RFP - Willsboro Bay Park Shoreline Access & Land Use Mngt Plan.pdf

TOWN OF WILLSBORO | ESSEX COUNTY, NEW YORK

Willsboro Bay Park Shoreline Access & Land Use Management Plan RFP

TOWN OF WILLSBORO

Essex County, New York

REQUEST FOR PROPOSALS

Willsboro Bay Park

Shoreline Access & Land Use Management Plan

Professional Planning and Conservation Consultant Services

RFP Information Details Issue Date 10/27/2026 Deadline for Written Questions 11/12/2026

Proposal Due Date Wednesday, November 18th, 2026 at 2:00pm Eastern Time

Submit To

Town of Willsboro Attn: Susan Thompson, Town Clerk Via email to: townclerk@townofwillsborony.gov Or online at: https://www.townofwillsboro.com/submit-documents

Town Contact Hannah Neilly, Director of Community and Economic Development hneilly@townofwillsborony.gov

This project has been funded wholly or in part by the United States Environmental Protection Agency under assistance agreement BIL 4N0A001022-4 to NEIWPCC in partnership with the Lake Champlain Basin Program.

mailto:townclerk@townofwillsborony.gov https://www.townofwillsboro.com/submit-documents mailto:hneilly@townofwillsborony.gov

RFP Contents

1. Notice and Procurement Overview

2. Property Background and Project Context

3. Project Objectives and Required Outcomes

4. Scope of Services and Deliverables

5. Consultant Qualifications and References

6. Proposal Response Format

7. Evaluation and Selection

8. Fee Proposal and Contract Requirements

9. Procurement Schedule

10. Questions and Proposal Submission

11. Town Reservations and Conditions

Appendices and Required Forms

1. Notice and Procurement Overview The Town of Willsboro, Essex County, New York (the “Town”), invites proposals from qualified planning, landscape architecture, natural resource, conservation, and related professional consulting firms to prepare a Shoreline Access and Land Use Management Plan for the Town’s newly acquired Lilly Farm property, to be known as Willsboro Bay Park (the “Property”).

The Town seeks a practical, site-specific plan that protects water quality and native habitat while identifying appropriate opportunities for sustainable public access, recreation, education, and long-term municipal stewardship. The plan will be reviewed by the Town and project stakeholders and, following revisions, presented to the Willsboro Town Board for consideration and formal adoption.

The Town intends to select a consultant based on the overall quality, qualifications, relevant experience, proposed approach, public/stakeholder engagement strategy, schedule, and fee. The Town may negotiate scope and fee with the selected proposer, subject to applicable law, grant requirements, Town procurement policies, and Town Board authorization.

The Town encourages participation by New York State-certified Minority- and Women-Owned Business Enterprises (MWBEs), Service-Disabled Veteran-Owned Businesses (SDVOBs), disadvantaged business enterprises, and other qualified firms.

All costs associated with preparing a proposal, interviews, or presentations shall be borne by the proposer unless otherwise agreed to in writing by the Town.

2. Property Background and Project Context The Town has purchased Lilly Farm, an approximately 68-acre Lake Champlain waterfront property. The Property is a scenic wildlife sanctuary for grassland birds and is currently managed as a hay field with seasonal cuttings. Municipal acquisition presents an opportunity to protect a significant portion of the Lake Champlain shoreline from subdivision and private development and preserve the Property as municipal parkland in perpetuity.

The Town is seeking a plan that balances protection of water quality, grassland and migratory bird habitat, and other natural resources with appropriate public access and low-impact recreational opportunities. Potential public-use features may include walking trails, birding stations, shoreline/waterfront access, interpretive or educational features, and other amenities that are determined through site assessment and planning.

3. Project Objectives and Required Outcomes

• Prepare a practical, implementable Shoreline Access & Land Use Management Plan for Willsboro Bay Park that can be adopted by the Town Board.

• Protect Lake Champlain water quality, shoreline resources, native species, grassland habitat, and other sensitive ecological areas.

• Identify where public access and recreational activities are appropriate, where they should be limited, and where habitat protection requires no public intrusion.

• Establish short- and long-term stewardship, conservation, maintenance, and monitoring priorities.

• Provide a mapped framework for future uses, access points, trails, birding areas, habitat management areas, buffers, and potential restoration areas.

• Recommend best management practices for hay production and any other appropriate agricultural or land-management activities.

• Identify phased, realistic actions and planning-level cost estimates, where appropriate, to help the Town implement recommendations as funding becomes available.

4. Scope of Services and Deliverables The Town anticipates the following tasks. Proposers shall describe their approach, assumptions, level of effort, and deliverables for each task. Proposers may recommend refinements that improve the plan’s quality or cost-effectiveness, but shall identify any proposed exclusions or deviations.

Task 1 — Project Initiation, Coordination, and Work Plan

• Conduct a kickoff meeting with Town staff and the project team to confirm objectives, roles, available information, decision points, and communication procedures.

• Prepare a project work plan and schedule identifying tasks, milestones, meetings, public/stakeholder engagement, draft deliverables, and Town review periods.

