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Attachment 2

Bidder Response Forms

Part I —Technical Submittal (Cover Sheet) Attachment 2: Bidder Response Forms

Group 79008 Fuel Card ServicesRequest for Proposals #22445

BID PROPOSAL COVER SHEET

PART I - TECHNICAL SUBMITTAL*** Important - Failure to Furnish All Required Information may render the Bid Non-Responsive ***

The bid must be fully and properly executed by an authorized person. By signing you certify your express authority to sign on behalf of yourself, your company, or other entity and full knowledge and acceptance of this REQUEST FOR PROPOSALS, Appendix A (Standard Clauses For New York State Contracts, June 2011), Appendix B (OGS General Specifications, July 2006), and State Finance Law §139-j and §139-k (Procurement Lobbying), and that all information provided is complete, true and accurate. By signing, Bidder affirms that it understands and agrees to comply with the OGS procedures relative to permissible contacts as required by State Finance Law §139-j (3) and §139-j (6) (b). Information may be accessed at:

Procurement Lobbying: http://www.ogs.ny.gov/aboutOgs/regulations/defaultSFL_139j-k.asp

By signing, Bidder affirms that it understands and agrees to requirements of this RFP except as otherwise noted in its’ proposal as allowable within this RFP.

Bidder’s Federal Tax Identification Number:(Do Not Use Social Security Number)

NYS Vendor Identification Number:(See “New York State Vendor File Registration” clause)

Legal Business Name of Company Bidding:

D/B/A - Doing Business As (if applicable):

Street City State Zip County

Bidder’s Signature:

Title:

Printed or Typed Name:

Date:

Name of Preparer: __________________________________________________

Telephone Number of Preparer: _______________________________________

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Part I —Technical Submittal (Cover Sheet) Attachment 2: Bidder Response Forms

CORPORATE ACKNOWLEDGMENT

STATE OF : ss.:

COUNTY OF

On the _____________ day of ______________________in the year _____ , before me personally came: _______________________________________________________________, to me known, who, being by me duly sworn, did depose and say that he/she/they reside(s) in _________________________; that he/she/they is (are) _____________________________________________ (the President or other officer or director or attorney in fact duly appointed) of ___________________________________________, the corporation described in and which executed the above instrument; and that he/she/they signed his/her/their name(s) thereto by authority of the board of directors of said corporation.

__________________________________________Notary Public


Part I —Technical Submittal (Checklist) Attachment 2: Bidder Response Forms

Bid Submittal ChecklistThe following checklist must be completed and submitted with each bid. Unless otherwise noted, all submissions are mandatory. Failure to respond or submit required information may render the bid non-responsive.

Proposal is bound.Proposal pages are numbered.

Proposal is submitted in two (2) separately sealed parts:1. Part I -- Technical Submittal (i.e., response to Section VI, Bidder Technical Qualifications & Service

Requirements).2. Part II -- Financial Submittal (i.e., response to Section VII, Bidder Financial Requirements).

Proposal has a Table of Contents and indexed tabs for Part I, Technical Submittal, following the order set forth in Section IX.2, Part I – Response to Section VI, Bidder Technical Qualifications & Service Requirements.

Bidder has enclosed:1. Three written and signed originals of Part I, Technical Submittal2. Three written and signed originals of Part II, Financial Submittal3. Five CD-ROMs containing Part I, Technical Submittal, labeled with Bidder name, RFP # and “Part I”4. Five CD-ROMs containing Part II, Financial Submittal, labeled with Bidder name, RFP # and “Part II”

Bidder has completed all information and provided original signatures as appropriate on:1. RFP Cover page;2. Attachment 2: Bidder Response Forms, Part I --Technical Submittal;

a) Bid Proposal Cover Sheet;b) Bid Submittal Checklist;c) Mandatory Contractor Questionnaire (including MacBride Certification and Non-Collusive

Bidding Certification);d) Contact Information;e) Bidder’s Affirmation of Qualifying Technical Requirements Checklist; andf) Bidder’s Response to Technical Requirements Table.

3. Attachment 2: Bidder Response Forms, Part II -- Financial Submittala) Bid Proposal Cover Sheet; andb) Attachment 3: Part II – Financial Submittal (Discount Tables).

Extraneous Terms are fully detailed in a separate section of the Bid Proposal.

