Indigent Burial Services Request for Proposals

CHAUTAUQUA COUNTY FINANCE DEPARTMENT REQUEST FOR PROPOSALS PROPOSAL NO. RFP-2-23 DMHSS CODE BLUE SERVICES PROPOSAL ISSUE DATE: December 6, 2023 QUESTIONS DUE BY: December 20, 2023 PROPOSAL DUE DATE: December 29, 2023 TIME: 3:30 PM RESPOND TO: ATTN: BECKY ANDERSON, PURCHASING MANAGER 3 NORTH ERIE ST. MAYVILLE, NY 14757 PH. 716-753-4918 PAUL M. WENDEL, JR. COUNTY EXECUTIVE KITTY CROW DIRECTOR OF FINANCE BECKY ANDERSON PURCHASING MANAGER BRANDI PETERSON PURCHASING AGENT JOSE SOLER PURCHASING CLERK NICOLE PATTISON PURCHASING AGENT Intent of Proposal: The County of Chautauqua, through its Department of Mental Hygiene and Social Services, Division of Social Services, is seeking proposals for the purpose of providing emergency shelter during Code Blue Activation. Per 18 NYCRR Social Services Law 304.1, a Code Blue alert must be called when temperatures are expected to fall below 32 degrees Fahrenheit with wind chill for at least two consecutive hours, based on the local forecast issued by

the National Weather Service (http://forecast.weather.gov/) for the city, town or village within the district that is known to have the largest population of unsheltered homeless persons. The Code Blue season is October through May. It is the County’s intent to select the Proposer(s) that provides the best solution for the County’s needs. Background The Chautauqua County Department of Mental Hygiene and Social Services, Division of Social Services is currently seeking proposals responsible for providing shelter to homeless individuals during Code Blue conditions. Specification for Services A. Contract to provide a Code Blue warming center to be utilized for the purpose of providing shelter for individuals experiencing homelessness. The warming center must be safe, clean, well-maintained, and supervised as required by state and local laws, regulations, administrative directives, and guidelines including local building and fire codes. B. Code Blue shelter shall be provided to individuals experiencing homelessness through referrals from a Code Blue authorizing agency, which includes the Code Blue shelter, when DMHSS has determined Code Blue conditions are in effect. Agency must contact DMHSS making a referral the following business day for an eligibility determination for Temporary Housing Assistance. C. Have the physical space to accommodate potentially large numbers of guests overnight, at a minimum of 25 participants and must include either chairs or cots and bathroom facilities. Services to be provided for individuals experiencing homelessness in Chautauqua County. D. Collaborative Projects between multiple agencies, organizations, and not for profits, are permitted. Proposals that contain plans to provide for any combination of the following services will be given greater weight: mental health services, peer services, transportation, bathrooms, shower/laundry facilities, meals, a plan/network to help individuals find transitional housing. E. A budget must be included in the proposal utilizing the State approved format. F. Agency must accept all individuals referred by a Code Blue Authorizing Agency, without exception, unless the warming center is at capacity or upon mutual agreement between Agency and DMHSS. G. Code Blue reimbursement is for essential additional costs that are directly related to the requirements of the Code Blue regulation to provide shelter during inclement weather and are not already funded in any other way. Emergency Shelter and Supportive Services for the Homeless During Code Blue Activation awards are contingent upon approved/allocated state funding. Chautauqua County’s allocation from New York State for program costs in its entirety is $443,000 for the 2023-2024 season. This allocation is to cover all code blue related expenses including code blue sheltering whether at a code blue warming center or other facility as permitted in the Homeless Services Plan. The total amount available for Code Blue Services through this RFP is $393,000. H. Agency will extend shelter hours to allow individuals experiencing homelessness to remain indoors. http://forecast.weather.gov/ I. Agency will work with local police and other relevant personnel in relation to transport of individuals who refuse to go inside and who appear mentally ill and at risk for cold-related injuries to appropriate facilities for assessment. J. Agency will work with police to ensure individuals facing homelessness receive assistance as needed to protect their health and safety. K. Agency shall report the number of individuals housed each night for Code Blue to the designated DMHSS representative. Reports must be received for program opening through March 31st no later than April 15th and for April 1st through May 31st no later than June 15th. In addition, information on all individuals and families shall be entered into the Homeless Management Information System (HMIS). L. Confidentiality: All individual identifying information, including client names, received by or in the possession of either party in the course of this Agreement shall be kept confidential and shall not be disclosed except in the terms of this Agreement, or allowed or mandated by applicable law. Evaluation Criteria • A determination that the Proposer has submitted a complete and responsive proposal as required by this RFP. • The Proposer’s demonstrated capability to provide the services. • Evaluation of the professional qualifications and experience of program staff. • The Proposer’s experience in performing the proposed services. • The Proposer’s financial ability to provide the services. • An evaluation of the Proposer’s projected approach and plans to meet the requirements of this RFP. GENERAL TERMS AND CONDITIONS SECTION 1: INSTRUCTIONS 1.1. RFP - The services that are required herein are not subject to formal competitive bidding under Section 103 of New York State General Municipal Law. Chautauqua County Purchasing Policy rules in this case require selection of a contractor through a Request for Proposal process. 1.2. Chautauqua County encourages all qualified applicants, including Minority-Owned Business Enterprises, Women-Owned Business Enterprises, Small Business Enterprises and Disadvantaged Business Enterprises, to partake in the solicitation of these and all other services. The successful proposer must be an Equal Opportunity Employer. 1.3. Chautauqua County is exempt from all Federal and State taxes. 1.4 Insurance shall be in place prior to execution of the agreement and shall be up to date and maintained for the contract term. It is preferred that you attach samples or original certificates of insurance along with your proposal. • Within (5) five days receipt of the notice of award the proposer shall supply up- to-date certificates of insurance. Certificates may be e-mailed to the insurance department representative at the following address email wakamata@chqgov.com. • Failure to do so may be cause for the County to declare a proposal non- responsive, with the result that the award may go to the next highest scoring proposal. 1.5 A copy of the Chautauqua County Minimum Insurance Requirements is attached, along with a sample copy of the contract or agreement of service with terms and conditions. 1.6 The successful proposer must obtain Chautauqua County approval prior to utilizing a subcontractor in order to perform the requirements of this RFP. SECTION 2: SUBMISSION OF PROPOSALS: Sealed proposals shall be submitted to Chautauqua County Purchasing Department 3 North Erie St., Mayville, NY by December 29, 2023 at 3:30p.m. Please include the following information on the front of the sealed envelope: Attention: Becky Anderson, Purchasing Manager Proposal No: RFP-2-23 DMHSS Title of Proposal: Code Blue Services Any proposals, or unsolicited amendments to proposals, received after the due date and time specified on the cover page may not be considered in the review process. No faxed or e-mailed documents will be accepted. Chautauqua County takes no responsibility for any third party error in the delivery of the applications (e.g., U.S. Post Office, Federal Express, UPS, courier, etc.). Copies of proposals shall be available in a Microsoft Word or PDF document by e-mail after all proposals have been opened and awarded. 2.1 No proposal will be considered which is not accompanied by pricing information for services to be rendered, and all proposals shall be signed by an authorized individual. 