• Review available property, title/deed, survey, aerial, natural-resource, wetland, shoreline, floodplain, land-use, water-quality, recreation, and prior planning information provided by the Town or available from public sources.

• Identify additional data, field work, or technical expertise needed to prepare a reliable plan, and clearly distinguish included work from optional or additional services.

Task 2 — Site Assessment, Inventory, and Resource Mapping

• Conduct site visits sufficient to understand site conditions, access, topography, existing uses, shoreline conditions, vegetation, habitat, drainage, and potential public-use opportunities and constraints.

• Compile and map relevant existing conditions, including property boundaries based on available mapping, hayfields/grassland, shoreline, access points, sensitive habitat, wetlands or other constraints where information is available, and potential use areas.

• Identify native bird species and other wildlife/habitat areas warranting special protection, using available data and consultation with appropriate technical experts. Clearly identify the limits of any field surveys included in the fee.

• Assess potential impacts and conflicts between public use, seasonal hay management, bird breeding seasons, wildlife habitat, shoreline protection, and water quality.

• Identify additional surveys or specialist studies that may be beneficial but are outside the base scope, with a separate estimated fee or allowance where practicable.

Task 3 — Conservation and Land Management Recommendations

• Develop short- and long-term stewardship strategies for grassland and migratory bird habitat, shoreline protection, native vegetation, invasive species considerations, and general site maintenance.

• Recommend best management practices for hay production and any other appropriate agricultural activities, including timing of cutting, pesticide and nutrient practices, buffers, and measures to protect water quality and native species habitat.

• Identify habitat restoration priorities where appropriate, including areas that may be suitable for restoration if additional funding becomes available.

Task 4 — Shoreline Access and Public Use Plan

• Develop a conceptual, mapped layout identifying appropriate public access and potential low-impact features such as walking trails, shoreline/waterfront access, interpretive features, and environmental education opportunities.

• Identify sensitive areas where recreational activities should be restricted, seasonally managed, routed away, or excluded to protect habitat and water quality.

• Consider accessible and safe visitor circulation, parking/access needs, wayfinding, visitor management, erosion prevention, and maintenance implications at a planning level.

• Evaluate potential uses against known shoreline, wetland, floodplain, permitting, and other site constraints based on information available. Identify approvals or additional technical studies likely to be needed before implementation; do not assume that any specific permit or construction approval is secured.

• Recommend a phased approach that distinguishes near-term actions from longer-term improvements dependent on additional design, permitting, or funding.

Task 5 — Stakeholder Engagement and Preliminary Findings

• Meet with the Town project team at key milestones and consult appropriate technical experts, land managers, and regional stakeholders.

• Propose a proportionate public/stakeholder input process appropriate to the project, including the format and number of meetings or engagement activities included in the base fee.

• Present preliminary findings and conceptual mapped alternatives or options to the Town/project team for review.

• Document substantive comments received and explain how comments were addressed or why a recommendation was retained.

Task 6 — Draft Plan, Revisions, and Final Adoptable Plan

• Prepare a draft Shoreline Access & Land Use Management Plan with a clear narrative, mapped recommendations, management actions, implementation priorities, and stewardship framework.

• Include a parcel map identifying proposed uses and activities and delineating preservation areas, habitat-protection areas, hay-management areas, public-use areas, and potential access features as supported by the site assessment.

• Ensure recommendations are consistent with the grant/workplan requirements provided by the Town, and any applicable deed restrictions or requirements made available to the consultant.

• Present the draft plan to the Town and project team, incorporate one consolidated round of Town/project-team comments and any additional revisions expressly included in the proposal, and prepare a final plan suitable for Town Board review and adoption.

• Present the final plan to the Town Board if requested by the Town. The Town Board retains sole authority to determine whether to adopt the plan.

Minimum Deliverables

Deliverable Minimum Content / Format

Project work plan and schedule Tasks, milestones, meetings, responsibilities, review periods, and anticipated completion dates.

Existing conditions and resource inventory

Concise narrative and maps summarizing relevant site conditions, habitat, constraints, access, and available data.

Preliminary findings / concept Presentation and concept map(s) showing potential use and conservation approaches for Town/project-team review.

Draft management plan Draft narrative, mapped plan, management recommendations, phased implementation actions, and stewardship framework.

Final management plan Revised, Town Board-ready plan incorporating Town/project-team comments; accessible PDF and editable source files.

Implementation matrix Recommended action, priority/timeframe, likely lead or partner, dependencies/approvals, and planning-level cost estimate where feasible.

All maps and deliverables shall be provided in PDF and in commonly usable editable/native formats where available (for example, Word and GIS/CAD-compatible files used by the consultant). The consultant shall identify any data, software, or license limitations affecting the Town’s ability to use or update deliverables.

5. Consultant Qualifications and References Proposers shall demonstrate the expertise and capacity needed to complete the scope. The Town is interested in multidisciplinary teams and may consider subconsultants where their roles and costs are clearly identified.

• Describe the firm, its relevant services, years in business, office locations, and organizational structure.

