NYS Office of General Services RFP 2639

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record Addendum 2

DIVISION OF FINANCIAL ADMINISTRATION

ADDENDUM #2

REQUEST FOR PROPOSAL # 2639

INSURANCE BROKER(S) OF RECORD

Date: March 8, 2023

Proposal Due Date: March 28, 2023 @ 2:00pm

To Prospective Proposers: This second addendum is being issued to provide clarifications.

Clarifications:

C1: On RFP 2639 Attachment 2 – Insurance Schedules per Lot, each line item represents an individual

policy currently in place.

C2: The approximate breakdown of total premium values placed through BRIM is as follows:

1. 87% is for non-executive agencies (Authorities & Public Benefit Corporations)

a. 36% is Hudson River Park & Trust

b. 28% is Battery Park City Authority

c. 10% is Long Island Power Authority

d. 8% is City University of New York

2. 13% is for is for NYS Agencies

Policies are place for NYS Agencies in order to meet contractual obligations. State owned risks

are self-retained.

All other terms and conditions of RFP 2639 remain unchanged. If submitting a proposal, this Addendum

#2 for RFP #2639 must contain an original signature, be dated, and should be attached to your proposal.

Company Name

Signature

Bidders Name (please print)

Title

Date

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record Addendum 1

DIVISION OF FINANCIAL ADMINISTRATION

ADDENDUM #1

REQUEST FOR PROPOSAL # 2639

INSURANCE BROKER(S) OF RECORD

Date: March 7, 2023

Proposal Due Date: March 28, 2023 @ 2:00pm

To Prospective Proposers: This first addendum is being issued to provide a list of Vendors submitting a

Mandatory Intent to Submit a Proposal and provide answer to questions.

Mandatory Intent to Submit a Proposal:

Alliant Insurance Services, Inc.

Arthur J. Gallagher, Inc.

March USA, LLC

Willis Towers Watson Northeast, Inc.

Questions and Answers:

Q1: Is there a MWBE Goal for RFP 2639 (NY State Office of General Services)? I have reviewed the

solicitation and can’t seem to find it.?

A1: For purposes of this procurement, OGS determined that the Contract does not offer sufficient

opportunities to set goals for participation by MWBEs as subcontractors, service providers, or

suppliers to Contractor. However, MWBEs and SDVOBs are encouraged to bid as Prime. Please

also see RFP 2639 Appendix E – M/WBE and EEO Requirements.

Q2: What changes, improvements or areas or emphasis would the OGS like to see from your broker

moving forward?

A2: It is important that BRIM receives information from BOR (quotes, policies, responses to questions)

in a timely manner. Please also refer to RFP 2639 sections 2.2 – Project Goals and Scope and 2.4

Summary of Required Services.

Q3. What are OGS’s key priorities from an insurance and risk management perspective?

A3. BRIM’s priority is to offer its customers the best protection in the most cost-effective manner.

Q4: When was the last marketing exercise of the various insurance programs and is a marketing effort

contemplated for the immediate future?

A4: Marketing is required for every renewal of every policy unless prior approval is obtained from BRIM.

Please see RFP 2639 Section 2.6 Marketing and Placement of Insurance Policies.

Q5: Could OGS please provide a sample copy of a contract?

A5: Please see RFP 2639 Appendix C – Sample Contract.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record Addendum 1

Q6: Who is typically responsible for the builders risk insurance on joint projects?

A6. Builders risk insurance policies placed by BRIM cover all vendors working on projects managed by

covered Agency Customer, including joint projects.

Q7: Please advise the current brokers involved on the OGS’s program by Lot and how long they have

been working on the program(s).

A7: Arthur J. Gallagher holds the contract for Lots 1, 2, 4, and 6. Willis Towers Watsons holds the

contract for Lots 3 and 5. For additional information, please go to

https://www.osc.state.ny.us/open-

book-new-york, or submit a FOIL request. Directions for submitting a FOIL request may be found

at https://ogs.ny.gov/freedom-of-information-law

Q8: Please disclose the current compensation structure and amount for the incumbent broker(s) by Lot.

A8: OGS respectfully declines to answer questions regarding current contract compensation. Please

refer to RFP 2639 Section 5.5.2 Payment Methodologies for method of compensation on any

contract resulting from this RFP.