Bidder agrees to extend use of contract in accordance with RFP, Appendix B, §39 (c ), Participation in Centralized Contracts – Voluntary Extension.

ST-220 - NY State Taxation and Finance Forms (Check only the box(s) that applies to Bidder submission)

ST-220-CA is enclosedST-220-TD sent to NY State Taxation and Finance DepartmentBidder will provide within 5 business days of written request by OGS

Standard Vendor Responsibility Questionnaire (SVRQ) for-profit businesses (Check only the box(s) that applies to Bidder submission)

Bidder has filed the Vendor Responsibility Questionnaire on-lineBidder will provide within 5 business days of written request by OGSIf Bidder submitted on-line, certification (or recertification) is less than six months old.Bidder has submitted a hard copy of the Vendor Responsibility Questionnaire

Workers Compensation Requirements (Check only the box that applies to Bidder submission) Bidder has submitted current NY State Workers Compensation Insurance and Disability certificates. Bidder has submitted a NY State exemption certificate. Bidder will provide within 10 business days of written request by OGS


Part I — Technical Submittal (Mandatory Questionnaire) Attachment 2: Bidder Response Forms

MANDATORY CONTRACTOR QUESTIONNAIRE[BIDDER MUST ANSWER ALL QUESTIONS]

Page 1 of 3

1. Are you a New York State resident business? Yes_____ No_____

2. Total number of people employed by your firm:

3. Total number of people employed by your firm in New York State:

4. Is your company independently owned and operated? Yes_____ No______

5. Place of manufacture or development of Product(s) offered(Please indicate “Yes” or “No” for A, B or C):

A. All NYS manufacture/development? OR

B. All manufactured/developed outside NYS? OR

C. Manufactured/developed in NYS and outside NYS?

Yes_____

Yes _____

Yes_____

No______

No______

No______

6. Is your firm at least 51% owned and controlled by women, or 51% owned and controlled by minority group members, i.e., Black Hispanic, Asian, Pacific Islander, American Indian, Alaskan Native?

If yes, _____Minority Owned ______Women Owned

If yes, have you been certified or registered? ____Yes _____No

If yes, List certification or registration authority:_____________________________________________

Yes_____ No______

7. Do any of the Products offered herein incorporate recycled materials?

Yes_____ No____ N/A___

8. Do any of the Products offered herein contain remanufactured components?

Yes_____ No____ N/A ___

9. Are any of the Products offered herein Energy Star Compliant?

If yes, which Products?__________________________________________

Yes_____ No____

N/A ___

10. BIDDER/OFFERER DISCLOSURE OF PRIOR NON-RESPONSIBILITY DETERMINATIONSPursuant to Procurement Lobbying Law (SFL §139-j)

A. 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?

Yes_____ No____ N/A ___

If yes, please answer the following:

question:B. Was the basis for the finding of non-responsibility due to a violation of State Finance Law §139-j?

Yes_____ No____

N/A ___



C. If yes, was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a governmental entity?

Yes_____ No____

N/A ___

If yes, please provide details regarding the finding of non-responsibility:

Governmental Entity: ________________________Date of Finding of Non-responsibility: ________________________

Basis of Finding of Non-Responsibility:

(add additional pages if necessary)D. Has any governmental agency terminated or withheld a

procurement contract with the above-named individual or entity due to the intentional provision of false or incomplete information?

Yes_____ No______

If yes, please provide details:

Governmental Entity: _________________________Date of Termination or Withholding of Contract: _________________________

Basis of Termination or Withholding:(add additional pages if necessary)

_________________________

Signature: _________________________Printed Name: _________________________

Date: _________________________

11. Are prices quoted the same as or lower than those quoted other corporations, institutions and government agencies (including GSA/VA contracts) on similar products, quantities, terms and conditions? See "Best Pricing Offer" in Appendix B, OGS General Specifications.If "NO", please explain on a separate sheet.

Yes_____ No______

A. Do you have a contract with the General Services Administration (GSA) or Veterans Affairs (VA) for products offered? (Check all that apply.)

GSA

Yes_____ No______

VA

Yes_____ No______B. If yes, will you offer New York State your GSA or VA

pricing or better? GSAYes_____ No______

VA

Yes_____ No______C. If yes, a copy of the GSA or VA schedule is required.