• Identify the proposed project manager and key staff, including relevant qualifications, experience, and anticipated roles. Include resumes or brief biographies.

• Describe experience with conservation management plans, waterfront/shoreline access planning, grassland or migratory bird habitat, natural-resource inventories, municipal parks, public access, water-quality protection, and implementation planning.

• Provide at least three examples of comparable projects, including client, project description, services delivered, approximate project value or fee if available, completion date, and reference contact information.

• Identify subconsultants and technical specialists, their responsibilities, and whether their services are included in the proposed fee.

• Disclose any actual or potential conflict of interest that could affect services to the Town.

6. Proposal Response Format Proposals should be clear, concise, and organized in the following order. The Town may request clarification or deem a materially incomplete proposal nonresponsive.

Separate Cost Proposal Requirement: The cost proposal must be submitted as a separate electronic file, clearly identified as “COST PROPOSAL – [Firm Name].” All pricing and fee information shall be excluded from the Technical Proposal and included only in the separate Cost Proposal upload.

Section Required Content

1. Cover letter Authorized signature, firm name and contact, proposal validity period, acknowledgment of all addenda, and confirmation that the proposal is binding for the stated period.

2. Executive summary Understanding of Willsboro Bay Park, proposed approach, key strengths, and major assumptions or exclusions.

3. Qualifications and team Firm background, key staff, relevant expertise, resumes, subconsultants, and availability.

4. Relevant project experience At least three comparable projects and references.

5. Technical approach and work plan

Task-by-task methodology, field assessment approach, conservation and public-use planning approach, stakeholder engagement, quality control, and deliverables.

6. Schedule Proposed schedule with milestones, Town review periods, meetings, draft and final plan dates, and key dependencies.

7. Cost proposal

Completed Appendix A – Fee Proposal Form and supporting cost information, including task-based fees, hourly rates, reimbursable expenses, optional services, assumptions, exclusions, and total proposed fee. Submit as a separate electronic PDF file, not as part of the Technical Proposal.

8. Required forms and disclosures

Addenda acknowledgment, conflict-of-interest disclosure, and any certifications identified in this RFP or required by applicable law/funding conditions.

7. Evaluation and Selection The Town anticipates evaluating proposals using the criteria below. The Town may use a review committee, conduct interviews or presentations, contact references, and request clarifications. Final selection is subject to Town Board authorization and successful negotiation of a written agreement.

Evaluation Category Maximum Points Evaluation Focus

Qualifications and relevant experience 25 Firm/team expertise and comparable conservation, habitat, shoreline, and municipal planning projects.

Understanding and technical approach 30 Understanding of project goals; quality and practicality of methods; integration of conservation, water quality, hay management, and public access.

Work plan, engagement, and deliverables 15 Appropriate site assessment, stakeholder/public input, useful maps, implementation matrix, and quality of deliverables.

Project schedule and capacity 10 Realistic schedule, availability of key staff, coordination, and ability to meet milestones.

Fee and value 20 Completeness and reasonableness of proposed fee, clarity of assumptions, cost control, and value relative to proposed services.

TOTAL 100

The Town may invite one or more highly ranked proposers to an interview or presentation. Any interview format and topics will be communicated to invited firms. The Town may verify references and may consider that information in the final evaluation. The Town is not required to select the lowest-cost proposal.

The Town may negotiate the scope and fee with the highest-ranked proposer. If the Town cannot reach an agreement, it may end negotiations and begin negotiations with another proposer, consistent with applicable law and Town procurement policies.

8. Fee Proposal and Contract Requirements

8.1 Fee Proposal

Provide a clear fee proposal organized by task and deliverable. Identify the proposed total fee and any not-to-exceed amount. Separate professional labor, subconsultant costs, reimbursable expenses, and additional services. Identify staff classifications and hourly rates for any work authorized on a time-and-materials basis.

8.2 Agreement and General Requirements

• The selected consultant shall enter into a written agreement acceptable to the Town and approved by the Town Board.

• The agreement shall define scope, deliverables, schedule, compensation, invoicing, Town review and acceptance, change authorization, and termination provisions.

• The consultant shall maintain project records and provide copies to the Town upon request. Records shall be retained for the period required by applicable law, contract, or funding conditions.

• The consultant shall acknowledge the project’s funding from the Lake Champlain Basin Program (LCBP) and NEIWPCC in applicable project materials and final deliverables, as directed by the Town. The required funding acknowledgement statement and LCBP/NEIWPCC logos shall be included in the final management plan and any other materials identified by the Town. The consultant shall comply with applicable grant acknowledgement and visibility requirements provided by the Town.

• The consultant shall comply with applicable federal, state, and local laws.

• The consultant shall disclose conflicts of interest and maintain appropriate insurance. Proposed coverage and limits shall be provided by the selected consultant and reviewed by the Town before contract execution.

• The Town shall retain the right to use, reproduce, and maintain the final deliverables for municipal purposes, subject to clearly disclosed third-party software, data, and licensing restrictions.

• Payment shall be based on invoices and the milestones or terms established in the final agreement. Work outside the authorized scope requires prior written approval.

