new york city department of health and mental hygiene€¦ · health and mental hygiene. 2 2. at...

1

Date May 29, 2020 PIN 21MI008501R0X00 Request Title HVAC Inspection, Repair and Maintenance Services This request is being issued in accordance with §3-08(c)(1)(iv) of the City of New York Procurement Policy Board (“PPB”) Rules as a “M/WBE Noncompetitive Small Purchase.” Only responses received from New York City-Certified M/WBE firms shall be considered.

To Whom It May Concern:

The New York City Department of Health and Mental Hygiene (“DOHMH” or “the agency”) is seeking an appropriately qualified vendor to furnish inspection, testing, preventative maintenance, incidental servicing, major repair, emergency service, installation of software updates and all parts for the Computer Room Air Conditioner (CRAC) Units, Dry Coolers, Custom Air Handler (CAH) units, evaporator units and condenser units and all ancillary equipment installed at various DOHMH locations. Locations can be added and / or deleted during the term of the contract. The extent of such testing, maintenance and repair services, and parts shall include the requisite qualified labor, supervision, transportation means (where and when required); establishment and maintenance of records; and all parts, tools, equipment, and interior cleaning. The maintenance records shall itemize testing and repair work performed and parts utilized.

The Contractor shall regularly and systematically examine, clean, troubleshoot, adjust, test, and when conditions warrant, repair or replace the covered equipment. Individual sub-systems shall be operated by a designee from the CRAC Unit in an integrated overall system fashion to verify individual sub-system software and hardware system operation. The extent of such testing, maintenance and repair services, and parts shall include the requisite qualified labor, supervision, transportation means (where and when required); establishment and maintenance of records; and all parts, tools, equipment, and interior cleaning. The maintenance records shall itemize testing and repair work performed and parts utilized. Locations may be added and /or deleted during the term of the contract.

Experience and Organizational Capability: The contractor would have the following credentials, organizational capability, and/or experience:

1. At least five (5) years of commercial/industrial experience in performing preventiveHVAC maintenance services.

NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE

2

2. At least three service technicians who o Currently hold a valid Certificate of Fitness for Fire Guard for Torch Operations

(F-60) and Certificate of Fitness for Torch Use of Flammable Gases (G-60) issued by the New York City Fire Department

o Have the requisite training and experience in the servicing, maintaining and repairing of Computer Room Air Conditioner (CRAC) and Custom Air Handler (CAH) units with the Liebert components listed on Attachment C

Scope of Services: The Contractor would provide the following services:

1. Check the following for CRAC Units, CAH Units, and Evaporator Units: o filters o blower o compressor o condenser/humidifier o refrigeration cycle o electrical service

2. Check the following for Dry Coolers, and Condenser Units:

o overall assembly o pump package o fan motors o electrical panel

3. Monthly Maintenance: which includes CRAC units, Dry Coolers, CAH units,

Evaporator units and Condenser units: o Check filters for restricted air flow, replace as needed o Check all filter switches o Ensure that filter grille areas are unrestricted o Ensure that the filter sections are wiped clean o Check that blower section impellers are free of debris and move freely o Check belt tension and overall condition of all blower belts; replace all worn belts o Check that all blower bearings are in good condition o Check for oil leaks in the compressor assembly o Where applicable, clean condenser coils and check for motor mount tightness o Where applicable, check that condenser bearings are in good condition o Inspect all reheat elements for overall cleanliness o Check wire connections inside reheat box o Inspect steam generating humidifier canister for deposits o Check overall condition of steam hoses o Inspect the water make-up valve for evidence of leaking o Inspect infrared humidifier pan drain for evidence of clogging o Check infrared humidifier lamps – replace as required o Check infrared humidifier pan for mineral deposits

3

o Check refrigeration section for moisture (sight glass) o Check suction pressure in refrigeration section o Check head pressure in refrigeration section o Check discharge pressure in refrigeration section o Check hot gas bypass valve in refrigeration section o Check thermostatic expansion valve in refrigeration section o Check the refrigerant charge level o Ensure that the air distribution grille area is free of restriction o Perform all around inspection for any signs of leakage

4. Semi-Annual Preventative Maintenance – same as monthly maintenance listed above,

however with the following additional maintenance requirements which includes CRAC units, Dry Coolers CAH units, Evaporator units and Condenser units:

o Replace filters o Inspect and tighten blower electrical connections o Check blower motor mounts o Check oil level in compressor o Inspect and tighten compressor electrical connection o Check compressor motor mounts o Ensure that compressor cap tubes are not rubbing o Check wire connections inside compressor box o Check compressor operation for excessive vibration/noise o Where applicable, check that condenser refrigerant lines are properly supported o Where applicable, inspect and tighten all condenser electrical connections o Check reheat element operation o Inspect the water make-up valve for evidence of leaking o Inspect and tighten all steam generating humidifier electrical connections o Inspect and tighten all infrared humidifier electrical connections o Check fuses in electrical panel o Check electrical panel operations sequence o Check electrical panel contactor panel operation o Inspect and tighten electrical connections in electrical panel o If applicable, ensure that water condenser copper tubes are clean o If applicable, check water condenser regulating valve function o If applicable, check for water/glycol leaks and glycol pump operation

Anticipated Term of Contract:

It is anticipated that the term of the contract awarded from this Request will be from 10/01/2020 to 09/30/2021.

