and shall cooperate in the defense of any such actions. If this indemnity, or any part thereof, is made void or otherwise impaired by any law controlling construction thereof, such indemnity shall be deemed to conform to the indemnity permitted by law, so as to require indemnification in whole or in part to the fullest extent permitted by law.

7. A provision requiring the Contractor to assume sole responsibility for completing services as requested and the Contractor may not assign the work to be performed without the consent of the Town of Salem, which consent shall rest in the sole discretion of the Town.

8. A provision providing that the Contractor shall not be deemed an agent of the Town for any purpose whatsoever.

9. Inclusion of such other terms and conditions that may be required pursuant to Federal or State Law, Regulation and/or by the Town Attorney.

B. Please note that retention of services by reason of this RFP is not certain. The right to reject any and all proposals, solicit new or additional proposals or perform some or all of the services in-house or by using services available from professionals currently under contract are retained at all times, even after proposals have been reviewed and considered.

C. Additional information, interviews and/or presentations may be required at the option of the Town of Salem. In no event shall the Town, its Boards, Officers and employees be liable for any costs incurred for the preparation of and participation in the submission of responses to this request or subsequent interviews of persons or companies.

D. It is the Contractor’s sole responsibility to be familiar with and understand all terms and conditions regarding the RFP before the opening. Any questions should be submitted in writing to the contact person listed above and, if relevant, should cite the section and page number of the RFP document relating to the question raised by the Contractor. Answers to all questions of a substantive nature will be given to all Contractors as a formal addendum which will be annexed to and become part of the

RFP. Please be advised that the Town shall not be bound by any verbal response by any Town employee which is not confirmed in writing.

E. The Town of Salem reserves the right to waive or modify minor irregularities in proposals received, utilize any and all ideas submitted in the proposals unless those ideas are covered by legal patent or proprietary rights and generally adapt any or all of the proposal in developing contract language. With regard to legal patent or proprietary rights, it shall be incumbent upon the party furnishing the proposal to notify the Town of such.

F. Nothing contained herein shall be deemed an offer by the Town or be interpreted as making a representation or giving any assurances that a contract may be entered into or that The Town is in some fashion obligated. Should the Town be unsuccessful in negotiating a contract with the Contractor within the time frame acceptable to the Town, the Town may begin contract negotiations with another Contractor responding to the RFP, reject all RFPs, re-advertise, or take such other action as may be deemed appropriate.

G. Proposals will not be returned once submitted, and the Town may dispose of the same in any manner allowed under law.

H. Submission of the proposal to the Town of Salem shall be deemed consent for the proposals to be publicly identified, and information contained therein shall be deemed a matter of public record unless such information is designated by the party submitting the proposal as trade secrets, as affecting present or imminent contract awards, or other information allowed to be kept confidential pursuant to the Section 87 of the Public Officer’s Law of the State of New York. In order to designate information as confidential, the Contractor submitting the proposal must highlight the information and inform the Town of its desire to keep that information confidential in a letter transmitting the proposal. Whether the information designated by the Contractor is allowed to be kept confidential pursuant to New York State Laws shall be determined by the Town Attorney and notice of such determination shall be made to the Provider prior to the release of the information to afford the service provider an opportunity to appeal the decision.

I. The Town of Salem reserves the right to make any investigation deemed necessary to determine Contractor qualifications and responsibility. The Contractor shall furnish to the Town, upon request, all data pertinent thereto.

J. Submission of a proposal constitutes agreement to all terms and conditions set forth herein. By submitting a signed proposal, the Contractor a) warrants that the contents of its proposals are accurate and binding upon the Contractor; b) represents that its staff is knowledgeable about the services to be provided as identified in this RFP;

and c) warrants that it will use reasonable and appropriate efforts to provide such services in a professional and timely manner. In addition, the Contractor further warrants that it has become sufficiently acquainted with the conditions, facts, and circumstances relating to providing the requested services. Failure or omission of the Contractor to adequately acquaint itself with existing conditions, facts and circumstances shall not in any way relieve it of any obligations with respect to this

RFP.

K. 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 an individual’s age, race, creed, color, national origin, gender identity or expression, sexual orientation, military status, sex, disability, predisposing genetic characteristics, marital status or domestic violence victim 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 subcontractors 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. Contractor is subject to fines of $50 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 hereunder for a second or subsequent violation.

L. The Town of Salem reserves the right to allow all municipal and not-for-profit organizations authorized under the General Municipal Laws of the State of New York, to purchase any goods and/or services awarded as a result of this bid in accordance with the latest amendments to NYS GML 100 through 104. However, it is understood that the extension of such contracts are at the discretion of the vendor and the vendor is only bound to any contract between the Town and the vendor.

