NIAGARA FRONTIER TRANSPORTATION AUTHORITY REQUEST FOR PROPOSAL FOR HEALTH BENEFITS CONSULTING SERVICES NFTA RFP NO. 4597

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1 NIAGARA FRONTIER TRANSPORTATION AUTHORITY REQUEST FOR PROPOSAL FOR HEALTH BENEFITS CONSULTING SERVICES NFTA RFP NO SUBMIT 5 HARD COPIES OF PROPOSAL and 1 ELECTRONIC COPY (A CD OR FLASH DRIVE). The following items are to be included with the proposal and made part of any agreement entered into pursuant to this RFP. Cover Letter Description of Products/Services Firm, Management and Staff Qualifications References Cost Proposal Proposal Forms (Refer to Forms and Reference Section) Technical Submittals (if applicable) Proof of Insurance PROPONENTS MUST REGISTER AND DOWNLOAD THIS RFP FROM THE NFTA WEB SITE, IN ORDER TO BE NOTIFIED OF SUBSEQUENT AMENDMENTS. ONLY REGISTERED SUPPLIERS WILL RECEIVE NOTIFICATION OF NEW RFP S AS THEY BECOME AVAILABLE. THE RFP NUMBER MUST BE REFERENCED ON ALL SUBMITTALS AND CORRESPONDENCE. 1

2 NIAGARA FRONTIER TRANSPORTATION AUTHORITY REQUEST FOR PROPOSAL NO Proposals will be received by the undersigned until 11:00 a.m., on AUGUST 2, 2016: HEALTH BENEFITS CONSULTING SERVICES in accordance with the attached proposal documents. The Authority reserves the right to reject any or all proposals, or to waive any informality in the proposal. Proposals shall be submitted in a sealed envelope showing Proponent s name and addressed to: NIAGARA FRONTIER TRANSPORTATION AUTHORITY Department of Procurement - Fifth Floor Attention: Andrea Herald 181 Ellicott Street Buffalo, New York phone, fax Andrea_Herald@nfta.com MARK ON LOWER LEFT HAND CORNER OF ENVELOPE: RFP: 4597 DUE DATE: AUGUST 2, 2016 FOR: HEALTH BENEFITS CONSULTING SERVICES NAME OF PROPONENT: PROPOSALS MUST BE RECEIVED AT 181 ELLICOTT STREET, 5TH FLOOR, PROCUREMENT DEPARTMENT, BEFORE THE TIME DESIGNATED FOR OPENING IN ORDER TO BE CONSIDERED. All correspondence, communications and/or contact with the NFTA in regard to any aspect of this proposal shall be with the Procurement Official designated above or her designated representative. Prospective proponents, or their representatives, shall not make contact with or communicate with any representatives of the NFTA, including employees and consultants, other than the designated Procurement Official, in regard to any aspect of this proposal. Andrea Herald Procurement Manager

3 RFP NO HEALTH BENEFITS CONSULTING SERVICES SCOPE OF WORK The NFTA requests proposals from qualified consulting firms to provide employee health benefits brokerage and consulting services for approximately 1500 employees and 800 retirees. Due to the rising cost of employee benefits and the complexities associated with the management and administration of these benefits, NFTA is seeking a Broker/Consultant for assistance. The Consultant will be expected to provide the following on an as needed basis : Renewal Analysis: Review and evaluate carrier projections Prepare shadow renewal projection Create financial modeling reports Coordinate carrier negotiations Create employee contribution modeling reports Review identified benchmarks of projected plan costs Develop working rates for Client analysis and approval Assist with budget projections Provide renewal alternatives with cost impact of benefit plan changes Periodic Plan Financial Reports: (frequency to be mutually agreed upon) Summary of plan costs Analysis of actual vs. budget Employee contributions Large claims tracking Identification of costs for specific line of coverage Comparison of plan costs to aggregate stop-loss projections, if applicable Utilization review Comparison to prior claim period Plan trends Annual Financial Reports (End of Year Accounting): Executive summary of program expenses Comparison of current costs to renewal costs Incurred But Not Reported (IBNR) claims analysis Overview of specific Stop-loss projections Future plan costs projections Dollars saved by contract negotiation Percent of benefit dollars paid by employee Claims by size Physician visit details Benefits paid by type of service Plan funding/budget comparison Fixed expense comparison 3

4 PCORI Fee Calculation for Self-Funded Plan Assist in Reinsurance Fee calculation and website filing for self-funded plan Assist and coordinate vendor conference calls for 6055/6056 reporting Provide stop loss policy summary annually Legislative and Corporate Compliance Support: Provide legislative updates, including Technical Bulletins and Directions newsletters Evaluate plan design to assist with compliance with state and federal regulations Review benefit plan documents, including summary plan descriptions, contracts, employee summaries, and policies/procedures Conduct periodic seminars on regulatory issues Assist with the review and evaluation of COBRA and HIPAA compliance procedures Provide general information and guidance to assist with compliance with ERISA, FMLA, USERRA, Medicare Part D and other Federal legislation that directly affects the administration of plan benefits Provide template or sample compliance notices, certificates of creditable coverage and enrollment forms as reasonably requested by Client Carrier Marketing and Negotiations (as requested): Work with Client to develop a strategy to identify goals, analyze program costs and review both current and alternative funding arrangements Manage the renewal process with the current carrier to control costs Implement carrier renewal strategies with NFTA Develop timeline covering every aspect from RFP preparation to the delivery of employee communications Provide analysis of employee disruption report and preparation of geo-access report Provide analysis of discounts offered by various carriers by using CPT codes and carrier pricing data Manage RFP development that tailors the RFP to the desires, needs and financial directions provided by NFTA Explore alternative funding solutions Evaluate vendor responses to track variations in coverage and costs as they are identified Conduct finalist interviews to investigate and document intangibles such as personalities, service orientation and responsiveness Draft renewal analysis report, based on renewal negotiation, covers program and claims cost projections as well as complete information on benefit designs Facilitate decision process by coordinating close collaboration and discussions with the NFTA Day to Day Administrative Assistance Employee Education Programs: Facilitate focus groups Monthly benefit communication directed to employees Educational meetings on coverage and trends Communication Materials: Assist with the drafting and distribution of participant Satisfaction Surveys 4

5 Assist with the drafting and distribution of Open Enrollment-New Member Orientation summary information and any other communications pertaining to the health and welfare program Provide annual open enrollment guidance and employee meeting materials Assist with marketing and oversight of Customized Enrollment Materials (if elected) Assist with participant wellness initiatives, as directed by Client Provide Human Resources with a Medicare D Creditable Coverage Letter Benefit Administration Assessment: Periodic evaluation of internal plan enrollment and benefit termination processes Review, coordinate and implement NFTA agreed upon plan best practices to help limit plan liability and increase participant satisfaction Help identify opportunities for streamlining and improving administration procedures Remind Human Resources to register Rx plans on CMS website Assist Human Resources in Medicare Secondary Payer Questionnaires Market Benchmarking Studies: Local Area Surveys Industry Surveys Merger and Acquisition: Project claim liability and cost implications of active employee health welfare benefits plan integration or consolidation, as requested Provide coverage comparison analysis and recommendations as to plan design, carrier selections and funding mechanisms Provide disruption analysis reports Assist with employee meetings to introduce integrated program(s) or plan changes Benefit Plan Design (or Redesign): Help identify business and HR objectives that impact benefits Review with possible benefit strategies to meet objectives Help evaluate/review current scope of benefits package e.g., types & levels of coverage Work to develop funding and contribution strategies Assist with budget projections for design alternatives Term of Agreement The term of an agreement is for a period of three years, with four one-year renewal options to be exercised at the discretion of the NFTA. Cost Proposal Submit a monthly cost for the requested services for all seven years of the contract. Also, submit an hourly rate for any service that may be required that is not included in the Scope of Work. 5

6 Submit responses to the following questions in the proposal: 1. How would you describe the integrity and ethics of your organization? Can you provide specific examples? Have you received any recognition for these principles? 2. Do you provide educational/communication materials? Can you provide samples? 3. Do you have attorneys on staff, if so how many? 4. Do you charge extra for legal guidance? If so please detail rates. 5. Do you offer a private exchange solution? Please provide specifics 6. What is the longevity of your average client and staff members who would be working on the account? Where are they located? 7. Do you have underwriters or actuaries on staff, if so how many? 8. How do you disclose fees/commissions to your clients? How often? 9. How many public entity clients do you currently work with? What is their average size? 10. What percentage of your business is clients who are self-funded for medical? 11. The medical benefits field continues to become more regulated and complicated; how do your compliance recourses, updates and legal support team operate with your clients? 12. Please provide the frequency and format with which you provide information to your clients. 13. What recommendations have you assisted your client with when trying to help control and manage costs? 14. Do you provide a proactive wellness initiative? Please describe. 15. Are there any qualities that are unique to your organization compared to other broker/consulting firms? 6

7 INSURANCE SPECIFICATIONS The Consultant agrees to procure and maintain, for the term of the Agreement, insurance of the kinds and in the amounts hereafter required, with insurance companies authorized to do business in New York State, covering all operations under this Agreement whether performed by it or its sub-contractors. The insurance companies affording coverage must be deemed acceptable to the Authority throughout the term of this contract. If any insurance company is deemed unacceptable to the Authority the Contractor aggress to procure and maintain at its expense coverage with an acceptable insurer as soon as notified by the Authority. The policies shall provide for a 30-day notice to the Authority prior to termination, cancellation or change. Prior to the execution of the Agreement, the Consultant shall supply the Authority by delivering to the Manager of Procurement, 181 Ellicott St., Buffalo, NY 14203, a certificate(s) of insurance providing evidence of insurance coverage for the Consultant for the following coverage: General Liability Insurance in a comprehensive form including coverage for property damage, bodily injury, personal injury and completed operations with a single limit of at least $1,000,000 per occurrence with a $2,000,000 aggregate. The certificate shall name the Niagara Frontier Transportation Authority and Niagara Frontier Transit Metro System, Inc. as additional insureds. If any motor vehicle is used in the work, Auto Liability Insurance covering bodily injury and property damage with minimum combined single limit of $1,000,000. Workers Compensation and Employer s Liability in accordance with the applicable laws of the State of New York. Professional Liability Insurance, in the amount of $5,000,000. Each insurance policy shall be kept in force until the receipt of final payment to the Consultant except for professional liability insurance, which shall be kept in force until at least one year after final payment to Consultant. The Authority and the Consultant agree to waive all rights against each other for damages to the extent covered by the insurance, except for such rights they may have to the proceeds of such insurance held by the Authority as trustee. The Consultant shall require similar reciprocal waivers by all sub-consultants. This policy shall recognize such waivers of recovery by an appropriate Waiver of Subrogation Clause Endorsement, excluding any subrogation rights granted under New York Law to the contrary notwithstanding. Above needed insurance coverage should be provided on a primary and non-contributory basis. Copies of any required policies shall be provided to the Authority upon request. 7