Have you included a copy? GSA

Yes_____ No______

VA

Yes_____ No______12. Will you offer a Cash Discount for payment within 15 days of delivery

and/or receipt of voucher?Yes_____

_____ %

No______

13. Will you offer a Cash Discount for payment within 30 days of delivery and/or receipt of voucher?

Yes_____

_____ %

No______



BIDDER IS REQUIRED TO SIGN BOTH SECTIONS BELOW

MACBRIDE CERTIFICATION

NON-DISCRIMINATION IN EMPLOYMENT IN NORTHERN IRELAND:MACBRIDE FAIR EMPLOYMENT PRINCIPLES

In accordance with Chapter 807 of the Laws of 1992 the Bidder, by submission of this bid, certifies that it or any individual or legal entity in which the Bidder holds a 10% or greater ownership interest, or any individual or legal entity that holds a 10% or greater ownership interest in the Bidder, either: (answer yes or no to one or both of the following, as applicable),

(1) have business operations in Northern Ireland,

Yes___ or No ___if yes:

(2) shall take lawful steps in good faith to conduct any business operations they have in Northern Ireland in accordance with the MacBride Fair Employment Principles relating to nondiscrimination in employment and freedom of workplace opportunity regarding such operations in Northern Ireland, and shall permit independent monitoring of their compliance with such Principles.

Yes ___ or No ___

__________________________________ __________________________ (Bidder’s Signature) (Name of Business)

NON-COLLUSIVE BIDDING CERTIFICATION

NON-COLLUSIVE BIDDING CERTIFICATION

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

(1) The prices in this bid have been arrived at independently without collusion, consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other Bidder or with any competitor;

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

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

BIDDER JOINT BIDDER

__________________________________ __________________________ (Bidder’s Signature) (Joint Bidder’s Signature)

__________________________________ __________________________ (Name of Business) (Name of Business)


Part I —Technical Submittal (Contact Information) Attachment 2: Bidder Response Forms

Contact Information (for Contract Administration Purposes)

Company Name:Company Headquarters

Address:(From first page of Contract)

FEDERAL ID #:NYS Vendor ID #:

Type of Company:

(Legal entity for contractual purposes)

Corporation Partnership Joint Venture Other (explain)

If Joint Venture Name of Lead Entity: _______________________________________

2. CONTRACT ADMINISTRATIONContract Administrator Name:

Title:Mailing Address:

“Toll” Free Phone Number:Telephone Number:

E-mail:FAX:

3. SALES/BILLING Contact Name:

Title:Address:

Telephone Number:E-mail:

FAX:4. HELP DESK/ SERVICE

Contact Name:Title:

Address: E-mail:

WWW Address:Telephone Number: FAX:

Contract “Toll” Free Support Phone Number:

Hours of Availability:


Part I — Technical Submittal (Bidder’s Affirmation) Attachment 2: Bidder Response Forms

BIDDER’S AFFIRMATION OF QUALIFYING TECHNICAL REQUIREMENTS CHECKLIST (PASS / FAIL)In addition to providing the following affirmations, Bidder must respond to the requirements as specified in this RFP. Responses should follow this document in Tab #2.

Technical Requirements – Qualifying Criteria Bidder’s Affirmation

Section II.1 Mandatory Requirements (A)Bidder has a minimum of four (4) years experience providing Fuel Card Services. Yes No

Section II.1 Mandatory Requirements (B)Bidder has statewide (covers all New York State counties), and nationwide Fuel Locations, supported by a Fuel Card that may be used for Fuel supplied by multiple oil companies (e.g. Exxon Mobil, Chevron, Hess, Gulf and Shell), and Associated Product. See Section VI.2A, Fuel Location network.

Yes No

Section II.1 Mandatory Requirements (C)Bidder has provided a tiered Fuel discount structure, as indicated in Attachment 3: Part II -- Financial Submittal (Discount Tables), and shall apply the discount as specified in Section V.3, Fuel and Associated Product Discount(s).

Yes No

Section II.1 Mandatory Requirements (D)Bidder has the ability to, and shall assign Authorized User Fuel Card usage options as specified in Section VI.2B, Fuel Card Services and Authorized User options.

Yes No

Section II.1 Mandatory Requirements (E)Bidder has the ability to, and shall deduct all applicable federal, state and local government taxes for Fuel purchases, due to the government’s tax-exempt nature, from the Fuel Card bills prior to invoicing/billing Authorized User, as specified in Section VI.2C, Tax Deduction.