2.2 Confidential, trade secret or proprietary materials as defined by the laws of the State of New York must be clearly marked and identified as such upon submission. Proposers intending to seek an exemption from disclosure of these materials under the Freedom of Information Law (NYS Public Officers Law, Sections 84-90) must request the exemption in writing, at the time of the submission of the materials, setting forth the reason for the claimed exemption. In addition, the proposer must mark each page of its submission on which there appears any material claimed to be protected as confidential or proprietary with the following legend, in bold face, capital letters at the top of each page: “THE PROPOSER BELIEVES THAT THIS INFORMATION IS PROTECTED FROM DISCLOSURE UNDER THE NEW YORK STATE FREEDOM OF INFORMATION LAW”. Acceptance of the claimed materials does not constitute a determination on the exemption request, which determination will be made in accordance with statutory procedures. SECTION 3: MODIFICATIONS OR WITHDRAWAL OF PROPOSAL: 3.1 Questions about or requests for clarification of an item for this RFP must be submitted in writing to Becky Anderson, Purchasing Manager at andersob@chqgov.com. Questions must be submitted prior than the date on the front of this solicitation. County responses will be submitted to all parties in the form of an Addendum to the original RFP, receipt of which must be acknowledged with each proposal submittal. 3.2 Other than the contact person identified in the proposal, or their designee, prospective proposers shall not approach County employees during the period of this RFP process about any matters related to this RFP or any proposals submitted pursuant thereto. 3.3 A proposal that is in the possession of Chautauqua County may be altered by a sealed letter bearing the signature or name of the authorized person, provided it is received PRIOR to the date and time of the proposal due date. Fax, email, telephone or verbal alterations will not be accepted. A proposal that is in the possession of Chautauqua County may be withdrawn by the proposer up to the time of the proposal due date. Failure of the successful proposer to furnish the service awarded, as a result of this Request for Proposal, may eliminate the proposer from the active vendors list for a period of time as determined by the Purchasing Manager. SECTION 4: EVALUATION CRITERIA: 4.1 The County reserves the right to seek any clarifications needed to determine the most qualified submittal and/or require correction of arithmetic or other apparent errors for the purpose of assuring a full and complete understanding of a proposer’s proposal and/or to determine compliance with the requirements of the solicitation. 4.2 Alternatives/Value-Added Considerations: The Proposer may include items not specified in this RFP in their proposal in which the vendor feels can be pertinent to or an added benefit to the services requested. All such alternatives must be listed separately from the proposal and the cost thereof must be separated and itemized. 4.3 A contract may be awarded to the proposer whose proposal achieves the highest evaluation score by the evaluation committee based on the specified criteria, and not solely on the basis of price. 4.4 Unless otherwise specified in the solicitation, every offer is firm and not revocable for a period of sixty (60) days from the due date of the proposals. 4.5 Evaluation will be performed to determine the proposers understanding of work to be performed, technical approach, potential for completing the work as specified herein, cost reasonableness, the probable cost to the County, and ranking with competing proposers. SECTION 5: PROPOSAL FORMAT AND SUBMITTALS: 5.1 The County requests that the following format be followed when submitting your proposal:  The title page: RFP Subject, name of proposer, address, telephone, email address, contact person and table of contents.  Qualifications: List of qualifications and experience to carry out the requested services. Qualification to do business in NYS, number of years in business and length of experience. Limit this to two (2) pages maximum.  References: Include at least two references from supervisors of previous projects. Provide a list of municipal clients whom you have had past projects with that are of similar size and quality.  Plan Implementation: This is the scope of services in terms of the proposer’s plan to carry out the requested services. Limit of a total of 6 pages maximum.  Cost Proposal Section: This shall include all costs associated with the proposer’s plan to carry out the requested services as specified. Any cost proposal forms furnished by the County must be included in this section. Alternatives must be separated and itemized.  Mandatory Documents: Please use the Response Checklist when submitting your proposal. SECTION 6: PREPARATION OF PROPOSAL 6.1 In case of error in the extension of prices in the proposal, unit prices will govern, where applicable. 6.2 Proposers are expected to examine special provisions, the scope of work, schedules and instructions included in this Request. Failure to do so will be at the proposer’s risk 6.3 The County will not reimburse proposers for any costs associated with the preparation and submittal of any proposal, or for any travel and/or per diem costs that are incurred. SECTION 7: PROPOSER QUALIFICATIONS: 7.1 Each proposer shall submit a statement of the proposer’s qualifications, experience, organization, equipment, and facilities available to adequately provide the service and material necessary to fulfill the minimum specifications for this RFP, unless otherwise specified in the scope of work. 7.2 The County shall have the right to take such steps as it deems necessary to determine the ability of the proposer to perform obligations under the contact, and the proposer shall furnish to the County all such information and data for this purpose as may be requested. SECTION 8: AWARD AND CONTRACT INFORMATION: 8.1 The proposer agrees that should their firm be awarded a contract, proposer will not discriminate against any person who performs work hereunder because of age, race, color, sex, creed, sexual orientation, national origin, or disability. 8.2 The proposer expressly warrants to the County that it has the ability and expertise to perform its responsibilities hereunder and in so doing shall use the highest standards of professional workmanship. 8.3 Chautauqua County reserves the right to reject any or all proposals, to waive any informality or technical defect in the proposals, or to award the contract in whole or in part, if deemed to be in the best interest of the County to do so. Explanations of County decisions shall not be required except as otherwise provided by law. 8.4 The successful proposer will be required to enter into and sign an Agreement or an Agreement of Services (Contract) with the County with reasonable adjustments acceptable to the County. This RFP and the response of the successful proposer may become a part of the Contract and will be in effect for the duration of the contract. The Contract language will control over any conflicting language contained within this RFP. 8.5 The successful proposer will not commence any work, which could be billed, until a valid Contract has been executed by both the proposer and the County. 