4

Anticipated Payment Structure:

The payment structure of the contract awarded from this Request will be based on a time and material basis. Time is based on hour or half hour increments.

Anticipated Contract Amount

It is anticipated that the available funding for this request will be 150,000.00 for the full term of the contract.

All anticipated funding amounts are estimated, and are contingent upon funding availability.

Other Notices and Requirements:

Notice or Requirement Applies to this Request (“X” indicates applicability)

General Liability, Workers Comp, and Disability Insurance requirements: Please see Schedule A for insurance requirements. The selected vendor will be required to provide proof of coverage prior to contract award.

X

Subcontracting Pre-Approval Required: If any portion of the work will be performed by a subcontractor, use of this subcontractor must be pre-approved by DOHMH. Contractors should indicate their intention to use subcontractor(s) in their Proposal. The Contractor will be required to report all subcontractors, and enter all payments to subcontractors, in the New York City Payment Information Portal (PIP).

Subcontracting Limits for M/WBE Non-competitive Small Purchases: Subcontracting is permitted under this contract with DOHMH’s prior approval. Subcontracting is limited to no more than 40% of the total contract amount; the use of non-MWBE subcontractors is limited to no more than 20% of the value of the contract.

If any portion of the work will be performed by a subcontractor, use of this subcontractor must be pre-approved by DOHMH. Contractors should indicate their intention to use subcontractor(s) in their Proposal. The Contractor will be required to report all subcontractors, and enter all payments to subcontractors, in the New York City Payment Information Portal (PIP).

Subcontracting not permitted: Subcontracting will not be permitted under the resulting contract. The selected vendor is expected to self-perform all work.

X

Prevailing Wage: To the extent that any trades covered by the work stipulated herein involves titles covered by Prevailing Wage Rates pursuant to New York State Labor Law Sections 220 and 230, and Section 6-109 of the New York City Administrative

X

5

Code, contractor shall be required to pay not-less-than the prevailing wage rate in effect at the time work is performed. Current prevailing wage rate schedules may be found at the following website: http://comptroller.nyc.gov/prevailing-wage/wage-schedules/

Project Labor Agreements: Project Labor Agreements apply to the contract that results from this Request, as it involves the renovation, repair, alteration, rehabilitation, or expanstion of an existing City-owned building or structure within the five boroughs of New York City in excess of $250,000.

Doing Business Data Project: Pursuant to Local Law 34 of 2007, amending the City's Campaign Finance Law, the City is required to establish a computerized database containing the names of any "person" that has "business dealings with the city" as such terms are defined in the Local Law. In order for the City to obtain necessary information to establish the required database, vendors responding to this solicitation are required to complete the attached Doing Business Data Form and return it with this proposal, and should do so in a separate envelope. (If the responding vendor is a proposed joint venture, the entities that comprise the proposed joint venture must each complete a Data Form.) If the City determines that a vendor has failed to submit a Data Form or has submitted a Data Form that is not complete, the vendor will be notified by the agency and will be given four (4) calendar days from receipt of notification to cure the specified deficiencies and return a complete Data Form to the agency. Failure to do so will result in a determination that the proposal is non-responsive. Receipt of notification is defined as the day notice is e-mailed or faxed (if the vendor has provided an e-mail address or fax number), or no later than five (5) days from the date of mailing or upon delivery, if delivered.

X

Iran Divestment Act: Pursuant to State Finance Law Section 165-a and General Municipal Law Section 103-g, the City is prohibited from entering into contracts with persons engaged in investment activities in the energy sector of Iran. Each proposer is required to complete the attached Bidders Certification of Compliance with the Iran Divestment Act, certifying that it is not on a list of entities engaged in investments activities in Iran created by the Commissioner of the NYS Office of General Services. If a proposer appears on that list, the Agency will be able to award a contract to such proposer only in situations where the proposer is takings steps to cease its investments in Iran or where the proposer is a necessary sole source. Please refer to the Iran Divestment Act attachment for information regarding the requirements for this solicitation and instructions on how to complete the required form. Visit http://www.ogs.ny.gov/About/regs/ida.asp for additional information concerning the list of entities.

X

Earned Sick Time Act: The Earned Sick Time Act, also known as the Paid Sick Leave Law (“PSLL”), requires covered employees who annually perform more than 80 hours of work in New York City to be provided with paid sick time. Contractors of the City of New York [or of other governmental entities] may be required to provide sick time pursuant to the PSLL codified at Title 20, Chapter 8, of the New York City Administrative Code.