8 PROPOSAL EVALUATION An NFTA Selection Team will evaluate proposals. The team will select the proponent whose proposal is most advantageous to the NFTA, considering the evaluation criteria. Selection Procedure 1. The selection team will evaluate and score all proposals received. 2. Proposals not meeting minimum requirements and those that are not responsive, will not be given further consideration. 3. Proposals in the competitive range will be determined. These proponents may be asked to present their proposal to the selection team. 4. When presentations, discussions and negotiations are concluded, NFTA may request revised proposals and /or best and final offers from responsible proponents in the competitive range. 5. Proposals will be re-evaluated and scored. The selection team will recommend that the proponent with the highest overall score be awarded the contract. The recommendation must be approved by the NFTA Board of Commissioners prior to the execution of a contract. NOTE: NFTA reserves the right to make the award based upon the initial proposals submitted, without presentations or discussions. Evaluation Criteria (Listed in order of importance) 1. Qualifications and experience: Demonstrated ability in the industry, references, past performance, key personnel, organization, and management. 40% 2. Compliance with requirements: Approach, methods and systems proposed. 30% 3. Cost. 30% 8

9 PROPOSAL INSTRUCTIONS 1. INTRODUCTION This Request for Proposal ("RFP") invites proposals for HEALTH BENEFITS CONSULTING SERVICES as set forth herein. These services may be modified during contract negotiations between the Proponent and the NFTA. The Proponent is encouraged to use its previous knowledge and experience to develop a proposal to meet the NFTA s needs and a time schedule for completion within the constraints set forth in the project description and technical requirements. This RFP does not commit the NFTA to negotiate a contract, nor does it obligate the NFTA to pay for any costs incurred in preparation and submission of proposals or costs incurred prior to entering into a formal agreement. Proposals will be accepted until 11:00 am, AUGUST 2, 2016 at the Office of the Manager, Procurement, Fifth Floor, Metropolitan Transportation Center, 181 Ellicott Street, Buffalo, New York Proposals should be submitted in an opaque, sealed envelope. Proposals received after the date and time specified above shall be considered late proposals and, therefore, shall not be opened nor considered for award. The RFP number must be referenced on all submittals and correspondence. 2. PROPONENT QUALIFICATIONS To be considered qualified, the Proponent must demonstrate in its proposal that it has the background, experience, and the technical and management resources required to organize and conduct the services outlined in this RFP. The Proponent shall furnish information documenting its ability to provide and perform all work related to its implementation and ongoing effectiveness of the project, in a timetable acceptable by the NFTA. The NFTA reserves the right to investigate the qualifications of firms under consideration to confirm any part of the information furnished by the Proponent. Anything less than satisfactory performance on a prior NFTA contract may lead to the NFTA concluding that the Proponent is not qualified. 2.1 Joint Venture: Proposals submitted by a joint venture shall not be considered unless the contractual responsibilities of the parties to the joint venture are clearly and specifically identified. 2.2 Validity Period: The proposal shall be considered valid for the period of time it takes to negotiate a contract with the successful Proponent. This may involve a period of up to 90 days following submittal. If a proposal is not valid for this time period, notification of the valid time period must be made in the letter of transmittal. 2.3 Disclosure of Proposal Data: Access to the NFTA s records is governed by Article 6 of the Public Officers Law of the State of New York ( Freedom of Information Law ). Except as otherwise required by the Freedom of Information 9

10 Law, the NFTA will exempt from disclosure records submitted in the proposal which are trade secrets or are maintained for the regulation of commercial enterprise which if disclosed would cause substantial injury to the competitive position of the subject enterprise. Any such records that an Offeror believes should be exempted from disclosure shall be specifically identified and marked as such. Blanket-type identification by designating whole pages or sections as records exempt from disclosure will not assure confidentiality. The specific records must be clearly identified and an explanation submitted as to why they should be exempt. Proposal Forms shall not be designated to be proprietary. The NFTA will disregard any proprietary markings on any Proposal Form. NFTA will not be liable for disclosure of information not marked consistent with the instructions above. Upon a request for records from a third party regarding any records submitted with this proposal for which an exemption was sought the NFTA will notify in writing the party involved. The party involved must respond within 10 (ten) business days with a written statement of the necessity for the continuation of such exemption. 2.4 Agreement: The Proponent awarded the contract will be required to execute an Agreement in a form acceptable to the Authority. 3. RFP AMENDMENTS/QUESTIONS This RFP represents a written statement on the part of the NFTA explaining the requirements, terms, and conditions for submissions of proposals. The RFP covers this material as comprehensively and completely as it can at this time and thus contains all representations of the NFTA with respect to this matter. Any information or understandings, verbal or written, which are not contained within this RFP, or in later written addenda to this RFP, if issued, will be excluded from consideration in evaluating proposals. Any questions, objections or requests for revisions which Proponents may have should be submitted in writing to Andrea Herald via and received no later than July 15, If questions submitted to the NFTA make issuance of addenda to this RFP necessary, such addenda will be distributed to all prospective Proponents. However, it is the responsibility of the Proponent to determine whether addenda have been issued and to acknowledge their receipt in its proposal. 4. PROPOSAL PROTEST PROCEDURES 4.1 Pre-Submittal Opening Protests: If a Proponent can demonstrate that the Contract Documents issued by the NFTA are unduly exclusionary and restrictive or that federal, state or local laws or regulations have been violated during the course of the procurement, then the Proponent may seek a review by the Executive Director or his appointed representative, at 181 Ellicott Street, Buffalo, New York Protests shall 10

11 be clearly identified as Protests and submitted in writing as early as possible but no later than five (5) business days before the date specified for proposal submittal. Within four (4) business days after receipt of a pre-submittal protest, the Executive Director shall make one of the determinations listed in paragraph Post-Submittal Protests: A protest to the acceptance or rejection of any or of all proposals for a contract, or to the award thereof, or to any such action proposed or intended by the NFTA, must be received in writing by the Executive Director no later than five (5) business days after the protesting party first learned, or reasonably ought to have learned, of the action or the proposed or intended action to which he/she protests. 4.3 Decision-Makers: In the event the protester alleges that the Executive Director or the representative appointed by the Executive Director to serve as Decision-Maker for the particular protest, engaged in improper conduct during the subject procurement, the General Counsel shall serve as the Decision-Maker. In the event it has been alleged that the General Counsel has engaged in improper conduct during the subject procurement, either the Executive Director or the Chief Financial Officer shall serve as the Decision-Maker. 4.4 Rulings on Protests: Within four (4) business days, the Executive Director shall render one of the following determinations: (a) Protest is overruled. (b) Protest is substantiated. Executive Director shall issue instructions to remedy issues relating to the protest. (c) Procurement activity is suspended until written notification by the Executive Director. The determination shall be in writing and shall provide at a minimum a general response to each material issue raised in the protest. All documents submitted by the Protester and/or Authority Staff and reviewed by the Decision-Maker in the reaching of a determination shall form and be retained by the Authority as the formal record of the dispute resolution process. The issuance of the foregoing determination is the NFTA's final decision of the dispute. All interested parties shall be notified of any protests that are filed. The NFTA shall refrain from awarding a contract within five (5) business days of the date of a decision rendered by the Executive Director regarding a protest, unless the NFTA determines that: (a) The items to be procured are urgently required. (b) Delivery or performance will be unduly delayed by failure to make a prompt award. (c) Failure to make a prompt award will otherwise cause undue harm to the NFTA, state government or the federal government. 4.5 Protester s Appeal to Federal or State Agencies: In the event that the NFTA fails to have written protest procedures or fails to abide by the protest procedures set forth 11

12 above, and federal or state funds are participating in the procurement, then the protester may seek a review by the appropriate funding agency. Protesters shall file such a protest in accordance with the requirements set forth below, not later than five (5) business days after a final decision is rendered under the NFTA's protest procedure. In instances where the protester alleges that the NFTA failed to make a final determination on the protest, protesters shall file a protest with the appropriate agency not later than five (5) business days after the protester knew or should have known of the NFTA's failure to render a final determination on the protest. 5. PROPOSAL The Proponent shall submit 5 hard copies of their proposal and 1 electronic copy. 5.1 Format: The proposal must be in compliance with the format described herein. The proposal shall be prepared on 8-1/2" x 11" paper bound on the long side. All pages are to be sequentially numbered. Unnecessarily elaborate proposals are not desired. Proposals should be concise, particularly with respect to past experience on other projects and the resumes of key personnel. Related experience is essential. Be specific on past and current assignments. Define the firm's involvement and responsibilities in each project. Electronic Copy: The electronic copy of the proposal must be included with the hard copies of the proposal. The electronic copy must be submitted in the form of a CD or flash drive. An ed copy of the electronic version will not be accepted. The Proponent's technical proposal shall be prepared using the following format to facilitate evaluation. If a Proponent fails to provide the information requested in one or more sections, the proposal may be considered non-responsive. 5.2 Content: The proposal shall contain the following items: Cover Letter Project Implementation Project Organization Key Personnel Related Projects Background Experience Cost Proposal Proposal Forms - Completed as appropriate with supplemental data. (Refer to Forms and Reference Section) Cover Letter: The proposal shall be submitted with a cover letter summarizing key points in the proposal. Any introductory remarks may also be placed in the cover letter. Provide a contact name, address, phone number and address. The cover letter should not exceed three pages in length Project Implementation: The Proponent shall describe its plans to provide the requested services. This section should include a narrative description of the proposed 12