9. Procurement Schedule Milestone Date RFP issued 10/27/2026 Deadline for written questions 11/12/2026 Addendum / responses to questions issued 11/13/2026 Proposal submission deadline 11/18/2026 Proposal review and reference checks 11/19-11/20/2026 Interviews, if required 11/23-11/25/2026 Town Board selection / authorization 12/09/2026 Anticipated contract execution and kickoff 12/21/2026 Target draft and final plan completion TBD

10. Questions and Proposal Submission

10.1 Questions

All questions concerning this RFP shall be submitted in writing to the Town contact listed on the cover page by the deadline in the procurement schedule. No oral interpretation or modification shall be binding. Only written addenda issued by the Town may modify this RFP.

10.2 Submission Instructions

Item Requirement

Format

Technical Proposal: Include the required proposal sections and supporting documentation identified in Section 6, excluding all cost and fee information.

COST PROPOSAL – [Firm Name]: Include the completed Appendix A – Fee Proposal Form and any supporting cost information, including task-based costs, hourly rates, reimbursable expenses, optional services, assumptions, exclusions, and total proposed fee.

The Cost Proposal shall be submitted as a separate electronic file from the Technical Proposal and clearly labeled “COST PROPOSAL – [Firm Name].” All cost and fee information must be excluded from the Technical Proposal.

Proposals may be submitted by email or through the Town's designated online submission portal, as identified in this RFP. When submitting by email, attach the Technical Proposal and Cost Proposal as separate PDF files. When using the online portal, submit each file separately if the portal permits separate file submissions.

Submit to Susan Thompson, Town Clerk Via email to: townclerk@townofwillsborony.gov mailto:townclerk@townofwillsborony.gov

Or online at: https://www.townofwillsboro.com/submit-documents Subject / file name Willsboro Bay Park Shoreline Access & Land Use Management Plan– [Firm Name] Deadline Wednesday, November 18th, 2026, at 2:00pm Eastern Time

Late proposals Proposals received after the stated deadline will be rejected. Proposers are responsible for ensuring timely delivery.

Proposals shall be signed by a person authorized to bind the proposer. Any confidential or proprietary material shall be clearly identified, recognizing that disclosure is governed by applicable law.

11. Town Reservations and Conditions

• The Town reserves the right to reject any or all proposals, waive nonmaterial irregularities, request clarifications or supplemental information, conduct interviews, verify references, negotiate scope and fee, issue addenda, amend or cancel the RFP, or make no award if determined to be in the Town’s best interest, subject to applicable law.

• The Town is not obligated to award a contract or reimburse proposal preparation, travel, interview, or negotiation costs.

• Issuance of this RFP does not obligate the Town to proceed with any particular improvement, amenity, construction project, or funding commitment.

• Any award is subject to Town Board authorization, required funding approvals, successful negotiation, and execution of a written agreement.

• The Town’s procurement, review, and award process shall be conducted in accordance with applicable New York State law, Town policies, and any applicable grant conditions.

Appendices and Required Response Forms Appendix Document / Form Requirement

A Fee Proposal Form Complete by task; include total fee, hourly rates, reimbursables, optional services, assumptions, and exclusions.

B Reference Information Provide at least three current municipal references, preferably comparable New York Towns/Villages.

C Conflict-of-Interest Disclosure Disclose actual or potential conflicts, or state that none are known.

D Non-Collusion Affidavit Mandatory. Complete, sign, and notarize the Non-Collusion Affidavit provided by the Town.

E Iran Divestment Act Form Mandatory. Complete, sign the Iran Divestment Act Form provided by the Town.

F Vendor Responsibility Questionnaire

Mandatory. Complete, sign the Vendor Responsibility Questionnaire Form provided by the Town.

G NYS Sexual Harassment Prevention Certification Form

Mandatory – Complete, sign the NYS Sexual Harassment Prevention Certification Form.

https://www.townofwillsboro.com/submit-documents

Appendix A — Fee Proposal Form (Template) Proposers may reproduce this table or provide an equivalent task-based fee table with the same information.

Task / Service Task Fee Notes / Assumptions Task 1 — Project initiation and work plan $ Task 2 — Site assessment and resource mapping $

Task 3 — Conservation and land management recommendations $

Task 4 — Shoreline access and public use plan $ Task 5 — Stakeholder engagement and preliminary findings $

Task 6 — Draft plan, revisions, and final plan $ Subconsultants / reimbursables (itemize) $

TOTAL BASE PROPOSAL $

Optional services (itemize separately) $ Not included in base total unless expressly stated.

Hourly rates for additional services, if authorized:

Staff Classification Hourly Rate Staff Name / Notes Principal / Project Director $ Project Manager / Senior Planner $ Planner / Landscape Architect / Natural Resource Specialist $

GIS / Mapping Specialist $ Other (identify) $

Authorized representative: ____________________________________ Title: ______________________________

Firm: ____________________________________ Signature: ____________________________________

Date: ____________________________________

Appendix B — Reference Information

Appendix C — Conflict-of-Interest Disclosure

Appendix D — Non-Collusion Affidavit

NON-COLLUSION AFFIDAVIT

The undersigned bidder or agent, being duly sworn on oath, says that he/she has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding.

