TNH001RR-2026 Veterinary Services.pdf

TOWN OF NORTH HEMPSTEAD

REQUEST FOR PROPOSALS

FOR

VETERINARY SERVICES

Department of Public Safety

220 Plandome Road

P.O. Box 3000

Manhasset, NY 11030-2327

(516) 869-6311

Supervisor

Jennifer DeSena

Town Board

Robert J. Troiano

Edward Scott

Dennis J. Walsh

Christine Liu

Yaron Levy

Mariann Dalimonte

Commissioner of Public Safety

Derek Skuzenski

Issue Date: August 7, 2026

Proposals Due: August 21, 2026 11AM

RFP No. TNH001RR-2026

REQUEST FOR PROPOSALS

I. INTRODUCTION

A. General Information

The Town of North Hempstead (the "Town") is requesting proposals from qualified vendors to provide routine and emergency veterinary services for canine animals assigned to, or in the care of, the Town of North Hempstead Animal

Shelter. A firm may be selected from among responding firms based on a thorough analysis of each firm’s ability to provide the Town with the highest quality services at the most cost-effective fees

The following conditions apply to this RFP:

• There is no express or implied obligation for the Town to reimburse responding firms for any expenses incurred in preparing proposals in response to this request, and the Town will not reimburse such expenses.

• Any inquiries concerning this RFP must be in writing or by email and should be addressed to Georgina Carr at contracts@northhempsteadny.gov. All inquiries must bear the RFP number assigned to this RFP. This shall be the sole point of contact for this RFP. Written responses to all inquiries will be posted to the Town’s website as an addendum to the RFP. It shall be the responsibility of the

Proposer(s) to inquire as to any addenda issued.

• To be considered, one (1) original and (1) thumb drive containing the same proposal must be delivered in a sealed envelope and received by the

Procurement Division at 220 Plandome Road, Manhasset, New York

11030 by 11:00 a.m. August 21, 2026. The Town reserves the right to reject any or all proposals submitted.

• During the evaluation process, the Town reserves the right, where it may serve the Town's best interest, to request additional information or clarification from a proposer, or to allow corrections on non-material errors or omissions or waive non-material requirements. At the discretion of the Town, some or all of the firms submitting proposals may be requested to make oral presentations as part of the evaluation process. If conducted, oral presentations will be scheduled with each proposer being considered.

• The Town reserves the right to retain all proposals submitted and to use any ideas in a proposal regardless of whether that proposal is selected.

• Upon submission, all proposals become the property of the Town. The

Town has the right to disclose all or any part of the proposal to public inspection based on its determination of what disclosure will serve the public interest. Proposers are further advised that, except for trade secrets and certain personnel information (both of which the town has reserved the right to disclose), all parts of the proposals must be disclosed to those members of the public making inquiry under the New

York State Freedom of Information Law. Should a proposer wish to request an exemption from public access to information contained in its proposal, the proposer must, at the time of submission and on the face of the proposal, specifically identify the information they claim to be exempt from disclosure and explain in detail why the information should be exempt.

• Submission of a proposal indicates acceptance by the firm of the conditions contained in this RFP, unless clearly and specifically noted in the proposal submitted and confirmed in the contract between the

Town and the firm selected.

• The selection of a firm will be set forth in a resolution of the Town

Board. The selection of a vendor by the Town Board shall not constitute a binding commitment on behalf of the Town to enter into any contract with the selected vendor, as any binding arrangement must be set forth in definitive documentation signed by both the vendor and the Town

(the “agreement”). The agreement shall be executed by vendor and delivered to the Town with necessary insurance certification for approval by the Town Board.

• It is anticipated the selection of a firm will be completed by September

8, 2026. Following notification of the selected firm an agreement will be executed between both parties.

• The Town reserves the right, as best serves its interest, to change any of the projected dates set forth in this RFP, including, but not limited, to the due date for receipt of proposals.

• The Town reserves the right to accept more than one proposal or reject all proposals.

B. Subcontracting

The Proposer will be responsible for the entire contract performance. The Proposer must indicate in the RFP if it intends to use a sub-contractor for any part of the work. If so, the Proposer shall identify each sub-contractor by name, business address and expertise, and must include the name(s) of the principal(s) of the subcontracting entity. A full description of the tasks to be performed by the sub-contractor must be included. No subcontracting shall be permitted without the express permission of the Town.

II. SCOPE OF SERVICES

A. Summary

The Town is requesting proposals from qualified vendors to provide routine and emergency veterinary services for canine animals assigned to or in the care of the Town of North

Hempstead Animal Shelter. The ideal Consultant shall possess demonstrated experience in

Veterinary Services. All proposals must be made on the basis of, and either meet or exceed, the requirements contained herein.

B. Statement of Work

The selected firm will be responsible for providing routine and emergency veterinary services for canine animals assigned to or in the care of the Town of North Hempstead

Animal Shelter, including, but not limited to, the following:

1. The contractor will supervise and oversee general health programs for the Animal

Shelter and the approximately 150-300 canines it cares for annually.