13 methodology to accomplish the required tasks, as well as any innovations used on similar projects which may be applicable to the project Project Organization: This section of the proposal should be used to provide information on the Proponent s organization and staffing of the project. It should briefly describe the Proponent s personnel and pertinent qualifications Key Personnel: A list of key personnel for this project must be submitted along with resumes for each person Related Projects: A list of other contracts entered into by your firm that are similar to this project should be provided. Each should include the degree of involvement by your firm Background Experience: This section should contain a brief history of your firm, names of principals, concise description of the types of work accomplished, indication of current staff size and location and other relevant background information. This section should also contain information demonstrating that your firm has a good working relationship with its clients, including a list of references (include contact names, addresses, phone numbers) copies of letters of commendation and a discussion of how problems arising during the course of project are addressed. Indicate if your firm has ever defaulted on a contract; describe the circumstances and outcome Project Cost Proposal: Submit an itemized cost proposed Proposal Forms: All forms requiring Proponent responses must be completed and submitted with the proposal. 13

14 NEW YORK STATE CONTRACT REQUIREMENTS: 1. Executory Clause In accordance with Section 41 of the State Finance Law, the State shall have no liability under this contract to the Contractor or to anyone else beyond funds appropriated and available for this contract. 2. Permits and Compliance with Laws The NFTA, in the construction, installation and operation of transportation facilities, is not required to obtain licenses or permits from any municipal or political subdivision of the State of New York. The Contractor, therefore, will not be required to obtain licenses or permits from any county, city, town or village agency or department. The Contractor shall, however, secure and pay for all permits, fees and licenses necessary to comply with applicable federal or state laws. Except as provided above, the Contractor shall comply with all federal, state, county and municipal laws, codes and regulations in connection with the prosecution of the work. The Contractor shall protect, indemnify and hold harmless the NFTA and all of their officers, agents and employees against any and all claims and liabilities arising from or based on the violation of any such requirement or law whether by the Contractor, its employees, agents or subcontractors. 3. Non-Assignment In accordance with Section 138 of the State Finance Law, this contract may not be assigned by the Contractor or its right, title or interest therein assigned, transferred, conveyed, sublet or otherwise disposed of without the State s previous written consent, and attempts to do so are null and void. Notwithstanding the foregoing, such prior written consent of an assignment of a contract let pursuant to Article XI of the State Finance Law may be waived at the discretion of the contracting agency and with the concurrence of the State Comptroller where the original contract was subject to the State Comptroller s approval, where the assignment is due to a reorganization, merger or consolidation of the Contractor s business entity or enterprise. The State retains its right to approve an assignment and to require that any Contractor demonstrate its responsibility to do business with the State. The Contractor may, however, assign its right to receive payments without the State s prior written consent unless this contract concerns Certificates of Participation pursuant to Article 5-A of the State Finance Law. 4. Worker s Compensation In accordance with Section 142 of the State Finance Law, this contract shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this contract for the benefit of such employees as are required to be covered by the provisions of the Workers' Compensation Law. 5. Non-Discrimination Requirements To the extent required by Article 15 of the Executive Law (also known as the Human Rights Law) and all other State and Federal statutory and constitutional nondiscrimination provisions, the Contractor will not discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, sexual orientation, age, disability, genetic predisposition or carrier status, or marital status. 14

15 Furthermore, in accordance with Section 220-e of the Labor Law, if this is a contract for the construction, alteration or repair of any public building or public work or for the manufacture, sale or distribution of materials, equipment or supplies, and to the extent that this contract shall be performed within the State of New York, Contractor agrees that neither it nor its subcontractors shall, by reason of race, creed, color, disability, sex, or national origin: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. If this is a building service contract as defined in Section 230 of the Labor Law, then, in accordance with Section 239 thereof, Contractor agrees that neither it nor its subcontractors shall by reason of race, creed, color, national origin, age, sex or disability: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. Contractor is subject to fines of $50.00 per person per day for any violation of Section 220-e or Section 239 as well as possible termination of this contract and forfeiture of all moneys due hereunder for a second or subsequent violation. 6. Wage and Hours Provisions If this is a public work contract covered by Article 8 of the Labor Law or a building service contract covered by Article 9 thereof, neither Contractor's employees nor the employees of its subcontractors may be required or permitted to work more than the number of hours or days stated in said statutes, except as otherwise provided in the Labor Law and as set forth in prevailing wage and supplement schedules issued by the State Labor Department. Furthermore, Contractor and its subcontractors must pay at least the prevailing wage rate and pay or provide the prevailing supplements, including the premium rates for overtime pay, as determined by the State Labor Department in accordance with the Labor Law. Additionally, effective April 28, 2008, if this is a public work contract covered by Article 8 of the Labor Law, the Contractor understands and agrees that the filing of payrolls in a manner consistent with Subdivision 3-a of Section 220 of the Labor Law shall be a condition precedent to payment by the State of any State approved sums due and owing for work done upon the project. 7. Non-Collusion Bidding Certification In accordance with Section 139-d of the State Finance Law, if this contract was awarded based upon the submission of bids, Contractor affirms, under penalty of perjury, that its bid was arrived at independently and without collusion aimed at restricting competition. Contractor further affirms that, at the time Contractor submitted its bid, an authorized and responsible person executed and delivered to the State a non-collusive bidding certification on Contractor's behalf. 8. International Boycott Prohibition In accordance with Section 220-f of the Labor Law and Section 139-h of the State Finance Law, if this contract exceeds $5,000, the Contractor agrees, as a material condition of the contract, that neither the Contractor nor any substantially owned or affiliated person, firm, partnership or corporation has participated, is participating, or shall participate in an international boycott in violation of the federal Export Administration Act of 1979 (50 USC App. Sections 2401 et seq.) or regulations thereunder. If such Contractor, or any of the 15

16 aforesaid affiliates of Contractor, is convicted or is otherwise found to have violated said laws or regulations upon the final determination of the United States Commerce Department or any other appropriate agency of the United States subsequent to the contract's execution, such contract, amendment or modification thereto shall be rendered forfeit and void. The Contractor shall so notify the State Comptroller within five (5) business days of such conviction, determination or disposition of appeal (2NYCRR 105.4). 9. Set-Off Rights The State shall have all of its common law, equitable and statutory rights of set-off. These rights shall include, but not be limited to, the State's option to withhold for the purposes of set-off any moneys due to the Contractor under this contract up to any amounts due and owing to the State with regard to this contract, any other contract with any State department or agency, including any contract for a term commencing prior to the term of this contract, plus any amounts due and owing to the State for any other reason including, without limitation, tax delinquencies, fee delinquencies or monetary penalties relative thereto. The State shall exercise its set-off rights in accordance with normal State practices including, in cases of set-off pursuant to an audit, the finalization of such audit by the State agency, its representatives, or the State Comptroller. 10. Records The Contractor shall establish and maintain complete and accurate books, records, documents, accounts and other evidence directly pertinent to performance under this contract (hereinafter, collectively, "the Records"). The Records must be kept for the balance of the calendar year in which they were made and for six (6) additional years thereafter. The State Comptroller, the Attorney General and any other person or entity authorized to conduct an examination, as well as the agency or agencies involved in this contract, shall have access to the Records during normal business hours at an office of the Contractor within the State of New York or, if no such office is available, at a mutually agreeable and reasonable venue within the State, for the term specified above for the purposes of inspection, auditing and copying. The State shall take reasonable steps to protect from public disclosure any of the Records which are exempt from disclosure under Section 87 of the Public Officers Law (the "Statute") provided that: (i) the Contractor shall timely inform an appropriate State official, in writing, that said records should not be disclosed; and (ii) said records shall be sufficiently identified; and (iii) designation of said records as exempt under the Statute is reasonable. Nothing contained herein shall diminish, or in any way adversely affect, the State's right to discovery in any pending or future litigation. 11. Identifying Information and Privacy Notification (a) Identification Number(s). Every invoice or New York State Claim for Payment submitted to a New York State agency by a payee, for payment for the sale of goods or services or for transactions (e.g., leases, easements, licenses, etc.) related to real or personal property must include the payee's identification number. The number is any or all of the following: (i) the payee s Federal employer identification number, (ii) the payee s Federal social security number, and/or (iii) the payee s Vendor Identification Number assigned by the Statewide Financial System. Failure to include such number or numbers 16

17 may delay payment. Where the payee does not have such number or numbers, the payee, on its invoice or Claim for Payment, must give the reason or reasons why the payee does not have such number or numbers. (b) Privacy Notification. (1) The authority to request the above personal information from a seller of goods or services or a lessor of real or personal property, and the authority to maintain such information, is found in Section 5 of the State Tax Law. Disclosure of this information by the seller or lessor to the State is mandatory. The principal purpose for which the information is collected is to enable the State to identify individuals, businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally identify persons affected by the taxes administered by the Commissioner of Taxation and Finance. The information will be used for tax administration purposes and for any other purpose authorized by law. (2) The personal information is requested by the purchasing unit of the agency contracting to purchase the goods or services or lease the real or personal property covered by this contract or lease. The information is maintained in the Statewide Financial System by the Vendor Management Unit within the Bureau of State Expenditures, Office of the State Comptroller, 110 State Street, Albany, New York PARTICIPATION BY MINORITY GROUP MEMBERS AND WOMEN WITH RESPECT TO STATE CONTRACTS: REQUIREMENTS AND PROCEDURES I. General Provisions A. The NFTA is required to implement the provisions of New York State Executive Law Article 15-A and 5 NYCRR Parts ( MWBE Regulations ) for all State contracts as defined therein, with a value (1) in excess of $25,000 for labor, services, equipment, materials, or any combination of the foregoing or (2) in excess of $100,000 for real property renovations and construction. B. The contractor to the subject contract (the Contractor and the Contract, respectively) agrees, in addition to any other nondiscrimination provision of the Contract and at no additional cost to the NFTA, to fully comply and cooperate with the NFTA in the implementation of New York State Executive Law Article 15-A. These requirements include equal employment opportunities for minority group members and women ( EEO ) and contracting opportunities for certified minority and women-owned business enterprises ( MWBEs ). The Contractor s demonstration of good faith efforts pursuant to 5 NYCRR shall be a part of these requirements. These provisions shall be deemed supplementary to, and not in lieu of, the nondiscrimination provisions required by New York State Executive Law Article 15 (the Human Rights Law ) or other applicable federal, state or local laws. C. Failure to comply with all of the requirements herein may result in a finding of nonresponsiveness, non-responsibility and/or a breach of contract, leading to the withholding of funds or such other actions, liquidated damages pursuant to Section VII of this Appendix or enforcement proceedings as allowed by the Contract. 17