He/She further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee gift, commission or thing of value on account of such sale.

OATH AND AFFIRMATION

I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS

AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC

WORKS ARE TRUE AND CORRECT.

Dated this ___ day of ____________________, ________

(Name of Organization)

(Title of Person Signing)

(Signature)

ACKNOWLEDGEMENT

STATE OF _______________________)

) ss

COUNTY OF_____________________)

Before me, a Notary Public, personally appeared the above named and swore that the statements contained in the foregoing document are true and correct.

Subscribed and sworn to me this _______ day of _____________, _______.

Notary Public Signature

My Commission Expires: __________________________________________________

Appendix E — Iran Divestment Act Form

BIDDER’S CERTIFICATION OF COMPLIANCE WITH IRAN DIVESTMENT ACT

The law is known as the "Iran Divestment Act of 2012" (the "Act") and can be found at § 165-a of the NY State Finance Law. The Act became effective on April 12, 2012. The Act imposes limitations on "persons" that are determined to be engaged in investment activities in the Iranian energy sector, as defined in the Act.

[Please Check One]

BIDDER’S CERTIFICATION

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

I am unable to certify that my name and the name of the bidder/proposer does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify.

Dated: , New York

, 2026

SIGNATURE

PRINTED NAME

TITLE

Sworn to before me this day of , 2026

Notary Public

Appendix F — Vendor Responsibility Questionnaire

AC 3290-S (Rev. 03/2022) NYS Vendor ID: 000000000

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

You have selected the For-Profit Non-Construction questionnaire which may be printed and completed in this format or, for your convenience, may be completed online using the New York State VendRep System.

COMPLETION & CERTIFICATION

The person(s) completing the questionnaire must be knowledgeable about the vendor’s business and operations. An owner or owner’s official representative authorized to legally bind the Reporting Entity must certify the truth of the questionnaire answers.

NEW YORK STATE VENDOR IDENTIFICATION NUMBER (VENDOR ID)

The Vendor ID is a ten-digit identifier issued by New York State when the vendor is registered on the Statewide Vendor File. This number must now be included on the questionnaire. If the business entity has not obtained a Vendor ID, contact the IT Service Desk at ITServiceDesk@osc.state.ny.us or call 866-370-4672.

DEFINITIONS

All underlined terms are defined in the “New York State Vendor Responsibility Definitions List,” found at https://www.osc.state.ny.us/files/vendors/2017-11/vendor-questionnaire-definitions.pdf. These terms may not have their ordinary, common or traditional meanings. Each vendor must read the respective definitions for any and all underlined terms. By submitting this questionnaire, the vendor agrees to be bound by the terms as defined in the "New York State Vendor Responsibility Definitions List" existing at the time of certification.

RESPONSES

Every question must be answered fully. Each response must provide all relevant information to appropriately explain the answer. If you have concerns as to the legal requirements behind your answers, please seek clarification from your counsel. However, information regarding a determination or finding made in error which was subsequently corrected or overturned, and/or was withdrawn by the issuing government entity is not required to be identified. Individuals and Sole Proprietors may use a Social Security Number but are encouraged to obtain and use a federal Employer Identification Number (EIN).

REPORTING ENTITY

Each vendor must indicate if the questionnaire is filed on behalf of the entire Legal Business Entity or an Organizational Unit within or operating under the authority of the Legal Business Entity and having the same EIN. Generally, the Organizational Unit option may be appropriate for a vendor that meets the definition of “Reporting Entity” but due to the size and complexity of the Legal Business Entity, is best able to provide the required information for the Organizational Unit, while providing more limited information for other parts of the Legal Business Entity and Associated Entities.

ASSOCIATED ENTITY

An Associated Entity is one that owns or controls the Reporting Entity, or any entity owned or controlled by the Reporting Entity.

However, the term Associated Entity does not include “sibling organizations” (i.e., entities owned or controlled by a parent company that owns or controls the Reporting Entity), unless such sibling entity has a direct relationship with or impact on the Reporting Entity. Please refer to the Definitions List for the complete definition.

STRUCTURE OF THE QUESTIONNAIRE

The questionnaire is organized into eleven sections. Section I is to be completed for the Legal Business Entity. Section II requires the vendor to specify the Reporting Entity for the questionnaire. Section III refers to the individuals of the Reporting Entity, while Sections IV-VIII require information about the Reporting Entity. Section IX pertains to any Associated Entities, with one question about their Officials/Owners. Section X relates to disclosure under the Freedom of Information Law (FOIL). Section XI requires an authorized contact for the questionnaire information.

http://www.osc.state.ny.us/vendrep/ mailto:ITServiceDesk@osc.state.ny.us https://www.osc.state.ny.us/files/vendors/2017-11/vendor-questionnaire-definitions.pdf

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

I. LEGAL BUSINESS ENTITY INFORMATION

Legal Business Entity Name* EIN

Address of the Principal Place of Business (street, city, state, zip code) New York State Vendor Identification Number

Telephone Ext.