8.6 The County intends to enter into a three (3) year contract with the awarded proposer. Social Services District Provider Agency 1. Salary Costs -$ 2. Fringe Benefits -$ 3. Total Salary & Fringe Benefits -$ NON-SALARY COSTS 4. Contractual Costs -$ 5. Travel Costs -$ 6. Equipment Costs -$ 7. Supplies -$ 8. Other Direct Expenses -$ 9. Total Non-Salary Expenses -$ CLIENT RELATED COSTS 10. Assistance Direct to Clients -$ 11. Transportation -$ 12. Other -$ 13. Total Client Related Costs -$ 14. Total Project Costs -$ Homelessness During Inclement Weather (Code Blue) Contractor Budget Form Budget Categories SALARY COSTS ADMINISTRATION COSTS PROGRAM COSTS TOTAL COSTS -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ CHAUTAUQUA COUNTY RESPONSE CHECKLIST - PROPOSAL NO. RFP-2-23 DMHSS Please note below a list of documents which must be submitted in full as part of this proposal. Failure to submit any of the documents as part of your proposal or failure to acknowledge any addendum in writing with your proposal may be cause for rejection of the proposal. Submitting a proposal on any condition, limitation or provision not officially invited in this RFP (Request for Proposal) may also be cause for rejection. Please check each item indicating your compliance: THIS CHECKLIST MUST BE SUBMITTEDAS PART OF YOUR PROPOSAL. _____RESPONSE CHECKLIST _____NON-COLLUSION CERTIFICATE _____IRANIAN DIVESTMENT CERTIFICATE _____FINANCIAL AFFIDAVIT _____ AFFIDAVIT OF A FOREIGN CORPORATION _____CORPORATE ACKNOWLEDGEMENT CERTIFICATE _____EXCLUSION CHECK _____PRICING SUBMISSION SHEET (PROPOSAL FORM) IF INCLUDED OR VENDOR’S OWN SUBMISSION _____REQUIRED FORMS AS LISTED IN RFP _____ADDENDUM(S) ACKNOWLEDGE (IF APPLICABLE) _____ONE (1) ORIGINAL AND ONE (1) COPY OF YOUR SUBMITTED PROPOSAL _____INSURANCE CERTIFICATES COMPANY TELEPHONE NUMBER ADDRESS EMAIL ADDRESS AUTHORIZED REPRESENTATIVE (PRINT) TITLE AUTHORIZED SIGNATURE DATE PROPOSAL RESPONSE FORM Proposal No. RFP-2-23 DMHSS Proposal Title: Code Blue Services VENDOR NAME: ___________________________________ COMPANY: ________________________________________ REPRESENTATIVE:_________________________________ EMAIL:_________________________/PH._______________ Below are two options, please indicate which one is applicable to your response and return to the contact below: We the above referenced Company will be preparing a proposal to submit for this project. I am returning this document to assure that I receive all further communication regarding the RFP including any addendums issued. We the above referenced Company will not be preparing a proposal to submit for this project for the following reasons listed below. Please check where applicable: _____ Project or scope not suited to our Company. _____ Our items and/or materials do not meet your specifications. _____ Insurance Requirements _____ Bond Requirements too restrictive (when required) _____ Scope of services are not clearly understood or applicable _____too vague _____ too rigid _____ Insufficient time allowed for preparation of proposal _____ Other reason not listed above (or) elaborate on the checked marked reason above: ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ Please send your response to: Becky Anderson, Purchasing Manager Phone: 716-753-4918 Email: andersob@chqgov.com mailto:francet@co.chautauqua.ny.us Page 1 of 12 AGREEMENT Code Blue Services for Individuals Without Minor Children This Agreement is made as of ___, by and between the following parties: COUNTY : CHAUTAUQUA COUNTY Gerace Office Building 3 North Erie Street Mayville, New York 14757, hereinafter called "County, " —and— DMHSS : CHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE AND SOCIAL SERVICES Division of Social Services Hall R. Clothier Building 7 North Erie Street Mayville, New York 14757, hereinafter called "DMHSS, " -and- AGENCY : hereinafter called "Agency. " WITNESSETH: WHEREAS, DMHSS desires to enter into an agreement with a local agency or organization to provide Code Blue Emergency Housing services for single men and women who do not qualify for Temporary Housing Assistance (hereinafter called THA)in Chautauqua County, and WHEREAS, County is funded by New York State to provide emergency code blue housing to homeless individuals; and WHEREAS, County issued an RFP [ ] for such services, and Agency having submitted a proposal dated [ ]; and WHEREAS, Agency is qualified and able to provide said services to eligible single individuals who qualify for Code Blue Emergency Housing in Chautauqua County, and WHEREAS, the parties wish to enter into an Agreement for said services, NOW, THEREFORE, THE PARTIES AGREE AS FOLLOWS: 1. Services. Agency shall maintain and staff a Warming Center located at [ ], New York, with capacity of [ # of beds, chairs, benches, couches, etc] during the cold weather period from November 15 through April 30 of each year, as enumerated in Agency proposal submitted to the County on ______, attached and incorporated into this document as Appendix B. The Warming Center shall be open whenever a Code Blue alert is called, when temperatures are expected to fall below 32 ̊F with wind chill for at least two consecutive hours, based on the local forecast issued by the National Weather Service (http://forecast.weather.gov/) for the city, town or village within the district that is known to have the largest population of unsheltered homeless persons. Agency shall provide warming center services for the duration of the Cold Blue alert, which at a minimum means until the temperature rises above 32 ̊F with wind chill, but at least until 7:00 a.m. the next morning. 18 NYCRR 304.1, 23-LCM-11. Code Blue Services shall be provided to homeless men and women without minor children through referrals from a Code Blue authorizing agency, listed in Appendix C. Agency agrees to refer the individual to DMHSS the following business day for an eligibility determination for Temporary Housing Assistance (THA). Agency shall not reject any referral or forbid admittance to any individual under any circumstance, unless the Agency is at capacity or upon mutual agreement between Agency and DMHSS. The rules of the Warming Center shall be posted in an open and obvious location in the Center. Agency is required to Page 2 of 12 Page 3 of 12 provide interpretation services, if requested, pursuant to New York State Language Access Law and may contact DMHSS to request resources via the County’s contracted language service. Agency shall take all necessary steps to extend warming center hours to allow individuals experiencing homelessness to remain indoors, but at a minimum must allow individuals to remain in the warming center for the duration of the code blue alert, but at least until 7:00 a.m. the next morning. The facility used as a warming center shall be safe, clean, well maintained, and supervised, pursuant to local and state laws, regulations, administrative directives, and guidelines, including local fire, building, and health codes. Facility may be subject to inspections by the Chautauqua County Health Department. 2. Staffing. Agency shall hire well-qualified, properly vetted staffing as follows and pursuant to the job-descriptions attached hereto as Appendix D. ; Independent Contractors. Agency and all staffing hired through Agency for purposes of this agreement are independent contractors and not employees, servants, or agents of the County. Agency shall have exclusive responsibility for the means, manner, time and methods of performing its obligations under this Agreement. Agency shall exercise no authority or control over any County employees other than the general supervision contemplated by this Agreement. Agency and all staffing hired through Agency for purposes of this agreement shall not be entitled to any of the benefits afforded to County employees including, but not limited to, paid personal, sick, or vacation time, health insurance, and retirement benefits. Contractor shall not have an office in any County office building, nor shall he have an assigned phone or computer or assigned clerical support. Pursuant to Article 15 of New York Executive Law (also Page 4 of 12 known as the Human Rights Law) and all other State and Federal statutory and constitutional nondiscrimination provisions, the Contractor will not discriminate against any employee or applicant for employment because of race, creed (religion), color, sex (including gender expression), national origin, sexual orientation, military status, age, disability, predisposing genetic characteristic, marital status or domestic violence victim status, and shall also follow the requirements of the Human Rights Law with regard to non-discrimination on the basis of prior criminal conviction and prior arrest. 