18 II. Contract Goals A. For purposes of this procurement, the NFTA hereby establishes an overall goal of 30% for MWBE participation, 15% for New York State certified minority-owned business enterprises ( MBE ) participation and 15% for New York State certified women-owned business enterprises ( WBE ) participation (collectively, MWBE Contract Goals ) based on the current availability of qualified MBEs and WBEs. B. For purposes of providing meaningful participation by MWBEs on the Contract and achieving the MWBE Contract Goals established in Section II-A hereof, the Contractor should reference the directory of New York State Certified MBWEs found at the following internet address: Additionally, the Contractor is encouraged to contact the Division of Minority and Woman Business Development ((518) ; (212) ; or (716) ) to discuss additional methods of maximizing participation by MWBEs on the Contract. C. Where MWBE Contract Goals have been established herein, pursuant to 5 NYCRR 142.8, the Contractor must document good faith efforts to provide meaningful participation by MWBEs as subcontractors or suppliers in the performance of the Contract. In accordance with Section 316-a of Article 15-A and 5 NYCRR , the Contractor acknowledges that if it is found to have willfully and intentionally failed to comply with the MWBE participation goals set forth in the Contract, such a finding constitutes a breach of contract and the Contractor shall be liable to the NFTA for liquidated or other appropriate damages, as set forth herein. III. Equal Employment Opportunity (EEO) A. The Contractor agrees to be bound by the provisions of Article 15-A and the MWBE Regulations promulgated thereunder by the Division of Minority and Women's Business Development of the New York State Department of Economic Development (the Division ). If any of these terms or provisions conflict with applicable law or regulations, such laws and regulations shall supersede these requirements. B. The Contractor shall comply with the following provisions of Article 15-A: 1. Each contractor and subcontractor performing work on the Contract shall undertake or continue existing EEO programs to ensure that minority group members and women are afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. For these purposes, EEO shall apply in the areas of recruitment, employment, job assignment, promotion, upgrading, demotion, transfer, layoff, or termination and rates of pay or other forms of compensation. 18

19 2. The Contractor shall submit an EEO policy statement to the NFTA within seventy two (72) hours after the date of the notice by NFTA to award the Contract to the Contractor. 3. If the Contractor or Subcontractor does not have an existing EEO policy statement, the NFTA may provide the Contractor or Subcontractor a model statement (see Form Minority and Women-Owned Business Enterprises Equal Employment Opportunity Policy Statement). 4. The Contractor s EEO policy statement shall include the following language: a. The Contractor will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, sex, age, disability or marital status, will undertake or continue existing EEO programs to ensure that minority group members and women are afforded equal employment opportunities without discrimination, and shall make and document its conscientious and active efforts to employ and utilize minority group members and women in its work force. b. The Contractor shall state in all solicitations or advertisements for employees that, in the performance of the contract, all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. c. The Contractor shall request each employment agency, labor union, or authorized representative of workers with which it has a collective bargaining or other agreement or understanding, to furnish a written statement that such employment agency, labor union, or representative will not discriminate on the basis of race, creed, color, national origin, sex age, disability or marital status and that such union or representative will affirmatively cooperate in the implementation of the Contractor's obligations herein. d. The Contractor will include the provisions of Subdivisions (a) through (c) of this Subsection 4 and Paragraph E of this Section III, which provides for relevant provisions of the Human Rights Law, in every subcontract in such a manner that the requirements of the subdivisions will be binding upon each Subcontractor as to work in connection with the Contract. C. Staffing Plan To ensure compliance with this Section, the Contractor shall submit a staffing plan to document the composition of the proposed workforce to be utilized in the performance of the Contract by the specified categories listed, including ethnic background, gender, and Federal occupational categories. The Contractor shall complete the Staffing plan form and submit it as part of their bid or proposal or within a reasonable time, but no later than the time of award of the contract. (See attached form and instructions at the end of this document.) 19

20 D. Workforce Employment Utilization Report (Workforce Utilization Reports shall be collected on a monthly basis for construction contracts and on a quarterly basis for all other contracts.) 1. The Contractor shall submit a Workforce Report, and shall require each of its Subcontractors to submit a Workforce Report, in such format as shall be required by NFTA on a [MONTHLY/QUARTERLY] basis during the term of the contract. (See attached form and instructions at the end of this document. Also attached is the EEO-1 JOB CLASSIFICATION GUIDE, 2014.) 2. Separate forms shall be completed by Contractor and any Subcontractor. 3. In limited instances, the Contractor may not be able to separate out the workforce utilized in the performance of the Contract from the Contractor's and/or Subcontractor's total workforce. When a separation can be made, the Contractor shall submit the Workforce Report and indicate that the information provided related to the actual workforce utilized on the Contract. When the workforce to be utilized on the contract cannot be separated out from the Contractor's and/or Subcontractor's total workforce, the Contractor shall submit the Workforce Report and indicate that the information provided is the Contractor's total workforce during the subject time frame, not limited to work specifically under the contract. E. The Contractor shall comply with the provisions of the Human Rights Law, all other State and Federal statutory and constitutional non-discrimination provisions. The Contractor and Subcontractors shall not discriminate against any employee or applicant for employment because of race, creed (religion), color, sex, national origin, sexual orientation, military status, age, disability, predisposing genetic characteristic, marital status or domestic violence victim status, and shall also follow the requirements of the Human Rights Law with regard to non-discrimination on the basis of prior criminal conviction and prior arrest. IV. MWBE Utilization Plan A. The Contractor represents and warrants that Contractor has submitted an MWBE Utilization Plan, by submitting evidence thereof through the New York State Contract System ( NYSCS ), which can be viewed at provided, however, that the Contractor may arrange to provide such evidence via a non-electronic method to NFTA, either prior to, or at the time of, the execution of the contract. B. The Contractor agrees to use such MWBE Utilization Plan for the performance of MWBEs on the Contract pursuant to the prescribed MWBE goals set forth in Section III-A of this Appendix. C. The Contractor further agrees that a failure to submit and/or use such MWBE Utilization Plan shall constitute a material breach of the terms of the Contract. Upon the occurrence of such a material breach, NFTA shall be entitled to any 20

21 V. Waivers remedy provided herein, including but not limited to, a finding of the Contractor non-responsiveness. A. For Waiver Requests, the Contractor should use the NYSCS, provided, however, that Bidder may arrange to provide such evidence via a non-electronic method to NFTA. B. If the Contractor, after making good faith efforts, is unable to comply with MWBE goals, the Contractor may submit a Request for Waiver documenting good faith efforts by the Contractor to meet such goals. If the documentation included with the waiver request is complete, the NFTA shall evaluate the request and issue a written notice of acceptance or denial within twenty (20) days of receipt. C. If the NFTA, upon review of the MWBE Utilization Plan and updated Quarterly MWBE Contractor Compliance Reports determines that the Contractor is failing or refusing to comply with the MWBE Contract Goals and no waiver has been issued in regards to such non-compliance, the NFTA may issue a notice of deficiency to the Contractor. The Contractor must respond to the notice of deficiency within seven (7) business days of receipt. Such response may include a request for partial or total waiver of MWBE Contract Goals. VI. Quarterly MWBE Contractor Compliance Report The Contractor is required to submit a Quarterly MWBE Contractor Compliance Report through the NYSCS, provided, however, that Bidder may arrange to provide such evidence via a non-electronic method to the NFTA by the 10 th day following each end of quarter over the term of the Contract documenting the progress made towards achievement of the MWBE goals of the Contract. VII. Liquidated Damages - MWBE Participation A. Where NFTA determines that the Contractor is not in compliance with the requirements of the Contract and the Contractor refuses to comply with such requirements, or if the Contractor is found to have willfully and intentionally failed to comply with the MWBE participation goals, the Contractor shall be obligated to pay to the NFTA liquidated damages. B. Such liquidated damages shall be calculated as an amount equaling the difference between: 1. All sums identified for payment to MWBEs had the Contractor achieved the contractual MWBE goals; and 2. All sums actually paid to MWBEs for work performed or materials supplied under the Contract. 21

22 C. In the event a determination has been made which requires the payment of liquidated damages and such identified sums have not been withheld by the NFTA, the Contractor shall pay such liquidated damages to the NFTA within sixty (60) days after they are assessed by the NFTA unless prior to the expiration of such sixtieth day, the Contractor has filed a complaint with the Director of the Division of Minority and Woman Business Development pursuant to Subdivision 8 of Section 313 of the Executive Law in which event the liquidated damages shall be payable if Director renders a decision in favor of the NFTA. 13. SERVICE-DISABLED VETERAN-OWNED BUSINESSES (SDVOBs) Article 17-B of the Executive Law enacted in 2014 acknowledges that Service-Disabled Veteran-Owned Businesses (SDVOBs) strongly contribute to the economies of the State and the nation. As defenders of our nation and in recognition of their economic activity in doing business in New York State, bidders/proposers for this contract for commodities, services or technology are strongly encouraged and expected to consider SDVOBs in the fulfillment of the requirements of the contract. Such partnering may be as subcontractors, suppliers, protégés or other supporting roles. SDVOBs can be readily identified on the directory of certified businesses at: Bidders/proposers need to be aware that all authorized users of this contract will be strongly encouraged to the maximum extent practical and consistent with legal requirements of the State Finance Law and the Executive Law to use responsible and responsive SDVOBs in purchasing and utilizing commodities, services and technology that are of equal quality and functionality to those that may be obtained from non- SDVOBs. Furthermore, bidders/proposers are reminded that they must continue to utilize small, minority and women-owned businesses consistent with current State law. Utilizing SDVOBs in State contracts will help create more private sector jobs, rebuild New York State s infrastructure, and maximize economic activity to the mutual benefit of the contractor and its SDVOB partners. SDVOBs will promote the contractor s optimal performance under the contract, thereby fully benefiting the public sector programs that are supported by associated public procurements. Public procurements can drive and improve the State s economic engine through promotion of the use of SDVOBs by its contractors. The State, therefore, expects bidders/proposers to provide maximum assistance to SDVOBs in their contract performance. The potential participation by all kinds of SDVOBs will deliver great value to the State and its taxpayers. The SDVOB goal for this procurement is 6%. Complete the attached Use of Service-Disabled Veteran-Owned Business Enterprises in Contract Performance form and submit with your bid/proposal. 14. Conflicting Terms In the event of a conflict between the terms of the contract (including any and all attachments thereto and amendments thereof) and the terms of this Request for Proposal, the terms of this Request for Proposal shall control. 22