Fax

Email Website

Additional Legal Business Entity Identities: If applicable, list any other DBA, Trade Name, Former Name, Other Identity, or EIN used in the last five (5) years and the status (active or inactive).

Type Name EIN Status

1.0 Legal Business Entity Type – Check appropriate box and provide additional information:

Corporation (including PC) Date of Incorporation

Limited Liability Company (LLC or PLLC) Date of Organization

Partnership (including LLP, LP or General) Date of Registration or Establishment

Sole Proprietor How many years in business?

Other Date Established

If Other, explain:

1.1 Was the Legal Business Entity formed or incorporated in New York State? Yes No

If ‘No,’ indicate jurisdiction where Legal Business Entity was formed or incorporated and attach a Certificate of Good Standing from the applicable jurisdiction or provide an explanation if a Certificate of Good Standing is not available.

United States State

Other Country

Explain, if not available:

1.2 Is the Legal Business Entity publicly traded? Yes No

If “Yes,” provide CIK Code or Ticker Symbol

1.3 Does the Legal Business Entity have a DUNS Number? Yes No

If “Yes,” Enter DUNS Number

*All underlined terms are defined in the “New York State Vendor Responsibility Definitions List,” which can be found at

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

I. LEGAL BUSINESS ENTITY INFORMATION

1.4 If the Legal Business Entity’s Principal Place of Business is not in New York State, does the Legal Business Entity maintain an office in New York State?

(Select “N/A,” if Principal Place of Business is in New York State.)

Yes No N/A

If “Yes,” provide the address and telephone number for one office located in New York State.

1.5 Is the Legal Business Entity a New York State certified Minority-Owned Business Enterprise (MBE), Women-Owned Business Enterprise (WBE), Service-Disabled Veteran-Owned Business (SDVOB), New York State Small Business (SB) or a federally certified Disadvantaged Business Enterprise (DBE)?

If “Yes,” check all that apply:

New York State certified Minority-Owned Business Enterprise (MBE) New York State certified Women-Owned Business Enterprise (WBE) New York State certified Service-Disabled Veteran-Owned Business (SDVOB) New York State Small Business (SB) Federally certified Disadvantaged Business Enterprise (DBE)

Yes No

1.6 Identify Officials and Principal Owners of the Reporting Entity, if applicable. For each person, include name, title, date of birth, and percentage of ownership. For each Business Entity that is a Principal Owner, include name, address, EIN, and percentage ownership. Identify all Business Entities owning 25% or more of the Reporting Entity and include name, address, EIN and percentage of ownership. Attach additional pages if necessary. If applicable, reference to relevant SEC filing(s) containing the required information is optional. Each Business Entity identified as a Principal Owner must also submit a vendor responsibility questionnaire.

If there is no person or Business Entity that owns 25% or more of the Reporting Entity (or 10% or more if the Reporting Entity is publicly traded), check here.

Name of Officials and Principal Owners (for each person, please include a middle initial)

Title

Date of Birth Percentage Ownership (Enter 0% if not applicable)

Name of each Business Entity owning 25% or more of Reporting Entity

Address

EIN

Percentage Ownership

II. REPORTING ENTITY INFORMATION

2.0 The Reporting Entity for this questionnaire is:

Note: Select only one.

Legal Business Entity Note: If selecting this option, “Reporting Entity” refers to the entire Legal Business Entity for the remainder of the questionnaire. (SKIP THE REMAINDER OF SECTION II AND PROCEED WITH SECTION III.)

Organizational Unit within and operating under the authority of the Legal Business Entity

SEE DEFINITIONS OF “REPORTING ENTITY” AND “ORGANIZATIONAL UNIT” FOR ADDITIONAL

INFORMATION ON CRITERIA TO QUALIFY FOR THIS SELECTION.

Note: If selecting this option, “Reporting Entity” refers to the Organizational Unit within the Legal Business Entity for the remainder of the questionnaire. (COMPLETE THE REMAINDER OF SECTION II AND ALL REMAINING

SECTIONS OF THIS QUESTIONNAIRE.)

IDENTIFYING INFORMATION

a) Reporting Entity Name

Address of the Primary Place of Business (street, city, state, zip code) Telephone ext.

b) Describe the relationship of the Reporting Entity to the Legal Business Entity

c) Attach an organizational chart

d) Does the Reporting Entity have a DUNS Number? Yes No

If “Yes,” enter DUNS Number

e) Identify the designated manager(s) responsible for the business of the Reporting Entity.

For each person, include name and title. Attach additional pages if necessary.

Name Title

INSTRUCTIONS FOR SECTIONS III THROUGH VII

For each “Yes,” provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). For each “Other,” provide an explanation which provides the basis for not definitively responding “Yes” or “No.” Provide the explanation at the end of the section or attach additional sheets with numbered responses, including the Reporting Entity name at the top of any attached pages.