3. Reports, Agency shall report the number of individuals housed each night for Code Blue and services provided to the designated Principal Social Welfare Examiner in charge of Code Blue at DMHSS as follows: Contract Start Date through March 31, 2024. This report shall be submitted no later than April 15, 2024. • April 1, 2024 through May 31, 2024. This report shall be submitted no later than June 15, 2024. Agency may be requested to provide data specific to the Homeless Management Information System (HMIS). Agency and DMHSS each agree to provide reports, documents, and other information that will enable the other party to perform its duties under this Agreement. All information exchanged between agencies is confidential and shall be used only for the intended purposes. Each party shall take appropriate measures to safeguard the confidentiality of such information to the extent required by any applicable state and federal laws and regulations including, but not limited to, the Federal Social Security Act, New York State Social Services Law S136, 18 NYCRR Part 357 et. seq., New York State Public Health Law Article 27 -F, and all applicable provisions of the New York State Mental Hygiene Law. Contractor shall, as part of the Agreement, include specific procedures ensuring the protection of health history information Page 5 of 12 related to an individual who has been diagnosed as have AIDS or an HIV-related illness, or an HIV infection or laboratory test performed on an individual for HIV related illness. All program staff to whom confidential HIV-related information is disclosed as a necessity for providing services and in accordance with 18 NYCRR Part 405, Section 36.6, and section 18 of the Public Health Law are fully informed of the penalties and fines for re-disclosure in violation of state law and regulation. Any disclosure of confidential HIV-related information must be accompanied by a written statement as follows: “The information has been disclosed to you from confidential records which are protected by State law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of State law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is not sufficient authorization for further disclosure.” All applicable records hereunder shall be kept for a period of six (6) years and shall be available upon request, and may not be made available to anyone provided however that such records may be made available for audit purposes to the New York State Audit and Control, OTDA, and DMHSS. 4. Payment. In consideration of the services to be performed by Agency pursuant to this Agreement, County agrees to pay Agency the maximum sum not to exceed [ ] to support the wages and fringe benefits for staffing as enumerated above. This amount also encompasses operating expenses as set forth in the Budget, attached and incorporated heretofore as Appendix E. No other charges are permitted by Agency when billing DMHSS. The maximum amount allowable under this contract for the term of this contract is [ ]. This amount Page 6 of 12 shall not be exceeded or increased without consent in writing signed by all parties to this contract and based upon funding and aid availability. Payment shall be made upon submission by Agency to County of properly executed, itemized and certified bills in a form and content approved by the Commissioner of Mental Hygiene and Social Services or duly authorized designee together with all records and documentation as are reasonably requested. Agency shall submit all vouchers no later than thirty (30) days following Agency's billing period. Vouchers not submitted within thirty days following Agency’s billing period may be disallowed by County. County may have additional or in excess CODE BLUE grant funds available to cover additional costs directly associated with providing code blue services. For example, Agency may need to order additional blankets or kitchen and laundry appliances may break during the course of code blue operations. Reimbursement for these costs may be considered by DMHSS, depending on funding. Agency is required to notify DMHSS, Office of Temporary Assistance, Principle Social Welfare Examiner of such need and shall submit a written request for reimbursement, along with three quotes for any proposed expense directly associated with providing code blue services. DMHSS, in its sole discretion and based upon grant availability may authorize a reimbursement payment in the amount of the lowest quote for these additional costs. Any request pursuant to this subsection shall be submitted no later than June 20, 2024. Applications submitted after this date shall be denied. 5. Term. This Agreement shall be effective November 1, 2023, and shall terminate [ ], provided either party may terminate this Agreement upon sixty (60) days advance written notice with accounts between the parties to be adjusted and prorated as of the termination date. Such notice shall be mailed by certified mail to the attention of the respective signatory of this Page 7 of 12 agreement. In the event of a violation of any of the terms of this agreement, County may terminate this agreement immediately by written notice, with amounts adjusted prorated to termination date. Agency shall not incur any further obligations pursuant to this Agreement beyond the termination date, and shall provide County within thirty (30) days’ of termination with a full report of receipts and expenditure of funds, program activities, accomplishments, and abstracts. This Agreement shall be deemed executory to the extent of funds provided to County by New York State and authorized by the County Legislature for the objects and purposes hereof. In the event of a reduction in funding, County reserves the right, by written notice, to immediately terminate this Agreement, in whole or in part, with accounts to between the parties to be prorated and adjusted as of such termination date. 6. Compliance with Laws. The Contractor shall comply with all the provisions of laws in the County of Chautauqua, the State of New York and of the United States of America which affect municipalities and municipal contracts, and provide at its expense, any and all permits, licenses and registrations required for the fulfillment of this agreement, and more particularly the Labor Law, the Immigration and Naturalization Laws and Regulation, the General Municipal Law, the Workers’ Compensation Law, the Lien Law, Personal Property Law, State Unemployment Insurance Law, Federal Social Security Law, State, Local and Municipal Health Laws, Rules and Regulation, and any and all regulations promulgated by the State of New York and of amendments and additions thereto, insofar as the same shall be applicable to any contract awarded hereunder with the same force and effect as if set forth at length herein. Agency agrees to comply with the provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Page 8 of 12 as amended, and any regulations adopted there under. A Business Associate Agreement may be made a part the resulting Agreement. Agency warrants and represents that its practices, policies and procedures for patient/medical record confidentiality are in full compliance with the “Standards for Privacy of Individually Identifiable Health Information” set forth in 45 CFR 160 et seq. as amended, if applicable. Confidentiality. Contactor agrees to comply with all applicable laws, rules, regulations, and Contract Documents regarding confidentiality and privacy, including but not limited to the provisions of HIPAA, and state privacy/confidentiality laws. Contractor agrees that it shall use and maintain personally identifiable information relating to individuals who may receive services, and their families pursuant to this Agreement, or any other information, data or records marked as, or reasonably deemed, confidential by the State (Confidential Information) only for the limited purposes of carrying out the purposes of this Agreement and in conformity with applicable provisions of State and Federal law. The Contractor (i) has an affirmative obligation to safeguard any such Confidential Information from unnecessary or unauthorized disclosure and (ii) must 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). The Contractor shall provide training to all staffing on confidentiality in accordance with this Agreement. 7. Non—Discrimination. Neither party shall discriminate or permit discrimination against any individual or group on the grounds of age, color, creed, disability, domestic violence victim status, handicap, marital status, military status, national origin, political affiliation, predisposing genetic characteristics, race, religion, sex (including gender identity or expression), sexual orientation, or veteran status. Page 9 of 12 8. Insurance. Agency shall secure and maintain the insurance specified at https://chqgov.com/finance/insurancerequirements incorporated by reference as though fully set forth herein, with County named as an additional insured for purposes of coverage on a direct, primary, and non-contributory basis. Agency shall file a certificate of insurance with the County prior to performing pursuant to this Agreement or receiving any payment. 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. 