23 15. Governing Law This contract shall be governed by the laws of the State of New York except where the Federal supremacy clause requires otherwise. 16. Late Payment Timeliness of payment and any interest to be paid to Contractor for late payment shall be governed by Article 11-A of the State Finance Law to the extent required by law. 17. No Arbitration Disputes involving this contract, including the breach or alleged breach thereof, may not be submitted to binding arbitration (except where statutorily authorized), but must, instead, be heard in a court of competent jurisdiction of the State of New York. 18. Service of Process In addition to the methods of service allowed by the State Civil Practice Law & Rules ("CPLR"), Contractor hereby consents to service of process upon it by registered or certified mail, return receipt requested. Service hereunder shall be complete upon Contractor's actual receipt of process or upon the State's receipt of the return thereof by the United States Postal Service as refused or undeliverable. Contractor must promptly notify the State, in writing, of each and every change of address to which service of process can be made. Service by the State to the last known address shall be sufficient. Contractor will have thirty (30) calendar days after service hereunder is complete in which to respond. 19. Prohibition on Purchase of Tropical Hardwoods The Contractor certifies and warrants that all wood products to be used under this contract award will be in accordance with, but not limited to, the specifications and provisions of Section 165 of the State Finance Law, (Use of Tropical Hardwoods) which prohibits purchase and use of tropical hardwoods, unless specifically exempted, by the State or any governmental agency or political subdivision or public benefit corporation. Qualification for an exemption under this law will be the responsibility of the contractor to establish to meet with the approval of the State. In addition, when any portion of this contract involving the use of woods, whether supply or installation, is to be performed by any subcontractor, the prime Contractor will indicate and certify in the submitted bid proposal that the subcontractor has been informed and is in compliance with specifications and provisions regarding use of tropical hardwoods as detailed in 165 State Finance Law. Any such use must meet with the approval of the State; otherwise, the bid may not be considered responsive. Under bidder certifications, proof of qualification for exemption will be the responsibility of the Contractor to meet with the approval of the State. 20. Macbride Fair Employment Principles In accordance with the MacBride Fair Employment Principles (Chapter 807 of the Laws of 1992), the Contractor hereby stipulates that the Contractor either (a) has no business operations in Northern Ireland, or (b) shall take lawful steps in good faith to conduct any business operations in Northern Ireland in accordance with the MacBride Fair 23

24 Employment Principles (as described in Section 165 of the New York State Finance Law), and shall permit independent monitoring of compliance with such principles. 21. Omnibus Procurement Act of 1992 It is the policy of New York State to maximize opportunities for the participation of New York State business enterprises, including minority and women-owned business enterprises as bidders, subcontractors and suppliers on its procurement contracts. Information on the availability of New York State subcontractors and suppliers is available from: NYS Department of Economic Development Division for Small Business Albany, New York Telephone: Fax: A directory of certified minority and women-owned business enterprises is available from: NYS Department of Economic Development Division of Minority and Women's Business Development 633 Third Avenue New York, NY The Omnibus Procurement Act of 1992 requires that by signing this bid proposal or contract, as applicable, Contractors certify that whenever the total bid amount is greater than $1 million: (a) (b) (c) The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors, including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State; The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L ), as amended; The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportunities on this project through listing any such positions with the Job Service Division of the New York State Department of Labor, or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said documentation to the State upon request; and 24

25 (d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts. 22. Reciprocity and Sanctions Provisions Bidders are hereby notified that if their principal place of business is located in a country, nation, province, state or political subdivision that penalizes New York State vendors, and if the goods or services they offer will be substantially produced or performed outside New York State, the Omnibus Procurement Act 1994 and 2000 amendments (Chapter 684 and Chapter 383, respectively) require that they be denied contracts which they would otherwise obtain. NOTE: As of May 15, 2002, the list of discriminatory jurisdictions subject to this provision includes the states of South Carolina, Alaska, West Virginia, Wyoming, Louisiana and Hawaii. Contact NYS Department of Economic Development for a current list of jurisdictions subject to this provision. 23. Compliance with New York State Information Security Breach and Notification Act Contractor shall comply with the provisions of the New York State Information Security Breach and Notification Act (General Business Law Section 899-aa; State Technology Law Section 208). 24. Compliance with Consultant Disclosure Law If this is a contract for consulting services, defined for purposes of this requirement to include analysis, evaluation, research, training, data processing, computer programming, engineering, environmental, health, and mental health services, accounting, auditing, paralegal, legal or similar services, then, in accordance with Section 163 (4-g) of the State Finance Law (as amended by Chapter 10 of the Laws of 2006), the Contractor shall timely, accurately and properly comply with the requirement to submit an annual employment report for the contract to the agency that awarded the contract, the Department of Civil Service and the State Comptroller. 25. Procurement Lobbying To the extent this agreement is a "procurement contract" as defined by State Finance Law Sections 139-j and 139-k, by signing this agreement the contractor certifies and affirms that all disclosures made in accordance with State Finance Law Sections 139-j and 139-k are complete, true and accurate. In the event such certification is found to be intentionally false or intentionally incomplete, the State may terminate the agreement by providing written notification to the Contractor in accordance with the terms of the agreement. 26. Certification of Registration to Collect Sales and Compensating Use Tax by Certain State Contractors, Affiliates and Subcontractors To the extent this agreement is a contract as defined by Tax Law Section 5-a, if the contractor fails to make the certification required by Tax Law Section 5-a or if during the term of the contract, the Department of Taxation and Finance or the covered agency, as defined by Tax Law 5-a, discovers that the certification, made under penalty of perjury, is false, then such failure to file or false certification shall be a material breach of this contract 25

26 and this contract may be terminated, by providing written notification to the Contractor in accordance with the terms of the agreement, if the covered agency determines that such action is in the best interest of the State 27. Iran Divestment Act By entering into this Agreement, Contractor certifies in accordance with State Finance Law 165-a that it is not on the Entities Determined to be Non-Responsive Bidders/Offerers pursuant to the New York State Iran Divestment Act of 2012 ( Prohibited Entities List ) posted at: Contractor further certifies that it will not utilize on this contract any subcontractor that is identified on the Prohibited Entities List. Contractor agrees that should it seek to renew or extend this contract, it must provide the same certification at the time the contract is renewed or extended. Contractor also agrees that any proposed Assignee of this contract will be required to certify that it is not on the Prohibited Entities List before the contract assignment will be approved by the State. During the term of the contract, should the state agency receive information that a person (as defined in State Finance Law 165-a) is in violation of the above-referenced certifications, the state agency will review such information and offer the person an opportunity to respond. If the person fails to demonstrate that it has ceased its engagement in the investment activity which is in violation of the Act within 90 days after the determination of such violation, then the state agency shall take such action as may be appropriate and provided for by law, rule, or contract, including, but not limited to, imposing sanctions, seeking compliance, recovering damages, or declaring the Contractor in default. The state agency reserves the right to reject any bid, request for assignment, renewal or extension for an entity that appears on the Prohibited Entities List prior to the award, assignment, renewal or extension 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. GENERAL PROVISIONS 1. Workmanship All work under the contract awarded shall be performed consistent with the proponent qualification set forth herein and, in any event, in a timely skillful, workmanlike and professional manner. The contractor shall not use any employees whose work does not meet the aforementioned standard, and shall remove any such employees from any work assignment involving the contract if requested to do so by NFTA. 2. Indemnification The contractor shall indemnify, defend and hold harmless NFTA, its affiliates and their respective commissioners, officers, employees, representatives and agents from any and all claims, actions, proceedings, investigations, losses, liabilities, damages (including, without limitation damage to property), injury to persons (including, without limitation, death), penalties, fines, costs and expenses (including, without limitation, attorneys fees 26

27 and costs) relating in any way to (i) contractor s proposal, (ii) any act or omission of contractor relating in any way to its performance under the contract, if awarded the contract contemplated hereby, and/or (iii) any default or breach, whether actual or alleged, by contractor. 3. Termination for Convenience NFTA reserves the right to terminate the contract awarded pursuant hereto for convenience and make settlement with the contractor upon an equitable basis as determined by NFTA, which shall fix the value of the services performed by Contractor prior to such termination. In determining the value of the services performed, NFTA shall consider the following: (a) The ratio of the percentage of the services performed by the contractor prior to termination to all Services contracted for, less any payment(s) previously made. (b) The amount of the expense incurred by the contractor in performing the services rendered prior to termination, in proportion to the amount of expense to which the contractor would have incurred had it been allowed to complete all services contracted for, less any payment(s) previously made. (c) The amount of the expense incurred by the contractor in performing the services rendered prior to termination, in proportion to the amount of expense to which the contractor would have incurred had it been allowed to complete all services contracted for, less any payment(s) previously made. In determining the value of the services, NFTA shall give no consideration whatsoever to the profit which the contractor might have made on any of the uncompleted portion of the services. 27

28 FORMS AND REFERENCE SECTION 1. MWBE Forms and Instructions: a. M/WBE Utilization Plan Form b. Request for Waiver Form c. Contractor s Monthly MWBE Payment Report d. Sub-consultant/Subcontractor/ Supplier Monthly Affirmation of Income Payments e. Product Key Code f. Requirement and Document Submission Instructions 2. Division of Service-Disabled Veterans Business Development Form (SDVOB) and Instructions 3. Workforce Utilization Report Form and Instructions (completed by awardee after the contract is awarded and monthly during the contract) 4. Staffing Plan Form and Instructions 5. Non-collusive Proposal Certification Form 6. NYS Finance Law 139-j and 139-k (Lobbying Law) Disclosure Statement 7. Disclosure of Prior Non-Responsibility Form 8. Bidder s/proposer Affirmation and Certification Form 9. Bid/Proposal Submittal Form 10. Exceptions and Deviations Form 11. Acknowledgement of Addenda Form 12. Contractor Certification Form ST-220-TD (complete if total estimated expenditure is in excess of $100,000, not including renewals) 13. EEO-1 Job Classifications Guide,