Q8a: What is their annual firm fixed fee, inclusive all services?

A8a: OGS respectfully declines to answer

questions regarding current contract compensation.

Q8b: What is their hourly rate for Loss Control Services? What services are utilized?

A8b: OGS respectfully declines to answer questions regarding compensation. Loss Control Services

are not a requirement of RFP 2639. Please refer to RFP 2639 section 2 Scope of Work for service

requirements.

Q8c: What is the current commission cap on existing lines of coverage which may be payable in addition

to the fee paid by the State, by line of coverage?

A8c: Please see A8.

Q8d: What is the negotiated commission cap on new lines placed mid-term?

A8d: Throughout the term of any contract resulting from RFP 2639, the commissions received by the

Contractor on behalf of NYS OGS will be equal to or lower than any commissions received by the

Contractor from other customers for like services. Please refer to RFP 2639 Section 5.5.2 Payment

Methodologies.

Q9: Does the OGS require the broker to disclose income from all sources (such as wholesale and/or

intermediary fees) and how is that reconciled?

A9: OGS does not have specific requirement for disclosure of all income sources, except as required

by law.

Q10: Is OGS willing to negotiate the contract language at a later time upon award?

A10: OGS would only be willing to consider nonmaterial items. Any exceptions to material terms would

have needed to be proposed prior to March 1, 2023, as detailed in RFP 2639 Section 5.9 -

Exceptions and Extraneous Terms.

Q11: Please provide a Schedule of Insurance listing current policies, including limits, deductibles,

carriers, coverages and premiums by Lots.

A11: Information OGS is willing to share at this time may be found in RFP 2639 Attachment 2 - Insurance

Schedules per Lot. Additional information will be provided to the awarded vendor.

Q12: What tasks consume the greatest amount of OGS/BRIM’s time (claims handling, insurance

renewals, insurance contracts, etc.)?

A12: Administrative tasks, not related to the Broker of Record, consume much of BRIM’s time.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record Addendum 1

Q13: What are the areas of focus of the OGS/BRIM Risk Management team?

A13: Please see A3.

Q14: Please provide a copy of current Cyber policy.

A14: To obtain a copy of current Cyber Policy, please submit a FOIL request. Directions for submitting a

FOIL request may be found at https://ogs.ny.gov/freedom-of-information-law

Q15: Who are the current TPA(s) and how are claims handled on the various lines of coverage for each

Lot?

A15: There are no TPAs. Claims are reported to BRIM by its Agency Customer(s). BRIM submits the

claim information to the BOR for lot on which claim is made. The BOR is responsible for submitting

claim to the carrier. Please refer to RFP 2639 Section 2.4 Summary of Required Services.

All other terms and conditions of RFP 2639 remain unchanged. If submitting a proposal, this Addendum

#1 for RFP #2639 must contain an original signature, be dated, and should be attached to your proposal.

Company Name

Signature

Bidders Name (please print)

Title

Date

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

REQUEST FOR PROPOSAL (RFP) 2639 SOLICITED BY THE

NEW YORK STATE OFFICE OF GENERAL SERVICES

FOR

INSURANCE BROKER(S) OF RECORD

BID DUE DATE: MARCH 28, 2023, 2:00PM

ISSUE DATE: FEBRUARY 1, 2023

Designated Contact:

Alternate Contact:

Seth Stark

Mary Slusarz

Phone: 518-486-2823

Phone: 518-486-2771

E-mail: seth.stark@ogs.ny.gov

E-mail: mary.slusarz@ogs.ny.gov

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Table of Contents

1. INTRODUCTION...................................................................................................................... 4

1.1 Overview ..................................................................................................................................... 4

1.2 Designated Contact ..................................................................................................................... 4

1.3 Minimum Proposer Qualifications ............................................................................................... 5

1.4 Key Events .................................................................................................................................. 5

1.5 Mandatory Intent to Submit a Proposal ....................................................................................... 6

1.6 Glossary of Terms ....................................................................................................................... 6

2. SCOPE OF WORK .................................................................................................................. 7

2.1 Background ................................................................................................................................. 7

2.2 Project Goals and Scope ............................................................................................................ 7

2.3 Project Administration and Reporting.......................................................................................... 7