III. LEADERSHIP INTEGRITY

Within the past five (5) years, has any current or former reporting entity official or any individual currently or formerly having the authority to sign, execute or approve bids, proposals, contracts or supporting documentation on behalf of the reporting entity with any government entity been:

3.0 Sanctioned relative to any business or professional permit and/or license? Yes No Other

3.1 Suspended, debarred, or disqualified from any government contracting process? Yes No Other

3.2 The subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation for any business-related conduct?

Yes No Other

3.3 Charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime or subject to a judgment for:

a) Any business-related activity; or

b) Any crime, whether or not business-related, the underlying conduct of which was related to truthfulness?

Yes No Other

For each “Yes” or “Other” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

IV. INTEGRITY – CONTRACT BIDDING

Within the past five (5) years, has the reporting entity:

4.0 Been suspended or debarred from any government contracting process or been disqualified on any government procurement, permit, license, concession, franchise or lease, including, but not limited to, debarment for a violation of New York State Workers’ Compensation or Prevailing Wage laws or New York State Procurement Lobbying Law?

Yes No

4.1 Been subject to a denial or revocation of a government prequalification? Yes No

4.2 Been denied a contract award or had a bid rejected based upon a non-responsibility finding by a government entity?

Yes No

4.3 Had a bid rejected on a government contract for failure to make good faith efforts on any Minority- Owned Business Enterprise, Women-Owned Business Enterprise, Service-Disabled Veteran-Owned Business or Disadvantaged Business Enterprise goal or statutory affirmative action requirements on a previously held contract?

Yes No

4.4 Agreed to a voluntary exclusion from bidding/contracting with a government entity? Yes No

4.5 Initiated a request to withdraw a bid submitted to a government entity in lieu of responding to an information request or subsequent to a formal request to appear before the government entity?

Yes No

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

V. INTEGRITY – CONTRACT AWARD

5.0 Been suspended, cancelled or terminated for cause on any government contract including, but not limited to, a non-responsibility finding?

Yes No

5.1 Been subject to an administrative proceeding or civil action seeking specific performance or restitution in connection with any government contract?

Yes No

5.2 Entered into a formal monitoring agreement as a condition of a contract award from a government entity? Yes No

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

VI. CERTIFICATIONS/LICENSES

6.0 Had a revocation, suspension or disbarment of any business or professional permit and/or license? Yes No

6.1 Had a denial, decertification, revocation or forfeiture of New York State certification of Minority-Owned Business Enterprise, Women-Owned Business Enterprise, Service-Disabled Veteran-Owned Business or federal certification of Disadvantaged Business Enterprise status for other than a change of ownership?

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered responses if necessary:

VII. LEGAL PROCEEDINGS

7.0 Been the subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation?

Yes No

7.1 Been the subject of an indictment, grant of immunity, judgment or conviction (including entering into a plea bargain) for conduct constituting a crime?

Yes No

7.2 Received any OSHA citation and Notification of Penalty containing a violation classified as serious or willful?

Yes No

7.3 Had a government entity find a willful prevailing wage or supplemental payment violation or any other willful violation of New York State Labor Law?

Yes No

7.4 Entered into a consent order with the New York State Department of Environmental Conservation, or received an enforcement determination by any government entity involving a violation of federal, state or local environmental laws?

Yes No

7.5 Other than previously disclosed:

a) Been subject to fines or penalties imposed by government entities which in the aggregate total

$25,000 or more; or

b) Been convicted of a criminal offense pursuant to any administrative and/or regulatory action taken by any government entity?

For each “Yes,” provide an explanation for the response and attach additional sheets with numbered response if necessary:

VIII. FINANCIAL AND ORGANIZATIONAL CAPACITY

8.0 Within the past five (5) years, has the Reporting Entity received any formal unsatisfactory performance assessment(s) from any government entity on any contract?

Yes No

If “Yes,” provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

8.1 Within the past five (5) years, has the Reporting Entity had any liquidated damages assessed over $25,000 for any reason, including failure to meet Minority-Owned Business Enterprise, Women-Owned Business Enterprise, Service-Disabled Veteran-Owned Business, or Disadvantaged Business Enterprise goals?

Yes No

If “Yes,” provide an explanation of the issue(s), relevant dates, contracting party involved, the amount assessed and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

8.2 Within the past five (5) years, have any liens, claims or judgments (not including UCC filings) over $25,000 been filed against the Reporting Entity which remain undischarged?

Yes No

If “Yes,” provide an explanation of the issue(s), relevant dates, the Lien holder or Claimant’s name(s), the amount of the lien(s), the current status of the issue(s), and the balance of the lien or judgment not yet paid. Provide answer below or attach additional sheets with numbered responses.

8.3 In the last seven (7) years, has the Reporting Entity initiated or been the subject of any bankruptcy proceedings, whether or not closed, or is any bankruptcy proceeding pending?

Yes No

If “Yes,” provide the bankruptcy chapter number, the court name and the docket number. Indicate the current status of the proceedings as “Initiated,” “Pending” or “Closed.” Provide answer below or attach additional sheets with numbered responses.

8.4 During the past three (3) years, has the Reporting Entity failed to file or pay any tax returns required by federal, state or local tax laws?