29 INSTRUCTIONS: M/WBE UTILIZATION PLAN FORM This form must be submitted with any bid, proposal, or proposed negotiated contract. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (M/WBE) under the contract. Attach additional sheets if necessary. Offeror s Name: Federal Identification No.: Address: Solicitation No.: City, State, Zip Code: Project No.: Telephone No.: M/WBE Goals in the Contract: MBE % WBE % Region/Location of Work: 1. Certified M/WBE Subcontractors/Suppliers Name, Address, Address, Telephone No. 2. Classification 3. Federal ID No. 4. Detailed Description of Work (Attach additional sheets, if necessary) 5. Dollar Value of Subcontracts/ Supplies/Services and intended performance dates of each component of the contract. A. NYS ESD CERTIFIED MBE WBE B. NYS ESD CERTIFIED MBE WBE 6. IF UNABLE TO FULLY MEET THE MBE AND WBE GOALS SET FORTH IN THE CONTRACT, OFFEROR MUST SUBMIT A REQUEST FOR WAIVER FORM (M/WBE 104). PREPARED BY (Signature): DATE: NAME AND TITLE OF PREPARER (Print or Type): SUBMISSION OF THIS FORM CONSTITUTES THE OFFEROR S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A, 5 NYCRR PART 143, AND THE ABOVE- REFERENCED SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND POSSIBLE TERMINATION OF YOUR CONTRACT. M/WBE 103 (Revised 11/08) TELEPHONE NO.: REVIEWED BY: ADDRESS: FOR M/WBE USE ONLY UTILIZATION PLAN APPROVED: YES NO Date: Contract No.: Project No. (if applicable): DATE: Contract Award Date: Estimated Date of Completion: Amount Obligated Under the Contract: Description of Work: NOTICE OF DEFICIENCY ISSUED: YES NO Date: NOTICE OF ACCEPTANCE ISSUED: YES NO Date: 29

30 REQUEST FOR WAIVER FORM Offeror/Contractor Name: Address: INSTRUCTIONS: SEE PAGE 2 OF THIS ATTACHMENT FOR REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS. Federal Identification No.: Solicitation/Contract No.: City, State, Zip Code: M/WBE Goals: MBE % WBE % Contractor is requesting a: By submitting this form and the required information, the offeror/contractor certifies that every Good Faith Effort has been taken to promote M/WBE participation pursuant to the M/WBE requirements set forth under the contract. 1. MBE Waiver A waiver of the MBE Goal for this procurement is requested. Total Partial 2. WBE Waiver A waiver of the WBE Goal for this procurement is requested. Total Partial 3. Waiver Pending ESD Certification (Check here if subcontractors or suppliers of Contractor are not certified M/WBE, but an application for certification has been filed with Empire State Development.) Date of such filing with Empire State Development: PREPARED BY (Signature): Date: SUBMISSION OF THIS FORM CONSTITUTES THE OFFEROR/CONTRACTOR S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A AND 5 NYCRR PART 143. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND/OR TERMINATION OF THE CONTRACT. Name and Title of Preparer (Printed or Typed): Telephone Number: Address: Submit with the bid or proposal or if submitting after award submit to: Niagara Frontier Transportation Authority Linda Seay, Director EEO/Diversity Development Department 181 Ellicott Street Buffalo, NY M/WBE 104 (Revised 11/08)Design and Construction ******************** FOR M/WBE USE ONLY ******************** REVIEWED BY: DATE: Waiver Granted: YES MBE: WBE: Total Waiver Partial Waiver ESD Certification Waiver *Conditional Notice of Deficiency Issued *Comments: Office of EEO/Diversity Development 30

31 181 Ellicott Street, Buffalo NY Phone: (716) FAX: (716) CONTRACTOR'S MONTHLY MWBE PAYMENT REPORT (DUE ON THE 10TH DAY OF EACH MONTH FOR THE Contract No.: PRECEDING MONTH'S ACTIVITY AS EVIDENCE TOWARDS ACHIEVEMENT OF THE MWBE GOALS ON THE CONTRACT) Contractor/Vendor Name, Contractor/Vendor Federal ID No.: MWBE Goals Reporting Period Address and Phone No.: MBE % WBE % Month Year Description of Project: MBE/WBE Subconsultant/Subcontractor/Supplier Name, Address and Phone Number: Federal ID No.: Federal ID No.: Federal ID No.: Federal ID No.: Description of Work or Supplies Provided Product Code * Designation Payment This Month 0 MBE 0 WBE 0 Sub 0 Supplier 0 Broker 0 Other 0 No Payment This Month 0 MBE 0 WBE 0 Sub 0 Supplier 0 Broker 0 Other 0 No Payment This Month 0 MBE 0 WBE 0 Sub 0 Supplier 0 Broker 0 Other 0 No Payment This Month 0 MBE 0 WBE 0 Sub 0 Supplier 0 Broker 0 Other 0 No Payment This Month Total Payments to Date Total Contract Amount Signature of Firm's Affirmative Action Officer Print Name Date Submission of this form constitutes the contractor's acknowledgement as to the accuracy of the information contained herein. Failure to submit complete and accurate information may result in a finding of noncompliance, non-responsibility, suspension and/or termination of the contract. Reviewed By: For NFTA Use Only: Date: 31

32 Design and Construction Office of EEO/Diversity Development 181 Ellicott Street, Buffalo NY Phone: (716) FAX: (716) MBE/WBE SUBCONSULTANT/SUBCONTRACTOR/SUPPLIER MONTHLY AFFIRMATION OF INCOME PAYMENTS Project No.: Each MBE and WBE Subconsultant/Subcontractor or Supplier must sign and submit this form to NFTA's Office of EEO/Diversity Development by the 10th of each month. Consultant or Contractor Name and Address of Consultant/Contractor or Supplier: Month Description of Work: Reporting Period Year Federal ID No.: Subconsultant Name and Address of MBE/WBE Firm: Classification: D MBE D WBE Date firm commenced work Month Year Federal ID No.: Summary of Payments: D No Income Activity This Month Total MBE/WBE Contract Amount MBE/WBE Payments Received For This R eporting Period Total MBE/WBE Payments Received As Of This Reporting Period _$ _$ _$ Signature of MBE/WBE Company Official Print Name Date This form is required pursuant to contract specifications. Failure to submit will result in noncompliance with contract specifications. Reviewed By: For NFTA Use Only: Date: 32

33 PRODUCT KEY CODE A = Agriculture/ Landscaping (e.g., all forms of landscaping services) B = Mining (e.g., geological investigations) C = Construction C15 = Building Construction General Contractors C16 = Heavy Construction (e.g., highway, pipe laying) C17 = Special Trade Contractors (e.g., plumbing, heating, electrical, carpentry) D = Manufacturing E = Transportation, Communication and Sanitary Services (e.g., delivery services, warehousing, broadcasting and cable systems) F/G = Wholesale/Retail Goods (e.g. hospital supplies and equipment, food stores, computer stores, office supplies G52 = Construction Materials (e.g., lumber, paint, law supplies) H = Financial, Insurance and Real Estate Services I = Services I73 = Business Services (e.g., copying, advertising, secretarial, janitorial, rental services of equipment, computer programming, security services) I81 = Legal Services I82 = Education Services (e.g., AIDS education, automobile safety, tutoring, public speaking) I83 = Social Services (Counselors, vocational training, child care) I87 = Engineering, architectural, accounting, research, management and related services 33

34 REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS When completing the Request for Waiver Form please check all boxes that apply. To be considered, the Request for Waiver Form must be accompanied by documentation for items 1 11, as listed below. If box # 3 has been checked above, please see item 11. Copies of the following information and all relevant supporting documentation must be submitted along with the request: 1. A statement setting forth your basis for requesting a partial or total waiver. 2. The names of general circulation, trade association, and MWBE-oriented publications in which you solicited certified MWBEs for the purposes of complying with your participation goals. 3. A list identifying the date(s) that all solicitations for certified MWBE participation were published in any of the above publications. 4. A list of all certified MWBEs appearing in the NYS Directory of Certified Firms that were solicited for purposes of complying with your certified MWBE participation levels. 5. Copies of notices, dates of contact, letters, and other correspondence as proof that solicitations were made in writing and copies of such solicitations, or a sample copy of the solicitation if an identical solicitation was made to all certified MWBEs. 6. Provide copies of responses made by certified M/WBEs to your solicitations. 7. Provide a description of any contract documents, plans, or specifications made available to certified MWBEs for purposes of soliciting their bids and the date and manner in which these documents were made available. 8. Provide documentation of any negotiations between you, the Offeror/Contractor, and the M/WBEs undertaken for purposes of complying with the certified MWBE participation goals. 9. Provide any other information you deem relevant which may help us in evaluating your request for a waiver. 10. Provide the name, title, address, telephone number, and address of offeror/contractor s representative authorized to discuss and negotiate this waiver request. 11. Copy of notice of application receipt issued by Niagara Frontier Transportation Authority (NFTA). Note: Unless a Total Waiver has been granted, the Offeror/Contractor will be required to submit all reports and documents pursuant to the provisions set forth in the Contract, as deemed appropriate by the NFTA, to determine MWBE compliance. M/WBE 104 Instructions (11/08) 34