2.4 Summary of Required Services .................................................................................................. 9

2.5 Lots ............................................................................................................................................ 10

2.5.1 Standard Lines Requirements ...................................................................................... 11

2.5.2 Specialized Lines Requirements .................................................................................. 11

2.5.3 Additional Contract Requirements ............................................................................... 12

2.6 Marketing and Placement of Insurance Policies ....................................................................... 12

2.7 Knowledge Transfer .................................................................................................................. 12

2.8 OSHA (Occupational Safety & Health Administration) Training Requirements ........................ 12

2.9 Conflict of Interest ..................................................................................................................... 13

2.10 Warranties ................................................................................................................................. 14

2.11 Contractors Compensatory Liability .......................................................................................... 14

3. PROPOSAL SUBMISSION ............................................................................................... 15

3.1 RFP Questions and Clarifications ............................................................................................. 15

3.2 Proposal Format and Content ................................................................................................... 15

3.2.1 Cover Letter.................................................................................................................. 15

3.2.2 Minimum Qualifications ................................................................................................ 15

3.2.3 Technical Proposal ....................................................................................................... 16

3.2.4 Administrative Proposal ............................................................................................... 19

3.3 Proposal Preparation ................................................................................................................ 20

3.4 Packaging of RFP Response .................................................................................................... 20

3.5 Instructions for Bid Submission ................................................................................................. 20

4. EVALUATION AND SELECTION PROCESS............................................................................... 22

4.1 Proposal Evaluation .................................................................................................................. 22

4.1.1 Evaluation Categories .................................................................................................. 22

4.2 Notification of Award ................................................................................................................. 23

5. ADMINISTRATIVE INFORMATION............................................................................................ 24

5.1 Issuing Office ............................................................................................................................. 24

5.2 Method of Award ....................................................................................................................... 24

5.3 Notification of Award ................................................................................................................. 24

5.4 Price .......................................................................................................................................... 24

5.5 Method of Payment ................................................................................................................... 24

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

5.5.1 Payment Procedures .................................................................................................... 24

5.5.2 Payment Methodology ................................................................................................. 25

5.6 Electronic Payments ................................................................................................................. 25

5.7 Term of Contract ....................................................................................................................... 26

5.7.1 No Knowledge Transfer Term ...................................................................................... 26

5.7.2 Knowledge Transfer Term ............................................................................................ 26

5.8 Past Practice ............................................................................................................................. 26

5.9 Exceptions and Extraneous Terms ........................................................................................... 26

5.10 Dispute Resolution .................................................................................................................... 26

5.11 Examination of Contract Documents......................................................................................... 27

5.12 Rules of Construction ................................................................................................................ 27

6. CONTRACT CLAUSES AND REQUIREMENTS .............................................................. 28

6.1 Appendix A / Order of Precedence ........................................................................................... 28

6.2 Summary of Policy and Prohibitions on Procurement Lobbying ............................................... 28

6.3 Confidentiality ............................................................................................................................ 28

6.4 Ethics Compliance..................................................................................................................... 28

6.5 Tax and Finance Clause ........................................................................................................... 28

6.6 Freedom of Information Law / Trade Secrets ........................................................................... 29

6.7 General Requirements .............................................................................................................. 29

6.8 Subcontractors .......................................................................................................................... 30

6.9 Procurement Rights................................................................................................................... 31

6.10 Extent of Services ..................................................................................................................... 32

6.11 Debriefings ................................................................................................................................ 32

6.12 Termination ............................................................................................................................... 32

6.13 NYS Vendor Responsibility Questionnaire ............................................................................... 32

6.14 New York State Vendor File Registration ................................................................................. 33

6.15 Indemnification .......................................................................................................................... 34

6.16 Force Majeure ........................................................................................................................... 34

6.17 Participation Opportunities For New York State Certified Service-Disabled Veteran-Owned Businesses 34

6.18 Encouraging Use of NYS Businesses ....................................................................................... 34

6.19 Information Security Breach ...................................................................................................... 35

6.20 Sexual Harassment Prevention ................................................................................................. 36

