Project Manual

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Bid Documents

Project No. 753.1

Institute for Human Performance Expansion Inverted Microscope System

September 17, 2013

State University of New York Upstate Medical University Syracuse, New York _____________________

Form UF-7 June 1997(4/05)

TABLE OF CONTENTS SUNY UPSTATE PROJECT NO. 753.1 PROJECT TITLE:

AGENCY NUMBER

Institute for Human Performance Expansion Inverted Microscope System 28110 PAGE NO(s).

SECTION TITLE

Bidding Documents General Instructions to Bidders .............................................................................. Pages 1-7 Bid Form and Excel Sheet ............................................................................................. Page 8 Decline to Participate Form .......................................................................................... Page 9 Exhibit A Standard Contract Clauses Exhibit A-1 Affirmative Action Clauses Exhibit A-2 Insurance Requirements and Forms State Finance Law 139 package ....................................................... Pages SFL 139 pages1-4 Public Officer’s Law 73 & 74 ................................................................. Pages SFL 139 page 5 Vendor Notice - MWBE PROGRAM OF UPSTATE MEDICAL UNIVERSITY Form 107 MWBE Utilization Plan SubContracting Information Campus Contractor Affidavit Vendor EEO Staffing Plan Vendor’s EEO Staffing Policy Form 1040 EEO Program Policy Statement NY State Council of Contracting Agencies – Standard Vendor Responsibility Questionnaire .............................................................................................................. Page 1-6 Form State Tax & Finance ST-220 CA– Contractor Certification to Covered Agency (form required if contract over $ 100,000) June 1997

TOC - 1

Specifications and Conditions Exhibit B – Inverted Microscope System - Proposal Requirements, Specifications, Conditions and Selection Criteria

June 1997

TOC - 2

State University of New York (SUNY) UPSTATE MEDICAL UNIVERSITY

Campus Purchasing Dr. Sarah Loguen Center 650 South Salina Street, Rm 2045 Syracuse, New York 13202 Phone: (315) 464 – 5720 Fax: (315) 464 - 4599

Bid Name: Institute for Human Performance Expansion Inverted Microscope System Bid No.: 753.1

Location Room: # 2045 Dr. Sarah Loguen Center, 650 South Salina Street, Syracuse, New York 13202 Opening Time: 2:00 PM Bid Date: Thursday, October 10, 2013

===================================================================== *** BID PROPOSAL *** ===================================================================== GENERAL INSTRUCTIONS TO BIDDERS 1. Bidders must submit 3 signed copies of their bid. 2. Bidders must submit 2 signed copies of the State Finance Law 139 –j. packet: pages 2, 3, 4 3. Bidders must submit 2 signed copies of Public Officer Law 73. 4. Bidders must submit 2 signed copies of the New York State Council of Contracting Agencies Standard Vendor Responsibility Questionnaire. 5. Bidders must submit

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signed copies of their MWBE Utilization Plan.

6. Bidders must submit

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signed copies of their EEO Staffing Plan.

7. Bidders must submit

2

signed copies of NYS Dept of Tax & Finance Form ST-2201 CA

8. All prices must be F.O.B. Destination, freight prepaid. 9. The enclosed “Exhibit A”, “Exhibit A-1"and will become a part of any contract awarded as a result of this bid.

10. Bids must be submitted in plain envelopes and clearly marked with the following information: if not correctly addressed bids, may not be considered. Project No.: 753.1 Project: Institute for Human Performance Expansion – Inverted Microscope System Bid: 2:00 PM on October 10, 2013 To: Campus Purchasing Dr. Sarah Loguen Center 650 South Salina Street, Room 2045 Syracuse, New York 13202 11. Bids received after the announced bid opening date and time will not be considered. 12. Bids shall be submitted on the forms furnished. Bid pricing sheets must be completed in their entirety. All prices and conditions must be shown. Additions not shown on the bid will not be allowed. Bids must be quoted in terms of the unit specified. Any changes and deletions made on the bid by the bidder, must be signed and dated by the bidder. 13. INSURANCES: Purchases by the State of New York are not subject to any sales or federal taxes. Exemption certificates will be furnished upon request by the ordering agency. The State of New York is also exempt from the transportation tax and no exemption certificates are required for this tax. Vendor will be required to provide proof of coverage for NYS Worker’s Compensation, NYS Disability and General Liability, Automobile Liability, and Owner’s Protective Liability Insurance to the limits of and as required by SUNY Upstate Medical University. See attached form UF-14 that will need to be completed by the low bidder. There is no exemption however, for social security, unemployment insurance, and like taxes. 14. REFERENCES: On all bid documents the words “or equal” are understood to apply where a brand name, trade name, catalog reference, or patented commodity is referenced. References to such specific commodities are intended as descriptive, not restrictive, unless otherwise stated. Comparable products will be considered if proof of compatibility is provided, including appropriate catalog excerpts, descriptive literature, specifications and test data, etc. SUNY Upstate Medical University Center decision as to acceptance of the product as equal will be final. 15. Should a supply shortage exist on this material, a bidder may submit an alternate proposal containing deviations in detailed specifications, contract period, quantity, etc. Bidder shall state in detail wherein it differs from the terms of the proposal and specifications as issued, and consideration may be given to any or all such differences provided such action is in the best interest of the State. 16. Right is reserved to increase or reduce quantities when placing an order. 17. Right is reserved to reject any and all bids or to accept any bid in part.

18. Articles which in any respect fail to conform with the specifications upon which the award is made will be rejected and held subject to the shipper’s order as his risk and expense. 19. Award will be made on a weighted ranking of the following criteria: a) Operation / functionality – 25% b) Quality / technical specifications – 35% c) Service, warranty, support – 25% d) Price – 15% A list of detailed requirements and specifications is contained in the Additional Instructions to Bidders. 20. Purchase orders shall be effective and binding upon the contractor when placed in the mail addressed to the contractor at the address shown herein. 21. DELIVERY: Delivery shall be expressed in number of calendar days required to make delivery after receipt of a purchase order. Delivery is required within 70 days after receipt of purchase order and no more than 56 calendar days after approval of shop drawings. In the event a specified manufacturer’s commodity listed in the successful vendor’s bid becomes unavailable or cannot be supplied to the State by the contractor for any reason, a product deemed by the SUNY Upstate Medical University to be the equal; of the specified commodity must be substituted by the contractor at no additional cost or expense to the University. 22. Bid prices shall remain in effect for a 90 day period, or a period required to make an award, unless and until either the bidder in writing withdraws his bid, or a contract is awarded, whichever is first. Upon contract award, prices will remain in effect for the term of the agreement, unless otherwise specified. 23. PAYMENT TERMS: The payment of interest on certain payments due and owned by a State Agency may be made in accordance with the criteria established by Chapter 153, Laws of 1984 (Article IIA of New York State Finance Law) and the Comptroller’s Bulletin No. A-91. Payments will be issued as follows: Equipment Delivered to Site 50% Installation 30% Start Up & Training 20% 24. Where applicable, the enclosed Wage Rate Schedule shall apply. PRC # 2013004299 25.Provisions under Article 15-A of the New York State Executive Law, relating to participation by minority group members and women with respect to State contracts,

enacted by Chapter 261 of the Laws of 1988, require that the State of New York develop measures and procedures to ensure that certified minority and women-owned businesses (M/WBE’s) are given the opportunity for meaningful participation in the performance of State contracts, to identify those State contract requirements for which such businesses may best bid, and to promote employment of minority group members and women. It is the policy of the State of New York and the State University of New York to encourage minority business enterprise participation in this project by contractors, subcontractors and suppliers, and all bidders are expected to cooperate in implementing this policy. The successful Vendor must comply with M/WBE goals. State University of New York goals are: 12% MBE and 7% WBE of the total contract value. State University of New York also has a goal for Work Force Participation: EEO 10% WBE and EEO 10% MBE of the total work force on the project.

26.GUARANTEE: The contractor warrants and guarantees that the goods provided under this agreement shall be free of liens and defects in design, material, workmanship and title and that it shall conform to all standards and codes including those outlined in this solicitation. Manufacturer shall be responsible for one year warranty covering all parts and seven year extended warranty on the compressor, motor and refrigeration components as indicated hereinafter after

acceptance. Should it appear that the goods do not conform to the standards under this agreement within the warranty period, the University shall notify the contractor in writing of the nonconformity and it shall be incumbent upon the contractor to promptly correct or replace the goods at the contractor’s sole expense; failing which it shall be the University’s right to reject or revoke acceptance, and cover by making reasonable purchase of the goods in substitution for those rejected and the contractor shall be liable to the University for any price difference for purchases of similar goods. The bidder guarantees that the equipment offered is standard new equipment, latest model of regular stock with all parts regularly used with the type of equipment offered; also, that no attachment or part has been substituted or applied contrary to manufacturer’s recommendations and standard practice. Every unit delivered must be guaranteed against faulty material and workmanship for a period of one (1) year unless otherwise specified. If, during the period, such faults develop, the unit or part affected is to be replaced without any cost to the State including any charges for parts and labor. Equipment and installation shall conform to applicable requirements of H.E.W., UL, OSHA, NEC, agency’s and New York Building Codes. Guarantee shall commence upon final acceptance of the installed equipment by SUNY Upstate Medical University. 27.QUALIFICATION OF BIDDER: Bids will be accepted only from established manufacturers or their authorized dealers. In the event a bid is submitted by a dealer, the dealer hereby guarantees that he is an authorized dealer of the manufacturer and that the

manufacturer has agreed to supply the dealer with all quantities of items to be ordered by the dealer pursuant to any resulting contract with the SUNY Upstate Medical University and agrees further to provide the SUNY Upstate Medical University with a certificate from the manufacturer acknowledging same, if requested. 28.RECIPROCITY AND SANCTIONS PROVISIONS: Bidders are hereby notified that if their principal place of business is located in a state 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 amendments (Chapter 684, Laws of 1994) require that they be denied placement on bidders mailing lists and contracts for which they would otherwise obtain. Bidders of services must be denied the award of a contract if their principal place of business is located in a state that discriminates or imposes a preference against New York State firms. A current list of states which penalize New York State firms is available from the office letting this contract, or from the Procurement Assistance Unit, NYS Department of Economic Development, Albany, NY (518-474-7756). 29.INFORMATION TO BE FURNISHED WITH BID: The bidder must submit with his bid detailed specifications, circulars and all necessary data on the commodity to be furnished. If the commodity offered differs from the provisions listed, such differences must be explained in details. Failure to submit any of the above data may result in rejection of the bid. SUNY Upstate Medical University, however, reserves the right to request any additional information deemed necessary for the proper evaluation of bids. NOTE: A copy of bidders Standard Terms and Conditions will NOT be considered relevant to his bid and should not be included with bid. In order to be considered, deviations must be submitted in a letter attached to bid. Otherwise, bid will be considered to be in accordance with the terms and conditions of this bid document. 30.BIDDER RESPONSE: Failure to respond, even on a No Bid may result in the removal of your name from the Bid List. 31.AMENDMENT OF BID PROPOSAL: Any amendment or change to this bid proposal shall be issued in writing and shall identify the change to be made in the bid proposal. Firms are required to complete the amendment response sheet provided and submit it with their bids to indicate that they have received the document and are aware of the changes made. 32.MISTAKES IN BID: Firms are cautioned to check all prices provided in their bid response before submission. If a mistake in price is discovered after award, the University will hold the contractor to the quoted price.

33.NEW YORK STATE FINANCE LAW 139-K - Certification: Contractor certifies that all information provided to the Agency with respect to New York State Finance Law 139-k is complete, true, and accurate. 34.NEW YORK STATE FINANCE LAW 139-K– Termination: The University reserves the right to terminate this contract in the event it is found that the certification filed by the Contractor in accordance with New York State Finance Law §139-k was intentionally false or intentionally incomplete. Upon such finding, the University may exercise its termination right by providing written notification to the Contractor in accordance with the written notification terms of this contract. 30. NEW YORK STATE FINANCE LAW 139 j & k. The University shall provide a copy of the Policy and Procedure of the State University of New York relating to State Finance Law §§139-j and 139-k and will seek written affirmations from all Contractors as to the Contractor’s understanding of and agreement to comply with SUNY’s – procedures relating to permissible contacts during a Governmental Procurement pursuant to subdivision three of this section.

ADDITIONAL INSTRUCTIONS TO BIDDERS 1.

PRODUCTS Scope: The purpose of this bid is to provide a lump sum quote to furnish and install a complete Inverted Microscope System for electrophysiology and calcium imaging including equivalents to the specified objectives, motorized encoded stage, motorized specific excitation and emission filters, automatic focus, illuminator, 2 cameras, and computer and software system for image acquisition and calcium imaging analysis. Detailed components, requirements and specifications are as noted in Exhibit B.

2.

CONTRACT PERIOD The contract shall be for a period of 145 calendar days.

3.

PRICE Pricing shall include: 3.1 All components required for complete working system as outlined in Exhibit B. 3.2 All vendor design effort required to install and confirm operation of a complete working system. 3.3 All installation material and labor costs. 3.4 Inside delivery to the Institute for Human Performance, 505 Irving Avenue, Syracuse, NY, and shall include installation, as designated by SUNY Upstate Medical University. Price shall include all customs duties and charges. 3.5 Startup, training and 1-year parts & labor warranty.

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QUANTITIES The contract shall be for the actual quantities and dollar value stated on the proposal. Upstate reserves the right to change quantities as required prior to shop drawing approval.

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QUALITY ASSURANCE The contractor guarantees that every unit delivered is guaranteed against faulty material, workmanship, and defects, for the manufacturer’s standard warranty. Sub-standard products are to be replaced at no charge to SUNY Upstate Medical University, including labor and transportation charges.