2. The contractor must operate a licensed Veterinary Clinic that specializes in animal medical services that includes consultation, office visits, surgeries and euthanasia within ten miles of the Animal Shelter.

3. Consultations and services must be available by the Veterinarian during normal working hours of 8:30 a.m.-4:30 p.m. Monday through Saturday.

4. The Veterinarian must be available to spend up to four (4) hours per week on-site at the Animal Shelter (days and times to be agreed upon by the Town and the contractor) providing health examinations to new routine veterinary consultations and services.

5. The vendor must have the capability to treat non-canine mammals, birds and reptiles, on occasion.

6. The Veterinarian must be able to perform sick and injured animal care and treatment for animals that can be treated without undue suffering, to allow the animal to be claimed by its owner.

7. Assist the Shelter Director in the development of medical treatment procedures for the operation of the Animal Care Services Facility.

8. The contractor must be available to offer testimony in court for animal cruelty cases.

Please include pricing for testimony time.

9. Order medications and vaccinations for the Animal Shelter. All controlled drugs, supplies and records for controlled drugs and supplies shall be kept in the possession of the Animal Care Services Division.

10. Assist the staff with questions and concerns regarding the health issues pertaining to the animals in the animal shelter.

11. Oversee testing, vaccination and euthanization programs at the animal shelter and assist with vaccinations and euthanization when needed.

12. Be available to provide emergency care to animals.

13. Provide veterinarian services for annual rabies vaccination clinic. The Town will require between one (1) and two (2) rabies clinics per year at the animal shelter off-site location within the Town of North Hempstead.

14. Issue discharge reports for all treated animals.

15. Spay/neuter surgery for dogs under the care of Town of North Hempstead Animal

Shelter, including flank/abdominal spays and cryptorchids at a reduced rate of cost. A permanent tattoo placed on the ventral abdomen of all shelter owned dogs and cats.

Proposers must be a New York State licensed Veterinary Clinic and shall specialize in animal medical services. The contractor shall maintain all necessary licenses for the duration of the contract.

The selected proposer will be responsible for meeting with representatives of the Town at the commencement of the contract to consult with the Town on its plan to execute this contract, and to finalize and agree upon the responsibilities expected of both the Town and the successful proposer.

C. Additional Requirements

The following requirements will be made a part of any agreement entered into between the Town and the selected firm(s):

1. The Town reserves the absolute right to terminate the services at any time and for any reason.

2. The Firm may be required to provide regular periodic status reports to the Town which may include an initial report and quarterly status reports thereafter. The Firm shall prepare such other reports as shall be requested by the Town. The Firm shall provide copies of said reports to the

Town’s insurance carriers, or their designated representatives, if the Town so requests. In addition, the Firm may be required to prepare a report to the Town’s auditors, within the time frame they set forth, when requested to do so.

3. The firm shall maintain full and complete books and records of accounts in accordance with accepted accounting practices and such other records as may be prescribed by the Town

Comptroller, including a contemporaneous record of work indicating in brief summary, a description of the work performed. Such books and records shall be retained for a period of six

(6) years and shall at all times be available for audit and inspection by the Town Comptroller, the

Town’s auditors or a duly designated Town representative.

4. The firm will promptly provide a response to any requests from the Town’s Records

Access/FOIL Officer.

5. The firm shall, to the fullest extent provided by law, defend and indemnify and save harmless the Town from claims, suits, action, damages and costs of every nature, kind, name and description resulting from the negligent performance of the services. Such defense and indemnity shall not be limited by reason of enumeration of any insurance coverage provided by the firm.

Negligent performance of service shall include, in addition to negligence founded upon tort, negligence based upon the firm’s failure to meet professional standards and resulting in obvious or patent errors in the progression of its work. Nothing shall create or give third parties any claim or right of action against the firm or the Town beyond those provided by law.

6. The firm shall procure and maintain during the term of any agreement resulting from this

RFP, with a carrier holding an “A” rating from AM Best Company, or its equivalent, and furnish certificates of insurance evidencing its procuring, the following insurance policies:

(a) Commercial general liability insurance covering the liability of the firm, and indemnifying and holding harmless the Town, its agents, employees, and representatives from any and all loss and/or damage arising out of the performance of the services with limits of One Million Dollars ($1,000,000) each occurrence and Two Million Dollars ($2,000,000) general aggregate. The Town of North

Hempstead and all appointed and elected officials, employees and volunteers shall be named as additional insured on said policy on a primary and non-contributory basis with waiver of subrogation in favor of the additional insured, as evidenced by the certificate of insurance and endorsement pages; and

(b) Workers’ compensation insurance or proof of its not being required to secure same, as evidenced by certificates or affidavits approved by the State Workers’

Compensation Board pursuant to State Workers’ Compensation Law § 57(2); and

(c) Disability benefits insurance or proof of its not being required to secure same, as evidenced by certificates or affidavits approved by the State Workers’

Compensation Board pursuant to State Workers’ Compensation Law § 220(8).