Yes No

Section II.1 Mandatory Requirements (F)Bidder has the ability to, and shall provide detailed Fuel Card usage reports, as specified in Section VI.2D, Reporting

Yes No

Section II.1 Mandatory Requirements (G)Bidder has the ability to, and shall provide any necessary training for use of the Fuel Card, and customer services to aid in use of the Fuel Card by Authorized Users, as specified in Section VI.2E, Training and Help Desk Services.

Yes No

Section II.1 Mandatory Requirements (H)Bidder has the ability to, and shall issue to each Authorized User, on a monthly basis, a Central Bill (as defined herein), that details the NYS discount and applicable taxes that have been deducted. Invoices shall be accompanied by a report that details the transactions that have occurred during the invoiced billing cycle. See Section VI.2F, Invoicing

Yes No

Section II.1 Mandatory Requirements (I)Bidder has the ability to, and shall provide Fuel Card security and confidentiality, as specified in Section VI.2G, Security and Confidentiality.

Yes No

Section II.1 Mandatory Requirements (J)Bidder has the ability to, and shall implement the Fuel Card Services program in accordance with Section VI.2H, Implementation Plans;

Yes No

Section II.1 Mandatory Requirements (K)Bidder shall not assess or collect any Fuel Card fees, (e.g. annual fees, fees for issuance, renewals and cancellation, fees for Authorized User option changes), from Authorized Users.

Yes No


Part I — Technical Submittal (Bidder’s Response) Attachment 2: Bidder Response Forms

BIDDER’S RESPONSE TO TECHNICAL REQUIREMENTS TABLEBidder should refer to the RFP for detailed Technical Requirements and Specifications when preparing their bid responses. The following tables are provided as a convenience for preparing responses. The information provided only summarizes the Technical Requirements and the associated Specifications. The Bidder should refer to the detailed requirements as specified within the text of the RFP. The following response forms were prepared to facilitate the review process. The sections are generally arranged in order of the RFP. A Bidder should prepare their responses to the sections designated as Technical Requirements using the table below.

MANDATORY RESPONSE REQUIREMENTS(Enter information in white response boxes only. Boxes may be expanded or reduced as necessary.

Separate attachments may be included, and should reference the applicable response Section number.)

Section VI.1 Bidder Qualifications

A. Describe and provide documentation of Bidder’s experience and qualifications in providing Fuel Card Services of the type and magnitude of that contained in this RFP.1. Provide an executive summary, including profiles of operations and

qualifications, outlining the technical qualifications and experience relevant to the performance of the Contract;

2. Provide evidence relevant work experience, including evidence of a minimum of four (4) years providing Fuel Card Services, and list and describe the Bidder’s relevant work experience in specific projects and contracts for providing Fuel Card Services to large governmental entities

B. Note other qualifications or additional information that would be of importance to the State in determining that the Bidder is qualified.

Response to:



Section VI.2Service RequirementsA. Fuel Location network

Indicate which brands of conventional Fuel (e.g., Exxon Mobil, Chevron, Hess, Gulf and Shell) are available for purchase with Bidder’s Fuel Card.

Response:

Section VI.2Service RequirementsA. Fuel Location network

Indicate which types of alternative Fuels (e.g., hydrogen, propane, compressed natural gas (CNG), liquefied natural gas (LNG), methanol, ethanol and electricity) are available for purchase with Bidder’s Fuel Card. Include a description of the availability of alternative Fuels (e.g., available statewide or in specific counties only). Note: A Bidder shall not be required to provide Fuel Locations that supply all Fuel types identified herein. Bidder is not required to provide alternative Fuels.

Response:

Section VI.2A Service Requirements

Indicate the number of Fuel Locations that accept the Bidder’s Fuel Card, and supply at least conventional Fuel (i.e., gasoline and/or diesel), in each county in New York



A. Fuel Location network

State.

Bidder must also submit a Microsoft Excel spreadsheet (2002 or later version) that lists all Fuel Locations, (including station name, address, county and indication if it is a Secondary Fuel Location), that may be used with the Bidder’s Fuel Card, for conventional Fuel purchases, in New York State. Each physical Fuel Location address shall be listed only once on the list.