Appendix A………. Standard Clauses for New York State Contracts

RFP Appendix B………...Required Forms

RFP Appendix C………...Sample Contract

RFP Appendix D………...Insurance Requirements

RFP Appendix E………...MWBE Requirements

RFP Attachment 1………Proposal Submission Checklist

RFP Attachment 2………Insurance Schedules per Lot

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

1. Introduction

1.1 Overview

The Office of General Services (OGS), through this request for proposals (RFP), is seeking insurance broker of

record (BOR) services. If an award is made from RFP 2639, the awarded Contractor(s) would assist OGS Bureau

of Risk and Insurance Management (BRIM) in the marketing and placement of existing and potentially new

insurance policies for the State. The objective is to obtain optimal protection for the State for those exposures

the State insures or determines to insure. The BOR will also advise BRIM on the risk landscape and assist with

contract insurance requirement reviews and recommendations. The insurance policies and programs, and all

ensuing placements, are coordinated by and through BRIM on behalf of Agency Customers (please also see

RFP 2639 section 2.1 – Background).

While New York State (NYS) as a whole is self-retained and does not purchase insurance for any State-owned

risks, BRIM assists NYS Executive Agency customers in the procurement of insurance policies when coverage

is contractually required, and self-retention is not accepted by entity requiring insurance. For example, NYS

owned vehicles are not insured, but there is an insurance policy in place to cover leased and rented vehicles.

BRIM also places insurance for State Authorities and Public Benefit Corporations when requested. Since

Authorities and Public Benefit Corporations are not covered by self-retention, they are able to purchase

insurance policies to cover their full scope of risks. There is no mandate for the use of BRIM, and all Agency

Customers use BRIM’s services on a voluntary basis.

1.2 Designated Contact

In compliance with the Procurement Lobbying Law, Seth Stark, Contract Management Specialist II, NYS Office

of General Services, Division of Financial Administration has been designated as the PRIMARY contact for this

procurement and may be reached by email or voice for all inquiries regarding this solicitation.

Seth Stark, Contract Management Specialist II

New York State Office of General Services

NYS Office of General Services

Financial Administration – Agency Procurement Office

32nd Floor, Corning Tower Bldg., Empire State Plaza

Albany, New York 12242

Phone: 1-518-486-2823

Email: [email protected]

In the event the designated contact is not available; the alternate designated contact is:

Mary Slusarz, Contract Management Specialist III

NYS Office of General Services

Financial Administration – Agency Procurement Office

32nd Floor, Corning Tower Bldg., Empire State Plaza

Albany, New York 12242

Phone: 1-518-474-8209

Email: [email protected]

For inquires related specifically to Minority Women-Owned Business Enterprises (MWBE) provisions of this

solicitation, the designated contact is:

Joshua Quiles, Compliance Specialist I

NYS Office of General Services, Minority and Women-Owned Business Enterprises

Floor, Corning Tower Bldg., ESP

Albany, NY 12242

Voice: 1-518-486-9284

Email: [email protected].gov

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

For inquires related specifically to Service-Disabled Veteran Owned Businesses (SDVOB) provisions of this

solicitation, contact:

NYS Division of Service-Disabled Veterans’ Business Development

Corning Tower, 32

Floor, ESP

Albany, NY 12242

Phone: 1-518-474-2015

Email: [email protected]

For inquires related specifically to the insurance requirements of this solicitation, the designated contact is:

Peggy Beattie, Casualty Insurance Analyst I

New York State Office of General Service Bureau of Risk and Insurance Management

32nd Floor, Corning Tower Bldg., Empire State Plaza

Albany, New York 12242

Office: 1-518-457-4567

Email: [email protected]

1.3 Minimum Proposer Qualifications

Proposers are advised that the State's intent is to ensure that only qualified and reliable contractors enter into a

contract to perform the work as defined in this document.

The State considers the following qualifications to be a pre-requisite in order to be considered as a qualified

Proposer for purposes of this solicitation. Proposers not meeting the qualifications below will be disqualified.

Proposers may not use a subcontractor’s or any other entity’s qualifications to meet requirements.

The following minimum requirements must be met by each Proposer:

1. Proposers must be duly licensed by, and in good standing with, the New York State Department of Financial

Services.

2. Proposers must have at least five years’ experience in providing broker of record services for governmental

agencies.

3. Proposers must have at least five years’ experience in providing broker of record services for entities with

250 or more employees.