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RETURNS Products returned due to quality problems or duplicated shipments shall be picked up by the contractor within 30 business days, after notification, with no restocking fees and replaced with specified products or a credit/refund shall be issued to SUNY Upstate

Medical University for the full purchase price. Standard stock products ordered in error by SUNY Upstate Medical University may be returned for credit within 30 days of receipt with no restock fee. Products returned by SUNY Upstate Medical University must be unused and in their original container. 7

EVALUATION METHOD Evaluation for award selection will consist of a spreadsheet scoring responses of vendors representing their product against the RFP criteria. Points of consideration will include the following:

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7.1 Operation / Functionality - User-friendly system control features - Serviceability, preventative maintenance requirements - Ease of modification - Software features / ability to integrate with other platforms

25%

7.2 Quality / Technical Specifications - Quality of materials / reliability / accuracy - Components manufactured by single vendor - Evidence of widespread use in the scientific community - Compatibility with existing equipment

35%

7.3 Service, warranty & support - Response time - Quality & terms of warranty - Availability of parts and expertise of service engineers

25%

7.4 Price - Equipment cost - Installation & startup costs - Maintenance cost

15%

DELIVERIES/SHIPMENTS 8.1 Delivery shall be made during regular working hours at the designated location: Institute for Human Performance 505 Irving Avenue (delivery entrance at north side of building, off Madison St) Syracuse, NY 13210 8.2 All transportation charges shall be prepaid to destination and absorbed by the contractor. All products shall be packed in accordance with commercial practice to ensure carrier acceptance and safe delivery in accordance with rules and regulations applicable to the mode of transportation. Invoices, packing slips, and shipping containers will be marked with an appropriate purchase order number, which will be provided by SUNY Upstate Medical University at Syracuse.

Please note that existing loading dock is approximately 45’ from dock to edge of street (overlapping the sidewalk) with overhead clearance of 12’-6”. New dock shall be approximately 52’ from dock lift to edge of street (overlapping the sidewalk), with overhead clearance of 11’-9”. Straight truck and/or power lift gate may be required for delivery depending on carrier’s preferences. 8.3 Mailing address: SUNY Upstate Medical University 750 East Adams Street Syracuse, NY 13210 8.4 All packing and shipping materials to be removed and disposed of by the vendor and at the expense of the vendor. 8.5 Vendor is responsible for the complete installation of the system(s) including all materials such as cabling, conduits, and power supplies. Vendor will be responsible to provide written requirements for site preparation, which are subject to review and approval by Upstate facilities engineers prior to bid award. Any work to be performed by vendor as part of site preparation will be included in total package price of the project. Detailed description of site preparation, approved by Upstate’s facility engineer, must be provided with vendor’s purchase order acceptance. Schedule of site preparation requirements, equipment delivery, and equipment installation must be coordinated closely between Upstate and vendor. 8.6 A seventy-two (72) hour minimum notice of delivery must be provided by the vendor or carrier to SUNY Upstate. 9

CANCELLATION CLAUSE Either party may cancel the awarded contract with 60-days’ prior written notice.

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PRODUCT AVAILABILITY Merchandise shall be as specified, however, in the event that a specified manufacturer’s product listed in the contract award becomes unavailable or cannot be supplied to SUNY Upstate Medical University by the contractor, a product deemed by SUNY Upstate Medical University to be equal or better than the specified product must be substituted by the contractor at no additional cost or expense to SUNY Upstate Medical University.

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QUOTED PRODUCTS The basis-for-design of the equipment specified in this RFP are the Coherent Incorporated Chameleon Ultra II laser system and the Chameleon Compact Optical Parametric Oscillator (OPO) with detailed component information as noted in Exhibit B. Vendors responding to this RFP shall provide quotes for a system meeting the mandatory requirements, with components equal or equivalent as approved by SUNY Upstate Medical University.

Alternate products shall meet all performance and technical specifications of the basis-fordesign equipment as deemed mandatory by SUNY Upstate Medical University. Bidders shall submit detailed documentation and supplemental information as may be required to demonstrate the product quoted meets the mandatory requirements. SUNY Upstate Medical University shall be the sole judge as to whether an alternate product is equivalent to the product specified.

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CONTACT INFORMATION 12.1 Prospective Bidder should understand and agree that it has an affirmative duty to inquire about and clarify any RFP question that it does not fully understand, or that may, in his or her opinion, be susceptible to more than one interpretation. All questions should be submitted in writing, citing the particular proposal section and paragraph number. Prospective Bidders should note that all clarifications and exceptions including those relating to the terms and conditions of the contract are to be resolved prior to the submission of a proposal. Answers to all questions of a substantive nature will be given to all Prospective Bidders in the form of a formal addendum, which will be annexed to and become part of the resultant contract. 12.2 All questions or additional information requests concerning this bid should be directed to: Michael Stewart Office of Facility Design Services SUNY Upstate Medical University 750 East Adams Street Syracuse, New York 13210 Telephone: (315) 464-3824 [email protected]

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DELIVERY OF PROPOSALS 13.1 A public bid opening will be held at Campus Purchasing, Dr. Sarah Loguen Center, Room 2045, 650 S Salina Street, Syracuse, NY 13202. Proposals are to be received at Campus Purchasing at 2:00 PM on Thursday, October 10, 2013, at which time a representative of Campus Purchasing will publicly announce the names of those vendors submitting proposals. Proposals must be in a sealed envelope marked with the name of the bidder, title of the bid, bid number, and the date and time the proposal is due. No telephone or facsimile proposals will be accepted. Proposals received after the bid opening date and time will not be considered.

13.2 Address for responses delivered in person or sent via US Mail, Fed Ex, UPS, etc.: Terry Larkin, Director Campus Purchasing SUNY Upstate Medical University Dr. Sarah Loguen Center, Room 2045 650 S Salina Street Syracuse, New York 13202

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CONTRACT AWARD Upstate reserves the right to reject any or all proposals, or any part thereof, or to accept any proposal, or any part thereof, or to withhold the award, and to waive or decline to waive irregularities in any proposal when it determines that it is in Upstate’s best interest to do so. Every offer shall be firm and not revocable for a period of 180 days from the bid opening, or a longer period of time specified in the solicitation. All bids shall remain firm unless withdrawn in writing. If a contract is awarded under this RFP, it will be awarded in one lot, it will be made to the highest rated (bidder receiving the most evaluation points), responsible, and responsive bidder. Any bidder that omits any information required as set forth in this RFP will be determined to be non-responsive, and their proposal will rejected. Contract award is expected to be on or before November 21, 2013.

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UPSTATE’S RIGHTS TO PROPOSALS 15.1 By submitting a proposal, the bidder covenants not to make any claim for or have any right to damages because of any misinterpretation or misunderstanding of the specification, or because of any misinformation or lack of information. Upstate has the following prerogatives with regard to proposals submitted: - To accept or reject any or all proposals - To correct any arithmetic errors in any or all proposals - To change the proposal's due date upon appropriate notification to all prospective bidders - To adopt any or all of a successful bidder's proposal - To negotiate with the selected bidder prior to contract award - To begin contract negotiations with another bidder should Upstate be unsuccessful in negotiating a contract with the selected contractor within 45 calendar days 15.2 Upstate reserves the right to request clarifications from offerors for purposes of assuring a full understanding of responsiveness and further reserves the right to permit revisions from all offerors determined to be susceptible to being selected for contract award, prior to award.

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TERMS & CONDITIONS 16.1 The terms of Exhibit A, Standard Clauses for State University of New York Contracts, attached hereto, are hereby incorporated into this RFP and any resulting contract. The contractor is required to adhere to the clauses in Exhibit A. 16.2 The terms of Appendix B-1, General Specifications, Technology Products and Specifications, attached hereto, are hereby incorporated into this RFP, and any resulting contract, and apply to any situations not covered by this RFP or Exhibit A. 16.3 Independent Contractor – The Contractor and its employees engaged in the performance of work shall at all times be deemed to be performing as an independent contractor and not as agents or employees of Upstate. Therefore, the Contractor bears the full responsibility for any and all liability, loss, damages, and expenses which may be suffered from any claim, demand, suit, or cause of action which may be made or held against them by reason of negligence or malpractice on the part of the Contractor, its agents, or employees. 16.4 Financial Stability – The Bidder must be financially stable and able to substantiate its financial stability upon request within five working days of the request. Upstate reserves the right to reject any bidder who does not demonstrate financial stability sufficient for the scope of the contract. 16.5 Ownership – All information collected during the project and subsequent recommendations will be the sole property of the Upstate. Any use of this information and the recommendations that emerge must receive prior written approval from the University. 16.6 Exceptions – Exceptions taken to this RFP must be submitted in writing specifying item and page number of the clause being excepted. 16.7 Termination – Upstate reserves the right to cancel any contract awarded under this RFP for recurring non-compliance with the terms and conditions set forth in the RFP, or unsatisfactory work. 16.8 Cancellation for Convenience - Upstate retains the right to cancel the contract without reason provided that the Contractor is given at least 60 (sixty) days written notice of its intent to cancel. This provision should not be understood as waiving the Upstate’s right to terminate the contract for cause or stop work immediately for unsatisfactory work, but is supplementary to that provision. 16.9 Presentation – Bidders may be asked to provide a presentation about their proposal at their own expense. 16.10 Indemnification and Hold Harmless – The bidder shall indemnify and hold harmless Upstate, its employees, and designated representatives from any and all

claims, suits, actions, liabilities and costs of any kind, including attorney’s fees, for personal injury or damage to real property or tangible personal property arising from the acts or omissions of the Bidder, its agents, officers, employees or subcontractors. Notwithstanding anything herein to the contrary, in no event shall the Bidder be liable for any indirect or economic consequential damages arising thereunder.

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EXHIBIT B SUNY Upstate Medical University Institute for Human Performance Expansion

Inverted Microscope System Proposal Requirements, Specifications, Conditions & Selection Criteria

EXHIBIT B - TABLE OF CONTENTS Introduction

2

1.

Timeline

3

2.

Mandatory Requirements

3

3.

Technical / Performance Specifications

4

4.

Installation

6

5.

Warranty, Maintenance & Service Requirements

6

6.

System Check Prior to Expiration of Warranty

7

7.

Training

7

8.

Field Service Notes

7

9.

Required Documentation

8

10.

New Technology

8

SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

Introduction The SUNY Upstate Medical University (Upstate) is soliciting proposals from qualified laboratory equipment vendors for the furnishing and installation of an inverted microscopy rig ideally suited for dissociated cell calcium imaging and electrophysiology. The successful vendor shall be responsible for furnishing all labor, equipment, hardware and software necessary for the complete installation of: An Inverted Microscope System for electrophysiology and calcium imaging including equivalents to the specified objectives, motorized encoded stage, motorized specific excitation and emission filters, automatic focus, illuminator, 2 cameras, and computer and software system for image acquisition and calcium imaging analysis. The successful bidder must provide a list of at least five sites currently using the vendor’s proposed microscopy systems. Upstate reserves the right to visit select vendor’s sites to confirm functionality of similarly installed systems prior to contract award. Bidders are to answer all questions in the order they appear in this document. Bid responses submitted out of specified order of this document are subject to disqualification. Bidders must explain in detailed writing any exception(s) or objection(s) to specifications, term and conditions, requirements, or any other area of this RFP. Bidders are cautioned that any such exception or objections may render their bid nonresponsive. Any formal publicly or commercially available upgrades/improvements to the system other that what was included in the original bid, whether they be software, hardware, or entire system replacement, prior to installation are to be disclosed to Upstate. Upstate subsequently will determine whether to accept or reject any such modifications prior to installation. If any modifications are accepted, they are to be at no cost to Upstate.

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SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

1 - Timeline All dates and timing are approximate and are subject to change at the discretion of Upstate, based on the construction schedule or other unforeseen circumstances. 1.1 Vendor must store, at its expense, the equipment should any delays occur. 1.2 Bidding Dates: RFP release date: 9-17-13 Final date for receipt of written questions: 10-3-13 Proposal due date and time: 10-10-13 @ 2:00 PM 1.3 It is anticipated that a purchase order for the equipment will be issued by 11-14-13 1.4 Milestone Dates: 1.4.1

Equipment delivered into building 1-23-14

1.4.2

System assembled in place by 1-30-14

1.4.3

Testing/calibration complete; final acceptance by Upstate 2-6-14

1.4.5

System put into service 2-6-14

2 - Mandatory Requirements 2.1

The following items are considered mandatory qualifications and requirements for the proposal. Upstate reserves the right to reject the proposal for failure to comply with any item. Upstate also reserves the right to eliminate mandatory requirements not met by all bidders. A. The microscopy system shall be a completely operational, integrated systems from a company regularly engaged in the design, fabrication, assembly and installation of microscopy systems having a minimum of 10-years experience. B. A dissociated cell calcium imaging/electrophysiology system shall include the following components: 1) An inverted microscope with phase contrast, DIC, and fluorescence optics 2) 10X, 20X, 40X, 60X oil and 100X oil objectives 3) Motorized epifluoresence filters for FURA2, DAPI, FITC, TRITC, CY5 4) Fluorescence illumination system with rapid wavelength switching 5) High-sensitivity, high-speed CMOS camera for high-speed calcium imaging

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SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

6) 6) 7) 8)

High-sensitivity CCD camera Encoded motorized stage with controller Automatic focusing system Software and workstation for high speed calcium imaging

3 - Technical / Performance Specifications The basis of design is a Nikon Ti-E perfect Focus microscope with a motorized encoded stage, motorized epifluorescence filters, Sutter DG-4 illuminator, an Andora Zyla 10 Tap CMOS camera and Andora Clara CCD camera with software that works integratively with all these components and provides high speed imaging and calcium imaging analysis functionality. The basis of design is intended to give a basis for functionality and quality requirements, and is not intended to preclude other bidders to provide a system with the same quality and end result functionality. Bidders should note any areas where a specified system provides different functionality, construction or quality than the specifications. Upstate reserves the right to reject proposals that do not provide the same quality and functionality as the basis of design and are not in the best interests of Upstate. 3.1 Inverted Microscope 3.1.1 – Should include the following features: a. Automatic focus (Internal encoded Z drive 0.025um step size) b. motorized encoded stage (0.1um step. Repeatability +/- 0.5um) c. Stage controller and joystick for XY and Z. d. Six-position fluorescence filter turret, motorized with noise terminator e. Epifluorescence filters for the following: FURA2, DAPI, FITC,TRITC, CY5 f. DIC optics for all objective magnifications g. 10X, 20X, 40X, 60X oil and 100X oil objectives. Should meet or exceed the following specifications: Plan fluorite 10X 0.30 NA phase objective WD 15.2mm. PFS offset up to 1200um Super Fluorite 20X 0.75 NA WD 1.00mm. PFS offset up to 450um Super Plan Fluor 40X apodized high S/N phase contrast objective 0.60NA. PFS offset up to 120um. Plan apochromat Lambda 60X 1.40 NA objective. Corrected from 435 to 850nm. PFS offset up to 40um. Plan apochromat Lambda 100X 1.45 NA objective. Corrected from 435 to 850 nm. PFS offset up to 45um. h. Matching DIC Prisms for all objectives i. Led illumination j. motorized port switching

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SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

3.2 Cameras 3.2.1 – Should be equivalent or better than the following cameras: Andor Zyla 10 CMOS camera: a. Active Pixels: 2560 X 2160 (5.5 megapixels) b. Sensor Size: 16.6 X14 mm c. Pixel Width: 6.5 µm d. Pixel Depth: 25,000 ee. Read Noise: 1.2 ef. Maximum frame rate: 100 fps g. Dynamic range: 25,000:1 Andor Clara CCD camera: a. Active Pixels: 1392 X1040 b. Sensor Size: 8.98 X 6.71 mm c. Pixel Width: 6.45 µm d. Pixel Depth: 18,000 ee. Read Noise: 2.4 ef. Maximum frame rate: 11 fps g. Dynamic range: 6,500:1 3.3 Epifluoresence Illuminator 3.3.1 – Should match or exceed the capabilities of the Sutter DG4 illuminator as far as speed, intensity and wavelength precision. 3.4 Software and Workstation 3.4.1 – Should include the following features: a. Advanced imaging software package, including camera, microscope and stage drivers. Image capture, advanced interpreter, live compare and time measurements and fast wavelength switching. Multi dimensional imaging, Z stacks and creating large images. b. Module for 6 dimensional imaging (includes: time, wavelength and focus, multipoint) c. LED illumination control d. Ratio and FRET ratio: Ratio view, live ratio graphing and measurement with calcium calibration e. Triggered device control f. Work station running windows 7 with at minimum a 64 bit 3.6 Ghz quad core process, 16 Gb RAM and 1 Tb with mirrored raid drive, 1 Gb graphics card and 24” LED monitor (1920 X 1200 dot pitch). 3.5 Size Requirements 3.5.1 – Components must fit onto designated air table and fit within the faraday cage. a. Room 3622 – Microscope and core elements should fit on a 3’ X 4’ air table. Peripherals (such as the computer, screen, illuminator, etc) can be placed on an adjacent table.

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SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

3.5.2 – System must provide the necessary clearance at the top, rear and sides of the equipment for installation and serviceability. 3.6 Utility Requirements 3.6.1 – Vendor shall provide all labor and materials necessary to install equipment. Vendor shall be responsible for all connections between system components for internet or network access, electrical, water and waste disposal. 3.6.4 – Vendor will indicate the location of all equipment utility connections. 3.7 Design Data and Outline Drawings 3.7.1 Include in the proposal dimensions and weights and utility requirements of the component parts of the system. Provide the number of crates including sizes and weights to assist with the anticipated delivery. All shipping / packaging materials will be removed from the site by the vendor.

4 - Installation 4.1 - Successful bidder shall install all items of equipment specified in the request for proposal and perform all manufacturer's testing procedures. 4.2 - All prices quoted shall include complete installation and demonstration/application training. 4.3 - Installation shall be deemed completed when the equipment has been demonstrated as operational within performance specifications including the running of all diagnostics and test samples. 4.4 - Installation shall meet the requirements of all applicable State and Federal codes, regulations and accreditation standards. 4.5 - The vendor shall be responsible for any damage to adjacent new construction resulting from the actions of installing contractors.

5 – Warranty, Maintenance and Service Requirements 5.1 - The manufacturer shall warrant that all equipment furnished under this section be free of defective materials, design and workmanship. 5.2 - A minimum one-year parts and labor warranty is required on all equipment provided. Include descriptions of services offered and excluded in service contracts.

6

SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

5.3 - The warranty period shall commence upon acceptance of the equipment and completion of final installation and training. 5.4 - Manufacturer’s recommended preventive maintenance shall be performed by the vendor within the warrantee period at no additional expense to the purchaser. 5.5 - All maintenance documentation, including field modification instructions and “proprietary information”, shall be provided to Upstate. 5.6 - Indicate in vendor’s proposal recommended preventive maintenance activities and intervals 5.7 - Include in vendor’s proposal a separate price for a preventative maintenance and service contract after the warranty expiration date. 5.8 - Request for service via telephone call shall be responded to within 4 hours of initial call during normal office hours (8:30 AM – 5:00 PM EST), Monday through Friday (excluding holidays). 5.10 - On-site response time for service calls shall be within 1 week of initial request.

6 - System Check Prior to Expiration of Warranty 6.1 - At least three (3) weeks prior to the Warranty expiration date the vendor shall perform a complete system checkout to insure that the system is performing at its optimum level and meets or exceeds the specifications and parameters agreed to herein. Failure on the part of the vendor to arrange and perform this system check or any required corrective action at the conclusion of the specified warranty period shall automatically extend the warranty period until the system check is successfully completed. Failure of the system to meet the agreed to specifications or parameters shall automatically extend the warranty period of the total system until the system is compliant.

7 - Training 7.1 - The vendor shall provide at its expense all required in-service education for users. Training periods shall be minimum 2-hour duration to be conducted weekdays at Upstate’s discretion for a minimum of 2 days or 4 hours total training.

8 - Field Service Notes 8.1 - The successful vendor shall for the useful life of the equipment being bid, provide to Upstate all past and future manufacturer and vendor field service notes pertaining to operation, maintenance, preventative maintenance, and safety of the equipment installed. These materials shall be delivered on a continuing basis, on a factory direct mailing basis to a designated staff member.

7

SUNY Upstate Medical University – IHP Expansion Inverted Microscope System

9 - Required Documentation 9.1 addressing each requirement described below: 1)

A cover letter not to exceed three (3) pages which introduces the firm, with firm name, address, corporate headquarters and telephone number. The name of one individual must be provided who will be the primary contact person with Upstate and who will be authorized to represent the organization.

2)

A detailed table of contents of the proposal.

3)

A description of the organization’s experience in providing services to academic or medical research institutions. This description should include: a) b) c) d) e) f)

Name, address, email address and telephone number of three (3) client references How many New York State academic or medical research institutions are clients. (if applicable) Explain other factors you feel are pertinent to the assessment of your firm’s experience and expertise that will be of benefit to Upstate. Length of time providing similar services. Other state or federal government agencies previously and/or currently under contract with the bidder’s firm.(if applicable) Written response to all Specifications and Terms and Conditions of the bid proposal specified herein or in the accompanying Instructions to Bidders.

9.2 - Provide (2) complete hard copy sets + (2) electronic copies of Operation and Maintenance (O&M) Manuals. Manuals are to be submitted to Upstate for review and approval prior to acceptance of the equipment. At a minimum the O&M Manuals shall include the following: a. b. c. d. e.

Operator instruction materials/user’s manual Downtime procedure/troubleshooting manual Outline drawings and installation manual Parts and materials list Equipment and space requirements

10 - New Technology 10.1 - In the event manufacturing or production changes occur between the time the equipment is bid and shipment received, the vendor shall notify Upstate of such changes for review and acceptance. 10.2 - In the event the vendor introduces a new product or version of this product within twelve (12) months of the contract award date, the vendor shall make it available to Upstate at no additional charge in exchange for the installed item.

8

VENDOR INFORMATION AND BID FORM Project #753.1 – Institute for Human Performance Expansion – Inverted Microscope System Cash discount for payment within thirty days of Delivery at destination and/or receipt of voucher

%

Cash discount will not be considered in determining low bidder, but will be taken into consideration in awarding tie bids. Cash discounts of less than one percent will not be considered. Cash Discount will not be taken unless payment is made within the discount period. _________________________________________ Bidder

________________________________________________ Street & Number

_________________________________________ City

________________________________________________ State Zip

_________________________________________ Signed by

_______________________________________________ Federal ID No.

_________________________________________ Printed or Typed Signature

________________________________________________ Telephone Number

_________________________________________ Title $____________________________________________________________________________

TOTAL LUMP SUM BID (in figures) ____________________________________________________________________________

TOTAL LUMP SUM BID (in words)

ACKNOWLEDGEMENT OF ADDENDA RECEIVED: Addenda No.: ________________ Date: _______________ Date Received: ______________ Addenda No.: ________________ Date: _______________ Date Received: ______________ Addenda No.: ________________ Date: _______________ Date Received: ______________

By signing this bid, you indicate your express authority to sign on behalf of yourself, or your company or other entity and full knowledge and acceptance of the GENERAL INSTRUCTIONS TO BIDDERS and AMENDMENTS HERETO.

-Page- 13-

SUNY Upstate Medical University 750 East Adams Street Syracuse, New York 13210

Project Number and Title: Institute for Human Performance Expansion - Inverted Microscope System

Pricing Sheet Bidder Name and Address:

Item Quantity

DESCRIPTION with Manaufacturer name and number

1

Microscope

2

Cameras

1

Epifluoresence Illuminator

1

Software and Workstation

1

Delivery

1

Installation

1

Testing and Training

Pricing

Comments

TOTAL BID VALUE

June 13, 2007

DECLINE TO PARTICIPATE If you decide not to respond to this Request for Proposal, please fill out this form, sign it, and fax or mail this page to: SUNY UPSTATE MEDICAL UNIVERSITY. Terry Larkin Campus Purchasing Department Sarah Loguen Center, Room 2045 Syracuse, New York 13202 FAX (315) 464-4599 FAX (315) 464-4599

Project

-

We will keep your company on our active list for future business opportunities. Your cooperation in this matter is greatly appreciated. Please be advised that for the reasons stated below, our company is not in a position to respond to your Request for Proposal at this time.

Name Title Company Name Address City, State, Zip FAX

Page 9

Standard Contract Clauses State University of New York

EXHIBIT A

December 13, 2012

The parties to the attached contract, license, lease, amendment or other agreement of any kind (hereinafter, "contract") agree to be bound by the following clauses which are hereby made a part of the contract (the word "Contractor" herein refers to any party other than the State, whether a Contractor, licensor, licensee, lessor, lessee or any other party): 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. PROHIBITION AGAINST ASSIGNMENT Except for the assignment of its right to receive payments subject to Article 5-A of the State Finance Law, the Contractor selected to perform the services herein are prohibited in accordance with Section 138 of the State Finance Law from assigning, transferring, conveying, subletting or otherwise disposing of its rights, title or interest in the contract without the prior written consent of SUNY and attempts to do so are null and void. Notwithstanding the foregoing, SUNY may, with the concurrence of the New York Office of State Comptroller, waive prior written consent of the assignment, transfer, conveyance, sublease or other disposition of a contract let pursuant to Article XI of the State Finance Law if the assignment, transfer, conveyance, sublease or other disposition is due to a reorganization, merger or consolidation of Contractor’s its business entity or enterprise and Contractor so certifies to SUNY. SUNY retains the right, as provided in Section 138 of the State Finance Law, to accept or reject an assignment, transfer, conveyance, sublease or other disposition of the contract, and to require that any Contractor demonstrate its responsibility to do business with SUNY. 3. COMPTROLLER'S APPROVAL. (a) In accordance with Section 112 of the State Finance Law, Section 355 of New York State Education Law, and 8 NYCRR 316, Comptroller’s approval is not required for the following contracts: (i) materials; (ii) equipment and supplies, including computer equipment; (iii) motor vehicles; (iv) construction; (v) construction-related services; (vi) printing; and (vii) goods for State University health care facilities, including contracts for goods made with joint or group purchasing arrangements. (b) Comptroller’s approval is required for the following contracts: (i) contracts for services not listed in Paragraph (3)(a) above made by a State University campus or health care facility certified by the Vice Chancellor and Chief Financial Officer, if the contract value exceeds $250,000; (ii) contracts for services not listed in Paragraph (3)(a) above made by a State University campus not certified by the Vice Chancellor and Chief Financial Officer, if the contract value exceeds $50,000; (iii) contracts for services not listed in Paragraph (3)(a) above made by health care facilities not certified by the Vice Chancellor and Chief Financial Officer, if the contract value exceeds $75,000; (iv) contracts whereby the State University agrees to give something other than money, when the value or reasonably estimated value of such consideration exceeds $10,000; (v) contracts for real property transactions if the contract value exceeds $50,000; (vi) all other contracts not listed in Paragraph 3(a) above, if the contract value exceeds $50,000, e.g. SUNY acquisition of a business and New York State Finance Article 11B contracts and (vii) amendments for any amount to contracts not listed in Paragraph (3)(a) above, when as so amended, the contract exceeds the threshold amounts stated in Paragraph (b) herein. However, such pre-approval shall not be required for any contract established as a centralized contract through the Office of General Services or for a purchase order or other transaction issued under such centralized contract. (c) Any contract that requires Comptroller approval shall not be valid, effective or binding

upon the State University until it has been approved by the Comptroller and filed in the Comptroller’s office. 4. WORKERS' COMPENSATION BENEFITS. 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 non-discrimination 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. 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 SUNY of any SUNY-approved sums due and owing for work done upon the project. 7. NON-COLLUSIVE BIDDING CERTIFICATION. In accordance with Section 139-d of the State

Finance Law, if this contract was awarded based on the submission of competitive bids, Contractor affirms, under penalty of perjury, and each person signing on behalf of Contractor, and in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and belief that 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 it to SUNY 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 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 (2 NYCRR 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 or monetary penalties relative thereto. The State shall exercise its setoff 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, 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 SUNY and its representatives and entities 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. SUNY 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 SUNY 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, SUNY’s or the State's right to discovery in any pending or future litigation. 11. IDENTIFYING INFORMATION AND PRIVACY NOTIFICATION. Identification Number(s). Every invoice or New York State Claim for Payment submitted to the State University of New York 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 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 University of New York 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 State University of New York 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 12236. 12. EQUAL EMPLOYMENT OPPORTUNITIES FOR MINORITIES AND WOMEN. (a) In accordance with Section 312 of the Executive Law and 5 NYCRR 143, if this contract is: (i) a written agreement or purchase order instrument, providing for a total expenditure in excess of $25,000.00, whereby a contracting agency is committed to expend or does expend funds in return for labor, services, supplies, equipment, materials or any combination of the foregoing, to be performed for, or rendered or furnished to the contracting agency; or (ii) a written agreement in excess of $100,000.00 whereby a contracting agency is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon; or (iii) a written agreement in excess of $100,000.00 whereby the owner of a State assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon for such project, then the following shall apply and by signing this agreement the Contractor certifies and affirms that it is Contractor’s equal employment opportunity policy that: (1) The Contractor will not discriminate against employees or applicants for employment because of race, creed, color, national origin, sex, age, disability or marital status, and will undertake or continue existing programs of affirmative action to ensure that minority group members and women

are afforded equal employment opportunities without discrimination. Affirmative action shall mean recruitment, employment, job assignment, promotion, upgradings, demotion, transfer, layoff, or termination and rates of pay or other forms of compensation; (2) at SUNY’s request, 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; and (3) Contractor shall state, in all solicitations or advertisements for employees, that, in the performance of the State contract, all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. (b) Contractor will include the provisions of "1", "2" and "3", above, in every subcontract over $25,000.00 for the construction, demolition, replacement, major repair, renovation, planning or design of real property and improvements thereon (the "Work") except where the Work is for the beneficial use of the Contractor. Section 312 does not apply to: (i) work, goods or services unrelated to this contract; or (ii) employment outside New York State. The State shall consider compliance by a Contractor or sub-contractor with the requirements of any federal law concerning equal employment opportunity which effectuates the purpose of this section. SUNY shall determine whether the imposition of the requirements of the provisions hereof duplicate or conflict with any such federal law and if such duplication or conflict exists, SUNY shall waive the applicability of Section 312 to the extent of such duplication or conflict. Contractor will comply with all duly promulgated and lawful rules and regulations of the Department of Economic Development’s Division of Minority and Women's Business Development pertaining hereto. 13. 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 Exhibit A, the terms of this Exhibit A shall control. 14. GOVERNING LAW. This contract shall be governed by the laws of the State of New York except where the Federal supremacy clause requires otherwise. 15. 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.

18. 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 State Finance Law §165 (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 subcontactor, 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 Section 165 of the State Finance Law. Any such use must meet with the approval of the State, otherwise, the bid may not be considered responsive. Under bidder certification, proof of qualification for exemption will be the responsibility of the Contractor to meet with the approval of the State. 19. MacBRIDE FAIR EMPLOYMENT PRINCIPLES. In accordance with the MacBride Fair Employment Principles (Chapter 807 of the Laws of 1992) , the Contractor hereby stipulates that Contractor and any individual or legal entity in which the Contractor holds a ten percent or greater ownership interest and any individual or legal entity that holds a ten percent or greater ownership interest in the Contractor either (a) have 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 Employment Principles (as described in Section 165(5) of the State Finance Law), and shall permit independent monitoring of compliance with such principles. 20. 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 30 South Pearl St., 7th Floor Albany, NY 12245 Tel: 518-292-5100 Fax: 518-292-5884 email: [email protected] A directory of certified minority and womenowned business enterprises is available from:

16. 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.

NYS Department of Economic Development Division of Minority and Women’s Business Development 633 Third Avenue New York, NY 10017 212-803-2414

17. 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.

email: [email protected] http://esd.ny.gov/MWBE/directorySearch.html 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) 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 SUNY; (b)

The Contractor has complied with the

Federal Equal Employment Opportunity Act of 1972 (P.L. 92-261), as amended; (c) 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 Search 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 (d) The Contractor acknowledges notice that SUNY may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with SUNY in these efforts. 21. 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 of 1994 and 2000 amendments (Chapter 684 and Chapter 383, respectively) require that they be denied contracts which they would otherwise obtain. Contact the NYS Department of Economic Development, Division for Small Business, 30 South Pearl Street, Albany, New York 12245, for a current list of jurisdictions subject to this provision. 22.

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). 23. 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, the Contractor shall timely, accurately and properly comply with the requirement to submit an annual employment report for the contract to SUNY, the Department of Civil Service and the State Comptroller. 24. PURCHASES OF APPAREL AND SPORTS EQUIPMENT. In accordance with State Finance Law Section 165(7), SUNY may determine that a bidder on a contract for the purchase of apparel or sports equipment is not a responsible bidder as defined in State Finance Law Section 163 based on (a) the labor standards applicable to the manufacture of the apparel or sports equipment, including employee compensation, working conditions, employee rights to form unions and the use of child labor; or (b) bidder’s failure to provide information sufficient for SUNY to determine the labor conditions

applicable to the manufacture of the apparel or sports equipment. 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 139j 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 SUNY 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 and this contract may be terminated, by providing written notification to the Contractor in accordance with the terms of the agreement, if SUNY determines that such action is in the best interests of the State.

COMPLIANCE WITH NEW YORK STATE THE FOLLOWING PROVISIONS SHALL APPLY ONLY TO THOSE CONTRACTS TO WHICH A HOSPITAL OR OTHER HEALTH SERVICE FACILITY IS A PARTY

27. Notwithstanding any other provision in this contract, the hospital or other health service facility remains responsible for insuring that any service provided pursuant to this contract complies with all pertinent provisions of Federal, state and local statutes, rules and regulations. In the foregoing sentence, the word "service" shall be construed to refer to the health care service rendered by the hospital or other health service facility. 28. (a) In accordance with the 1980 Omnibus Reconciliation Act (Public Law 96-499), Contractor hereby agrees that until the expiration of four years after the furnishing of services under this agreement, Contractor shall make available upon written request to the Secretary of Health and Human Services, or upon request, to the Comptroller General of the United States or any of their duly authorized representatives, copies of this contract, books, documents and records of the Contractor that are necessary to certify the nature and extent of the costs hereunder. (b) If Contractor carries out any of the duties of the contract hereunder, through a subcontract having a value or cost of $10,000 or more over a twelve-month period, such subcontract shall contain a clause to the effect that, until the expiration of four years after the furnishing of such services pursuant to such subcontract, the subcontractor shall make available upon written request to the Secretary of Health and Human Services or upon request to the Comptroller General of the United States, or any of their duly authorized representatives, copies of the subcontract and books, documents and records of the subcontractor that are necessary to verify the nature and extent of the costs of such subcontract. (c) The provisions of this section shall apply only to such contracts as are within the definition established by the Health Care Financing Administration, as may be amended or modified from time to time.

Affirmative Action Clauses State University of New York 1. DEFINITIONS. The following terms shall be defined in accordance with Section 310 of the Executive Law: STATE CONTRACT herein referred to as "State Contract”, shall mean: (a) a written agreement or purchase order instrument, providing for a total expenditure in excess of twenty-five thousand dollars ($25,000.00), whereby the State University of New York (“University”) is committed to expend or does expend funds in return for labor, services including but not limited to legal, financial and other professional services, supplies, equipment, materials or an combination of the foregoing, to be performed for, or rendered or furnished to the University; (b) a written agreement in excess of one hundred thousand dollars ($100,000.00) whereby the University is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon; and (c) a written agreement in excess of one hundred thousand dollars ($100,000.00) whereby the University as an owner of a state assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon for such project. SUBCONTRACT herein referred to as "Subcontract”, shall mean any agreement for a total expenditure in excess of $25,000 providing for services, including non-staffing expenditures, supplies or materials of any kind between a State agency and a prime contractor, in which a portion of the prime contractor’s obligation under the State contract is undertaken or assumed by a business enterprise not controlled by the prime contractor. WOMEN-OWNED BUSINESS ENTERPRISE herein referred to as "WBE", shall mean a business enterprise, including a sole proprietorship, partnership or corporation that is: (a) at least fifty-one percent (51%) owned by one or more United States citizens or permanent resident aliens who are women; (b) an enterprise in which the ownership interest of such women is real, substantial and continuing; (c) an enterprise in which such women ownership has and exercises the authority to control independently the day-today business decisions of the enterprise; (d) an enterprise authorized to do business in this state and independently owned and operated; (e) an enterprise owned by an individual or individuals, whose ownership, control and operation are relied upon for certification, with a personal net worth that does not exceed three million five hundred thousand dollars ($3,500,000), as adjusted annually on the first of January for inflation according to the consumer price index of the previous year; and (f) an enterprise that is a small business pursuant to subdivision twenty of this section. A firm owned by a minority group member who is also a woman may be certified as a minority-owned business enterprise, a

EXHIBIT A-1 women-owned business enterprise, or both, and may be counted towards either a minority-owned business enterprise goal or a women-owned business enterprise goal, in regard to any Contract or any goal, set by an agency or authority, but such participation may not be counted towards both such goals. Such an enterprise's participation in a Contract may not be divided between the minorityowned business enterprise goal and the women-owned business enterprise goal. MINORITY-OWNED BUSINESS ENTERPRISE herein referred to as "MBE", shall mean a business enterprise, including a sole proprietorship, partnership or corporation that is: (a) at least fifty-one percent (51%) owned by one or more minority group members; (b) an enterprise in which such minority ownership is real, substantial and continuing; (c) an enterprise in which such minority ownership has and exercises the authority to control independently the day-today business decisions of the enterprise; (d) an enterprise authorized to do business in this state and independently owned and operated; (e) an enterprise owned by an individual or individuals, whose ownership, control and operation are relied upon for certification, with a personal net worth that does not exceed three million five hundred thousand dollars ($3,500,000.00), as adjusted annually on the first of January for inflation according to the consumer price index of the previous year; and (f) an enterprise that is a small business pursuant to subdivision twenty of this section. MINORITY GROUP MEMBER shall mean a United States citizen or permanent resident alien who is and can demonstrate membership in one of the following groups: (a) Black persons having origins in any of the Black African racial groups; (b) Hispanic persons of Mexican, Puerto Rican, Dominican, Cuban, Central or South American of either Indian or Hispanic origin, regardless of race; (c) Native American or Alaskan native persons having origins in any of the original peoples of North America. (d) Asian and Pacific Islander persons having origins in any of the Far East countries, South East Asia, the Indian Subcontinent or Pacific Islands. CERTIFIED ENTERPRISE OR BUSINESS shall mean a business verified as a minority or women- owned business enterprise pursuant to section 314 of the Executive Law. A business enterprise which has been approved by the New York Division of Minority & Women Business Development (“DMWBD”) for minority or women-owned enterprise status subsequent to verification that the business enterprise is owned, operated, and controlled by minority group members or women, and that also meets the financial requirements set forth in the regulations. 2. TERMS. The parties to the attached State Contract agree to be bound by the following provisions which are made a part hereof (the word "Contractor" herein refers to any party other than the University: 1(a) Contractor and its Subcontractors shall undertake or continue existing programs of affirmative action to ensure that minority group

January 14, 2013 members and women are afforded equal employment opportunities without discrimination. For these purposes, affirmative action 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. (b) Prior to the award of a State Contract, the Contractor shall submit an equal employment opportunity (EEO) policy statement to the University within the time frame established by the University. (c) As part of the Contractor’s EEO policy statement, the Contractor, as a precondition to entering into a valid and binding State Contract, shall agree to the following in the performance of the State Contract: (i) The Contractor will not discriminate against any employee or applicant for employment, will undertake or continue existing programs of affirmative action 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 on State Contracts;(ii) The Contractor shall state in all solicitations or advertisements for employees that, in the performance of the State Contract, all qualified applicants will be afforded equal employment opportunities without discrimination; (iii) At the request of the University 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, and that such union or representative will affirmatively cooperate in the implementation of the Contractor’s obligations herein. (d) Except for construction contracts, prior to an award of a State Contract, the Contractor shall submit to the contracting agency a staffing plan of the anticipated work force to be utilized on the State Contract or, where required, information on the Contractor’s total work force, including apprentices, broken down by specified ethnic background, gender, and Federal occupational categories or other appropriate categories specified by the contracting agency. The form of the staffing plan shall be supplied by the contracting agency. If Contractor fails to provide a staffing plan, or in the alternative, a description of its entire work force, the University may reject Contractor's bid, unless Contractor either commits to provide such information at a later date or provides a reasonable justification in writing for its failure to provide the same. (e) After an award of a State Contract, the Contractor shall submit to the University a workforce utilization report, in a form and manner required by the agency, of the work force actually utilized on the State Contract, broken down by specified ethnic background, gender, and Federal occupational categories or other appropriate categories specified by the University. (f) The Contractor shall include the provisions of this section in every Subcontract

in such a manner that the requirements of the provisions will be binding upon each Subcontractor as to work in connection with the State Contract, including the requirement that Subcontractors shall undertake or continue existing programs of affirmative action to ensure that minority group members and women are afforded equal employment opportunities without discrimination, and, when requested, provide to the Contractor information on the ethnic background, gender, and Federal occupational categories of the employees to be utilized on the State Contract. (g) To ensure compliance with the requirements of this paragraph, the University shall inquire of a Contractor whether the work force to be utilized in the performance of the State Contract can be separated out from the Contractor’s and/or Subcontractors' total work force and where the work of the State Contract is to be performed. For Contractors who are unable to separate the portion of their work force which will be utilized for the performance of this State Contract, Contractor shall provide reports describing its entire work force by the specified ethnic background, gender, and Federal Occupational Categories, or other appropriate categories which the agency may specify. (h) The University may require the Contractor and any Subcontractor to submit compliance reports, pursuant to the regulations relating to their operations and implementation of their affirmative action or equal employment opportunity program in effect as of the date the State Contract is executed. (i) If a Contractor or Subcontractor does not have an existing affirmative action program, the University may provide to the Contractor or Subcontractor a model plan of an affirmative action program. Upon request, the Director of DMWBD shall provide a contracting agency with a model plan of an affirmative action program. (j) Upon request, DMWBD shall provide the University with information on specific recruitment sources for minority group members and woman, and contracting agencies shall make such information available to Contractors 2. Contractor must provide the names, addresses and federal identification numbers of certified minority- and women-owned business enterprises which the Contractor intends to use to perform the State Contract and a description of the Contract scope of work which the Contractor intends to structure to increase the participation by Certified minorityand/or women-owned business enterprises on the State Contract, and the estimated or, if known, actual dollar amounts to be paid to and performance dates of each component of a State Contract which the Contractor intends to be performed by a certified minority- or woman-owned business enterprise. In the event the Contractor responding to University solicitation is joint venture, teaming agreement, or other similar arrangement that includes a minority-and women owned business enterprise, the Contractor must submit for review and approval: i. the name, address, telephone number and federal identification of each partner or party to the agreement; ii. the federal identification number of the joint venture or entity established to respond to the solicitation, if applicable; iii. A copy of the joint venture, teaming or other similar arrangement which describes the percentage of interest owned by each party to the agreement and the

value added by each party; iv. A copy of the mentor-protégé agreement between the parties, if applicable, and if not described in the joint venture, teaming agreement, or other similar arrangement. 3. PARTICIPATION BY MINORITY GROUP MEMBERS AND WOMEN. The University shall determine whether Contractor has made conscientious and active efforts to employ and utilize minority group members and women to perform this State Contract based upon an analysis of the following factors: (a) Whether Contractor established and maintained a current list of recruitment sources for minority group members and women, and whether Contractor provided written notification to such recruitment sources that contractor had employment opportunities at the time such opportunities became available. (b) Whether Contractor sent letters to recruiting sources, labor unions, or authorized representatives of workers with which contractor has a collective bargaining or other agreement or understanding requesting assistance in locating minority group members and women for employment. (c) Whether Contractor disseminated its EEO policy by including it in any advertising in the news media, and in particular, in minority and women news media. (d) Whether Contractor has attempted to provide information concerning its EEO policy to Subcontractors with which it does business or had anticipated doing business. (e) Whether internal procedures exist for, at a minimum, annual dissemination of the EEO policy to employees, specifically to employees having any responsibility for hiring, assignment, layoff, termination, or other employment decisions. Such dissemination may occur through distribution of employee policy manuals and handbooks, annual reports, staff meetings and public postings. (f) Whether Contractor encourages and utilizes minority group members and women employees to assist in recruiting other employees. (g) Whether Contractor has apprentice training programs approved by the N.Y.S. Department of Labor which provides for training and hiring of minority group members and women. (h) Whether the terms of this section have been incorporated into each Subcontract which is entered into by the Contractor. 4. PARTICIPATION BY MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES. Based upon an analysis of the following factors, the University shall determine whether Contractor has made good faith efforts to provide for meaningful participation by minority-owned and womenowned business enterprises which have been certified by DMWBD: (a) Whether Contractor has actively solicited bids for Subcontracts from qualified M/WBEs, including those firms listed on the Directory of Certified Minority and WomenOwned Business Enterprises, and has documented its good faith efforts towards meeting minority and women owned business enterprise utilization plans by providing, copies of solicitations, copies of any advertisements for participation by certified minorityand women-owned business enterprises timely published in appropriate

general circulation, trade and minority- or women-oriented publications, together with the listing(s) and date(s) of the publications of such advertisements; dates of attendance at any pre-bid, pre-award, or other meetings, if any, scheduled by the University, with certified minorityand women-owned business enterprises, and the reasons why any such firm was not selected to participate on the project. (b) Whether Contractor has attempted to make project plans and specifications available to firms who are not members of associations with plan rooms and reduce fees for firms who are disadvantaged. (c) Whether Contractor has utilized the services of organizations which provide technical assistance in connection with M/WBE participation. (d) Whether Contractor has structured its Subcontracts so that opportunities exist to complete smaller portions of work. e) Whether Contractor has encouraged the formation of joint ventures, partnerships, or other similar arrangements among Subcontractors. (f) Whether Contractor has requested the services of the Department of Economic Development (DED) to assist Subcontractors' efforts to satisfy bonding requirement. (g) Whether Contractor has made progress payments promptly to its Subcontractors. (h) Whether the terms of this section have been incorporated into each Subcontract which is entered into by the Contractor. It shall be the responsibility of Con- tractor to ensure compliance by every Subcontractor with these provisions. 5. GOALS. (a) GOALS FOR MINORITY AND WOMEN WORK FORCE PARTICIPATION. (i) The University shall include relevant work force availability data, which is provided by the DMWBD, in all documents which solicit bids for State Contracts and shall make efforts to assist Contractors in utilizing such data to determine expected levels of participation for minority group members and women on State Contracts. (ii) Contractor shall exert good faith efforts to achieve such goals for minority and women's participation. To successfully achieve such goals, the employment of minority group members and women by Contractor must be substantially uniform during the entire term of this State Contract. In addition, Contractor should not participate in the transfer of employees from one employer or project to another for the sole purpose of achieving goals for minority and women's participation. (b) GOALS FOR MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES PARTICIPATION. For all State Contracts in excess of $25,000.00 whereby the University is committed to expend or does expend funds in return for labor, services including but not limited to legal, financial and other professional services, supplies, equipment, materials or an combination of the foregoing or all State Contracts in excess of $100,000.00 whereby the University is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon, Contractor shall exert good faith efforts to

achieve a participation goal of ten percent (10%) for Certified Minority-Owned Business Enterprises and ten percent (10%) for Certified Women-Owned Business Enterprises. 6. ENFORCEMENT. The University will be responsible for enforcement of each Contractor's compliance with these provisions. Contractor, and each Subcontractor, shall permit the University access to its books, records and accounts for the purpose of investigating and determining whether Contractor or Subcontractor is in compliance with the requirements of Article 15-A of the Executive Law. If the University determines that a Contractor or Subcontractor may not be in compliance with these provisions, the University may make every reasonable effort to resolve the issue and assist the Contractor or Subcontractor in its efforts to comply with these provisions. If the University is unable to

resolve the issue of noncompliance, the University may file a complaint with the DMWBD.

b. All sums actually paid to MWBEs for work performed or materials supplied under the Contract.

7. DAMAGES FOR NON COMPLIANCE. Where the University determines that Contractor is not in compliance with the requirements of the Contract and Contractor refuses to comply with such requirements, or if Contractor is found to have willfully and intentionally failed to comply with the MWBE participation goals, Contractor shall be obligated to pay to liquidated damages to the University. Such liquidated damages shall be calculated as an amount equaling the difference between:

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 University, Contractor shall pay such liquidated damages to the University within sixty (60) days after such damages are assessed, 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 University.

a. All sums identified for payment to MWBEs had the Contractor achieved the contractual MWBE goals; and

EXHIBIT A-2 The parties to the attached contract, amendment, or other agreement (hereinafter, “contract”) agree to be bound by the following clauses which are hereby made a part of the contract [the word “Contractor” herein refers to any party other than the SUNY Upstate Medical University and its components (collectively, the “SUNY Upstate Medical University”), including University Hospital]: Flammability: The Upstate Medical University intends to ensure that fabrics and materials introduced into its patient care areas are fire retardant to reduce the fire load in the event of a fire and to retard or prevent fire spread by means of decorative furnishings or patient clothing. If this is a contract involving the purchase of goods, all fabric provided or furnished by the Contractor pursuant to the terms of the contract shall be (a)100% inherently or intrinsically fire retardant and permanently fire retardant to pass NFPA 701 federal code; and (b) washable to one hundred sixty degrees (160 degrees) Fahrenheit. Goods subject to the foregoing shall include, but not limited to, the following: i. ii. iii. iv. v. vi. vii. viii. ix. x.

Mattresses, pillows, mattress covers Linen - bedspreads, sheets, blankets, pillow covers Clothing – scrub suits, pajamas, gowns, shoe covers, uniforms, coveralls Bags – cloth, poly can liners Building materials, wall coverings, door paints, solutions Containers – trash, utility, refuse Carpeting, mats, rugs Furniture fabrics – chairs, lounge furniture Cleaners, solutions, cloths, floor finishes, paper and plastic goods, including Med/Surg disposables Chemicals

Manufacturers MSDS must accompany all shipments to the SUNY Upstate Medical University containing any of the above goods.

STATE UNIVERSITY OF NEW YORK CERTIFICATE OF INSURANCE This is to certify to the State University of New York that the insurance policies listed below have been issues by the undersigned and are in full force and effect on the date borne by this Certificate. Name of Insured Contractor: Address of Insured Contractor:

Project Location and Certificate Holder (Campus):

SUNY Upstate Medical University , Syracuse New York

Project Title:

_

Project Number: ________________________

KIND OF INSURANCE

LIMITS OF LIABILITY

POLICY NO

EFFECTIVE

___________

EXPIRATION

Workers' Compensation Must Submit Form C105.2 NYS Disability Benefits

As required by law Carrier:

Must Submit Form DB-120-1 Contractor's Comprehensive General Liability

$

Each Occurrence

Bodily Injury Liability and

$

Aggregate

Property Damage Liability

$

Combined Single Limit

Carrier:

Contractor's Automobile Liability Each Accident Bodily Injury Liability and

$

or Occurrence

Property Damage Liability Owner's Protective Liability

$

Combined Single Limit

$ $ $

Each Occurrence Aggregate Combined Single Limit

Carrier:

$ $ $

Each Occurrence Aggregate Combined Single Limit

Carrier:

Bodily Injury Liability and Property Damage Liability Asbestos Abatement Insurance (If Applicable)

Carrier:

Builder's Risk (If Applicable)

$

Carrier:

Excess or Umbrella (If Applicable)

$

Carrier:

Name of Insurance Agency (if any)

Phone:

Authorized Representative (Original Signature Required - No Stamp) Date: As an inducement to the “University” to approve the above signed as an insurance company issuing the policies listed above and this Certificate as being in compliance with the contract between the “University” and the contractor named above, the above signed insurance company, duly licensed to do business in the State of New York, hereby agrees as follows: 1. That the insurance policies listed above shall not be changed or cancelled and that they will automatically be renewed upon expiration and continued in force until final acceptance by the “University” of all the work covered by the aforesaid construction contract unless the “University is given thirty (30) days written notice to the contrary. 2. That the “University shall not be liable for the payment of the premium on any of the insurance policies listed above and that such premium shall be payable by the Contractor named above who shall also receive any dividends or other refunds due under the above-listed insurance policies. 3. The insurer certifies that there is no inconsistency or conflict with or between any of the terms, provisions and conditions hereof and any of the terms, provisions and conditions of the policies listed above, except for the following:_____________________________________________________________. 4. That without the above signed foregoing agreements neither it nor this Certificate of Insurance would be approved by the “University.” UF-14Feb 2012) C2015-697

Page 1

State University of New York Protection of Rights and Property Compensation and Liability Insurance (1)

The Consultant or Contractor shall procure and maintain, at its own cost and expense, until final acceptance by the University of all the work covered by this Contract, the following kinds of insurance: a. Workers' Compensation Insurance. A policy complying with the requirements of the laws of the State of New York. b. General Liability and Property Damage Insurance. A standard general comprehensive liability insurance policy or a commercial general liability insurance policy issued to and covering the liability of the Consultant for all work and operations under this Contract, including, but not limited to, contractual and completed operations coverage. Such policy shall be written by a company licensed or approved as an excess line liability company by the New York State Department of Insurance. The coverage under such policy shall not be less than the following limits: Bodily Injury and Property Damage Liability $ 1,000,000 Each Occurrence $ 3,000,000 Aggregate The aforesaid insurance requirements will be deemed met by the Consultant's procurement and maintenance of either of the aforesaid policies and, in addition thereto, an umbrella policy providing similar coverage; provided, however, that the total amount of insurance coverage is at least equal to the requirements above set forth. c.

Automobile Liability and Property Damage Insurance.

A policy covering the use in connection with the work covered by the Contract Documents of all owned, non-owned and hired vehicles bearing, or, under the circumstances under which they are being used, required by the Motor Vehicle Laws of the State of New York to bear license plates. The coverage under such policy shall not be less than the following limit: Bodily Injury and Property Damage Liability $ 1,000,000 Each Occurrence d.

Owner's Protective Liability Insurance (If applicable)

A policy issued to and covering the liability for damages imposed by law upon the State University Construction Fund, the Dormitory Authority of the State of New York, the State of New York and the State University of New York, their trustees, officers, agents or employees, with respect to all operations under the Contract by the Consultant and its subConsultants, and/or their interest in the Project and the property upon which work under the Contract is to be performed, including omissions and supervisory acts of the former. Said insurance shall be in the same amounts as that required under subdivision b above and shall be written by a company licensed or approved as an excess line liability company by the New York State Department of Insurance. e.

Asbestos Abatement Insurance (If applicable)

A liability insurance policy issued to and covering the liability, of the Consultant and/or subConsultant engaged in the removal, handling or wrapping of asbestos, if any of such work is to be performed under the Contract, for bodily injury, illness, sickness or property damage caused by exposure to asbestos in an amount not less than $1,000,000 per occurrence and $2,000,000 aggregate. The Consultant and/or its aforesaid subConsultant shall either obtain an endorsement to the aforesaid required insurance policy adding the State University Construction Fund, the Dormitory Authority of the State of New York, the State of New York and the State University of New York, their trustees, officers, agents or employees, as additional parties insured thereunder or shall obtain a separate owner's protective liability insurance policy for such parties with coverage similar to that required by the first sentence of this subdivision. In addition, any Consultant or subConsultant engaged in the removal, handling, or wrapping of asbestos shall hold harmless and indemnify the State University Construction Fund, the Dormitory Authority of the State of New York, the State of New York and the State University of New York, for any claims or liabilities in connection with illness or sickness arising from work performed, not performed, or which should have been performed. The Consultant shall have said hold-harmless and indemnification conditions stipulated in all Contracts with subConsultants. (2)

The aggregate insurance limit set forth above shall apply separately to each project for which a certificate of insurance and/or policy is issued.

(3)

Before commencing the performance of any work covered by the Contract, the Consultant shall furnish to the University a certificate or certificates in duplicate of the insurance required under the foregoing provisions. Such certificates shall be on a form prescribed by the University, shall list the various coverages and shall contain, in addition to any provisions hereinbefore required, a provision that the policy shall not be changed or canceled and that it will be automatically renewed upon expiration and continued in force until final acceptance by the University of all the work covered by the Contract, unless the University is given

fifteen (15) days' written notice to the contrary. Upon request, the Consultant shall furnish the University with a certified copy of each policy. The State University reserves the right to receive a copy of the l insurance policy which was based on the Certificate of Insurance issued. (4)

All insurance required to be procured and maintained as aforesaid must be procured from insurance companies approved by the University and authorized to do business in the State of New York. The State University is to be cited as a named insured on all policies and certificates of insurance and shall be notified if a policy is canceled, terminated or modified.

(5)

If at any time any of the above-required insurance policies should be canceled, terminated or modified so that insurance is not in effect as above required, then, if the University shall so direct, the Consultant shall suspend performance of the work covered in the Contract. If the said work is so suspended, no extension of time shall be due on account thereof. If said work is not suspended, then the University may, at its option, obtain insurance affording coverage equal to that above required, the cost of such insurance to be payable by the Consultant to the University.

SUNY UPSTATE MEDICAL UNIVERSITY NEW YORK STATE FINANCE LAW 139 PACKET TO BE SUBMITTED WITH QUOTATIONS OVER $ 15,000.00 Contents: Page 1 Pages 2 - 4

Introduction, Directions, and Contact Information New York State Finance Law 139 summary, forms, and questionnaire

Introduction: All procurements by SUNY Upstate Medical University (Upstate) valued at $15,000 or greater, are subject to New York State’s State Finance Law Sections 139-j and 139-k, effective January 1, 2006. Pursuant to SFL139, all contacts and inquiries (oral, written, or electronic communications) with Upstate, occurring during a procurement, must be made with a designated Point of Contact. Moreover, SFL139 requires Upstate to obtain certain affirmations and certifications from vendors. The attached New York State Finance Law 139 Vendor Form provides a means for Upstate to obtain those affirmations and certifications. For your review, New York State Finance Law §139 can be found at the following web site: http://www.ogs.state.ny.us/aboutogs/regulations/advisoryCouncil/StatutoryReferences.html Directions: 1. The SUNY Upstate Medical University New York State Finance Law 139 vendor form consists of three (3) pages. 2. You must answer all questions contained within the form. 3. Where a response requires additional information, attach a written response that adequately details the requested information. Please note on each response the page and question number. 4. The completed forms (three pages) and attached responses will become a part of SUNY Upstate Medical University’s procurement record. 5. The form is a fillable document using MS Word. It is imperative the person completing the form be knowledgeable about the vendor’s business and operations. As an owner or officer, he or she will certify the form’s information. To expedite the receipt of the completed and signed form: Scan the completed document and e-mail it to [email protected] or you may fax it to 315-464-4698, Attn: Cathy Adamitis. The original must be sent to the address shown below Contact Information: If you have any questions regarding these forms or questionnaire, contact Cathy Adamitis at 315-464-4788 or e-mail [email protected] Send completed forms and questionnaire to: Attn: Cathy Adamitis, C.P.M., CBM Facility Design Services SUNY Upstate Medical University 750 East Adams Street/ CAB-208 Syracuse, New York 13210

1

Summary of SUNY Upstate Medical University’s policy and prohibitions regarding permissible contacts during a covered procurement. Pursuant to State Finance Law §§139-j and 139-k, this solicitation/contract includes and imposes certain restrictions on communications between SUNY Upstate Medical University and the Offerer during the procurement process.

The

Offerer/bidder is restricted from making contacts from the earliest notice of intent to solicit offers through final award and approval of the procurement contract by SUNY Upstate Medical University and, if applicable, Office of the State Comptroller to other than designated staff unless it is a contact that is included among certain statutory exceptions set forth in State Finance Law §139-j(3)(a). This phase of the procurement process is known as the restricted period. SUNY Upstate Medical University employees are also required to obtain certain information when contacted during the restricted period and make a determination of the responsibility of the Offerer/bidder pursuant to these two statutes. Certain findings of non-responsibility can result in rejection for contract award and in the event of two findings within a 4 year period, the Offerer/bidder is debarred from obtaining governmental procurement contracts.

New York State Finance Law 139-k Contract Termination Provision The Governmental Entity reserves the right to terminate this contract in the event it is found that the certification filed by the Offerer in accordance with New York State Finance Law §139-k was intentionally false or intentionally incomplete. Upon such finding, SUNY Upstate Medical University may exercise its termination right by providing written notification to the Offerer in accordance with the written notification terms of this contract. Offerer affirms that it understands and agrees SUNY Upstate Medical University reserves the right to terminate the associated contract in the event it is found that the certification filed by the Offerer in accordance with New York State Finance Law §139-k was intentionally false or intentionally incomplete.

Signature:

Date:

Name:

_____________________

Title:

____________________________

Contractor Name:

_______

Contractor Address:

________

_____________________________________________________________________________________ __________________________________________________________________________________________________

2

Offerer’s Affirmation of Understanding of and Agreement pursuant to State Finance Law §139-j (3) and §139-j (6) (b) All contacts and/or inquiries regarding this procurement, be they oral, written, or electronic commencing with the earliest written notice, advertisement, or solicitation and ending with the final contract award, approved by SUNY Upstate Medical University and, where applicable, Office of the State Comptroller shall only be directed to the following persons: 1)

Cathy Adamitis Facility Design Services SUNY Upstate Medical University 750 East Adams Street/ MT-205 Syracuse, NY 13210 Ph. 315-464-4788 Fax 315-464-4698 E-mail [email protected]

Offerer affirms that it understands and agrees to comply with the procedures of SUNY Upstate Medical University relative to permissible Contacts as required by State Finance Law §139-j (3) and §139-j (6) (b).

By: ____________________________________

Date:___________________________

Name: ___________________________________________________________________ Title: _____________________________________________________________________ Contractor Name: _____________________________________________________________________________ Contractor Address: ___________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Offerer’s Certification of Compliance with State Finance Law §139-k(5) I certify that all information provided to the SUNY Upstate Medical University with respect to State Finance Law §139-k is complete, true and accurate. By: __________________________________

Date:_______________________________

Name: _________________________________________________________________ Title: __________________________________________________________________ Contractor Name: ______________________________________________________________________________ Contractor Address: ____________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

3

Offerer’s Disclosure of Prior Non-Responsibility Determinations

Date:_____________________

Contract Procurement Number: ______________________

Name of Individual or Entity Seeking to Enter into the Procurement Contract: __________________________________________________________________________________________________ Address: __________________________________________________________________________________________ ___________________________________________________________________________________________________ Person Submitting this Form: _______________________________________ Name

__________________________ Title

1. Has any Governmental Entity made a finding of non-responsibility regarding the individual or entity seeking to enter into the Procurement Contract in the previous four years? (Please circle): No Yes If yes, please answer the next questions: 2. Was the basis for the finding of non-responsibility due to a violation of State Finance Law §139-j (Please circle): No Yes 3. Was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a Governmental Entity? (Please circle): No Yes 4. If you answered yes to any of the above questions, please provide details regarding the finding of non-responsibility below. Governmental Entity: __________________________________________________________________________________ Date of Finding of Non-responsibility: _____________________________________________________________________ Basis of Finding of Non-Responsibility: ___________________________________________________________________ ____________________________________________________________________________________________________ (Add additional pages as necessary) 5. Has any Governmental Entity or other governmental agency terminated or withheld a Procurement Contract with the abovenamed individual or entity due to the intentional provision of false or incomplete information? (Please circle): No Yes 6. If yes, please provide details below. Governmental Entity: _________________________________________________________________________________ Date of Termination or Withholding of Contract: ___________________________________________________________ Basis of Termination or Withholding: __________________________________________________________________ ____________________________________________________________________________________________________ (Add additional pages as necessary) Offerer certifies that all information provided to SUNY Upstate Medical University with respect to State Finance Law §139-k is complete, true and accurate. By:

Date: Signature

Name:

Title:

4

SUNY UPSTATE MEDICAL UNIVERSITY Public Officers Law - Form Introduction: The conflict of interest and code of ethics provisions of New York State Public Officers Law §§73 & 74 shall apply to all purchasing activities of SUNY Upstate Medical University and University Hospital at Community General (collectively Upstate). Upstate is required to inquire if any member of a business entity is an officer or employee of the State of New York or of a public benefit corporation of the State of New York. Directions: 6. The SUNY Upstate Medical University Public Officers Law form consists of one (1) page. 7. The completed form will become a part of SUNY Upstate Medical University’s procurement record. 8. The form is a fillable document using MS Word. 9. It is imperative the person completing the form be knowledgeable about the vendor’s business and operations. As an owner or officer, he or she will certify the form’s information 10. The original must be sent to the address shown below Contact Information: If you have any questions regarding the form, contact Cathy Adamitis at 315-464-4788 or e-mail [email protected] The original must be sent to the address shown below. Attn: Cathy Adamitis, C.P.M., CBM Facility Design Services SUNY Upstate Medical University 750 East Adams Street/ CAB-208 Syracuse, New York 13210 Name of Contractor:

Fed. ID#

Address: Name of Person Submitting this Form: Title of Person Submitting this Form: Question: Indicate if you or any officer of your organization, or any party owning or controlling more than ten (10) percent of your stock if you are a corporation, or any member if you are a firm or association is an officer or employee of the State of New York or of a public benefit corporation of the State of New York. Yes

No

Signature:_________________________ Date:

5

Vendor NOTICE MWBE PROGRAM OF UPSTATE MEDICAL UNIVERSITY Article 15-A of the Executive Law, signed into law on July 19, 1988, authorized the creation of a division of Minority and Women’s Business Enterprise Development to promote employment and business opportunities on state contracts for minorities and women. Under this statute, State agencies are charged with establishing business participation goals for minorities and women. This requirement applies to all discretionary purchases including construction related services, non-construction related services, commodities, supplies, equipment and materials over $25,000. Unless otherwise noted, the State University of New York State (SUNY) has established a University-wide participation goal of twenty percent (20%) for every procurement contract. SUNY has established a goal of ten percent (12%) for the participation of certified minority-owned business enterprises and a goal of eight percent (8%) for the participation of certified women-owned business enterprises. The Equal Employment Opportunity (EEO) goals are twenty (20%), ten percent (10%) for minority workforce participation and ten percent 10%) for women workforce participation. These goals have been published in SUNY Master Goal Plan: State Fiscal Year 2013-14 and all competitive procurement will include this as the basis for establishing contract specific goals within their respective region. Upstate is serious about achieving its MWBE participation goals, and we are witnessing an active interest on the part of primary contractors to identify MWBE’s that can participate as subcontractors. It is incumbent upon Upstate, to assist vendors and hold them accountable for demonstrating best efforts to achieve the agency goals. Consistent with this commitment, this document has been created to assist you in meeting goals that have been set by SUNY. A listing of NYS certified Minority and Women Owned Businesses can be found at the following website: https://ny.newnycontracts.com/FrontEnd/VendorSearchPublic.asp. Successful Bidders are also reminded that in order to supply Upstate with the products and service contracts, your business will utilize a wide variety of products and services from smaller vendors. Having these services providing through an MWBE vendor (Tier II Vendor) can be counted in your satisfaction of the goals established by SUNY. A partial listing of commodities and services are included below:

 If you need help finding providers of a specific service, please contact the MWBE Program Compliance Specialist at our campus, Steven Coker, at 315-464-4657 or via e-mail [email protected]; or the University-wide MWBE Program Office at 518-320-1340 or via email [email protected]. The requisite MWBE-EEO forms contained in the Attachment A, standard clauses for all SUNY contracts which have goals assigned must be completed and submitted along with the bid documents to provide verification that good faith efforts were made in the solicitation process. This document and relevant forms are available online at: http://www.upstate.edu/finance/mwbe/forms. Complete and include the following forms with the bid:     Issued Jan 2013

MWBE Utilization Plan (Form 107); MWBE Staffing Plan (Form 108); MWBE-EEO Policy Statement (Form 104); and MWBE Campus Consultant/Contractor Affidavit (Form 109).

Upstate Medical University Vendor Form Submission Instructions In order to monitor MWBE compliance, Upstate requires that all Tier I vendors complete and submit the following forms:     

MWBE Utilization Plan (Form 107); MWBE Staffing Plan (Form 108); MWBE-EEO Policy Statement (Form 104); MWBE Campus Consultant/Contractor Affidavit (Form 109); and Quarterly MWBE Compliance Report (Form 113).

INSTRUCTIONS STEP I:

At the time a bid, quote, or proposal for procurements over $50,000 is submitted, vendor must also complete and submit the following forms: 1. MWBE Utilization Plan (Form 107) Any modifications or changes to the MWBE Utilization Plan after the Contract award and during the term of the Contract must be reported on a revised MWBE Utilization Plan and submitted to the Upstate Contract Administrator. Upstate will review the submitted MWBE Utilization Plan and advise the Vendor of the University’s acceptance or issue a notice of deficiency within 30 days of receipt. If a notice of deficiency is issued, Vendor agrees that it shall respond to the notice of deficiency within seven (7) business days of receipt by submitting a written remedy in response to the notice of deficiency. If the written remedy is found to be inadequate, the University will schedule a sit down meeting with Vendor to discuss the issue, in particular, ways in which Vendor can satisfy the requirement. Failure to comply with the MWBE utilization requirement in a timely manner may be grounds for disqualification of the bid, quote or proposal.

2. MWBE Staffing Plan (Form 108) 3. MWBE-EEO Policy Statement (Form 104) 4. MWBE Campus Consultant/Contractor Affidavit (Form 109) STEP II:

Vendors are required to submit a Quarterly MWBE Compliance Report (Form 113) to Upstate by the 5th day following each end of quarter over the term of the contract documenting the progress made toward achievement of the MWBE goals of the contract. The Quarterly MWBE Compliance Report measures the utilization of MWBE Tier II (subcontractors). They must be sent directly to Upstate’s Supplier Diversity Coordinator or University-wide MWBE Program Director. Steven Coker Supplier Diversity Coordinator Upstate Medical University Syracuse, NY 13210 315-464-4657 [email protected]

Thanks you for your interest in doing business with Upstate Medical University. Issued Jan 2013

Pamela Swanigan University-wide MWBE Program Director State University Plaza Albany, NY 12246 518-320-1628 [email protected]

M/WBE UTILIZATION PLAN INSTRUCTIONS:

This form must be submitted with any bid, proposal, or proposed negotiated contract or within a reasonable time thereafter, but prior to contract award. 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: Address: City, State, Zip Code: Telephone No.: Authorized Representative: Authorized Signature: 1. Certified M/WBE Subcontractors/Suppliers Name, Address, Email Address, Telephone No.

1.

Federal Identification No.: Location of Work: SUNY Upstate Medical University

Project No.: M/WBE Goals in the Contract: EEO Goals in the Contract: 2. Classification

NYS ESD CERTIFIED

WBE

NYS ESD CERTIFIED MBE WBE

3.

NYS ESD CERTIFIED MBE WBE

4.

NYS ESD CERTIFIED MBE WBE

5.

NYS ESD CERTIFIED MBE WBE

6.

NYS ESD CERTIFIED MBE WBE

MWBE Form 107

4. Detailed Description of Work (Attach additional sheets, if necessary)

MBE

2.

3. Federal ID No.

MBE % WBE MBE 10% WBE 10%

%

5. Dollar Value of Subcontracts/ Supplies/Services and intended performance dates of each component of the contract.

M/WBE UTILIZATION PLAN 7.

NYS ESD CERTIFIED MBE WBE

8.

NYS ESD CERTIFIED MBE WBE

9.

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). TELEPHONE NO.: EMAIL ADDRESS: 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.

FOR M/WBE USE ONLY REVIEWED BY:

UTILIZATION PLAN APPROVED: Contract No.:

DATE:

YES NO Date: Project No. & Name:

Contract Award Date: Estimated Date of Completion: Amount Obligated Under the Contract: Description of Work: NOTICE OF DEFICIENCY ISSUED: NOTICE OF ACCEPTANCE ISSUED:

MWBE Form 107

YES YES

NO Date:______________ NO Date:_____________

STATE UNIVERSITY OF NEW YORK SUBCONTRACTING INFORMATION CONTRACTOR’S NAME

DATE

ADDRESS

DESCRIPTION

SUNY PROJECT NUMBER

DATE OF NOTICE OF AWARD TELEPHONE NUMBER (

AMOUNT AWARDED )

Provide the following information for all Sub-Contractors that are NOT MWBEs: Name Complete Address Telephone Number

Federal ID Number

PLEASE RETURN COMPLETED FORM TO:

Value of Subcontract or Supply Order

Scope of Work

MBE/ WBE

NAME OF COMPANY DESIGNEE (PRINT/TYPE) SIGNATURE DATE

TELEPHONE NUMBER ( )

Certified Business shall mean a business verified as a minority or women-owned business enterprise pursuant to Section 314 of the Executive Law. If you need additional space to provide information, please include attachments. C2123-697 Feb 2012

SUNY Upstate Medical University CAMPUS’ CONSULTANT AFFIDAVIT This Utilization Plan must be verified under oath in the following manner: (A) if the enterprise is a sole proprietorship, by owner, or if the enterprise is a partnership, by partner; or (B) if the enterprise is a corporation, by the principal officer designated by the Board of Directors. All Applicants/Contractors must read and review all items preceding the verification before signing. These items contain responsibilities of the Consultant, rights retained by the State University of New York (SUNY) and penalties that may be applied for false statements. FIRST, this Utilization Plan form, the supporting documents, and any other information provided in support of the utilization plan are considered part of the Campus’ Consultant contract. It is recognized and acknowledged that the information contained in this Utilization Plan is given under oath and that any misrepresentation made in this is subject to both the civil and criminal laws of the State of New York. SECOND, by filing this Utilization Plan, the Consultant consents to periodic examination of its books, records, and an interview of its principals and employees by the SUNY at Upstate Medical University for the purpose of determining the solicitation and utilization of NYS certified Minority and Woman-Owned Business Enterprises. THIRD, by filing this Utilization Plan, the Consultant consents to inquiries that may be directed by SUNY at Upstate Medical University to the Consultant’s companies, banking institutions, credit agencies, and contractors for the purpose of ascertaining the Consultant/Contractor’s payments to subcontractors. FOURTH, the Consultant agrees to provide notice to SUNY at Upstate Medical University of any material change in the information contained in the original application within fifteen (15) days of such change. FIFTH, by filing this Utilization Plan, the Consultant consents to SUNY at Upstate Medical University sharing reports, summaries, reviews, analyses, recommendations and determinations related to this Utilization Plan with other state agencies, which may request such information as a result of the Consultant submitting this Utilization Plan. I have read and acknowledged the foregoing. ____________________________________ Signature of Owner/Applicant

MWBE Form 109 (Part 1)

EEO STAFFING PLAN Solicitation No.:

Reporting Entity: SUNY Upstate Medical University Project # & Title:

Offeror’s Name: Offeror’s Address:

Instructions on page 2 Report includes Contractor’s/Subcontractor’s: □ Work force to be utilized on this contract □ Total work force □ Offerer □ Subcontractor Subcontractor’s name________________

Enter the total number of employees for each classification in each of the EEO-Job Categories identified EEO-Job Category

Total Work force

Work force by Gender Total Total Male Female (M) (F)

Work force by Race/Ethnic Identification White (M) (F)

Black (M) (F)

Hispanic (M) (F)

Asian (M) (F)

Native American (M) (F)

Disabled (M) (F)

Officials/Administrators Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Service Workers Temporary /Apprentices

Totals PREPARED BY (Signature):

NAME AND TITLE OF PREPARER (Print or Type):

MWBE Form 108

TELEPHONE NO.: EMAIL ADDRESS: Submit completed with bid or proposal

DATE:

Veteran (M) (F)

General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (ADM/EEO 100) 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: 1. Enter the Solicitation number that this report applies to along with the name and address of the Offeror. 2. Check off the appropriate box to indicate if the Offeror completing the report is the contractor or a subcontractor. 3. Check off the appropriate box to indicate work force to be utilized on the contract or the Offerors’ total work force. 4. Enter the total work force by EEO job category. 5. Break down the anticipated total work force by gender and enter under the heading ‘Work force by Gender’ 6. Break down the anticipated total work force by race/ethnic identification and enter under the heading ‘Work force by Race/Ethnic Identification’. Contact the M/WBE Permissible contact(s) for the solicitation if you have any questions. 7. Enter information on disabled or veterans included in the anticipated work force under the appropriate headings. 8. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes. RACE/ETHNIC IDENTIFICATION Race/ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. For the purposes of this 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 DISABLED INDIVIDUAL

VIETNAM ERA VETERAN GENDER

MWBE Form 108

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.

a veteran who served at any time between and including January 1, 1963 and May 7, 1975. Male or Female

State University of New York CONTRACTOR’S EEO POLICY STATEMENT

Campus

SUNY Upstate Medical University

Project Title

__

____________________________________________________

Project Number Prior to the award of a State Contract, the Consultant shall submit an Equal Employment Opportunity (“EEO”) Policy Statement to the contracting agency within the time frame established by that agency. The Consultant’s EEO Policy Statement shall contain, but not necessarily be limited to, and the Consultant, as a precondition to entering into a valid and binding State contract, shall, during the performance of the State contract, agree to the following: (a)

The Consultant will not discriminate against any employee or applicant for employment because of race,

creed, color, national origin, sex, age, disability or marital status, will undertake or continue existing programs of affirmative action to ensure that minority group members 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 on State contracts. (b)

The Consultant shall state in all solicitations or advertisements for employees that, in the performance of

the State contract, all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. (c)

At the request of the contracting agency, the Consultant 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 Consultant’s obligations herein.

Company

Signature

Date

Title

Page 1

MINORITY AND WOMEN’S BUSINESS - EQUAL EMPLOYMENT OPPORTUNITY PROGRAM POLICY STATEMENT

Policy Statement The __

______________commits to carrying out the intent of the New York State

(Consultant)

Executive Law, Article 15-A which assures the meaningful participation of minority and women’s business enterprises in contracting and the meaningful participation of minorities and women in the workforce on activities financed by public funds. Minority Business Officer __

_____________is designated as the Minority Business Enterprise Officer

(Name of Designated Officer)

responsible for administering the Minority and Women’s Business-Equal Employment Opportunity (M/WBE-EEO) program. M/WBE Contract Goals _10__% Minority Business Enterprise Participation _10____% Women’s Business Enterprise Participation EEO Contract Goals 10% Minority Labor Force Participation 10% Female Labor Force Participation

____________________________________ (Authorized Representative) Title:________________________________ Date:________________________________

MWBE Form 104

3/21/05

New York State Council of Contracting Agencies Standard Vendor Responsibility Questionnaire (Use the Uniform Contracting Questionnaire CCA-1, for all construction contracts) Each Contracting Agency conducts a review of prospective contractors (“vendors”) to provide reasonable assurances that the vendor is responsible. This questionnaire is used for all nonconstruction contracts and is designed to provide information to assess a vendor’s authorization to do business in New York State, as well as your business integrity, financial and organizational capacity, and performance history. (Review of construction contractors will be based upon the Uniform Contracting Questionnaire developed by the Council of Contracting Agencies.) Each vendor must answer every question contained in this questionnaire. Where a response requires additional information, the vendor must attach a written response that adequately details the requested information. Please number each response to match the question number. The completed questionnaire and attached responses will become part of the procurement record. In order to expedite the required review, when providing additional information for a “YES” answer to Questions 14 a-s, or any other response which requires additional explanation, your information and responses should address the relationship of the issue to the proposed contract. Be brief, concise and to the point. Discuss as appropriate the following: Provide a description of the issue and identify the actions taken or currently being implemented to ensure that the issue will not occur again. State whether the staff and/or organizational component involved in the identified issue(s) will work on the proposed contract. If so, provide information to assure the agency that the issue will not be repeated. Identify the relationship (or lack thereof) between the product/services involved in the issue and the type of product/services proposed for this contract. State whether the issue will affect your financial or organizational ability to perform under the proposed contract. Provide copies of relevant documents or any other information that would assist the agency in its vendor responsibility evaluation. It is imperative that the person completing the vendor responsibility questionnaire be knowledgeable about the proposing vendor’s business and operations, as an owner or officer of the vendor must attest to the questionnaire information. Please be advised that at the end of this questionnaire, you must certify, under oath, all responses given.

Page 1 of 6

3/21/05

STATE OF NEW YORK Council of Contracting Agencies

Standard Vendor Responsibility Questionnaire 1.

LEGAL BUSINESS NAME: ______________________________________________________________

2.

FEDERAL EMPLOYER ID NO. (FEIN): ____________________________________________________

3.

D/B/A — Doing Business As (if applicable): __________________________________________________ COUNTY FILED: _______________________________________________________________________

4.

WEBSITE ADDRESS (if applicable) __________________________________________

5.

PRINCIPAL PLACE OF BUSINESS ADDRESS: _____________________________________________

6.

TELEPHONE NUMBER: _________________________ 7.

8.

AUTHORIZED CONTACT FOR THIS QUESTIONNAIRE:

FAX NUMBER: ___________________

Name: _______________________________________________________________________ Title: ________________________________________________________________________ Telephone Number: _________________________ Fax Number: _____________________ E-mail: ____________________________________ 9.

TYPE OF BUSINESS: (please check appropriate box and provide additional information): a) Corporation State of Incorporation: __________________________ b) Sole Proprietor State/County filed in: ___________________________ c) General Partnership State/County filed in: ___________________________ d) Not-for-Profit Corporation Charities Registration Number: ___________________ e) Limited Liability Company (LLC) Jurisdiction filed:_______________________________ f) Limited Partnership State/County filed in: ___________________________ g) Other — Specify: Jurisdiction Filed (if applicable): __________________

10.

IF NOT INCORPORATED OR FORMED IN NEW YORK STATE, PLEASE PROVIDE A CURRENT CERTIFICATE OF GOOD STANDING FROM YOUR STATE OR APPLICABLE LOCAL JURISDICTION.

11. LIST NAME AND TITLE OF EACH PRINCIPAL, OWNER, OFFICER, MAJOR STOCKHOLDER (10% OR MORE OF THE VOTING SHARES FOR PUBLICLY TRADED COMPANIES, 25% OR MORE OF THE SHARES FOR ALL OTHER COMPANIES), DIRECTOR AND MEMBER, as applicable: a) ______________________________________________________________________________________ b) _____________________________________________________________________________________ c) ______________________________________________________________________________________ d) _____________________________________________________________________________________ e) ______________________________________________________________________________________ f) ______________________________________________________________________________________ g) ______________________________________________________________________________________ h) _____________________________________________________________________________________ 12.

AUTHORIZED CONTACT FOR THE PROPOSED CONTRACT: Name: _____________________________________ Title: ______________________________________ Telephone Number: _________________________ Fax Number: ______________________ E-mail: ____________________________________

Page 2 of 6

3/21/05

STATE OF NEW YORK Council of Contracting Agencies Standard Vendor Responsibility Questionnaire VENDOR FEIN: ____________ 13.

DOES THE VENDOR USE, OR HAS IT USED IN THE PAST FIVE (5) YEARS, ANY OTHER BUSINESS NAME, FEIN, OR D/B/A OTHER THAN WHAT IS LISTED IN QUESTIONS 1-3 ABOVE? Yes No If yes, provide the name(s), FEIN(s) and d/b/a(s) and the address for each such company and d/b/a on a separate piece of paper and attach to this response.

14.

WITHIN THE PAST FIVE (5) YEARS, HAS THE VENDOR, ANY PRINCIPAL, OWNER, OFFICER, MAJOR STOCKHOLDER (10% OR MORE OF THE VOTING SHARES FOR PUBLICLY TRADED COMPANIES, 25% OR MORE OF THE SHARES FOR ALL OTHER COMPANIES), AFFILIATE1 OR ANY PERSON INVOLVED IN THE BIDDING, CONTRACTING OR LEASING PROCESS BEEN THE SUBJECT OF ANY OF THE FOLLOWING: (a)

a judgment or conviction for any business related conduct constituting a crime under federal, state or local government law including, but not limited to, fraud, extortion, bribery, racketeering, price-fixing or bid collusion or any crime related to truthfulness and/or business conduct? Yes No

(b)

a criminal investigation or indictment for any business related conduct constituting a crime under federal, state or local government law including, but not limited to, fraud, extortion, bribery, racketeering, price-fixing or bid collusion or any crime related to truthfulness and/or business conduct? Yes No

(c)

an unsatisfied judgment, injunction or lien for any business related conduct obtained by any federal, state or local government agency including, but not limited to, judgments based on taxes owed and fines and penalties assessed by any federal, state or local government agency? Yes No

(d)

an investigation for a civil or criminal violation for any business related conduct by any federal, state or local agency? Yes No

(e)

a grant of immunity for any business-related conduct constituting a crime under federal, state or local governmental law including, but not limited to, fraud, extortion, bribery, racketeering, price-fixing, bid collusion or any crime related to truthfulness and/or business conduct? Yes No

(f)

a federal, state or local government suspension or debarment from the contracting process? Yes

(g)

No

a federal, state or local government contract suspension or termination for cause prior to the completion of the term of a contract? Yes No

1

"Affiliate"meaning: (a) any entity in which the vendor owns more than 50% of the voting stock; (b) any individual, entity or group of principal owners or officers who own more than 50% of the voting stock of the vendor; or (c) any entity whose voting stock is more than 50% owned by the same individual, entity or group described in clause (b). In addition, if a vendor owns less than 50% of the voting stock of another entity, but directs or has the right to direct such entity’s daily operations, that entity will be an “affiliate” for purposes of this questionnaire.

Page 3 of 6

3/21/05

STATE OF NEW YORK Council of Contracting Agencies Standard Vendor Responsibility Questionnaire VENDOR FEIN:____________ (h)

a federal, state or local government denial of a lease or contract award for non-responsibility? Yes

No

(i)

an administrative proceeding or civil action seeking specific performance or restitution in connection with any federal, state or local contract or lease? Yes No

(j)

a federal, state or local determination of a willful violation of any public works or labor law or regulation? Yes No

(k)

a sanction imposed as a result of judicial or administrative proceedings relative to any business or professional license? Yes No

(l)

a consent order with the New York State Department of Environmental Conservation, or a federal, state or local government enforcement determination involving a violation of federal, state or local laws? Yes No

(m)

an Occupational Safety and Health Act citation and Notification of Penalty containing a violation classified as serious or willful? Yes No

(n)

a rejection of a bid on a New York State contract or a lease with the State for failure to comply with the MacBride Fair Employment Principles? Yes No

(o)

a citation, violation order, pending administrative hearing or proceeding or determination issued by a federal, state or local government for violations of: health laws, rules or regulations

Yes

No

unemployment insurance or workers’ compensation coverage or claim requirements

Yes

No

ERISA (Employee Retirement Income Security Act)

Yes

No

human rights laws

Yes

No

federal U.S. Citizenship and Immigration Services laws

Yes

No

Sherman Act or other federal anti-trust laws

Yes

No

(p)

entered into an agreement to a voluntary exclusion from contracting with a federal, state or local governmental entity? Yes No

(q)

a denial, decertification, revocation or forfeiture of Women’s Business Enterprise, Minority Business Enterprise or Disadvantaged Business Enterprise status? Yes No

Page 4 of 6

3/21/05

(r)

a rejection of a low bid on a federal, state or local contract for failure to meet statutory affirmative action or Minority or Women's Business Enterprise or Disadvantaged Business Enterprise status requirements on a previously held contract? Yes No

(s)

a finding of non-responsibility by an agency or authority due to the intentional provision

incomplete information as required by State Finance Law 139 ?

Yes

of false or No

FOR EACH YES ANSWER TO QUESTIONS 14 a-s, PROVIDE DETAILS ON ADDITIONAL SHEETS REGARDING THE FINDING, INCLUDING BUT NOT LIMITED TO CAUSE, CURRENT STATUS, RESOLUTION, ETC. 15.

DURING THE PAST THREE YEARS, HAS THE VENDOR FAILED TO: (a) FILE RETURNS OR PAY ANY APPLICABLE FEDERAL, STATE OR LOCAL GOVERNMENT TAXES? Yes No If yes, identify the taxing jurisdiction, type of tax, liability year(s) and tax liability amount the company failed to file/pay and the current status of the liability: ________________________________________________________________________________________ _______________________________________________________________________________________. (b)

FILE RETURNS OR PAY NEW YORK STATE UNEMPLOYMENT INSURANCE? Yes

No

If yes, indicate the years the company failed to file/pay the insurance and the current status of the liability: _______________________________________________________________________________. 16.

HAVE ANY BANKRUPTCY PROCEEDINGS BEEN INITIATED BY OR AGAINST THE VENDOR OR ITS AFFILIATES WITHIN THE PAST SEVEN YEARS (WHETHER OR NOT CLOSED) OR IS ANY BANKRUPTCY PROCEEDING PENDING BY OR AGAINST THE VENDOR OR ITS AFFILIATES, REGARDLESS OF THE DATE OF FILING? Yes No If yes, indicate if this is applicable to the submitting vendor or one of its affiliates: ________________ If it is an affiliate, include the affiliate’s name and FEIN: ______________________________________ Provide the court name, address and docket number: __________________________________________ Indicate if the proceedings have been initiated, remain pending or have been closed:________________ If closed, provide the date closed: ______________________________

17.

DOES VENDOR HAVE THE FINANCIAL RESOURCES NECESSARY TO FULFILL THE REQUIREMENTS OF THE PROPOSED CONTRACT? Yes No

Page 5 of 6

3/21/05

STATE OF NEW YORK Council of Contracting Agencies

Standard Vendor Responsibility Questionnaire VENDOR FEIN: ____________

State of County of

) ) ss: )

CERTIFICATION: The undersigned, personally and on behalf of the vendor identified in questions 1-3 above, does hereby state and certify to SUNY Upstate Medical University that the information given above is true, accurate and complete. It is further acknowledged that the State of New York and the SUNY Upstate Medical University will rely upon the information contained herein and in any attached pages for purposes of evaluating our company for vendor's responsibility for contract award and the State may, in its discretion, by means which it may choose, verify the truth and accuracy of all statements made herein. It is further acknowledged that intentional submission of false or misleading information may constitute a felony under Penal Law Section 210.40 or a misdemeanor under Penal Law Section 210.35 or Section 210.45, and may also be punishable by a fine and/or imprisonment of up to five years under 18 USC Section 1001 and may result in contract termination. ____________________________________ Name of Business

____________________________________ Signature of Officer

____________________________________ Address

____________________________________ Typed Copy of Signature

____________________________________ City, State, Zip

____________________________________ Title

Sworn to before me this _____ day of ______________20__ .

_______________________ Notary Public: Registration No: State:

Page 6 of 6



New York State Department of Taxation and Finance



(Pursuant to Section 5-a of the Tax Law, as amended, effective April 26, 2006)



ST-220-CA

Contractor Certification to Covered Agency

(6/06)

For information, consult Publication 223, Questions and Answers Concerning Tax Law Section 5-a (see Need Help? on back). Contractor name

For covered agency use only Contract number or description

Contractor’s principal place of business

City

Contractor’s mailing address (if different than above) Contractor’s federal employer identification number (EIN)

State

ZIP code

Contractor’s sales tax ID number (if different from contractor’s EIN)

Estimated contract value over the full term of contract (but not including renewals) $

Contractor’s telephone number

Covered agency name

Covered agency address

SUNY Upstate Medical University, 750 East Adams Street, Syracuse, New York 13210

Covered agency telephone number

315

464-4788

I, , hereby affirm, under penalty of perjury, that I am (name) (title) of the above‑named contractor, that I am authorized to make this certification on behalf of such contractor, and I further certify that: (Mark an X in only one box)

G

The contractor has filed Form ST-220-TD with the Department of Taxation and Finance in connection with this contract and, to the best of contractor’s knowledge, the information provided on the Form ST-220-TD, is correct and complete.

G

The contractor has previously filed Form ST-220-TD with the Tax Department in connection with



(insert contract number or description)

and, to the best of the contractor’s knowledge, the information provided on that previously filed Form ST-220-TD, is correct and complete as of the current date, and thus the contractor is not required to file a new Form ST-220-TD at this time.

Sworn to this



day of

, 20

(sign before a notary public)

(title)

Instructions General information Tax Law section 5-a was amended, effective April 26, 2006. On or after that date, in all cases where a contract is subject to Tax Law section 5-a, a contractor must file (1) Form ST-220-CA, Contractor Certification to Covered Agency, with a covered agency, and (2) Form ST-220-TD with the Tax Department before a contract may take effect. The circumstances when a contract is subject to section 5-a are listed in Publication 223, Q&A 3. This publication is available on our Web site, by fax, or by mail. (See Need help? for more information on how to obtain this publication.) In addition, a contractor must file a new Form ST-220-CA with a covered agency before an existing contract with such agency may be renewed. If you have questions, please call our information center at 1 800 698-2931.

Note: Form ST-220-CA must be signed by a person authorized to make the certification on behalf of the contractor, and the acknowledgement on page 2 of this form must be completed before a notary public.

When to complete this form As set forth in Publication 223, a contract is subject to section 5-a, and you must make the required certification(s), if: i. The procuring entity is a covered agency within the meaning of the statute (see Publication 223, Q&A 5); ii. The contractor is a contractor within the meaning of the statute (see Publication 223, Q&A 6); and iii. The contract is a contract within the meaning of the statute. This is the case when it (a) has a value in excess of $100,000 and (b) is a contract for commodities or services, as such terms are defined for purposes of the statute (see Publication 223, Q&A 8 and 9). Furthermore, the procuring entity must have begun the solicitation to purchase on or after January 1, 2005, and the resulting contract must have been awarded, amended, extended, renewed, or assigned on or after April 26, 2006 (the effective date of the section 5-a amendments).

Page 2 of 2  ST-220-CA (6/06)

Individual, Corporation, Partnership, or LLC Acknowledgment STATE OF COUNTY OF



} :





}

SS.:

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.]

G (If an individual): _he executed the foregoing instrument in his/her name and on his/her own behalf. G

(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.

G

(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.

G

(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.

Need help? Privacy notification The Commissioner of Taxation and Finance may collect and maintain personal information pursuant to the New York State Tax Law, including but not limited to, sections 5-a, 171, 171‑a, 287, 308, 429, 475, 505, 697, 1096, 1142, and 1415 of that Law; and may require disclosure of social security numbers pursuant to 42 USC 405(c)(2)(C)(i). This information will be used to determine and administer tax liabilities and, when authorized by law, for certain tax offset and exchange of tax information programs as well as for any other lawful purpose. Information concerning quarterly wages paid to employees is provided to certain state agencies for purposes of fraud prevention, support enforcement, evaluation of the effectiveness of certain employment and training programs and other purposes authorized by law. Failure to provide the required information may subject you to civil or criminal penalties, or both, under the Tax Law. This information is maintained by the Director of Records Management and Data Entry, NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone 1 800 225‑5829. From areas outside the United States and outside Canada, call (518) 485‑6800.

 

Internet access: www.nystax.gov   (for information, forms, and publications) Fax-on-demand forms:

1 800 748-3676

Telephone assistance is available from   8:00 A.M. to 5:00 P.M. (eastern time),   Monday through Friday. To order forms and publications: From areas outside the U.S. and outside Canada:

1 800 698‑2931 1 800 462-8100 (518) 485-6800

Hearing and speech impaired (telecommunications device for the deaf (TDD) callers only):

1 800 634-2110

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, please call 1 800 972-1233.