7. The Firm shall be authorized to do business in New York and shall hold any and all licenses issued by the state, the County or the Town that are required to provide the services herein.

8. Firms and/or key staff must have experience of at least seven (7) years in the industry.

9. Firms must possess, in its own name, all of the necessary licenses, certifications, permits, approvals, and authorizations necessary to perform the services being sought.

10. Please provide three (3) references, including name, address, email and telephone numbers, whereby the contractor has provided the same or similar services as those requested herein.

Please include at least one municipal reference.

III. FEE STRUCTURE

Each proposal shall include Appendix A: Price Proposal and include the proposer’s fees for the required services including implementations costs, if any. The proposal shall include a description of services offered and pricing for each service. The Town is not establishing any specific fee or cost structure for the required services. The proposer include pricing hourly or as a flat rate. Where a defined project is requested, the proposer shall include a not to exceed number for the project.

If a contract price cannot be honored solely as a result of the imposition of a Federal tariff, then the Town may, at its sole discretion, pay the contracted price plus the increase resulting from the tariff imposition. Notwithstanding this option, the Town reserves the right to solicit lower pricing if determined it would be able to procure same regardless of the imposition of a Federal tariff.

Should an act of the courts, legislature, or any political body having jurisdiction rescind any tariff that impacts the cost of the contracted goods or services, Contractor shall immediately revert its fee structure back to the original, competitively bid price. Contractor shall only be required to offer the original, competitively bid price if the Town unilaterally exercised its option permitting contractor to include the cost of the tariff with the competitively bid price. If the Town agreed to pay, and subsequently paid, for the increased price and no tariff was actually assessed on the goods or services contracted, Contractor shall reimburse the Town the difference between the original, competitively bid price and the increased pay option.

IV. TIME REQUIREMENTS

A. Proposed Calendar

The following is a list of key dates up to and including the date proposals must be submitted:

RFP issued August 7, 2026

Last Date for Questions August 14, 2026

Due Date for proposal submissions August 21, 2026 11AM

B. Notification and Contract Dates

Selected firm notified On or about September 9, 2026

Contract date On or before September 9, 2026

C. The Town reserves the right, as best serves its interest, to change any of the projected dates set forth in this RFP, including, but not limited to, the due date for receipt of proposals.

D. The Town anticipates entering into a two (2) year agreement with the option to renew for two additional one (1) year terms on the same terms and conditions including price at the sole discretion of the Town.

V. PROPOSAL REQUIREMENTS

A. General Requirements

1. Inquiries

Written inquiries concerning the RFP and its subject must be made to Georgina

Carr, at contracts@northhempsteadny.gov. Written responses to all inquiries will be posted to the Town’s website as an addendum to the RFP. It shall be the responsibility of the Proposer(s) to inquire as to any addenda issued. As a courtesy, direct responses to all inquiries will be distributed to each potential proposer that has requested such responses. Proposers should not be contacting any other Town

Employees about this RFP.

2. Submission of Proposals

The following material is required to be received by the Due Date for a proposing firm to be considered.

a. The Proposal shall include:

i. Title Page

Title page showing the RFP subject; the firm's name; name, address and telephone number of the contact person; and the proposal date.

ii. A brief history and description of the firm submitting the proposal.

iii. Technical Proposal

A signed letter of transmittal stating the proposer's understanding of the services to be performed, a statement why the firm believes it to be best qualified to perform the engagement, the candidate’s project approach and work plan, a detailed list of previous experience relevant to this project, the firm's past history in providing such services for municipalities, biographical information of those personnel that would provide services to the Town under an agreement, visual examples of other displays produced by the proposer and a statement that the proposal is a firm and irrevocable offer. Such technical proposal must include, in addition to the above, all information and documentation described or requested in Section

II above.

iv. Completed price proposal attached as Attachment A

v. Fully completed Proposer’s Qualification Statement attached as

Attachment B, including the Statement of Understanding, Disclosure Statement, Non-Collusive Proposal Certification, Insurance Certification, Acknowledgement of Receipt of Addenda, Debarment and Suspension Certification, Byrd Anti-Lobbying

Amendment Certification, Iran Divestment Act, Procurement

Lobbying Certification and Local Business Certification. The contract will be executed by the Town and the selected candidate only after an evaluation of each proposal and a selection of a firm.

vi. Statement that the proposer agrees to the standard terms and conditions for Town agreements shown in Attachment C, or a description of requested changes.

b. The completed proposal should be sent to the following address in a sealed envelope marked "Request for Proposals TNH001RR-

2026- Veterinary Services":

Georgina Carr

Procurement Coordinator

Town of North Hempstead

220 Plandome Road

Manhasset, New York 11030

B. Guidance on Completing a Proposal Submission

The purpose of a proposal submission is to demonstrate the qualifications, competence and capacity of the firms seeking to provide services to the Town. As such, the substance of proposals will carry more weight than the form or manner of presentation. The Technical Proposal should demonstrate the qualifications of the firm and of the particular staff to be assigned to this engagement.