Yes No

If “Yes,” provide the taxing jurisdiction, the type of tax, the liability year(s), the tax liability amount the Reporting Entity failed to file/pay and the current status of the tax liability. Provide answer below or attach additional sheets with numbered

8.5 During the past three (3) years, has the Reporting Entity failed to file or pay any New York State unemployment insurance returns?

Yes No

If “Yes,” provide the years the Reporting Entity failed to file/pay the insurance, explain the situation and any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

8.6 During the past three (3) years, has the Reporting Entity had any government audit(s) completed? Yes No

a) If “Yes,” did any audit of the Reporting Entity identify any reported significant deficiencies in internal control, fraud, illegal acts, significant violations of provisions of contract or grant agreements, significant abuse or any material disallowance?

Yes No

If “Yes” to 8.6 a), provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

IX. ASSOCIATED ENTITIES

This section pertains to any entity(ies) that either controls or is controlled by the reporting entity.

(See definition of “associated entity” for additional information to complete this section.)

9.0 Does the Reporting Entity have any Associated Entities?

Note: All questions in this section must be answered if the Reporting Entity is either:

− An Organizational Unit; or − The entire Legal Business Entity which controls, or is controlled by, any other entity(ies).

If “No,” SKIP THE REMAINDER OF SECTION IX AND PROCEED WITH SECTION X.

If “Yes,” provide the name, address and EIN of each Associated Entity and its relationship to the Reporting Entity.

Yes No

9.1 Within the past five (5) years, has any Associated Entity Official or Principal Owner been charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime or subject to a judgment for:

a) Any business-related activity; or

b) Any crime, whether or not business-related, the underlying conduct of which was related to truthfulness?

If “Yes,” provide an explanation of the issue(s), the individual involved, their title and role in the Associated Entity, identify the Associated Entity’s name(s), EIN(s), primary business activity, the individual’s relationship to the Reporting Entity, relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s).

9.2 Does any Associated Entity have any currently undischarged federal, New York State, New York City or New York local government liens or judgments (not including UCC filings) over $50,000?

If “Yes,” provide an explanation of the issue(s), identify the Associated Entity’s name(s), EIN(s), primary business activity, relationship to the Reporting Entity, relevant dates, the Lien holder or Claimant’s name(s), the amount of the lien(s) and the current status of the issue(s). Provide answer below or attach additional sheets with numbered responses.

9.3 Within the past five (5) years, has any Associated Entity:

a) Been disqualified, suspended or debarred from any federal, New York State, New York City or other New York local government contracting process?

b) Been denied a contract award or had a bid rejected based upon a non-responsibility finding by any federal, New York State, New York City, or New York local government entity?

c) Been suspended, cancelled or terminated for cause (including for non-responsibility) on any federal, New York State, New York City or New York local government contract?

d) Been the subject of an investigation, whether open or closed, by any federal, New York State, New York City, or New York local government entity for a civil or criminal violation with a penalty in excess of $500,000?

e) Been the subject of an indictment, grant of immunity, judgment, or conviction (including entering into a plea bargain) for conduct constituting a crime?

f) Been convicted of a criminal offense pursuant to any administrative and/or regulatory action taken by any federal, New York State, New York City, or New York local government entity?

g) Initiated or been the subject of any bankruptcy proceedings, whether or not closed, or is any bankruptcy proceeding pending?

IX. ASSOCIATED ENTITIES

This section pertains to any entity(ies) that either controls or is controlled by the reporting entity.

(See definition of “associated entity” for additional information to complete this section.)

For each “Yes,” provide an explanation of the issue(s), identify the Associated Entity’s name(s), EIN(s), primary business activity, relationship to the Reporting Entity, relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). Provide answer below or attach additional sheets with numbered

X. FREEDOM OF INFORMATION LAW (FOIL)

10. Indicate whether any information supplied herein is believed to be exempt from disclosure under the Freedom of Information Law (FOIL).

Note: A determination of whether such information is exempt from FOIL will be made at the time of any request for disclosure under FOIL.

If “Yes,” indicate the question number(s) and explain the basis for the claim.

XI. AUTHORIZED CONTACT FOR THIS QUESTIONNAIRE

Name

Telephone Fax ext.

Title

Email

Certification

The undersigned: (1) recognizes that this questionnaire is submitted for the express purpose of assisting New York State government entities (including the Office of the State Comptroller (OSC)) in making responsibility determinations regarding award or approval of a contract or subcontract and that such government entities will rely on information disclosed in the questionnaire in making responsibility determinations; (2) acknowledges that the New York State government entities and OSC may, in their discretion, by means which they may choose, verify the truth and accuracy of all statements made herein; and (3) acknowledges that intentional submission of false or misleading information may result in criminal penalties under State and/or federal law, as well as a finding of non-responsibility, contract suspension or contract termination.

It being acknowledged and agreed that all responses included in this questionnaire are to the knowledge, information and belief of the Business Entity, the undersigned certifies under penalties of perjury that they:

The undersigned certifies that he/she:

•…