Response: Albany Allegany Broome

Cattaraugus Cayuga Chautauqua

Chemung Chenango Clinton

Columbia Cortland Delaware

Dutchess Erie Essex

Franklin Fulton Genesee

Greene Hamilton Herkimer

Jefferson Lewis Livingston

Madison Monroe Montgomery

Nassau Niagara Oneida

Onondaga Ontario Orange

Orleans Oswego Otsego

Putnam Rensselaer Rockland

Saratoga Schenectady Schoharie

Schuyler Seneca Steuben

St. Lawrence Suffolk Sullivan

Tioga Tompkins Ulster

Warren Washington Wayne

Westchester Wyoming Yates

Bronx New York (Manhattan)

Richmond (Staten Island)

Kings (Brooklyn) Queens

Section VI.2 Service RequirementsA. Fuel Location network

List U.S. States in which Bidder does not have Fuel Locations available for use with the Fuel Card.

Response:

Section VI.2 Service RequirementsA. Fuel Location network

Provide a link to the Bidder’s website that may be used to search for Fuel Locations.

Response:

Section VI.2 Service RequirementsB. Fuel Card Services

Indicate ability to provide the following Fuel Card Services and Authorized User options. Include a description of how the service will be provided and how the Authorized User may specify and update Fuel Card options (e.g., via phone, Bidder’s



and Authorized User Options

website, and/or email).1. Individual Fuel Cards that may be assigned to a specific individual, vehicle

or Authorized User, (or a combination);2. The Authorized User shall have the ability to assign up to two (2) prompts

to each Fuel Card, for Cardholder input at the Fuel pump or other keypad provided at the Fuel Location. The Authorized User may elect to assign no prompts, one (1) prompt, or two (2) prompts to each Fuel Card. Each prompt shall allow for up to six (6) digits to be entered. Promt options shall include individual Cardholder PIN, Authorized User vehicle number and odometer reading;

3. Fuel Card purchase authorization may be limited to Fuel only, Fuel Location, number of purchases (by day, week or month), or number of gallons of Fuel, (or any combination);

4. Fuel Cards shall be sorted, bundled and delivered according to the Authorized User specifications;

5. Fuel Cards shall be provided with custom embossing that includes up to three (3) lines of data;

6. Fuel Cards shall not expire during the initial Contract term and shall not be cancelled by the Bidder due to inactivity;

7. Fuel Card accounts may be managed at the Contractor’s website; 8. Bidder has internal management controls that include processes for

authorization and renewal of Fuel Cards, preventing inappropriate usage, cancellation of cards, lost or stolen cards, increase/decrease of Fuel Card limits, the level of Authorized User data embedded in the Fuel Card and the maintenance and security of Authorized User data; and

9. Fuel Cards may be assigned with fictitious names, with generic card backgrounds, and Bidder will keep confidential the true nature and identity of the Cardholder.

Response:

Section VI.2 Service Requirements

Provide information relative to Bidder’s experience and ability to deduct all applicable federal, state and local government Fuel taxes prior to invoicing



C. Tax Deduction Authorized Users.

Response:

Section VI.2 Service RequirementsD. Reporting

Provide information relative to the Bidder’s experience and ability to provide the following reports. Describe the Fuel Card transaction reporting process and the types and accessibility of reports that can provided. In these descriptions, demonstrate Bidder’s flexibility and capability to address the varying requirements and reporting needs of the State, (including the method for making reports available, accessibility to reports, timing for providing reports and input criteria available to Authorized Users). Include sample reports, if possible, or a link to sample reports at the Bidder’s website.

1. Authorized User Transaction Reports;2. Exception Reports; and3. Quarterly Summary Reports for Control Agencies.

Response:

Section VI.2 Service RequirementsE. Training and Help Desk Services

1. Describe the types of implementation and on-going training to be made available to Authorized Users throughout the term of the Contract related to the Fuel Card Services program.



Response:

Section VI.2 Service RequirementsE. Training and Help Desk Services

2. The Bidder must provide Help Desk Services for Authorized User based on a twenty-four (24) hours per day, seven (7) days per week basis, including holidays, in order to address all Authorized User customer assistance needs and technical issues. Bidder’s response should include:

a) A description of the system to be used in providing Help Desk Services to Authorized User, including access to the system, number of lines



available and staffing levels and experience, blockage rates and not to exceed times on hold.

b) A description of the Help Desk Services to be made available to Authorized User.

c) Identification of the types of issues the Help Desk can respond to on a twenty-four (24) hours per day, seven (7) days per week basis and the anticipated average response time for each of these issues.

d) Description of any additional Help Desk Services available to Authorized User at no additional cost.