The Technical Proposal should address all points outlined in the RFP. The

Technical Proposal should be prepared simply and economically, providing a straightforward, concise description of the proposer's capabilities to satisfy the RFP requirements.

All compliant Proposals will be reviewed by a committee that will consider candidates based exclusively on the Proposals submitted and any subsequent interviews with candidates and/or additional information submitted by candidates at the request of the evaluation committee.

VI. SELECTION OF FIRM

A. The Town will approve a firm based on an evaluation of the proposals by an evaluation committee. The Town reserves the right to enter into negotiations with the proposer offering the next-best value should the Town be unable to negotiate and execute a contract with the awardee. Proposals will be evaluated based on the following criteria and point system:

1. Substance of the Proposal 30 Points

• Responsiveness to and understanding of the RFP requirements

• Clear understanding of the Scope of Work

• Acceptable solutions, management, implementation

• Viable recommendations for approach

2. Relevant Experience of Proposer 20 Points

• Organizational Experience

• Experience of Individuals

• Experience with Municipalities

• Experience with the subject matter

3. Size, Staffing, Resources of vendor 10 Points

4. Technical Proposal/Completed Forms 10 Points

5. Fee Proposal 30 Points

6. MWBE or SDVOB (provide NYS Certificate) +5 Points

7. Local Business Certification (Nassau County Business) +5 Points

8. *Presentations (if held) 10 Points

The Town may also consider any other factors it deems necessary in evaluating each proposal.

The Town reserves the right to request additional information, including oral presentations, interviews and/or Best and Final offers from any or all of the proposers. Upon conclusion of the evaluation process, the evaluation committee will then select a proposer to be recommended to the Town Board for review and award.

B. Right to Reject Proposals

Submission of a proposal indicates acceptance by the firm of the conditions contained in the

RFP unless clearly and specifically noted in the proposal submitted and confirmed in the contract between the Town and the firm selected. The Town reserves the right without prejudice to reject any or all proposals.

C. Non-Guarantee of Service

The selection of a Contractor will not guarantee that any services will be requested of that candidate.

ATTACHMENT A

PRICE PROPOSAL

Each proposal shall include Appendix A: Price Proposal and include the proposer’s fees for the required services including implementations costs, if any. The proposal shall include a description of services offered and pricing for each service. The Town is not establishing any specific fee or cost structure for the required services. The proposer include pricing hourly or as a flat rate. Where a defined project is requested, the proposer shall include a not to exceed number for the project.

If a contract price cannot be honored solely as a result of the imposition of a Federal tariff, then the Town may, at its sole discretion, pay the contracted price plus the increase resulting from the tariff imposition. Notwithstanding this option, the Town reserves the right to solicit lower pricing if determined it would be able to procure same regardless of the imposition of a Federal tariff.

Should an act of the courts, legislature, or any political body having jurisdiction rescind any tariff that impacts the cost of the contracted goods or services, Contractor shall immediately revert its fee schedule back to the original, competitively bid price. Contractor shall only be required to offer the original, competitively bid price if the Town unilaterally exercised its option permitting contractor to include the cost of the tariff with the competitively bid price. If the Town agreed to pay, and subsequently paid, for the increased price and no tariff was actually assessed on the goods or services contracted, Contractor shall reimburse the Town the difference between the original, competitively bid price and the increased pay option.

The undersigned further stipulates that the information in this attachment and the proposer’s fee proposal is, to the best of its knowledge, true and accurate.

Signature

Name of Proposer

Title of Person Signing

ATTACHMENT B

BIDDER’S QUALIFICATION STATEMENT

INSTRUCTIONS:

The Bidder’s Qualifications Statement consists of the following documents:

1. Statement of Understanding;

2. Disclosure Form;

3. Noncollusive Proposal Certification;

4. Certification of Insurance (to be completed by an authorized insurance agent);

5. Acknowledgement of Receipt of Addenda Form;

6. Debarment and Suspension Certification;

7. Byrd Anti-Lobbying Amendment Certification;

8. Iran Divestment Act;

9. Procurement Lobbying Certification; and

10. Local Business Certification.

11. Certification of No Boycott of Israel

Please complete ALL ELEVEN forms and submit with the Bid/Proposal.

THE TOWN RETAINS THE ABSOLUTE RIGHT TO REJECT ANY BID/PROPOSAL

THAT FAILS TO INCLUDE COMPLETE AND ACCURATE ORIGNALS OF ALL

FORMS .

STATEMENT OF UNDERSTANDING

By signing in the space provided below, the undersigned certifies, under penalty of perjury, as follows:

1. I am duly authorized to submit this Bid/Proposal on behalf of the below listed sole proprietorship/company/partnership/corporation.