CONSULTANT’S ACKNOWLEDGMENT

(If a Corporation)

STATE OF NEW YORK )

COUNTY OF )

On this day of , 20 , before me personally came of , the Corporation described in and which executed the within instrument, who being duly sworn by me did depose and say that the said resides at and that he is the of said Corporation and knows the Corporate seal of the said corporation; that the seal affixed to the within instrument is such corporate seal and that it was so affixed by order of the Board of Directors of said Corporation, and that he signed his name by like order.

Notary Public

(If an Individual) to me known, and known to me to be the same person described in and who executed within instrument and he duly acknowledged to me that he executed the same.

(If a Co-Partnership) to me known, and known to me to be a member of the firm of and the person described in, and who executed the within instrument on behalf of said form, and he acknowledged to me that he executed the same.

INSURANCE AND INDEMNIFICATION

1. The Consultant shall purchase and/or maintain insurance policies approved by the Town of Salem, naming the Town as an additional insured on a primary, non-contributory basis (except for Workers’ Compensation & Disability Coverage) from a New York State Licensed Insurer with an A.M. Best Rating of A- or better. The Consultant shall furnish such evidence of the policies (certificates and/or copies of the policy) as may be requested by the Town. The Consultant shall also be required to indemnify the Town of Salem for any applicable deductibles. The policies shall contain a thirty (30) day notice of cancellation clause, shall provide “primary” coverage for the Town, its board, officers and/or employees and be of the following types and in the limits indicated:

A. Professional liability insurance in an amount not less than $1,000,000.00 per claim and

$1,000,000.00 annual aggregate.

B. Comprehensive general liability insurance, containing a contractual liability endorsement in favor of the Town for the liability imposed by paragraph 3 hereof, in an amount of not less than $1,000,000.00 per occurrence single limit for bodily injury death, and property.

C. Automobile Liability Insurance coverage with limits of $1,000,000 combined single limit for owned, hired and/or non-owned motor vehicles.

D. Workers’ Compensation - statutory limits and as set forth below:

i. CE-200 – Certificate of Attestation of Exemption from NYS Workers’ Compensation and/or Disability Benefits Coverage (Effective 12/1/08, this form can be filled out electronically on the Workers’ Compensation Board website (www.web.state.ny.us) under the heading of “Forms”. Those businesses filing electronically can print a finished CE-200 immediately upon completion. Those businesses without access to a computer may obtain a paper application for CE- 200 by writing or visiting any District Office of the Workers’ Compensation Board, and may wait up to four (4) weeks before receiving the form. Once the applicant receives the CE-200, the applicant will submit same to the Town); OR

ii. C-105.2 – Certificate of Workers’ Compensation Insurance (the business’ insurance carrier will send this form to the Town upon request); OR

iii. U-26.3 - Certificate of Workers’ Compensation Insurance (this form is used in lieu of C-105.2, when the insurance is obtained through the New York State Insurance Fund); OR

iv. SI-12 - Certificate of Workers’ Compensation Self-Insurance (the business calls the Board’s Self-Insurance Office at 518-402-0247 to obtain this form); OR

v. GSI-105.2 – Certificate of Participation in Workers’ Compensation Group Self- Insurance (the business’ Group Self-Insurance Administrator will send this form http://www.web.state.ny.us/ to the Town upon request).

NOTE: ACORD forms are not acceptable proof of workers’ compensation coverage.

E. Disability Insurance - statutory limits and as follows:

i. CE-200 – Certificate of Attestation of Exemption from NYS Workers’

Compensation and/or Disability Benefits Coverage (Effective 12/1/08, this form can be filled out electronically on the Workers’ Compensation Board website (www.web.state.ny.us) under the heading of “Forms”. Those businesses filing electronically can print a finished CE-200 immediately upon completion. Those businesses without access to a computer may obtain a paper application for CE- 200 by writing or visiting any District Office of the Workers’ Compensation Board, and may wait up to four (4) weeks before receiving the form. Once the applicant receives the CE-200, the applicant will submit same to the Town); OR

ii. DB-120.1 - Certificate of Disability Benefits Insurance (the business’ insurance carrier will send to the Town upon request); OR

iii. DB-155 - Certificate of Disability Benefits Self-Insurance (the business calls the Board’s Self-Insurance Office at 518-402-0247 to obtain).

2. The Consultant shall provide written proof of such insurance to the Town at the time of the execution of this Agreement, and whenever such insurance coverages are renewed during the term of this agreement. All policies of insurance shall provide that the same may not be canceled except upon fourteen (14) days prior written notice to the Town.