35 35

36 Instructions for Submitting the Workforce Utilization Report The Workforce Utilization Report ( Report ) is to be submitted on a monthly basis for construction contracts, and a quarterly basis for all other contracts, during the life of the contract to report the actual workforce utilized in the performance of the contract broken down by job title. When the workforce utilized in the performance of the contract can be separated out from the contractor s and/or subcontractor s total workforce, the contractor and/or subcontractor shall submit a Report of the workforce utilized on the contract. When the workforce to be utilized on the contract cannot be separated out from the contractor s and/or subcontractor s total workforce, information on the contractor s and/or subcontractor s total workforce shall be included in the Report. Reports are to be submitted electronically, using the provided Report worksheet, to Andrea Herald within ten (10) days of the end of each month or quarter, whichever is applicable. Instructions for Completing the Workforce Utilization Report 1. Check off the appropriate box to indicate if the entity completing the Report is the contractor or a subcontractor. 2. Enter the number of the contract that the Report applies to along with the name and address of the contractor or subcontractor for which the Report has been prepared. 3. Check off the box that corresponds to the applicable quarterly or monthly reporting period for this Report. 4. Check off the appropriate box to indicate if the workforce being reported is just for the contract or the contractor s or subcontractor s total workforce. 5. Verify that job titles are provided under the column titled SOC Job Title for each employee whose work will be reflected on the Report. If a necessary job title is not included, please add the corresponding job category, title and corresponding job code to the EEO 1 Job Categories SOC Job Title and SOC Job Code columns from the list of job categories, SOC titles, and SOC codes reflected on the attached Classification Guide. 6. In the first group of boxes, identify the number of hours worked by persons identifying with each racial/ethnic category by gender for each job title in the SOC Job Title column. 7. In the second group of boxes, identify the number of persons identifying with each racial/ethnic category by gender for each job title in the SOC Job Title column. 8. Enter the name and title for the person completing the form, enter the date upon which the Report was completed, and check the box accepting the name entered into the Report as the digital signature of the preparer. Race/Ethnic Identification Race/ethnic designations do not denote scientific definitions of anthropological origins. For the purposes of this Report, an employee must be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one race/ethnic group. The race/ethnic categories for this Report are: o WHITE: (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. o BLACK/AFRICAN AMERICAN: a person, not of Hispanic origin, who has origins in any of the black racial groups of the original peoples of Africa. o HISPANIC/LATINO: a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race. 36

37 o o ASIAN, NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands. NATIVE AMERICAN/ALASKAN NATIVE: a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition. Resources If you have questions regarding these requirements, are unsure of the appropriate job titles to include in your Report, or otherwise require assistance in preparing or submitting the Report, please contact Andrea Herald. 37

38 NIAGARA FRONTIER TRANSPORTATION AUTHORITY BID/RFP WORKFORCE UTILIZATION REPORT Reporting Entity Reporting Period - Select One Contractor Subcontractor January 1 - March 31 April 1 - June 30 July 1 - September 30 October 1 - December 31 Contractor Name Contractor Address January February March April May June July August September October November December Contract Number Workforce Identified in Report Workforce Utilized in Performance of Contract Contractor/Subcontractor's Total Workforce EO 1 Job Categorie SOC Job Title SOC Job Code White Hours worked by Race/Ethnic Identification During Reporting Period Black/African American Hispanic/Latino Asian/Native Hawaiian or Other Pacific Islander Native American/Alaska n Native Male Female Male Female Male Female Male Female Male Female Other - TOTAL HOURS WORKED 38

39 EO 1 Job Categorie SOC Job Title SOC Job Code Number of Employees by Race/Ethnic Identification During Reporting Period White Black/African American Hispanic/Latino Asian/Native Hawaiian or Other Pacific Islander Native American/Alaska n Native Male Female Male Female Male Female Male Female Male Female Other - TOTAL EMPLOYEES Preparer's Name By checking this box, I certify that I personally completed this document and I adopt the name typed above as my electronic signature under the NYS Electronic Signatures and Records Act, with like legal force and effect as if I had physically signed the document. Preparer's Title: Date: 39

40 STAFFING PLAN Submit with Bid or Proposal Instructions on page 2 Solicitation No.: Reporting Entity: Report includes Contractor s/subcontractor s: Work force to be utilized on this contract Offeror s Name: Offeror s Address: Total work force Offeror Subcontractor Subcontractor s name Enter the total number of employees for each classification in each of the EEO-Job Categories identified Work force by Work force by Gender Race/Ethnic Identification EEO-Job Category Officials/Administrat ors Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Total Work force Total Male (M) Total Femal e (F) White (M) (F) Black (M) (F) Hispanic (M) (F) Asian (M) (F) Native American (M) (F) Disabled (M) (F) Veteran (M) (F) Service Workers Temporary /Apprentices Totals 40

41 PREPARED BY (Signature): TELEPHONE NO.: ADDRESS: DATE: NAME AND TITLE OF PREPARER (Print or Type): Submit completed with bid or proposal MWBE 101 (Rev 03/11) General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (MWBE 101) and submit it as part of the bid or proposal package. Where the work force to be utilized in the performance of the State contract can be separated out from the contractor s and/or subcontractor s total work force, the Offeror shall complete this form only for the anticipated work force to be utilized on the State contract. Where the work force to be utilized in the performance of the State contract cannot be separated out from the contractor s and/or subcontractor s total work force, the Offeror shall complete this form for the contractor s and/or subcontractor s total work force. Instructions for completing: 9. Enter the Solicitation number that this report applies to along with the name and address of the Offeror. 10. Check off the appropriate box to indicate if the Offeror completing the report is the contractor or a subcontractor. 11. Check off the appropriate box to indicate work force to be utilized on the contract or the Offerors total work force. 12. Enter the total work force by EEO job category. 13. Break down the anticipated total work force by gender and enter under the heading Work force by Gender 14. Break down the anticipated total work force by race/ethnic identification and enter under the heading Work force by Race/Ethnic Identification. Contact the Permissible contact(s) for the solicitation if you have any questions. 15. Enter information on disabled or veterans included in the anticipated work force under the appropriate headings. 16. Enter the name, title, phone number and address for the person completing the form. Sign and date the form in the designated boxes. RACE/ETHNIC IDENTIFICATION Race/ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. For the purposes of this form, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one race/ethnic group. The race/ethnic categories for this survey are: WHITE (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. BLACK a person, not of Hispanic origin, who has origins in any of the black racial groups of the original peoples of Africa. HISPANIC a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race. ASIAN & PACIFIC a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands. ISLANDER NATIVE INDIAN (NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal AMERICAN/ ALASKAN affiliation or community recognition. NATIVE) OTHER CATEGORIES: 41

42 DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, GENDER Male or Female 42

43 NON-COLLUSIVE PROPOSAL CERTIFICATION FORM By submission of this proposal, each Proponent and each person signing on behalf of any Proponent certifies, and in the case of a joint proposal each party thereto certifies as to his or her own organization, under penalty of perjury, that to the best of his or her knowledge and belief: a) 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 Proponent or with any competitor; b) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the Proponent and will not knowingly be disclosed by the Proponent prior to opening, directly or indirectly, to any other Proponent or to any competitor, and c) No attempt has been made or will be made by the Proponent to induce any other person, partnership or corporation to submit or not to submit a proposal for the purpose of restricting competition. Proponent Name Signature Title Date 43

44 NEW YORK STATE FINANCE LAW SECTIONS 139-j AND 139-k ( Lobbying Law ) DISCLOSURE STATEMENT General Information All procurements by the Niagara Frontier Transportation Authority in excess of $15,000 annually, are subject to New York State s State Finance Law Sections 139-j and 139-k, ( Lobbying Law ). Pursuant to the Lobbying Law, all contacts (defined as oral, written or electronic communications with NFTA intended to influence NFTA s conduct or decision regarding a procurement) during a procurement must be made with one or more designated Point(s) of Contact only. Exceptions to this rule include written questions during the bid/proposal process, communications with regard to protests, contract negotiations and RFP conference participation. Nothing in the lobbying Law inhibits any rights to make an appeal, protest or complaint under existing administrative or judicial procedures. Violations of the policy regarding permissible contacts must be reported to the NFTA Ethics Officer and investigated accordingly. The first violation may result in a determination of non-responsibility and ineligibility for award to the violator and its subsidiaries, affiliates and related entities. The penalty for a second violation within four (4) years is ineligibility for bidding/proposing on a procurement and/or ineligibility from being awarded any contract for a period of four (4) years. The NFTA will notify the New York State Office of General Services ( OGS ) of any determinations of non-responsibility or debarments due to violations of the Lobbying Law. Violations found to be knowing and willful must be reported to the NFTA Executive Director and OGS. Moreover, the statutes require the NFTA to obtain certain affirmations and certifications from bidders and proposers. This Disclosure Statement contains the forms with which to comply, together with additional information and instructions. Instructions New York State Finance Law δ139-k(2) obligates the NFTA to obtain specific information regarding prior nonresponsibility determinations. In accordance with New York State Finance Law δ139-k, an offerer must be asked to disclose whether there has been a finding of non-responsibility made within the previous four (4) years by any governmental entity due to: (a) a violation of New York State Finance Law δ139-j or (b) the intentional provision of false or incomplete information to a governmental entity. As part of its responsibility determination, New York State Finance Law δ139-k (3) mandates consideration of whether an offerer fails to timely disclose accurate or complete information regarding the above non-responsibility determination. In accordance with law, no procurement contract shall be awarded to any offerer that fails to timely disclose accurate or complete information under this section, unless the factual elements of the limited waiver provision can be satisfied on the written record. 44

45 Disclosure of Prior Non-responsibility Determinations Form Name of Bidder/Proposer: Address 1: Address 2: Name/Title of Person Submitting Form: Has any governmental entity 1 made a finding of non-responsibility regarding the Bidder/ Proposer in the previous four years? Yes No If yes: Was the basis for the finding of the Bidders/Proposer s non-responsibility due to a violation of State Finance Law δ139-j? Yes No Was the basis for the finding of Bidder s Proposer s non-responsibility due to the intentional provision of false or incomplete information to a governmental entity? Yes No If yes, please provide details regarding the finding or non-responsibility below: Governmental Entity: Years of Finding of Non-responsibility: Basis of Finding of Non-responsibility: (Add additional pages as necessary) Has any governmental entity terminated a procurement contract with the Bidder/Proposer due to the intentional provision of false or incomplete information? Yes No 1 A governmental entity is (1) any department, board, bureau, commission, division, office, council, committee or officer of New York State, whether permanent or temporary; (2) each house of the New York State Legislature; (3) the unified court system (4) any public authority, public benefit corporation or commission created by or existing pursuant to the public authorities law; (5) any public authority or public benefit corporation, at least one of whose members is appointed by the governor or who serves as member by virtue of holding a civil office of the state; (6) a municipal agency, as that term is defined in paragraph (ii) of subdivision(s) of section one-c of the Legislative Law; or (7) a subsidiary or affiliate of such a public authority. (SFL δ139-j, paragraph 1.a.) 45