2. That he/she has read and understands all terms and conditions pursuant to this RFP.

3. That he/she has the capacity to and will abide by all terms and conditions pursuant to this

RFP.

4. That he/she agrees to accept payment in accordance with the requirements of the RFP;

and

5. That he/she agrees that the proposed submitted to the Town shall be irrevocable and that he/she will, if his/her proposal is accepted, enter into a contract with the Town of North

Hempstead pursuant to the terms and conditions set forth in the RFP.

6. That he/she certified that his/her sole proprietorship/company/partnership/corporation will carry all types of insurance specified in the contract.

The undersigned further stipulates that the information in this Proposal is, to the best of its knowledge, true and accurate.

Signature

Name of Bidder

Title of Person Signing

DISCLOSURE FORM

The signatory of this questionnaire certifies under oath the truth and correctness of all Statements and of all answers to interrogatories hereinafter made.

Provide answers to each of the following and supporting documentation, where necessary. If there is nothing to disclose, please respond N/A:

1. Adverse Equal Opportunity Determinations: Identify all adverse determinations against your

Company/Corporation/Partnership, or its employees or persons acting on its behalf, with respect to actions, proceedings, claims or complaints concerning violations of state, Federal or municipal equal opportunity laws or regulations.

2. Convictions and Unscrupulous Practice: Has your Company/Corporation/Partnership, or any of its employees present or past, or anyone acting on its behalf, ever been cited for unscrupulous practice, or been convicted of any crime or offense arising directly or indirectly from the conduct of your

Company/Corporation/Partnership’s business, or has any of your Company/Corporation/Partnership’s officers, director or persons exercising substantial policy discretion ever been convicted of any crime or offense involving business/financial misconduct or fraud? If so, describe the convictions and surrounding circumstances in detail.

3. Pending or Threatened Actions/Suits: Describe any past or present action, suit, proceeding or investigation pending or threatened against your Company/Corporation/Partnership including, without limitation, any proceeding known to be contemplated by government authorities, private parties, or current or former clients.

4. Criminal Misconduct: Has your Company/Corporation/Partnership, or any of its employees, or anyone acting on its behalf, been indicted or otherwise charged in connection with any criminal matter arising directly or indirectly from the conduct of your Company/Corporation/Partnership’s business which is still pending, or has any of the Company/Corporation/Partnership’s officers, directors or persons exercising substantial policy discretion been indicted or otherwise charged in connection with any criminal matter involving business or financial misconduct or fraud which is still pending? If so, describe the indictments or charges and surrounding circumstances in detail.

5. Conflicts of Interest: disclose any of the following, and describe any procedures your

Company/Corporation/Partnership has, or would adopt, to assure the Town that a conflict of interest would not exist in the future):

(a) Any material financial relationships that your Company/Corporation/Partnership or any

Company/Corporation/Partnership employee has that may create a conflict of interest or the appearance of a conflict of interest in contracting with or representing the Town.

(b) Any family relationship that any employee of your Company/Corporation/Partnership has with a member, employee, or official of the Town or that may create a conflict of interest or the appearance of a conflict of interest in contracting with or representing the Town.

(c) Any other matter that your Company/Corporation/Partnership believes may create a conflict of interest or the appearance of a conflict of interest in contracting with or representing the Town.

6. Financial Disclosure: Submit with this Disclosure Statement Form, any one of the following three items:

(a) a financial statement, prepared on an accrual basis, in a form which clearly indicates: Bidder’s (1) assets, liabilities and net worth; (2) date of financial statement; and (3) name of firm preparing statement.

(b) a letter of credit reference from a recognized bank or financial institution; or

(c) a certified copy of a credit report from a recognized credit bureau, such as Dun and Bradstreet or

TRW.

THE TOWN RETAINS THE ABSOLUTE RIGHT TO REJECT ANY PROPOSAL THAT

FAILS TO INCLUDE COMPLETE DISCLOSURE STATEMENT FORM.

Dated at _____________________, this _______________________day of

_________________________, 20_____.

(Signature, if Individual)

By: ___________________________________________________________ (Seal, if corporation)

(Signature)

Print Name: _________________________________________________

(Legal Business Name of Company/Partnership/Corporation)

Print Title: __________________________________________________

NON-COLLUSIVE PROPOSAL CERTIFICATION

By submission of this proposal, each proposer and each person signing on behalf of any proposer certifies, and in the case of a joint proposal each party thereto certifies as to its own organization, under penalty of perjury, that to the best of knowledge and belief:

(1) The prices in this proposal 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 proposer or with any competitor;

(2) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the proposer and will not knowingly be disclosed by the proposer prior to opening, directly or indirectly, to any other proposer or to any competitor; and

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

I, hereby certify under the penalties that the foregoing statement is true.

