NON-COLLUSIVE BIDDING CERTIFICATION In accordance with Section 139-d of the Finance Law and paragraph 7 of Appendix A (Standard Clauses for NYS Contracts), the bidder hereby affirms, under penalty of perjury: By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a 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 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. A BID SHALL NOT BE CONSIDERED FOR AWARD NOR SHALL ANY AWARD BE MADE WHERE [1], [2], [3] ABOVE HAVE NOT BEEN COMPLIED WITH; PROVIDED HOWEVER, THAT IF IN ANY CASE THE BIDDER(S) CANNOT MAKE THE FORGOING CERTIFICATION, THE BIDDER SHALL SO STATE AND SHALL FURNISH BELOW A SIGNED STATEMENT WHICH SETS FORTH IN DETAIL THE REASONS THEREFORE: [AFFIX ADDENDUM TO THIS PAGE IF SPACE IS REQUIRED FOR STATEMEMNT.] Subscribed to under penalty of perjury under the laws of the State of New York, this ____ day of _________, 20___ as the act and deed of said corporation of partnership. The person signing on behalf of the bidder further affirms that he/she is authorized and responsible for signing this certificate. Identifying Data Name of Potential Contractor Street Address City, State, zip code: Telephone: Name: Signature: Joint or combined bids by companies or firms must be certified on behalf of each participant. Legal name of person, firm or corporation Legal name of person, firm or corporation By:
EQUAL EMPLOYMENT - STAFFING PLAN Instructions on Page 2 Bidder Name: Telephone: Address: Federal ID No.: City, State, ZIP: RFP No: Report includes: Reporting Entity: Work to be utilized on this contract Contractor Contractor/Subcontractor's total work force Subcontractor - Name: the total number of employees in each classification in each of the EEO-Job Categories identified. EEO - Job Categories Total Work Force Race/Ethnicity - report employees in only one category Hispanic or Latino Not-Hispanic or Latino Male Female Male Female White African-American or Black Native Hawaiian or Other Pacific Islander Asian American Indian or Native Two or More Races Disabled Veteran White African-American Native Hawaiian or Other Pacific Islander American Indian or Native Two or More Races Disabled Veteran Executive/Senior Officials and Managers First/Mid-Level Officials and Managers Professionals Technicians Workers Administrative Support Workers Craft Workers Operatives Laborers and Helpers Service Workers PREPARED BY (Signature): NAME AND TITLE OF PREPARER: TELEPHONE/EMAIL: (print or type) EEO 100 STAFFING PLAN INSTRUCTIONS