9. Indemnification. Agency shall be solely responsible and answerable in damages for any and all accidents and/or injuries to persons (including death) or property arising out of or related to the services to be rendered by Agency pursuant to this Agreement. To the fullest extent permitted by law, Agency shall defend, indemnify, and hold County and its officers and employees harmless from any liability, claim, demand, loss, judgment, expense, and cost of every type, amount, and nature, direct and indirect and without limitation, including the costs of defense, arising from Agency's performance or failure to perform the terms of this Agreement. In the event that this Agreement is funded by federal or state funds, and County is required to indemnify the funding source(s) of this Agreement, Agency shall be required to indemnify the funding source to the full extent that County is contractually obligated to do so, to the extent such obligation arises from Agency's action or failure to act in accordance with this Agreement. Page 10 of 12 10. 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 Section 165 of the State Finance Law, (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 subcontractor, 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 §165 State Finance Law. Any such use must meet with the approval of the State; otherwise, the bid may not be considered responsive. Under bidder certifications, proof of qualification for exemption will be the responsibility of the Contractor to meet with the approval of the State. 11. Assignment. Agency shall not assign, transfer, convey, sublet, or otherwise dispose of this Agreement or any of its right, title or interest therein, or power to execute this Agreement, without the prior written consent of DMHSS. 12. Entire Agreement. This Agreement contains the sole and entire agreement between the parties relating to the services provided hereunder and shall supersede any and all other agreements between the parties. Any other statements or representations made by either party are void and have no force or effect. Page 11 of 12 13. Digital Signatures and Document Storage. Each party may affix a digital signature to this Agreement by electronic means. By affixing a digital signature the parties are affirming they have authority to enter into this Agreement, and that this Agreement executed by digital signature or other electronic means shall be legally binding and effective. Each party also agrees that this Agreement, and any document including or relating to this Agreement, may be imaged and stored electronically and may be introduced as evidence as original business records and neither party shall contest their admissibility. 14. Execution in Counterparts. This Agreement, and any amendment or modification, may be signed in counterparts, each one of which is considered an original, but all of which constitute one and the same instrument. The exchange of copies of signature pages by scanned portable document format (pdf) email attachment, or through any digital signature program, shall constitute effective execution of this Agreement, and .pdf copies of this Agreement shall have the same force and effect as an original. 15. Additional Terms and Conditions. Contractor shall comply with all provisions contained in Appendix A attached hereto and made a part of this Agreement. IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first set forth above. COUNTY OF CHAUTAUQUA By ____________________________________ Date _____________ Paul M Wendel, Jr., County Executive Page 12 of 12 CHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE AND SOCIAL SERVICES, DIVISION OF SOCIAL SERVICES By ____________________________________ Date _____________ Carmelo Hernandez, Commissioner of Social Services [ ] By _____________________________________ Date _______________ Name: Title: Page 1 of 3 Chautauqua County Appendix A – March 2023 Amendment. No waiver, modification, or amendment of this Agreement or any part thereof shall be valid unless in writing and duly executed by the parties hereto. A waiver of any breach hereof shall not prevent forfeiture for any succeeding breach. Assignment. Contractor shall not assign, transfer, convey, sublet, or otherwise dispose of this Agreement or any of its right, title, or interest therein, or the power to execute this Agreement, without the prior written consent of the County. (GML Section 109) Audit. County, itself or through a third party, reserves the right to audit Contractor upon reasonable notice to ensure compliance with this Agreement. Contractor shall fully comply with any such audit. Binding Agreement. This Agreement shall be binding on the parties, their successors, heirs, and assigns. Certification. By submitting a claim to County for payment, Contractor certifies: that claims are just, true, and correct; that goods are of the quantity and quality stated and/or that the services were actually performed; that prices are reasonable and in accordance with this Agreement; that no portion of any claim has been paid; that there exist no offsets or counterclaims; and that no tax is included. Confidentiality. Information relating to individuals who may receive services pursuant to this Agreement shall be confidential, and maintained and used only for the purposes intended under this Agreement, in accordance with all applicable State and Federal laws, rules and regulations and industry standards. If Contractor is a Business Associate of the County as defined by HIPAA, Contractor shall comply with the terms of County’s standard Business Associate Agreement, as the same may be amended from time to time, unless otherwise agreed upon in writing by the parties. This requirement shall survive termination of this Agreement. Conflict. In the event of a conflict between the terms of this Agreement and the terms of any other Contract Document, the terms of this Agreement shall be controlling notwithstanding anything in Contractor’s documents to the contrary. Debarment/Suspension – see County solicitation documents. Digital Signatures and Document Storage. Each party may affix a digital signature to this Agreement by electronic means. By affixing a digital signature the parties are affirming they have authority to enter into this Agreement, and that this Agreement executed by digital signature or other electronic means shall be legally binding and effective. Each party also agrees that this Agreement, and any document including or relating to this Agreement, may be imaged and stored electronically and may be introduced as evidence as original business records and neither party shall contest their admissibility. Entire Agreement. This Agreement contains the sole and entire Agreement between the parties relating to the services provided hereunder and shall supersede any and all other Agreements between the parties. Any other statements or representations made by either party are void and have no force or effect. Execution in Counterparts. This Agreement, and any amendment or modification, may be signed in counterparts, each one of which is considered an original, but all of which constitute one and the same instrument. The exchange of copies of signature pages by scanned portable document format (".pdf") email attachment, or through any digital signature program, shall constitute effective execution of this Agreement, and .pdf copies of this Agreement shall have the same force and effect as an original. Force Majeure. The County may terminate or suspend its performance under this Agreement, in whole or in part, immediately upon the occurrence of a “force majeure.” A “force majeure” shall include, but not be limited to, natural disasters, war, rebellion, insurrection, riot, strikes, lockout, and any unforeseen circumstances and acts beyond the control of the County which render performance of its obligations impossible. Guarantee. Contractor shall fully guarantee the quality and workmanship of the services and/or goods provided, and shall represent and warrant that such goods or services meet or exceed all applicable industry standards. Governing Law. Notwithstanding any statement in this or any other document to the contrary, this Agreement shall be governed by the laws of the State of New York, without regard to its principles on conflicts of law, and Contractor consents to New York State Court jurisdiction in Chautauqua County, New York as the exclusive