4. Proposers must have at least five years’ experience in placing insurance for each lot indicated in Section 2 –

Scope of Work, for which it is submitting a proposal.

1.4 Key Events

The Table below outlines the tentative schedule for important action dates.

Action

Date

OGS Issues RFP #2639 February 1, 2023

Mandatory Intent to Submit a Proposal Notification due to

OGS (refer to Section 1.5)

February 23, 2023

Proposers’ questions due to OGS including any exception

waiver request (see Section 5.9)

March 1, 2023

OGS Issues Responses to Questions (estimated)

March 10, 2023

Proposals Due to OGS (no later than)

March 28, 2023, 2:00PM

Contract Start Date (See Section 5.7)

October 1, 2023 with Knowledge

Transfer Period, December 24, 2023

without Knowledge Transfer Period.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

1.5 Mandatory Intent to Submit a Proposal

Vendors who wish to submit a proposal must register their Intent to Submit a Proposal with OGS by sending

notice to Seth Stark, via email to [email protected]

. Vendors must include their company name, address,

phone, contact name, title, and email address. Vendors must register no later than the date & time indicated in

Section 1.4 – Key Events. Only registered vendors will be allowed to submit proposals for this RFP. Also, only

registered vendors will receive updates or responses to questions regarding this RFP. By registering an Intent

to Submit a Proposal, the Vendor is not obligated to submit a proposal. Vendors assume sole responsibility for

ensuring that their Intent to Submit a Proposal is properly registered and on time. Late submissions will not be

accepted.

1.6 Glossary of Terms

“Agency Customer” Shall mean all NYS Agencies that make use of any BRIM service including NYS Agencies,

Public Benefit Corporations, State Authorities, CUNY (City University of New York).

“BOR” shall mean Insurance Broker of Record

“BRIM” shall mean OGS Bureau of Risk and Insurance Management

“Commissioner” shall mean the Commissioner of General Services or duly authorized representative.

“Contractor” shall mean a successful company(s) awarded a contract pursuant to this RFP.

“Issuing Office” shall mean the Office of General Services Agency Procurement Office.

“Offeror,” “Proposer,” or “Bidder” shall mean any person, partnership, firm, corporation or other authorized

entity submitting a proposal to the State pursuant to this RFP.

“OGS” shall mean Office of General Services

“Request for Proposal” or “RFP” shall mean this document.

The “State” shall mean The People of the State of New York, which shall also mean the New York State Office

of General Services.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

2. Scope of Work

2.1 Background

The State of New York is a very large and diverse governmental organization, comprised of many different

agencies performing a wide range of functions and operations, with an overall annual budget of approximately

$150 billion, and over 250,000 employees, serving over 19 million residents. The State currently self-retains for

its automobile exposure, with auto (BI & PD) claims below $25,000 administered by a third-party administrator.

Liability exposures of the State of New York as well as those of the State Agencies are also self-retained. Suits

for bodily injury and property damage are brought in the NY State Court of Claims, which is supported by a multi-

million-dollar annual appropriation. Employees are protected against suits under Public Officers Law Section 17

for actions or alleged actions that occur while they are acting within the scope of their employment.

To this point, insurance coverage has generally only been procured by the Broker of Record when required by

contract. Our current book of business includes over 125 policies, representing about $20 million in premiums.

Policies procured by the Broker of Record are placed with multiple insurance carriers and renew throughout the

year. The types of insurance policies include commercial general liability, ocean and inland marine, property,

fine arts, cyber, workers comp, automobile, boiler and machinery, employee dishonesty bonds, aviation, crime

insurance, and other insurance coverage types (please also see RFP 2639 Section 2.5 – Lots). These are all

procured for the State and its various agencies, authorities and public benefit corporations through BRIM.

2.2 Project Goals and Scope

The State is seeking qualified Insurance Broker(s) of Record to:

1. Review BRIM’s current insurance policies to assess sufficiency of insurance limits and adequacy of

coverage required to protect our Agency Customers from reasonable risks, providing the best balance of

minimizing risk and insurance premiums.

2. Renew the current insurance policies placed through BRIM.

3. Advise BRIM on the most effective way to meet requirements on any new insurance requirements and

place appropriate coverage upon BRIM’s approval.