X

6

PASSPort: PASSPort Enrollment and Disclosure Filing: Effective August 1, 2017, the Procurement and Sourcing Solutions (PASSPort) system replaces the paper-based VENDEX process, and is now the primary portal to do business with the City. All organizations intending to do business with the City of New York should complete an online disclosure process to be considered for a contract. This disclosure process was formerly completed using Vendor Information Exchange System (VENDEX) paper-based forms. In anticipation of contract awards, DOHMH strongly encourages all proposers/bidders to create online accounts in PASSPort and to file all disclosure information. Paper submissions, including certifications of no changes (CNCs) to existing VENDEX packages will not be accepted in lieu of complete online filings. For more information about PASSPort, please visit nyc.gov/passport.

X

Ancillary Agreements: Depending upon the project covered herein, DOHMH may require that the resulting contract contain one or more of the following ancilliary agreements to which the parties must agree: a Data Use Agreement; a Business Associate Agreement; a Confidentiality Agreement; or a Non-Disclosure Agreement, each as applicable to the particular project.

X

IT Security: For projects with an information technology (“IT”) component, The Contractor would be asked to provide computer system and data security audit/review documents that cover the project domain for the DOHMH IT Information Security team to review to ensure that the contractor’s internal IT infrastructure conforms to NIST SP 800 Computer Security Standards. Any external cloud solutions (e.g., IaaS, SaaS, PaaS and XaaS) planned to be used in the project will be subjected to NYC DoITT’s security review and approval before usage to ensure optimal levels of contractor security technology are in place to protect city data. Hence, any internet browser based applications that are planned to be used for this project to access and/or share NYC DOHMH data, including applications for internal contractor project use, must be reviewed and approved by NYC DOHMH and NYC DoITT prior to DOHMH data being stored in the contractor’s network system.

X

Fixed Price: Unless otherwise specified herein, the unit prices will be fixed for the duration of the resulting agreement.

X

Quote Price Assumptions: Quoted prices shall be deemed to include the cost of delivery, F.O.B. Destination, inside delivery, and assembly, unless otherwise specified. Bid Price shall be a net price.

Material Guarantees:The vendor guarantees the following: that the equipment offered is standard new material, latest model of regular stock products with all parts regularly used with the type of material offered; that no attachment or part has been substituted or applied contrary to manufacturer’s recommendation and standard practice; that where applicable every unit delivered must be guaranteed as to sterility in transit and/or storage; and that every unit delivered must be guaranteed against faulty material and workmanship and if defective, the unit or part affected is to be replaced without cost to the City.

X

7

Applicability of Local Law 63 (Charter Section 312(a)): The contract that results from this request is estimated to be >$200,000 in value, and is for professional or standard services. Therefore, Local Law 63 is applicable.

Evaluation Criteria:

Proposals will be evaluated based on the following Evaluation Criteria:

• Demonstrated Quantity and Quality of Successful Relevant Experienceand Organizational Capability 40%

• Quality of Proposed Approach 20%

• Price 40%

TOTAL 100%

Submission Instructions:

Agency Contact Person:

Anne Marie White, Contract Manager NYC Department of Health and Mental Hygiene Office of the Agency Chief Contracting Officer 42-09 28th Street, 17th Floor, CN-30ALong Island City, NY 11101-4132Phone: 347-396-9668Email: [email protected]

Questions Due Date: June 2, 2020 by 5:00 p.m.

Questions about this Request must be received by this date. An addendum containing all questions and answers will be issued to all vendors that received this request.

Response Due Date and Time: June 11, 2020, 2:00 p.m.

Complete the attached Response Form (Attachment A) along with any other required documents, and submit it via mail or e-mail to the Agency Contact Person indicated above on or before the due date and time. Emailed responses must be in an unalterable electronic format, preferably .pdf. Emailed responses must include the PIN of this solicitation in the subject line, and must be sent to [email protected]

Responses received after the due date and time will not be considered.

mailto:[email protected]

8

ATTACHMENT A VENDOR RESPONSE FORM, PAGE 1 OF 2

HVAC Inspection, Repair and Maintenance Services

PIN: 21MI008501R0X00

Vendor’s ’s Legal Name:

Tax ID # (if an SSN, provide only last 4 digits):

Mailing Address: ____________________________________________________________________

City State Zip

Website: ___________________________________________________________________________

Vendor’s Authorized Representative

Name: Title:

Telephone: Fax:

Best time to call: _________________________ E-mail address: _________________________

YES NO Can you perform the services outlined in this request?

Are you available to provide these services between 10/01/2020 and 9/30/2021?

Do you have at least five (5) years of successful relevant experience?