By:________________________________________

Proposer’s Signature

Date

Print Name

Title

Legal Name of Individual or Business Name of

Company/Partnership/Corporation

Proposer's Federal Tax Identification #

(Do Not Use SS#)

Address

Email Address

INSURANCE CERTIFICATION

TO BE COMPLETED BY AN AUTHORIZED INSURANCE AGENT

INSTRUCTIONS:

Please complete this Insurance Certification and attach copies of proof of insurance as follows:

(a) Commercial General Liability/Automobile Liability/Excess Liability: ACCORD-25

FORM.

(b) Worker’s Compensation: Certificates or affidavits approved by the State Workers’

Compensation Board pursuant to State Workers’ Compensation Law § 57 (2) evidencing proof of workers’ compensation insurance or proof of Bidder not being required to secure same.

(c) Disability Benefits Insurance: Certificates or affidavits approved by the State Workers’

Compensation Board pursuant to State Workers’ Compensation Law § 220 evidencing proof of disability benefits insurance or proof of Bidder not being required to secure same.

This form and all supporting documentation must be submitted with this Bid/Proposal even if said information is on-file with the Town in connection with another bid, project or contract.

(Name and Address of Bidder)

Name of Bid: _________________________________________________________Bid

Number:________________

(1) Commercial General Liability with completed operations (plus X.C.U. when applicable), to which the Town of North Hempstead has been added as additional insured, and Automobile Liability: $ 2,000,000.00 Combined single limit (bodily and personal injury/property damage).

Insurance Carrier (Commercial General Liability): ____________________________________

Policy Number(s): _________________________________________________________________________

(2) Worker’s Compensation:

Insurance Carrier: ______________________________________ Policy

Number(s):____________________________

(3) The above insurance is effective with New York State admitted insurance companies, and is A- or higher rated or its equivalent .

(4) Policy cancellation or non-renewal shall be effective only upon thirty (30) days prior notice by certified mail to:

Town of North Hempstead, Office of the Town Attorney, 220 Plandome Road, P.O.B. 3000, Manhasset, New York

11030

Authorized Insurance Agent’s Signature and Title: ____________________________________________________

Name, Insurance Affiliation and Address:

Dated___________________

ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA FORM

The bidder hereby acknowledges that he/she has received and that he/she has considered in the preparation of his/her proposal, all requirements in the following Addenda to this RFP:

Note: This acknowledgement shall be signed by the person executing the Statement of

Understanding.

Insert additional pages, as necessary.

ADDENDUM NUMBER

DATE OF ADDENDUM

ACKNOWLEDGEMENT

IMPORTANT NOTICE:

THIS FORM MUST BE COMPLETED AND SUBMITTED BY ALL PROPOSERS. IF NO

ADDENDA ARE RECEIVED, CHECK THE “NO ADDENDUM” BOX ABOVE AND SIGN

THE ACKNOWLEDGEMENT.

THE TOWN RETAINS THE ABSOLUTE RIGHT TO REJECT AND PROPOSAL THAT

FAILS TO INCLUDE THIS ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA FORM

□ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS PROPOSAL.

ACKNOWLEDGEMENT:

DEBARMENT AND SUSPENSION CERTIFICATION

The Bidder/Offeror certifies to the best of his or her knowledge and belief, that:

By submitting a bid/proposal under this solicitation, the bidder or offeror certifies that at the time the bidder or offeror submits its proposal that neither it nor its principals are presently debarred or suspended by any Federal, state or local department or agency from participation in this or any similar transaction.

Name of Contractor: ____________________________________________________________

Authorized Representative Name: _________________________________________________

Signature of Authorized Representative: _____________________________________________

BYRD ANTI-LOBBYING AMENDMENT CERTIFICATION

The Offeror/Bidder certifies, by submitting this offer or bid, to the best of his or her knowledge and belief, that:

1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the bidder or offeror, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a

Member of Congress, an officer or employee of Congress, or an employee of a Member of

Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to

Report Lobbying,” in accordance with its instructions.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

CERTIFICATION - IRAN DIVESTMENT ACT OF 2012

This form must be signed

As a result of the Iran Divestment Act of 2012 (Act), Chapter 1 of the 2012 Laws of New York, added new provisions to the State Finance Law (SFL), §165-a and General Municipal Law (GML)

§103-g effective April 12, 2012. Under the Act, the Commissioner of the Office of General

Services (OGS) will be developing a list (prohibited entities list) of “persons” who are engaged in

“investment activities in Iran” (both are defined terms in the law). Pursuant to SFL § 165-a(3)(b) and GML §103-g, 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 response to this solicitation or by assuming the responsibility of a Contract awarded hereunder, Proposer (or any assignee) certifies that once the prohibited entities list is posted on the OGS website, it will not utilize on such Contract any subcontractor that is identified on the prohibited entities list. Additionally, Proposer is advised that once the list is posted on the

OGS website, any Proposer seeking to enter into, renew or extend a Contract or assume the responsibility of a Contract awarded in response to the solicitation, must certify at the time the

Contract is bid upon or a proposal submitted, or the contract is renewed, extended or assigned that it is not included on the prohibited entities list.