46 BIDDER S/PROPOSER/S AFFIRMATION AND CERTIFICATION FORM By signing below, the Bidder/Proposer: a) Affirms that the Bidder/Proposer understands and agrees to comply with the policy regarding permissible contacts in accordance with New York State Finance Law Sections 139-j and 139-k. b) Certifies that all information provided to the NFTA with respect to New York State Finance Law δ139-j and δ139- k is complete, true and accurate. By: Date: (Signature of Person Certifying) Print Name and Title: Title: Bidder/Proposer or Contractor/Consultant (Full Legal Name): Address of Bidder/Proposer or Contractor/Consultant: Business Telephone Number: NFTA s Right To Terminate The NFTA reserves the right to terminate a Contract in the event it is found that the certification filed by the Bidder/Proposer, in accordance with New York State Finance Law δ139-k, was intentionally false or intentionally incomplete. Upon such finding, the NFTA may exercise its termination right by providing written notification to the Bidder/Proposer in accordance with the written notification terms of the Contract. 46

47 NFTA RFP NO PROPOSAL SUBMITTAL FORM The undersigned submits the enclosed proposal, which is in complete conformity with the intent of the proposal documents. The proponent agrees that should it be awarded a contract on the basis of this proposal through the issuance of a contract from the Niagara Frontier Transportation Authority, it will provide the materials, supplies, equipment or services in strict compliance with the contract documents for the compensation stipulated herein. The proponent agrees that its proposal shall remain effective for a period of 90 days from the formal proposal opening date. Proponents with the submission of this proposal certify that they are not on the Comptroller General s List of Ineligible Contractors. Firm Name: Federal ID No.: Contact Person: Mailing Address: Authorized Signature: Title: Date: Telephone/Fax No.: address: 47

48 NFTA RFP NO EXCEPTIONS / DEVIATIONS List any exceptions, deviations or minor points of variances below that the proponent/bidder would like NFTA to consider. ITEM EXCEPTIONS/ DEVIATIONS

49 NFTA RFP NO ACKNOWLEDGMENT OF ADDENDA The following form shall be completed and included in the proposal/bid. Failure to acknowledge receipt of all addenda may cause the proposal/bid to be considered non-responsive to the solicitation. Acknowledged receipt of each addendum must be clearly established and included with the Offer. ACKNOWLEDGMENT OF ADDENDA The undersigned acknowledges receipt of the following addenda to the documents: Addendum No., Dated Addendum No., Dated Addendum No., Dated Addendum No., Dated Addendum No., Dated Addendum No., Dated Addendum No., Dated Addendum No., Dated Proponent/Bidder Street Address City, State, Zip Authorized Signature Printed Name Title Phone Fax 49

50 Contractor Certification ST-220-TD (Pursuant to Tax Law Section 5-a, as amended, effective April 26, 2006) For information, consult Publication 223, Questions and Answers Concerning Tax Law Section 5-a (see Need help? below). Contractor name (4/15) Contractor s principal place of business City State ZIP code Contractor s mailing address (if different than above) City State ZIP code Contractor s federal employer identification number (EIN) Contractor s sales tax ID number (if different from contractor s EIN) Contractor s telephone number ( ) Covered agency or state agency Contract number or description Covered agency telephone number ( ) Covered agency address City State ZIP code Is the estimated contract value over the full term of the contract (but not including renewals) more than $100,000? Yes No Unknown at this time General information Tax Law section 5-a, as amended, effective April 26, 2006, requires certain contractors awarded certain state contracts valued at more than $100,000 to certify to the Tax Department that they are registered to collect New York State and local sales and compensating use taxes, if they made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000, measured over a specified period. In addition, contractors must certify to the Tax Department that each affiliate and subcontractor exceeding such sales threshold during a specified period is registered to collect New York State and local sales and compensating use taxes. Contractors must also file Form ST-220-CA, Contractor Certification to Covered Agency, certifying to the procuring state entity that they filed Form ST-220-TD with the Tax Department and that the information contained on Form ST-220-TD is correct and complete as of the date they file Form ST-220-CA. All sections must be completed including all fields on the top of this page, all sections on page 2, Schedule A on page 3, if applicable, and Individual, Corporation, Partnership, or LLC Acknowledgement on page 4. If you do not complete these areas, the form will be returned to you for completion. For more detailed information regarding this form and Tax Law section 5-a, see Publication 223, Questions and Answers Concerning Tax Law Section 5-a, (as amended, effective April 26, 2006). See Need help? for more information on how to obtain this publication. Note: Form ST-220-TD must be signed by a person authorized to make the certification on behalf of the contractor, and the acknowledgement on page 4 of this form must be completed before a notary public. Mail completed form to: NYS TAX DEPARTMENT DATA ENTRY SECTION W A HARRIMAN CAMPUS ALBANY NY Privacy notification New York State Law requires all government agencies that maintain a system of records to provide notification of the legal authority for any request, the principal purpose(s) for which the information is to be collected, and where it will be maintained. To view this information, visit our Web site, or, if you do not have Internet access, call and request Publication 54, Privacy Notification. See Need help? for the Web address and telephone number. Need help? Visit our Web site at get information and manage your taxes online check for new online services and features Telephone assistance Sales Tax Information Center: (518) To order forms and publications: (518) Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): (518) Persons with disabilities: In compliance with the Americans with Disabilities Act, we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, call the information center 50

51 Page 2 of 4 ST-220-TD (4/15) I,, hereby affirm, under penalty of perjury, that I am (name) (title) of the above-named contractor, and that I am authorized to make this certification on behalf of such contractor. Complete Sections 1, 2, and 3 below. Make only one entry in each section. Section 1 Contractor registration status The contractor has made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certification is made. The contractor is registered to collect New York State and local sales and compensating use taxes with the Commissioner of Taxation and Finance pursuant to Tax Law sections 1134 and 1253, and is listed on Schedule A of this certification. The contractor has not made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certification is made. Section 2 Affiliate registration status The contractor does not have any affiliates. To the best of the contractor s knowledge, the contractor has one or more affiliates having made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certification is made, and each affiliate exceeding the $300,000 cumulative sales threshold during such quarters is registered to collect New York State and local sales and compensating use taxes with the Commissioner of Taxation and Finance pursuant to Tax Law sections 1134 and The contractor has listed each affiliate exceeding the $300,000 cumulative sales threshold during such quarters on Schedule A of this certification. To the best of the contractor s knowledge, the contractor has one or more affiliates, and each affiliate has not made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certification is made. Section 3 Subcontractor registration status The contractor does not have any subcontractors. To the best of the contractor s knowledge, the contractor has one or more subcontractors having made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certification is made, and each subcontractor exceeding the $300,000 cumulative sales threshold during such quarters is registered to collect New York State and local sales and compensating use taxes with the Commissioner of Taxation and Finance pursuant to Tax Law sections 1134 and The contractor has listed each subcontractor exceeding the $300,000 cumulative sales threshold during such quarters on Schedule A of this certification. To the best of the contractor s knowledge, the contractor has one or more subcontractors, and each subcontractor has not made sales delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certification is made. Sworn to this day of, 20 (sign before a notary public) (title) 51

52 Page 3 of 4 ST-220-TD (4/15) Schedule A Listing of each entity (contractor, affiliate, or subcontractor) exceeding $300,000 cumulative sales threshold List the contractor, or affiliate, or subcontractor in Schedule A only if such entity exceeded the $300,000 cumulative sales threshold during the specified sales tax quarters. See directions below. For more information, see Publication 223. A Relationship to contractor B Name C Address D Federal ID number E Sales tax ID number F Registration in progress Column A Enter C in column A if the contractor; A if an affiliate of the contractor; or S if a subcontractor. Column B Name - If the entity is a corporation or limited liability company, enter the exact legal name as registered with the NY Department of State, if applicable. If the entity is a partnership or sole proprietor, enter the name of the partnership and each partner s given name, or the given name(s) of the owner(s), as applicable. If the entity has a different DBA (doing business as) name, enter that name as well. Column C Address - Enter the street address of the entity s principal place of business. Do not enter a PO box. Column D ID number - Enter the federal employer identification number (EIN) assigned to the entity. If the entity is an individual, enter the social security number of that person. Column E Sales tax ID number - Enter only if different from federal EIN in column D. Column F If applicable, enter an X if the entity has submitted Form DTF-17 to the Tax Department but has not received its certificate of authority as of the date of this certification. 52

53 Page 4 of 4 ST-220-TD (4/15) STATE OF } : SS.: COUNTY OF } Individual, Corporation, Partnership, or LLC Acknowledgment On the day of in the year 20, before me personally appeared, known to me to be the person who executed the foregoing instrument, who, being duly sworn by me did depose and say that he resides at, Town of, County of, State of ; and further that: (Mark an X in the appropriate box and complete the accompanying statement.) (If an individual): he executed the foregoing instrument in his/her name and on his/her own behalf. (If a corporation): he is the of the corporation described in said instrument; that, by authority of the Board of Directors of said corporation, he is authorized to execute the foregoing instrument on behalf of the corporation for purposes set forth therein; and that, pursuant to that authority, he executed the foregoing instrument in the name of and on behalf of said corporation as the act and deed of said corporation. (If a partnership): he is a of the partnership described in said instrument; that, by the terms of said partnership, he is authorized to execute the foregoing instrument on behalf of the partnership for purposes set forth therein; and that, pursuant to that authority, he executed the foregoing instrument in the name of and on behalf of said partnership as the act and deed of said partnership. (If a limited liability company): he is a duly authorized member of LLC, the limited liability company described in said instrument; that he is authorized to execute the foregoing instrument on behalf of the limited liability company for purposes set forth therein; and that, pursuant to that authority, he executed the foregoing instrument in the name of and on behalf of said limited liability company as the act and deed of said limited liability company. Notary Public Registration No. 53

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