Attach the following documents: o A narrative that demonstrates and describes:

i. the proposer’s successful relevant experience as detailed on page 1. ii. the proposer’s organizational capability as detailed on page 1.

iii. the proposer’s approach to providing the services outlined in the solicitation letter, including timeline for any deliverables specified in the Scope of Work.

o Current valid F-60 and G-60 certificates issued by the New York City Fire Department from at least three (3) service technicians.

o Proof of Liebert Service Network Provider (LSNP) status or the equivalent, together with copies of all of its service technician’s credentials that will demonstrate requisite training and experience in the servicing, maintaining and repairing of CRAC and CAH units with the Liebert components listed on Attachment C.

o Two (2) signed letters of reference from different former clients for whom work, as specified herein, has been performed within the past five (5) years, and who can attest to the vendor’s experience and quality of services. Each letter must include the client’s name, business affiliation, work address, telephone and e-mail address. (Letters from DOHMH are not acceptable for the purposes of this Request.)

9

ATTACHMENT A VENDOR RESPONSE FORM, PAGE 2 OF 2

HVAC Inspection, Repair and Maintenance Services

PIN: 21MI008501R0X00

o Completed Bidder’s Certification of Compliance with Iran Divestment Act o Completed Doing Business Data Form

Complete the attached Price Quote Form (Attachment B)

Proposer’s/Firm’s Authorized Representative:

Name: Title:

Signature: Date:

10

Attachment B

Price Quote Form

QUOTE INSTRUCTIONS: enter an all-inclusive, fully-burdened Unit Price for every item associated with this Request. Include all costs associated with the performance of work, including (but not limited to) materials, labor, insurance, statutory and fringe benefites, taxes, overhead, delivery and profit. Calculate the Extended Price for each line item. Provide the Total Quote amount (sum of all Extended Prices). The Department will not reimburse for any other costs, so proposers must take this into consideration in developing their rates. The selected vendor would be paid upon successful, DOHMH-approved completion of each deliverable, at the rates set out below. Unit Prices and the proposed Material Cost Multiplier (not to exceed 1.15) will remain fixed for the term of the resulting agreement. The quantities listed herein are estimates; DOHMH may use more, less or none of the quantities listed below. The Material Cost Multiplier shall be net of all trade, industry, bulk and early payment discounts. The vendor shall only deliver items at DOHMH’s request; DOHMH shall only pay for approved items received. There will be no minimum or maximum guaranteed payments under the resulting agreement.

A B C D E

Prevailing Wage Title Unit of Measure

Estimated Number of Units

All-Inclusive Unit Price

Extended Price C x D

Technician (Refrigeration and Air Conditioner Service Person II) hour 500 $ $

Technician Helper (Refrigeration and Air Conditioner Service Person I)

hour 500 $ $

SUBTOTAL FOR LABOR (sum of Column E)

A B C

Estimated Cost Of Materials Material Cost Multiplier Total Price of Materials A x B

$30,000.00 1.___ (Not to exceed 1.15)

$

SUBTOTAL FOR MATERIALS (sum of Column C) $

SUBTOTAL FOR LABOR $

SUBTOTAL FOR MATERIALS $

TOTAL PRICE QUOTE* $ * Proposals with a Total Price Quote exceeding $200k will not be considered

11

Attachment C

CRAC) and CAH units with Liebert Components

125 Worth IDF Rooms Floor / Room Unit Make Model Capacity Serial #

10 West B3-3 Sanyo HKZ1252 12000 BTU 0025913

10 EAST SAC-10-1 Daikin FTX512LVJU 12000 BTU E000690


9 EAST B4-3 Sanyo HKZ1252 12000 BTU 0024113



3 West A2-3 Sanyo HKZ1252 12000 BTU 0025413


2 West A2-2 Sanyo HKZ1252 12000 BTU 0024713


1 NEW (144) A2-1 Sanyo HKZ1252 12000 BTU 0024413

1 Bur. Records A3-1 Sanyo HKZ1252 12000 BTU 0029314

1 Room 108 CHILLED Water MultiAqua HWW-24-H-1 12000 BTU WQWHC240803-0316

1 Kiosk (133) CRAC-1 Mitsubishi PKA-A 12HA6 12000 BTU 54A02846C

6fl TER Floor / Room Unit Make Model Capacity Serial #

6-125 1 CompuAire CKA532-DX 5 Ton 8745CK1201-6454



Condensors Unit Make Model Capacity Serial # SAC-10 Daikin RSX-12LVJU 12000 BTU E004480 A2 Panasonic U36-LE1U6 52000 BTU 0000714 A3 Panasonic U36-LE1U6 52000 BTU 0001714 B2 Panasonic U36-LE1U6 52000 BTU 0001914 B3 Panasonic U36-LE1U6 52000 BTU 0000614 B4 Panasonic U36-LE1U6 52000 BTU 0000314