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

Town reserves the right to reject any bid, proposal or request for assignment for an entity that appears on the prohibited entities list prior to the award of a contract, and to pursue a responsibility review with respect to any entity that is awarded a contract and appears on the prohibited entities list after contract award.

Signature: ___________________________________________ Date: ____________

PROCUREMENT LOBBYING CERTIFICATION WITH RESPECT TO

STATE FINANCE LAW SECTION §§ 139-j AND 139-k

1. Has a Governmental Entity, as defined in State Finance Law §139-j(1)(a), made a determination of non-responsibility with respect to the Contractor within the previous four years where such finding was due to a violation of State Finance Law §139-j or the intentional provision of false or incomplete information with respect to previous determinations of non-responsibility?

No ___

Yes ___

If yes, provide the following details:

Governmental Entity which made the finding:

Date of finding:

Basis of finding:

2. Has a Governmental Entity terminated or withheld a procurement contract with the

Contractor because of violations of State Finance Law §139-j or the intentional provision of false or incomplete information with respect to previous determinations of non-responsibility?

No ___

Yes ___

If yes, identify the following:

Governmental Entity which terminated the contract:

Date of contract termination or withholding:

Identify the related procurement contract:

Contractor AFFIRMS that he/she understands and agrees to comply with the New York State procedures relative to permissible contacts as required by State Finance Law §§ 139-j and 139-k.

Contractor CERTIFIES that all information provided by Contractor with respect to its compliance with State Finance Law §§139-j and 139-k is complete, true and accurate.

Address: _____________________________________________

Date: _____________________________________________

LOCAL BUSINESS PREFERENCE CERTIFICATION FORM

ALL INFORMATION MUST BE PROVIDED

A 5% Preference for Local Businesses (hereinafter, “Preference”) may be available for this procurement. To qualify, an Offeror MUST complete and submit this Preference Certification

Form WITH ITS OFFER, BID OR PROPOSAL.

If a Proposal is received without this Preference Certification Form and any required documentation attached, completed, signed and certified, or if this Preference Certification Form is received without the required information, the preference shall not be applied.

LOCAL BUSINESS PREFERENCE

To qualify for the local business preference, the business must:

1. be physically located within the geographical boundaries of the County of Nassau (the

“County”); and

2. such presence must have existed for at least a year, established by ownership or lease of premises that includes an operational office for conducting business or selling and/or manufacturing supplies, materials or equipment; and

3. the business must employ a minimum of two (2) full time employees in the County.

In the case of a two-party joint venture both entities must meet the pertinent test for a Local

Business set forth above. In the case of joint venture with more than two parties at least a majority of the entities must meet the pertinent test for a Local Business set forth above.

CERTIFICATION

The Preference Certification Form must include a physical location - NOT a post office box or other postal address.

PREFERENCE CERTIFICATION FORM MUST BE COMPLETED BY PRINCIPAL

OFFEROR. This Preference Certification Form must be completed for the Principal Offeror, or one of the Principal Offerors if the Offeror is a joint venture or partnership, or by an individual authorized to sign for the Offeror. Subcontractors of the Offeror shall not be used to qualify a

Proposal for a preference and should not complete or submit the Form.

The total percentage of all preferences awarded shall not exceed ten percent (10%).

ADDITIONAL DOCUMENTATION. If requested, a business shall provide, within three (3) working days of receipt of the request, documentation to substantiate the information provided on the Preference Certification Form. The Director of Procurement shall determine the sufficiency of such documentation.

NO PREFERENCES SHALL BE APPLIED IF THE PROCUREMENT IS SUBJECT TO

GENERAL MUNICIPAL LAW 103, IF FEDERAL FUNDS ARE USED OR IF OTHERWISE

INAPPLICABLE TO THIS PROCUREMENT.

LOCAL BUSINESS CERTIFICATION

I certify my company meets the following qualifications to be eligible for the local business preference:

1. the business is physically located within the geographical boundaries of the County of

Nassau (the “County”); and

2. the business has been physically located in the County for at least a year, established by ownership or lease of premises that includes an operational office for conducting business or selling and/or manufacturing supplies, materials or equipment,

3. the business employs a minimum of two (2) full time employees in the County.

Address______________________________________________________________________

Nassau County Address, if different:

CERTIFICATION OF NO BOYCOTT OF ISRAEL

Pursuant to Town of North Hempstead Code §24-65, the Town shall not enter into a contract with an individual or company identified by the New York State Office of General Services or the

Office of the New York State Comptroller as engaging in boycott of Israel.

By signing below, the Contractor agrees and certifies that they are not an individual or company identified by the New York State Office of General Services or the Office of the New York State

Comptroller as engaging in boycott of Israel. If any time after signing this certification the

Contractor is identified by the New York State Office of General Services or the Office of the New

York State Comptroller as engaging in boycott of Israel, the Contractor must notify the Town in writing.