jurisdiction for this contract, and any disputes hereunder shall be heard by a court of competent jurisdiction in Chautauqua County, New York, unless this paragraph is physically crossed out and initialed by both parties, or unless the Federal supremacy clause requires otherwise. Independent Contractor. Contractor is an independent contractor and not an employee, servant, or agent of the County. Contractor shall have exclusive responsibility for the means, manner, and methods of performing its obligations under this Agreement. Indemnification. Contractor shall be solely responsible and answerable in damages for any and all accidents and/or injuries to persons (including death) or property arising out of or related to the services to be rendered by Contractor or its subcontractors pursuant to this Agreement. To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold County and its officers and employees harmless from any liability, claim, demand, loss, judgment, expense, and cost of every type, amount, and nature, direct and indirect and without limitation, including the costs of defense, arising from Contractor's performance or failure to perform the terms of this Agreement. In the event that this Agreement is funded by Federal or State funds, and County is required to indemnify the funding source(s) of this Agreement, Contractor shall be required to indemnify the funding source to the full extent that County is contractually obligated to do so, to the extent such obligation arises from Contractor’s action or failure to act in accordance with this Agreement. All money expended by County as a result of such claims, actions, damages, losses, expenses, and costs, together with interest at a rate not to exceed the maximum interest rate permitted by law, shall be immediately and without notice due and payable by Contractor to County. Such obligation to the County shall not be construed to negate, abridge or reduce other rights of indemnity which would otherwise exist. This provision shall supersede any other provision in this Agreement, including attachments and referenced items, deemed to be in conflict, unless specifically stated otherwise. Insurance. Unless waived by the County Attorney or his/her designee in writing, Page 2 of 3 Chautauqua County Appendix A – March 2023 Contractor shall secure and maintain the insurance specified at https://chqgov.com/finance/insurance- requirements incorporated by reference as though fully set forth herein, with County named as an additional insured for purposes of coverage on a direct, primary, and non-contributory basis. The insurance afforded the additional insureds shall be at least as broad as that afforded to the first named insured. County as additional insured will be entitled to the limits stated in the contract or the full limits of the policy, whichever is greater. Contractor shall file a certificate of insurance with the County prior to performing pursuant to this Agreement or receiving any payment. Contractor shall provide new insurance certificates when the existing certificates expire, without demand. Contractor shall immediately forward to County (fax (716) 753-4888) any notice of actual or pending termination, suspension, or non-renewal of insurance. In the event Contractor's insurance expires or is terminated or suspended, County shall have all rights available for breach of contract, and may declare this Agreement to be automatically and immediately terminated effective as of the moment of expiration, termination, or suspension. In addition, County reserves the right to withhold payment to Contractor until such new certificates have been provided and approved. County shall have unlimited access to Contractor's insurance company and policies. Licenses and Permits. Contractor shall secure and maintain throughout the term of this Agreement all necessary licenses, permits, and other certifications and qualifications required for its performance of this Agreement. Contractor shall immediately notify the County of any notice of, or actual, revocation or restriction of a license, permit, or other certification necessary for its performance of this Agreement. In the event of a revocation which prohibits Contractor from being able to perform this Agreement, this Agreement shall automatically terminate effective as of the moment of such revocation. Non-Discrimination. In the performance of this Agreement, Contractor will not discriminate or permit discrimination against any individual or group on the grounds of age, color, creed, disability, domestic violence victim status, handicap, marital status, military status, national origin, political affiliation, predisposing genetic characteristics, race, religion, sex (including gender identity or expression), sexual orientation, or veteran status. Contractor shall comply with County's Title VI (non-discrimination) policy, which can be obtained by contacting the County Compliance Officer at (716) 753- 4714,and with the County's DBE policy. Payment. Contractor shall invoice County within ninety (90) days of the date of service. Payment will be made upon timely receipt of a properly executed invoice in form and content approved by the Department Head, or a duly authorized subordinate of the department requesting services, accompanied by such documentation as is reasonably requested. By submitting a claim to County for payment, Contractor certifies that: claims are just, true and correct; goods are of the quantity and quality stated and/or that the services were actually performed; that prices are reasonable and in accordance with the Agreement; that no portion of the claim has been paid; that there exist no offsets or counterclaims on this or any other Agreement with the County; and that no tax is included. Contractor acknowledges that County issues vendor payments electronically, and shall complete payment forms as required by the County for that purpose. Electronic Payment Methods forms can be found at: http://www.co.chautauqua.ny.us/218/Form s-Applications. Performance Time. Notwithstanding the stated Agreement date or term, County shall not be obligated to pay for goods or services which are furnished: prior to the date this Agreement is executed by both parties; or during any time when the required insurance is not in place. Notice of Investigation. Contractor shall notify County in writing within five (5) calendar days of obtaining knowledge of the commencement of any investigation or audit or adverse action against Contractor by any governmental agency, to the extent such audit, investigation, or action relates in any way to contract services. Records. Contractor shall keep and maintain records and other documents as required by the Agreement. Contractor shall submit to County upon request such schedule of quantities and costs, progress schedules, payrolls, reports, estimates, records, and other data that County may request concerning work performed or to be performed under this Agreement. All books and records of Contractor shall be available upon request for inspection and/or audit and/or copying by the County during the time hereof and for a period of six (6) years hereafter. Contractor shall also comply with audit requirements of third parties, as identified in Contract Documents. Set-Off Rights. County shall have all of its common law, equitable, and statutory rights of set-off. These rights shall include, but not be limited to, the option to withhold for the purposes of set-off any money due to Contractor under this or any other Agreement, up to any amounts due and owing to County with regard to any contract with any Chautauqua County department, office or agency. Severability. Should any part, term, or provision of this Agreement be determined, by a court of competent jurisdiction, to be invalid, unenforceable, illegal, or in conflict with any law, the validity, legality, and enforceability of the remaining portions shall not be impaired or affected. Statutory Compliance. Contractor shall perform in accordance with all applicable federal, state, and local laws, rules and regulations, including without limitation any applicable provisions of the Labor Law of the State of New York. All statutory and regulatory provisions applicable to this Agreement are hereby incorporated by reference. Contractor shall provide, at its own expense, all permits, licenses, and certifications required for the performance of its services pursuant to this Agreement and