3. The Consultant shall indemnify and hold harmless the Town, its officers, directors, agents and employees from, and against any and all claims, notices of claim, demands or causes of action for injury or death to any person, including Consultant’s employees or damage to property (including all costs and reasonable attorney’s fees incurred in defending any claim, demand or cause of action), arising directly or indirectly, out of or resulting from, the performance of Consultant’s work or any negligent or wrongful acts, errors, omissions, negligence, incompetence, malfeasance and misfeasance by the Consultant, its employees, agents, material men, suppliers and/or subcontractors in the performance of its obligations under this agreement. The Town and the Consultant shall notify each other in writing within thirty (30) days of any such claims or demands and shall cooperate in the defense of any such actions. If this indemnity, or any part thereof, is made void or otherwise impaired by any law controlling construction thereof, such indemnity shall be deemed to conform to the indemnity permitted by law, so as to require indemnification in whole or in part to the fullest extent permitted by law.

4. The Consultant shall promptly advise the Town of all damages to property of the Town or of others, or of injuries incurred by persons other than employees of the Consultant, in any manner relating, either directly or indirectly, to the performance of this Agreement.

http://www.web.state.ny.us/

PROPOSAL

PROPOSAL OF:

COMPANY NAME

TO:

The undersigned, having carefully examined the specifications and having to their satisfaction ascertained all the facts concerning these specifications, herewith submits a proposal including all information requested in the specifications attached hereto.

Date: Federal ID#:

Contractor Signature:

Contractor Name (Printed):

Name of Firm:

Business Address:

Phone No.: Fax No.:

E-mail of contact person:

REFERENCE SHEET

All bidders will be required to complete this form providing three references of past performance.

References should involve project and/or service situations of similar size and scope to this bid.

References must have had dealings with the Bidder within the last thirty-six months. The Town of Salem reserves the right to contact any or all of the references supplied for an evaluation of past performance in order to establish the responsibility of the Bidder before the actual award of the bid and/or contract.

Completion of the reference form is required.

Indicate filing date on the line provided.

BIDDERS NAME:

REFERENCES NAME:

ADDRESS:

TELEPHONE:

CONTACT PERSON:

ADDRESS:

ADDRESS:

PROPOSAL

CORPORATE RESOLUTION

RESOLVED that

(Name) be authorized to sign and submit the Bid, or Proposal, of this Corporation for the following project:

(Title of Project) and to include in such Bid Proposal the Certificate as to non-collusion required by Section 103-d of the General Municipal Law as the act and deed of such corporation, and for any inaccuracies of misstatements in such certifies this Corporate Bidder shall be liable under the penalties of perjury.

The foregoing is a true and correct copy of the Resolution adopted by

Corporation at a meeting of its Board of Directors held on the Day of , 20 , and is still in force and effective on this Day of

, 20 .

SECRETARY

(Signature)

(SEAL OF CORPORATION)

CERTIFICATION OF COMPLIANCE WITH THE IRAN DIVESTMENT ACT

As a result of the Iran Divestment Act of 2012 (the “Act”), Chapter 1 of the 2012 Laws of New York, a new provision has been added to State Finance Law (SFL) § 165-a and New York General Municipal Law § 103-g, both effective April 12, 2012. Under the Act, the Commissioner of the Office of General Services (OGS) will be developing a list of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law) (the “Prohibited Entities List"). Pursuant to SFL § 165-a(3)(b), the initial list is expected to be issued no later than 120 days after the Act’s effective date at which time it will be posted on the OGS website.

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

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

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

The Town reserves the right to reject any bid or request for assignment for a Bidder/Contractor that appears on the Prohibited Entities List prior to the award of a contract and to pursue a responsibility review with respect to any Bidder/Contractor that is awarded a contract and subsequently appears on the Prohibited Entities List.

I, _, being duly sworn, deposes and says that he/she is the of the

_ Corporation and that neither the Bidder/Contractor nor any proposed subcontractor is identified on the Prohibited Entities List.

SIGNED

SWORN to before me this day of _______

Notary Public:

CERTIFICATION

Non-Collusive Certification required of all bidders under Section 103-d of the General Municipal Law as amended by Chapter 675 of the Laws of 1966, and further amended by Chapter 56 of the Laws of 2010, effective June 22, 2010.

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 knowledge and belief:

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;

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

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-1) Notwithstanding the foregoing, the statement of non-collusion may be submitted electronically in accordance with the provisions of subdivision one of section one hundred three of the General Municipal Law.

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 therefor. Where

(a) (1) (2) and (3) above have not been complied with, the bid shall not be considered for award nor shall any award be made unless the District Manager of the political subdivision, public department, agency or official thereof to which the bid is made, or his designee, determines that such disclosure was not made for the purpose of restricting competition.

The person signing this bid or proposal certifies that he has fully informed himself regarding the accuracy of the statements contained in this certification, and under the penalties of perjury, affirms the truth thereof, such penalties being applicable to the bidder as well as to the person signing on its behalf;

That attached hereto (if a corporate bidder) is a certified copy of resolution authorizing the execution of this certificate by the signatory of this bid, or proposal, on behalf of the corporate bidder.

Individual Bidder

Co-Partnership

By Partner

Corporation

By

President

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

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: