New York State Office of Information Technology Services



Checklist ItemPage # Administrative Submission?Correct Number of Administrative Submissions?Electronic format submitted-Administrative???Attachment 1 - Bid Checklist, completed and signed ??Attachment 2 - Bidder Information Form?Attachment 6 - Consultant Confidentiality and Non-Disclosure Agreement??Attachment 7 – Worker’s Compensation and Disability Insurance RequirementsWorkers’ Compensation Requirements under WCL § 57: Completed Workers Compensation Coverage Form:C-105.2 (Certificate of NYS Workers' Compensation Insurance Coverage): Contact your insurance carrier or licensed NYS insurance agent for this form ORU-26.3 (NY State Insurance Fund Certificate of Workers' Compensation Coverage) Available from the NYS Insurance Fund ORSI-12 (Affidavit Certifying That Compensation Has Been Secured): Board-approved self-insurers must obtain this form from Board's Self-Insurance Office ORGSI-105.2 (Certificate of Participation in Workers' Compensation Group Board-Approved Self-Insurance): Employers must obtain this form from their group self-insurance administrator; ORDisability Benefits Coverage Form:DB-120.1 (Certificate of Insurance Coverage Under the NYS Disability Benefits Law): Contact your insurance carrier or licensed NYS insurance agent for this form ORDB-155 (Compliance with Disability Benefits Law): Board-approved self-insured employers must obtain this form from Board's Self-Insurance Office ORWC/DB CE-200, Certificate of Attestation of Exemption from New York State Workers Compensation and/or Disability Benefits Coverage: Request through the Workers’ Compensation Board website.?Attachment 8, NYS Required Certification??Attachment 9, Completed Lobbying Forms All-in-One Completed and signed Offeror’s Affirmation of Understanding of and Agreement pursuant to State Finance Law §139-j (3) and §139-j (6) (b)Completed and signed Offeror Disclosure of Prior Non-Responsibility Determinations?Attachment 10, EEO 100 – Equal Employment Opportunity Staffing Plan, completed and signed?Attachment 11, Completed and signed MWBE Utilization Plan-MWBE 100 ?Attachment 12, Completed MWBE and EEO Policy Statement- Form # 4 ?Attachment 13, Completed, signed Encouraging Use of NYS Businesses in Contract Performance?Attachment 14, Contractor Certification to Covered Agency, ST-220-CA, completed, signed, and notarized?Attachment 15, Vendor Responsibility Questionnaire For-Profit Business Entity, completed, signed and notarized by every subcontractor that is expected to receive income valued at $100,000 or more over the term of the agreementFinancial Bid?Number of Financial Bids submitted?Electronic Financial Bid submitted?Attachment 4, Completed, Signed, and Notarized Firm Offer Letter and Conflict of Interest Disclosure??Attachment 18, Financial Bid Workbook Technical Requirements??Number of Technical Requirements Plan submitted?Electronic Technical Requirements Plan submitted?Each Technical Requirements Plan should include:?Attachment 17 – Minimum Bidder Qualifications?Attachment 18 - Requirements Verification and Traceability Matrix(For each requirement identified in this Invitation for Bid, the Bidder must provide written plan as to how they will meet the requirement as written)?Resumés for Dispatch Coordinator, Lan Cabling Technician, and Registered Communications Distribution Designer (RCDD) * Should there be a discrepancy between the electronic media and the original hard copy, the hard copy takes precedent.I certify, with my signature below, that all required and requested information listed above is completed and included in this bid submission. Authorized Signature:Date: Print Name and Title:Company represented: ................
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