4. Provide efficient and effective insurance program administration and service to the State agencies.

Administrative services will include but are not limited to policy placement, certificate of insurance

issuance, and claims reporting.

5. Consult with BRIM to understand the insurance needs as they relate to new policy requests made by

State agencies to meet their contractual obligations.

6. Collaborate with BRIM in review of insurance requirements for State contracts and making

recommendations upon request to ensure that the State is protected.

The selected Insurance Broker(s) of Record will work with the Director of BRIM and their insurance procurement

team in the areas outlined in Section 2.4– Summary of Required Services.

The selected Insurance Broker(s) of Record will be utilized for each lot (outlined in Section 2.5 – Lots) they are

awarded at the State’s discretion and direction, in regard to specific insurance programs and insurance

placements.

2.3 Project Administration and Reporting

As part of the Contractor’s performance, the following apply to all policies or tasks assigned to the Contractor

pursuant to any contract issued as a result of this RFP and shall be provided at no additional compensation:

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

1. Designated Representatives

The Contractor will carry out assigned tasks under the direction and control of BRIM. The Director of BRIM,

with the commencement of this contract, shall designate OGS representatives to oversee this contract

(Designated OGS Representative). The Contractor shall make available their proposed designated

Contractor representative(s). The Director of BRIM shall approve any proposed changes to Designated

Contractor Representative. Contractor should seek approval of any changes to Designated Contractor

Representative as early as feasible, but no later than two weeks prior to the proposed change. The

Designated OGS Representatives will request, oversee, supervise and accept performance of services

provided by the Contractor and shall receive any required submissions. Whenever an action is to be taken,

or approval for services is being sought from BRIM, such action or approval may be given only by the

Designated OGS Representatives. All notices under this contract shall be directed to the representatives

identified in this section, or their designees. BRIM may, by way of written notice, designate other individuals

as its representatives. At no time, will the Contractor communicate directly with anyone other than the

designated representative described in this section unless in conjunction with designated representative

2. Contract Kickoff Meeting

Awarded contractor(s) will be required to attend a “kickoff” meeting at a location determined by BRIM at

the commencement of this contract and any newly assigned project in order to become familiar with BRIM

processes. The “kickoff” meeting may be held virtually if agreed by all parties. BRIM will schedule these

meetings. The kickoff meeting shall include, but is not limited to:

a. Contract Administration.

b. An introduction for each respective organization, chain of command, etc.

c. The Contractor's submission of a schedule of work to be reviewed and approved by the Director

of BRIM.

3. Reoccurring Monthly Status Meetings

The Contractor and BRIM staff will have regular communication regarding policy placements and

renewals, but there shall also be at minimum, monthly meetings for the following purposes:

a. Review policy placement progress, including timeliness of deliverables, and approval.

b. Identify and resolve problems that impede approval and placement.

c. Discuss outstanding items and reasons for delay, if applicable.

d. Maintain a sound working relationship between the Contractor and BRIM, and a mutual

understanding of the contract.

e. Maintain practical and effective working procedures.

4. Annual State of the Market Meeting

Attend an annual meeting, either in person or virtually, to discuss marketplace projections for the lot(s)

awarded and how they are likely to affect our placements in the coming year. Please also see reporting

requirement below.

5. Reports

a. Upon request, contractor(s) shall provide BRIM with reports. At a minimum, monthly reports

shall include:

i. The number of policies placed.

ii. Identify which State agencies, Authorities or Public Benefit Corporations the policies were

placed for.

iii. The premium amount paid for policies or endorsements placed during that month.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

iv. Specify the types of policies placed.

v. Indicate renewed policies vs. newly placed coverage.

vi. List of endorsements requested that month as well as endorsements from prior months

that are still outstanding.

vii. Details of new claims that were reported that month.

viii. Any additional details as requested by BRIM.

b. Contractor(s) shall provide a quarterly report (white paper) on the current and projected state of

the market for the lot(s) awarded.

c. No later than 30 days prior to the expiration of the contract, OGS and the contractor will develop

a list of pending assignments on which the contractor will continue its efforts. This will include,

but not be limited to, the administration of policies that are midterm, servicing open claims,

providing loss runs and issuing certificates. The final determination of which assignments the

contractor is responsible for will be at the sole discretion of OGS.