C-1 Mitsubishi PUY-A12NHA6 12000 BTU

43U02265B

12

6fl TER-1 TASK TGC-153CMD-3C 1800000 BTU D12-00401

485 Throop Floor / Room Unit Make Model Capacity Serial #

Basement Unit #1 Leibert VH125A-CA00 12000 BTU 614668-001 Setback Condeser Leibert DCDL165-Y 0403C68251

22 Cortlnadt Floor / Room Unit Make Model Capacity Serial # 34 floor Air Handler #1 Luxaire 4P60DX21B 5 Ton W1C6425979 35 floor Condesnser #1 Luxaire TCJD6054454A 5 Ton W1A5391959

303 9th Ave Floor / Room Unit Make Model Capacity

Basement Air Handler #1 Trane 4MXW8524A10N0CA 2 Ton

floor #2 Air Handler #2 Trane 4MXW8524A10N0CA 2 Ton

floor #3 Air Handler #3 Mitsubishi PKA-A24KA7 2 Ton Roof Condensor #1 Trane 4TXM6542A1050BA 2 Ton Roof Condensor #2 Trane 4TXM6542A1050BA 2 Ton Roof Condensor #3 Mitsubishi PUY06125A 2 Ton 135 Canal Street Floor / Room Unit Make Model Capacity Serial # 2 nd floor IDF Air Handler #1 Mitsubishi PKA-A18HA6 1.5 Ton 54A033BDC Roof Condesnser #1 Mitsubishi PKA-A18HA6 1.5 Ton 54U02663C

160 W100 Street Floor / Room Unit Make Model Capacity Basement Air Handler #1 Daikin FXSQ36MVJU 3 Ton floor #1 Air Handler #2 Daikin FXSQ12MVJU 1 Ton floor #2 Air Handler #3 Daikin FXSQ12MVJU 1 Ton floor #3 Air Handler #4 Daikin FXSQ12MVJU 1 Ton

13

259 Bristol Street, Brooklyn Floor / Room Unit Make Model Capacity 2fl / IDF Air Handler #1 Samsung AM018MNVDCH/AA 1.5 Ton Roof Condenser Samsung AM120FXVAFH/AA 10 Ton

1235 Zerega Ave, Bronx Floor / Room Unit Make Model Capacity IDF Air Handler #1 TBD TBD TBD Roof Condenser TBD TBD TBD

1932 Arthur Avenue, Bronx Floor / Room Unit Make Model Capacity 2fl IDF Air Handler #1 TBD TBD TBD 2fl IDF Package Unit TBD TBD TBD Roof Condenser #1 TBD TBD TBD

72-42 60th Lane, Queens Floor / Room Unit Make Model Capacity 1fl IDF Air Handler #1 TBD TBD TBD Garage IDF Air Handler #2 TBD TBD TBD 2fl IDF Air Handler #3 TBD TBD TBD Roof Condenser TBD TBD TBD

30-30 47 Avenue, Queens Floor / Room Unit Make Model Capacity 4th fl IDF Air Handler #1 LG 4th fl MDF Air Handler #2 LG 4th fl Condenser #1 LG 4th fl Condenser #2 LG 7th fl IDF-1 Air Handler #3 TBD TBD TBD 7th fl IDF-2 Air Handler #4 TBD TBD TBD 7th fl Condenser #3 TBD TBD TBD

14

7th fl Condenser #4 TBD TBD TBD

15

INSURANCE REQUIREMENTS

SCHEDULE A

The selected vendor will need to supply adequate proof of insurance coverage as follows:

• A Certificate of Liability Insurance evidencing liability coverage levels indicated in the second bullet below (“ACORD” certificate). This certificate should include the following language in the description of operations box: “The City of New York, including its employees and officials, are named as additional insured by written contract”. The Certificate of Liability insurance should also name the following as the Certificate Holder:

New York City Department of Health and Mental Hygiene Office of the ACCO 42-09 28th Street, 17th Fl, CN30A Long Island City, NY 11101

• At minimum, liability coverage amounts must be: o General Commercial Liability: $10,000,000 per incident

• An additional insured endorsement (form ISO CG 20 26 or ISO CG 20 10 or equivalent form) with

the following named as additional insured: “The City of New York, including its employees and officials.”

• Separate proof of Workers Compensation insurance (either the form from the NY State Workers Compensation Fund, form U-26.3, or the certificate indicated self-insurance, form C-105.2).

Separate proof of insurance coverage under NY State Disability Benefits Law, form DB-120.1.

Any entity receiving, applying for or proposing on an award or agreement must complete a Doing Business Data Form (see Q&A sheet for more information). Please either type responses directly into this fillable form or print answers by hand in black ink, and be sure to fill out the certification box on the last page. Submission of a complete and accurate form is required for a proposal to be considered responsive or for any entity to receive an award or enter into an agreement.