Address: _____________________________________________

Date: _____________________________________________

ATTACHMENT C

STANDARD TOWN TERMS AND CONDITIONS

1. Compensation

(a) Claim Forms, Claim Form Review and Approval. Payments shall be made to the

Consultant in arrears and shall be expressly contingent upon (i) the Contractor submitting a claim form (the “Claim Form”) in a form satisfactory to the Town, that (a) states with reasonable specificity the services provided and the payment requested as consideration for such services, (b) certifies that the services rendered and the payment requested are in accordance with the terms of this Agreement, and (c) is accompanied by documentation satisfactory to the Town supporting the amount claimed, and (ii) review, approval and audit of the Claim Form by the Town and/or the Comptroller. Drawdowns for the payment of eligible expenses shall be made against the activities specified herein and in accordance with applicable performance requirements.

(b) Timing of Payment Claims. The Contractor shall submit claims no more frequently than once a week and no later than one (1) months following the Town’s receipt of the services that are the subject of the claim. Any claims submitted in violation of this clause

3(c) shall not be due and payable by the Town and the Contractor hereby expressly waives any and all rights thereto.

(c) No Duplication of Payments. Payments for the Services shall not duplicate payments for any work performed or to be performed under any other agreements made between the Contractor and any funding source including the Town.

2. Termination

(a) The Town reserves the absolute right to terminate the Agreement at any time, for any reason, by service of a written notice sent by certified mail to the address set forth above.

The Town will be responsible for payment of any portion of the Services completed prior to termination and satisfactory to the Town’s Comptroller.

(b) Contractor Assistance Upon Termination. In connection with the termination or impending termination of this Agreement, the Contractor shall, regardless of the reason for termination, take all actions reasonably requested by the Town (including those set forth in other provisions of this Agreement) to assist the Town in transitioning the Contractor’s responsibilities under this Agreement. The provisions of this Section shall survive the termination of this Agreement.

(c) Accounting Upon Termination. Within thirty (30) days of the termination of this

Agreement, the Contractor shall provide the Supervisor with a complete accounting up to the date of termination of all monies received from the Town, and shall immediately refund to the Town any unexpended balance remaining as of the time of termination.

(d) Reimbursement Upon Termination. Payment to the Contractor following termination shall not exceed authorized expenditures made prior to termination, and may be suspended by the Town pending the Contractor’s reasonable compliance with the terms and provisions of (b) and (d) above.

3. Contractor as Professional Representative

The Contractor shall serve as the Town's professional representative in the execution of the

Services and shall give consultation and advice to the Town during the performance of the

Services. The Contractor represents to the Town that it is adequately staffed, skilled and experienced to perform the services required by this Agreement and further, that is duly licensed and qualified under the laws of the State of New York to perform these services.

4. Control of Services

The Contractor’s services shall at all times be subject to the direction and control of the

Head of the Issuing Department of the Town of North Hempstead (the “Department

Head”). The Department Head’s decision shall be final and binding upon the Contractor on all matters arising out of, in connection with or relating to this Agreement. To prevent all disputes and litigation, the Department Head shall, in all cases, determine the amount, quality, acceptability and fitness of the work being performed under the provisions of this

Agreement and shall determine every question which may arise relative to the Contractor’s performance of the Agreement. The decision of the Department Head shall be final, conclusive and binding upon the Contractor. This paragraph shall not operate as a waiver of the Contractor’s right to litigate or to perform work under protest while reserving the right to litigate with respect thereto.

5. Refusal to Testify

If any person when called to testify before a grand jury, head of a state department, temporary state commission or other state agency, the organized crime task force in the department of law, head of a municipal department, or other municipal agency which is empowered to compel the attendance of witnesses and examine them under oath to testify in an investigation concerning any transaction or contract had with the State of New York, or any political subdivision thereof, a public authority, or with any public department, agency or office of the state, or of any political subdivision thereof, or of a public authority, refuses to answer any relevant question concerning such transaction or contract even though offered immunity against the use of his (its) answer and evidence derived therefrom in any subsequent criminal case in which he (it) is a defendant, then any such person or any firm, partnership, or corporation of which he (it) is a member, partner, director, or official shall be disqualified for a period of five years after such refusal from submitting bids to, receiving awards from, or entering into any contracts with the Town of North

Hempstead or any department or agency or official thereof. If such a person refuses to answer any relevant question as aforesaid, then this Agreement may be cancelled and terminated by the Town without the Town incurring any penalty or damages by virtue of such cancellation or termination. Any monies owed for goods delivered or work done prior to cancellation shall be paid.

6. Staffing

The Contractor agrees that it will hire only competent qualified persons to effectuate the

Services under this Agreement.

7. Amendments

This Agreement may only be amended or modified by written agreement duly executed by the Parties.

8. Independent Contractor

The Contractor is an independent contractor of the Town. The Contractor shall not, nor shall any officer, director, employee, servant, agent or independent contractor of the

Contractor (a “Contractor Agent”), be (a) deemed a Town…