shall be solely responsible for paying any and all fines or penalties incurred as a result of any improper activities. Contractor's performance shall meet or exceed industry standards. Subcontracts. Contractor shall: (a) require any subcontractor, agent, volunteer, or other third party (Third Party) performing Agreement services to comply with all applicable Federal, State and Local laws, rules and regulations; (b) adopt and perform such review and inspection procedures as are necessary to ensure compliance by Third Party with this Agreement; (c) require any third party to indemnify County against any and all claims arising out of such Third Party’s performance of, or failure to perform, the Agreement, with Contractor assuming such indemnification itself to the extent a Third Party fails to do so; and (d) remain fully obligated under this Agreement notwithstanding its delegation of a Third Party to undertake all or any portion of the performance of this Agreement. https://chqgov.com/finance/insurance-requirements https://chqgov.com/finance/insurance-requirements Page 3 of 3 Chautauqua County Appendix A – March 2023 Contractor shall inform Third Parties, and require Third Parties to abide by, all relevant provisions of this Agreement. Survival. The terms and conditions of this Agreement shall survive the expiration of this Agreement to the full extent necessary for their enforcement and for the protection of the party in whose favor they operate. Termination Obligations. Upon receipt of notice of termination of this Agreement, Contractor shall cancel, prior to the effective date of any prospective termination, as many outstanding obligations as possible, unless otherwise directed by County, and shall not incur any new obligations after receipt of the termination notice without written approval of County. Waivers. Any waiver of a breach of this Agreement shall not be deemed to be a waiver of any preceding or future breach of the same or any other covenant, term, or condition. Wages and Hours. When applicable, Contractor shall comply with §§220-e and 239 of New York State Labor Law. 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, if this is a public work contract covered by Article 8 of the Labor Law, 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 County of any County-approved sums due and owing for work performed upon the project. Workers Compensation Coverage. If this Agreement is of such a character that the employees engaged thereon are required to be insured under the workers’ compensation law, then, in accordance with General Municipal Law §108, this Agreement is void and of no effect unless the person or corporation making or performing this Agreement shall secure compensation for the benefit of, and keep insured during the life of this Agreement, such employees, in compliance with the provisions of the workers’ compensation law. CHAUTAUQUA COUNTY MINIMUM INSURANCE REQUIREMENTS INSURANCE SHALL BE PROCURED AND CERTIFICATES DELIVERED BEFORE COMMENCEMENT OF WORK OR DELIVERY OF MERCHANDISE OR EQUIPMENT. This document shall be attached to and become part of the contract/agreement/service order. The contractor shall immediately forward to County, via facsimile to the County Department of Insurance (716) 753-4888 any notice of actual or pending termination, suspension or non-renewal of any of its policies. In the event the contractor's insurance expires or is terminated or suspended, County shall have all rights available for breach of contract and the contract/agreement/service order shall automatically and immediately terminate effective as of the moment of expiration, termination or suspension. The contractor agrees that County shall have unlimited access to its insurance company and policies. Certificate Requirements The certificate must: A. be addressed to CHAUTAUQUA COUNTY, Department of Insurance, 3 N. Erie Street, Mayville, NY 14757-1007; B. specify all coverage required below and elsewhere in the contract. Bid specifications or particular contracts, leases or agreements may require alternate coverages and limits, which must be evidenced on the Certificate in lieu of the coverages and limits specified below; C. be issued by an insurer which has at as a minimum, BEST’S RATING of A- and be size category VII or higher; D. state "CHAUTAUQUA COUNTY shall be an additional insured, as well as a certificate holder, on a direct, primary and non-contributory basis including products and completed operations" Note: Professional Liability, Worker’s Compensation, and Disability Benefits Liability Insurance policies are not required to have the County as an additional insured, however County shall be named as certificate holder; E. include a waiver of subrogation for "Construction and Maintenance" and "Property Leased to Others or Use of Facilities or Grounds" coverage; F. state "Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions"; and G. be delivered to the Chautauqua County, Department of Insurance, 3 North Erie Street, Mayville, New York 14757, Fax No. (716) 753-4888 � ����������� �� � ������� ������ ����� ��������������� �� �� ���� �� �� ��� �� � ���� ����� �� ��� ������� � ������������ ������ ����� ����� ����� ��������� ������� � � ���� �� �� ���� �� �������������� � ������������������ � ����� ��� � �� ����� � ������� ����� � � � � � � � � � � � � � � � �������������� ��������������� � !"#$$$#$$$����� ��� ��� ��#� !%#$$$#$$$��&&��&����� !"#$$$#$$$� !"#$$$#$$$�� !"#$$$#$$$�� !"#$$$#$$$�� !"#$$$#$$$�� ��'������ � �(��������� � )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� ��'����� ,�(��������������� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� ��'�) ���� �� ���� ������� � )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� ��'��� ����� ��� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� ��'�-�����������+� )*���+�� � ���������)*���+�� ��������)*���+�� ��������)*���+�� ��������)*���+�� ��'�.#��#��� )*���+�� � ��������)*���+�� � � � ��'���� � ���) / ��� � � )*���+�� )*���+�� � � ��'���0 �����1� � � )*���+�� � � � ��'�2� ����0 ��� � � � � � )*���+�� � � � � � � �� ������������� !"#$$$#$$$����� !"#$$$#$$$����� !"#$$$#$$$����� !"#$$$#$$$����� !"#$$$#$$$����� $1,000,000 ���� ��'��1 ��� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� ��'�2����� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� ��'�*� '�1 ��� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� )*���+�� � � � � � � ��3�� ��������������������� !"#$$$#$$$� !"#$$$#$$$� �����!"#$$$#$$$� !"#$$$#$$$� !�4#$$$#$$$�� !"#$$$#$$$� � � � � � � � *5��+� ��������-� ���������� �6�6�6�75� ����6�6�6�75� �6�6�6�75���� �6�6�6�75� ������6�6�6�75� ������6�6�6�75� �8��9��: ������ ���� ����� �6�6�6�75� �6�6�6�75� �������6�6�6�75� �6�6�6�75� �6�6�6�75� ������6�6�6�75� �(���������: ��3�� ����������� ���������*�)�)6�+� �����*�)�)6�+� �������*�)�)6�+� �������*�)�)6�+� ������*�)�)6�+� �������*�)�)6�+� � � � � � � � �1 �� ��� ������� ������������ !"#$$$#$$$� � � � � � � � � � � � ������ �� �������������� � !"#$$$#$$$� � � � �� *The comprehensive/commercial general liability limits can be met by one or more policies or in combination with an excess and/or umbrella liability policy. The COI must indicate if the coverage trigger is an ‘occurrence’ form or a ‘claims-made’ form. ** NYS Work Comp Board requires special certificates of insurance for these coverages. WC needs to be on C-105.2 (9-07) or U-26.3. Any business with a location in NYS must show DB on a DB-120.1(5-06) showing beginning and ending dates or DB-155. Self Employed vendors must use CE-200 to waive WC and DB. Form can be completed on NYS WCB website electronically. Construction and Maintenance contractors shall carry insurance for a minimum of two years after completion of the work. The expiration date for any claims-made policy must be at least ninety (90) days after the expiration of the contract for services or final delivery of any products. All claims made polices shall continue to provide evidence of coverage three (3) years after completion of work or product delivery. NOTE: Childcare providers minimum liability coverage is $1,000,000 and must include sexual abuse coverage, with cancellation notice as provided for in the insurance policy. The naming of Chautauqua County as an additional insured on Day Care insurance is required. � August 29, 2012 NON-COLLUSION BIDDING CERTIFICATION By submission of this bid, the bidder and each person signing on behalf of the bidder certifies, subject to the terms of Section 103-d of the General Municipal Law, as amended, and under penalty of perjury, that to the best of its knowledge and belief: (a) 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; (b) 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 the bid opening, directly or indirectly, to any other bidder or to any competitor; and (c) 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. (d) The person signing this bid certifies that s/he has fully informed him/herself regarding the accuracy of the statements contained in this certification, and under the penalties of perjury affirms the truth hereof, such penalties being applicable to the bidder as well as to the person signing on the bidder’s behalf. Signature ____________________________________________ Title ________________________________________________ STATE OF NEW YORK ) COUNTY OF ) SS: On this __________ day of ____________, 2023, before me personally appeared ____________________, to me known, who being by me duly sworn, did depose and say that s/he resides at ______________________________, New York: that s/he is the _________________ of _______________________, the corporation described in and which executed the within instrument; that s/he knows the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of said corporation. ____________________________ Notary Public IRANIAN DIVESTMENT CERTIFICATION NEW YORK STATE GENERAL MUNICIPAL LAW SECTION 103-G 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 its knowledge and belief that each bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of section 165-a of the state finance law (see https://ogs.ny.gov/iran-divestment-act-2012 ). Date: Signature Title Company Name On 1/13/12, Chapter 1 of the Laws of New York for 2012 was signed into law by Governor Andrew M. Cuomo. The law is known as the "Iran Divestment Act of 2012" (the "Act") and can be found at § 165-aof the NY State Finance Law. The Act became effective on April 12, 2012. The Act imposes limitations on "persons" that are determined to be engaged in investment activities in the Iranian energy sector, as defined in the Act. On 7/17/12, Governor Cuomo signed into law Chapter 106 of the laws of 2012, which extended the Iran Divestment Act to State and local public authorities, the State University of New York, and the City University of New York. EXCLUSION CHECKS CERTIFICATION Chautauqua County reserves the right to conduct exclusion checks on those who respond to its solicitations and on those with whom it contracts to verify that the contractor and its employees, subcontractors, and agents have not been sanctioned, excluded, debarred, suspended, or the subject of adverse governmental action by law enforcement, regulatory authorities, or licensing entities. This may include a check for exclusion from Federal healthcare programs. By submitting this bid, you are: certifying that you are not prohibited from providing these services and/or goods as a result of being sanctioned, debarred, suspended, or excluded; agreeing that the County has the right to decline to enter into a contract with you in the event the County finds there to be a legal or funding source impediment to contracting with you; agreeing to provide written notice to the County immediately upon the occurrence of any sanction, exclusion, debarment, or suspension relating to your contract with the County; and agreeing that upon the occurrence of any such sanction, exclusion, debarment, or suspension, the County has the right to declare its contract with you to be terminated effective as of the moment of such occurrence or at such later date as is deemed by the County to be in the best interest of the County. Date: Signature Title Company Name https://ogs.ny.gov/iran-divestment-act-2012 FINANCIAL AFFIDAVIT STATE / COMMONWEALTH OF ) ) ss: COUNTY OF___________________________ ) ___________________________________, being duly sworn, deposes and says that I have made a complete and thorough examination of the financial records of the bidder, ; and that I have determined that said bidder is currently not in arrears in taxes or upon debt or contract to or with the County of Chautauqua, that said bidder has not defaulted as surety or otherwise upon a contract or obligation to the County of Chautauqua, and that said bidder is not disqualified to bid upon municipal or state contracts under any act of New York State Legislature. ______________________________________________________________ Signature of above-named individual Sworn to before this ___________ day of __________________, 20__ _______________________________ NOTARY PUBLIC AFFIDAVIT OF A FOREIGN CORPORATION STATE / COMMONWEALTH OF ) ) ss: COUNTY OF___________________________ ) I, ________________________________as____________________________________ of __________________________________ , a corporation incorporated under the laws of _________________________ authorized to do business in the State of New York, do hereby certify and affirm that the above named corporation has complied Article 13 of the Business Corporations Law of the State of New York. As proof I submit a copy of: [ ] A receipt of filing an application with the New York Secretary of State to conduct business in The State of New York; OR [ ] A copy of our application for authority to conduct business in the State of New York filed with the Secretary of State on _______________________________,20___. As said corporation has complied with Article 13 of the Business Corporations Law of the State of New York, I hereby swear and affirm that the above-named corporation is authorized to conduct business in the State of New York. Under penalty of perjury, I declare that the facts presented herein are true and, to the best of my knowledge and belief, are true, correct and complete. In witness thereof, I set my hand and attach the corporate seal this _______ day of __________, 20____. _________________________________________ Signature Title Business Corporation Law of New York, Section 102(7): “Foreign Corporation” means a corporation...formed under laws other than the statutes of (New York)...”Authorized,” when used with respect to a foreign corporation, means having authority, under Article 13 of the Business Corporation Law, to conduct business in New York State. BID AUTHORIZATION CERTIFICATE Individual, Corporation, Partnership, or LLC Acknowledgement STATE / COMMONWEALTH OF ) ) ss: COUNTY OF ) 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 s/he resides in the Town of , County of , State / Commonwealth of ________________________________________, and that [Mark an X in the appropriate box and complete the accompanying statement.] ☐ (If an individual): this person executed the foregoing instrument in his/her name and on his/her own behalf. ☐ (If a corporation): this person is the ____________________________________________ of______________________, the corporation described in said instrument; that, by authority of the Board of Directors of said corporation, this individual is authorized to execute the foregoing bid documents on behalf of the corporation for purposes set forth therein; and that, pursuant to that authority, s/he has executed the foregoing bid document(s) in the name of and on behalf of said corporation as the act and deed of said corporation. ☐ (If a partnership): this person is the ______________________________________________ of___________________________, the partnership described in said instrument; that, by the terms of said partnership, this individual is authorized to execute the foregoing bid document(s) on behalf of the partnership for purposes set forth therein; and that, pursuant to that authority, s/he has executed the foregoing bid document(s) in the name of and on behalf of said partnership as the act and deed of said partnership. ☐ (If a limited liability company): this person is a duly authorized member of _________ LLC, the limited liability company described in said instrument; that, by authority of the Board of Directors or Members of said company, this individual is authorized to execute the foregoing bid document(s) on behalf of the company for purposes set forth therein; and that, pursuant to that authority, s/he has executed the foregoing bid document(s) in the name of and on behalf of said company as the act and deed of said company. ____________________ Date Signature Printed Name _______________________________________ NOTARY PUBLIC