This Data Form requires information to be provided on principal officers, owners and senior managers. The name, employer and title of each person identified on the Data Form will be included in a public database of people who do business with the City of New York, as will the organizations that own 10% or more of the enitity. No other information reported on this form will be disclosed to the public. This Data Form is not related to the City's PASSPort registration or VENDEX requirements.

Please return the completed Data Form to the City office that supplied it. Please contact the Doing Business Accountability Project at [email protected] or 212-788-8104 with any questions regarding this Data Form. Thank you for your cooperation.

If you are completing this form by hand, please print clearly.

Doing Business Data FormTo be completed by the City agency prior to distribution Agency Transaction ID

Check One Transaction Type (check one)

Proposal Award Concession Economic Development Agreement Franchise Grant Pension Investment Contract Contract

Entity is a Non-Profit Yes No

Entity Type Corporation (any type) Joint Venture LLC Partnership (any type) Sole Proprietor Other (specify)

Address

City State Zip

Phone E-mail Provide your e-mail address in order to receive notices regarding this form by e-mail.

Entity InformationEntity EIN/TIN Entity Name

Filing Status (Select One)

Entity has never completed a Doing Business Data Form. Fill out the entire form.

Change from previous Data Form dated . Fill out only those sections that have changed, and indicate the name of the persons who no longer hold positions with the entity.

No Change from previous Data Form dated . Skip to the bottom of the last page.

Principal OfficersPlease fill in the required identification information for each officer listed below. If the entity has no such officer or its equivalent, please check "This position does not exist." If the entity is filing a Change Form and the person listed is replacing someone who was previously disclosed, please check "This person replaced..." and fill in the name of the person being replaced so his/her name can be removed from the Doing Business Database, and indicate the date that the change became effective.

Chief Executive Officer (CEO) or equivalent officer This position does not exist The highest ranking officer or manager, such as the President, Executive Director, Sole Proprietor or Chairperson of the Board.

First Name MI Last Birth Date (mm/dd/yy)

Office Title Employer (if not employed by entity)

Home Address

This person replaced former CEO on date

Chief Financial Officer (CFO) or equivalent officer This position does not exist The highest ranking financial officer, such as the Treasurer, Comptroller, Financial Director or VP for Finance.



Home Address

This person replaced former CFO on date

Chief Operating Officer (COO) or equivalent officer This position does not exist The highest ranking operational officer, such as the Chief Planning Officer, Director of Operations or VP for Operations.



Home Address

This person replaced former COO on date

NEW: Data Forms submitted now must include the listing of organizations, as well as individuals, with 10% or more ownership of the entity. Until such certification of ownership is submitted through a change, new or update form, a no change form will not be accepted.

1/2018 For information or assistance, please contact the Doing Business Accountability Project at [email protected] or 212-788-8104.

DOHMH PIN # 21MI008501R0X00

Principal OwnersPlease fill in the required identification information for all individuals or organizations that, through stock shares, partnership agreements or other means, own or control 10% or more of the entity. If no individual or organization owners exist, please check the appropriate box to indicate why and skip to the Senior Managers section. If the entity is owned by other companies that control 10% or more of the entity, those companies must be listed. If an owner was identified on the previous page, fill in his/her name and write "See above." If the entity is filing a Change Form, list any individuals or organizations that are no longer owners at the bottom of this section. If more space is needed, attach additional pages labeled "Additional Owners."

There are no owners listed because (select one): The entity is not-for-profit The entity is an individual No individual or organization owns 10% or more of the entity

Other (explain)

Individual Owners (who own or control 10% or more of the entity)



Home Address



Home Address

Organization Owners (that own or control 10% or more of the entity)

Organization Name

Organization Name

Organization Name

Remove the following previously-reported Principal Owners

Name Removal Date

Name Removal Date

Name Removal Date

Senior ManagersPlease fill in the required identification information for all senior managers who oversee any of the entity's relevant transactions with the City (e.g., contract managers if this form is for a contract award/proposal, grant managers if for a grant, etc.). Senior managers include anyone who, either by title or duties, has substantial discretion and high-level oversight regarding the solicitation, letting or administration of any transaction with the City. At least one senior manager must be listed, or the Data Form will be considered incomplete. If a senior manager has been identified on a previous page, fill in his/her name and write "See above." If the entity is filing a Change Form, list individuals who are no longer senior managers at the bottom of this section. If more space is needed, attach additional pages labeled "Additional Senior Managers."

Senior Managers



Home Address



Home Address



Home Address

Remove the following previously-reported Senior Managers

Name removal date

Name removal date

CertificationI certify that the information submitted on these two pages and additional pages is accurate and complete. I understand that willful or fraudulent submission of a materially false statement may result in the entity being found non-responsible and therefore denied future City awards.