Response:

Section VI.2 Service RequirementsF. Invoicing

Describe the Bidder’s invoicing process and affirm that invoices shall, at a minimum, include the level of detail listed in the RFP, and that invoices will be accompanied by an accompanying transaction detail report. Affirm that the Fuel and Associated Product discount(s) set forth in Attachment 3: Part II – Financial Submittal (Discount Tables), shall be applied prior to applicable



tax deduction, and that all applicable Fuel taxes shall be deducted. Include a sample NYS invoice and transaction detail report.

Response:

Section VI.2 Service RequirementsG. Security and Confidentiality

Describe the Bidder’s experience and ability to provide security of Fuel Card transaction data and comply with confidentiality and security requirements of this RFP. Include description of security plan, methods of fraud prevention, and internal control plan.



Response:

Section VI.2 Service RequirementsH. Implementation Plans

Describe the Bidder’s plan to implement the NYS Fuel Card Services program with Authorized Users. Include in response:1. The affirmation of the Bidder’s intent to work with each Authorized User to

establish Fuel Card Services and to set up a plan for initial and continuing training as required by the individual Authorized User’s needs and



timeframes. 2. A description of Bidder’s standard methodology for implementation and

expansion of the Fuel Card Services3. Bidder’s capacity to implement Fuel Card Services programs, indicating the

expected timeframe for implementing various sized programs and its capacity to implement multiple programs.

Response:

Section VI.2 Service RequirementsI. Other Services

Provide information on Bidder’s ability to provide these desirable Fuel Card Services: 1. Integration of Bidder’s Fuel Card Services with Chevin FleetWave software;2. Security alerts identifying Fuel Card usage outside the Authorized User

specified Fuel Card options sent via email to an individual designated by



the Authorized User; 3. Acceptance of electronic Automated Clearing House (ACH) payments from

State Agencies; and4. Deduction of all applicable federal, state and local government taxes for

Associated Product prior to invoicing the Authorized User.

Response:


Part II — Financial Submittal (Cover Sheet) Attachment 2: Bidder Response Forms

Group 79008 Fuel Card ServicesRequest for Proposals #22445

BID PROPOSAL COVER SHEET

PART II - FINANCIAL SUBMITTAL*** Important - Failure to Furnish All Required Information may render the Bid Non-Responsive ***

The bid must be fully and properly executed by an authorized person. By signing you certify your express authority to sign on behalf of yourself, your company, or other entity and full knowledge and acceptance of this REQUEST FOR PROPOSALS, Appendix A (Standard Clauses For New York State Contracts, June 2011), Appendix B (OGS General Specifications, July 2006), and State Finance Law §139-j and §139-k (Procurement Lobbying), and that all information provided is complete, true and accurate. By signing, Bidder affirms that it understands and agrees to comply with the OGS procedures relative to permissible contacts as required by State Finance Law §139-j (3) and §139-j (6) (b). Information may be accessed at:

Procurement Lobbying: http://www.ogs.ny.gov/aboutOgs/regulations/defaultSFL_139j-k.asp By signing, Bidder affirms that it understands and agrees to requirements of this RFP except as otherwise noted in its’ proposal as allowable within this RFP.

Bidder’s Federal Tax Identification Number:(Do Not Use Social Security Number)

NYS Vendor Identification Number:(See “New York State Vendor File Registration” clause)

Legal Business Name of Company Bidding:

D/B/A - Doing Business As (if applicable):

Street City State Zip County

Bidder’s Signature:

Title:

Printed or Typed Name:

Date:

Name of Preparer: __________________________________________________

Telephone Number of Preparer: _______________________________________


Part II — Financial Submittal (Cover Sheet) Attachment 2: Bidder Response Forms

CORPORATE ACKNOWLEDGMENT

STATE OF : ss.:

COUNTY OF

On the _____________ day of ______________________in the year _____ , before me personally came: _______________________________________________________________, to me known, who, being by me duly sworn, did depose and say that he/she/they reside(s) in _________________________; that he/she/they is (are) _____________________________________________ (the President or other officer or director or attorney in fact duly appointed) of ___________________________________________, the corporation described in and which executed the above instrument; and that he/she/they signed his/her/their name(s) thereto by authority of the board of directors of said corporation.

________________________________________________Notary Public


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