Name Title

Entity Name Work Phone #

Signature Date

Please return this form to the City agency that supplied it to you, not to the Doing Business Accountability Project. Standard Form

How Entities Should Complete the First Doing Business Data Form of 2018 to Certify Ownership Status

Entities filing a Doing Business Data Form (DBDF) must certify if an organization holds 10% or more ownership of the entity. To do so, they must complete the new 2018 DBDF. The top of the new forms looks like this [email protected].

Unless an entity has never filed before, the first DBDF of 2018 should be completed with a filing status of “change from previous data form”. Many entities currently in the system will wish to file to certify no changes since pervious form, or make changes that do not include certification of their organization ownership status. Such entities MUST submit a 2018 DBDF to certify if there are organizations that own 10% or more of the entity before any no change or change DBDFs may be accepted. A new or change 2018 DBDF should certify organization ownership status in one of three ways:

1. If there are no owners at all, choose the appropriate reason in the box.

2. If the Filing Entity has no Organization Owners, but has Individual Owners (thus can’t choose box #3) they have previously reported, they should write “There are no organization owners” in the “Other” line at the start of the Owner section.

3. If there are Organization Owners, their names should be entered in that section.

To inquire if an entity has filed a 2018 DBDF and certified their organization ownership certification please email [email protected] or call 212-788-8104. 1/2018

Doing Business Accountability

What is the purpose of this Doing Business Data Form (DBDF)?

To collect accurate, up-to-date identification information about organizations that have business dealings with the City of New York to comply with Local Law 34 of 2007 (LL 34), New York City’s campaign finance law. LL 34 limits municipal campaign contributions from principal officers, owners and senior managers of entities doing business with the City and mandates the creation of a Doing Business Database to allow the City to enforce the law. The information requested in this DBDF must be provided, regardless of whether the organization or the people associated with it make or intend to make campaign contributions. No sensitive personal information collected will be disclosed to the public.

Why have I received this DBDF?

The Discretionary award for which you are applying is considered a business dealing with the City under LL 34. No proposal or application will be considered and no award will be made unless this DBDF is completed. Most transactions valued at more than $5,000 are considered business dealings and require completion of the DBDF. Exceptions include transactions awarded on an emergency basis or by “conventional” competitive sealed bid (i.e. bids that do not use a prequalified list or “Best Value” selection criteria.) Other types of transactions that are considered business dealings include real property and land use actions with the City.

I have already completed a Doing Business Data Form; do I have to submit another one?

Yes. All organizations applying for Fiscal 2020 discretionary funding must submit a current DBDF.

An organization is required to submit a DBDF each time it enters into a transaction considered a business dealing with the City, including contract, concession and franchise proposals. DBDFs submitted can be completed as a Change form, which requires only information that has changed since the last DBDF was filed, or a No Change form.

What individuals will be included in the Doing Business Database?

The principal officers, owners and certain senior managers of organizations listed in the Doing Business Database are themselves considered to be doing business with the City and will also be included in the Database, and are subject to the campaign donation limits under LL 34. • Principal Officers are the Chief Executive Officer (CEO), Chief Financial Officer (CFO) and Chief

Operating Officer (COO), or functional equivalents. See the DBDF for examples of titles that apply. • Principal Owners are individuals and organizations that own or control 10% of more of the

organization. This includes stockholders, partners, parent companies and anyone else with an ownership or controlling interest in the entity. NEW: Beginning January 1, 2018, the DBDF must report organizations, as well as persons, that own 10% or more of the organization.

• Senior Managers include anyone who, either by job title or actual duties, has substantial discretion and

high-level oversight regarding the solicitation, letting or administration of any contract, concession, franchise, grant or economic development agreement with the City. At least one Senior Manager must be listed or the DBDF will be considered incomplete.

Will the personal information on this DBDF be available to the public?

No. The names and titles of the officers, owners and senior managers reported on the DBDF will be made available to the public, as will information about the organization itself. However, personal identifying information, such as home address and date of birth, will not be disclosed to the public, and home address will not be used for communication purposes.

Questions and Answers About the Doing Business Data Form for

Fiscal Year 2020 Discretionary Awards

I provided some of this information on PASSPort; do I have to provide it again? Yes. Although the DBDF and PASSPort request some of the same information, they serve entirely different purposes. In addition, the Doing Business Data Form requests information concerning senior managers, which is not part of the PASSPort registration.

What organizations will be included in the Doing Business Database?

Organizations that hold $100,000 or more in grants, contracts for goods or services, franchises or concessions ($500,000 for construction contracts), or that hold any economic development agreement or pension fund investment contract, are considered to be doing business with the City for the purposes of LL 34. Because all of the business that an organization does or proposes to do with the City will be added together, the DBDF must be completed for all transactions valued at more than $5,000 even if the organization doesn’t currently do enough business with the City to be listed in the Database.

No one in my organization plans to contribute to a candidate; do I have to fill out this DBDF?

Yes. All organizations are required to return this DBDF with complete and accurate information, regardless of the history or intention of the entity or its officers, owners or senior managers to make campaign contributions. The Doing Business Database must be complete so that the Campaign Finance Board can verify whether future contributions are in compliance with the law.

How long will an organization and its officers, owners and senior managers remain listed on the Doing Business Database?

• Line item and discretionary appropriations: from the date of budget adoption until the end of the contract, plus one year.

• Contract, Concession and Economic Development Agreement holders: generally, for the term of the transaction, plus one year.

• Franchise and Grant holders: from the commencement or renewal of the transaction, plus one year. • Pension investment contracts: from the time of presentation on an investment opportunity or the

submission of a proposal, whichever is earlier, until the end of the contract, plus one year. • Contract proposers: for one year from the proposal date or date of public advertisement of the

solicitation, whichever is later. • Franchise and Concession proposers: for one year from the proposal submission date. For information on other transaction types, contact Doing Business Accountability.

How does a person remove him/herself from the Doing Business Database?

When an organization stops doing business with the City, the people associated with it are removed from the Database automatically. However, any person who believes that s/he should not be listed may apply for removal. Reasons that a person would be removed include his/her no longer being the principal officer, owner or senior manager of the organization. Organizations may also update their database information by submitting an update form. Removal Request and Update forms are available online at www.nyc.gov/mocs (once there, click MOCS Programs) or by calling 212-788-8104.

What are the campaign contribution limits for people doing business with the City?

Contributions to City Council candidates are limited to $250 per election cycle; $320 to Borough President candidates; and $400 to candidates for citywide office. Please contact the NYC Campaign Finance Board for more information at www.nyccfb.info, or 212-306-7100.

The DBDF is to be submitted via email to [email protected].

If you have any questions about the Doing Business Data Form please contact Doing Business Accountability at 212-788-8104 or [email protected].

IRAN DIVESTMENT ACT COMPLIANCE RIDER FOR NEW YORK CITY CONTRACTORS

The Iran Divestment Act of 2012, effective as of April 12, 2012, is codified at State

Finance Law (“SFL”) §165-a and General Municipal Law (“GML”) §103-g. The Iran Divestment Act, with certain exceptions, prohibits municipalities, including the City, from entering into contracts with persons engaged in investment activities in the energy sector of Iran. Pursuant to the terms set forth in SFL §165-a and GML §103-g, a person engages in investment activities in the energy sector of Iran if:

(a) the person provides goods or services of twenty million dollars or more in the energy sector of Iran, including a person that provides oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas, for the energy sector of Iran; or (b) The person is a financial institution that extends twenty million dollars or more in credit to another person, for forty-five days or more, if that person will use the credit to provide goods or services in the energy sector in Iran and is identified on a list created pursuant to paragraph (b) of subdivision three of Section 165-a of the State Finance Law and maintained by the Commissioner of the Office of General Services.

A bid or proposal shall not be considered for award nor shall any award be made

where the bidder or proposer fails to submit a signed and verified bidder’s certification. Each bidder or proposer must certify that it is not on the list of entities engaged in investment activities in Iran created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. In any case where the bidder or proposer cannot certify that they are not on such list, the bidder or proposer shall so state and shall furnish with the bid or proposal a signed statement which sets forth in detail the reasons why such statement cannot be made. The City of New York may award a bid to a bidder who cannot make the certification on a case by case basis if:

(1) The investment activities in Iran were made before the effective date of this section (i.e., April 12, 2012), the investment activities in Iran have not been expanded or renewed after the effective date of this section and the person has adopted, publicized and is implementing a formal plan to cease the investment activities in Iran and to refrain from engaging in any new investments in Iran: or

(2) The City makes a determination that the goods or services are necessary for the City to perform its functions and that, absent such an exemption, the City would be unable to obtain the goods or services for which the contract is offered. Such determination shall be made in writing and shall be a public document.

BIDDER’S CERTIFICATION OF COMPLIANCE WITH IRAN DIVESTMENT ACT

Pursuant to General Municipal Law §103-g, which generally prohibits the City from entering into contracts with persons engaged in investment activities in the energy sector of Iran, the bidder/proposer submits the following certification: [Please Check One] BIDDER’S CERTIFICATION

By submission of this bid or proposal, each bidder/proposer and each person signing on behalf of any bidder/proposer 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 its knowledge and belief, that each bidder/proposer is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law.

I am unable to certify that my name and the name of the bidder/proposer does not appear

on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify.

Dated: _________, New York ______, 20 ____ _______________________________

SIGNATURE _______________________________

PRINTED NAME _______________________________

TITLE Sworn to before me this _____day of_____, 20_____ ________________________ Notary Public

Dated:

new york city department of health and mental hygiene€¦ · health and mental hygiene. 2 2. at...

Documents