All reports shall be sent electronically to BRIM via [email protected] with a Cc to individual OGS

staff as requested.

2.4 Summary of Required Services

The selected Insurance Broker(s) of Record shall provide, at a minimum, the following services when

requested by the State:

1. Act as broker for policies currently in force and review the insurance policies accordingly.

2. Identify and organize pertinent information in order to market and place insurance programs and

coverages in the most efficient and cost-effective manner

3. Make recommendations regarding carriers, coverage, limits, terms, conditions and exposures in

their proposals.

4. At BRIM’s direction, market and place renewal insurance policies in the most efficient and cost-

effective manner.

5. At BRIM’s direction, market and place new insurance policies and coverages in the most efficient

and cost-effective manner.

6. Prepare underwriting briefs and summary checklists, which will contribute to the State obtaining

the broadest and most cost-effective insurance program.

7. Determine the policies placed are correct in terms of coverage proposed by the carrier, and verify

accuracy of price, rating classification and exposure. All policy documents will be reviewed by

the Broker of Record for accuracy prior to sending to BRIM,

8. Ensure proper service from carriers in regard to the receipt of policies placed and endorsements

ordered; All bound policies and endorsements are to be reviewed and sent electronically to BRIM

within 120 days of the effective date. Any policies or endorsements that are not received by the

Broker of Record within the 120-day timeframe, due to the carrier’s delay, will be reviewed for

accuracy and sent to BRIM within ten business days of the Broker’s receipt.

9. Issue certificates of insurance on policies placed through BRIM in a timely manner and in

compliance with any service standards or measures developed by BRIM. All certificates are to

be received within 72 hours from the request.

10. Work with BRIM to report claims to carrier and advocate for the State on any disputed or problem

claims. Claims will be reported by BRIM to the BOR. Upon notification the BOR will be

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

responsible for forwarding the claim onto the carrier. Any notice of claim received from a source

other than BRIM will be forwarded to BRIM immediately for review.

11. Monitor claims submitted to ensure they are properly handled by the carrier and responded to

within 72 hours. Send confirmation to BRIM from the carriers on all claims including the claim

number and carrier representative’s contact information. If an incident results in more than one

claim, all claim numbers will be provided with an explanation on the separation of coverage.

12. Broker will continue servicing all claims reported by them until claim is closed.

13. Provide claims status updates quarterly, or as requested, on all open claims.

14. Provide loss runs as requested by BRIM; this shall include the claim number, date of loss,

claimant, description, status, amount reserved, paid or recovered and named insured (if more

than one State agency is insured under the policy, the claims should be identified by each

agency); this shall also include a review of the appropriateness of reserved amounts, by the

BOR.

15. Provide loss runs for up to five years on policies placed with your office, even if the current term

is under a different broker.

16. Provide disclosure of all compensation, including direct and contingent, on proposals received

including a copy of each insurance carrier’s submission.

17. Assure the timely billing of all policies and endorsements to BRIM and assist with premium

allocations or breakdowns by agency for internal BRIM billing purposes. Invoices shall be sent

to BRIM and OGS Accounts payable within five business days of binding coverage. Any delays

due to the carrier will be expedited once received by the Broker of Record and invoiced to BRIM

& OGS Accounts Payable within two business days.

18. In the event a Notice of Cancellation for nonpayment has been issued, or policy is at risk of

cancellation due to tight payment timeframe, work with the carrier to resolve the situation and if

needed, make payment on behalf of the State.

19. Advise BRIM as requested, or at least on a semiannual basis about the existing risk landscape

and current developments in the insurance area affecting coverages, forms, availability, pricing

or other significant developments that would impact the State or vendors/Contractors dealing

with the State.

20. Advise BRIM of any new or revised Insurance Services Office, Inc. (ISO) forms of language.

21. Extend available training to BRIM as relevant topics arise and as requested.

22. At contractor’s sole expense, attend meetings, as requested, with BRIM and other

representatives of the State and State Agencies, insurers, or consultants. Historically update

meetings for Lot 1 are held virtually on a biweekly basis. In addition to biweekly meetings, OGS

may request attendance in meetings with Agency Customers for larger/complex policies. Most

meetings will be held virtually, but there may be times in person attendance is requested. It is

anticipated that in person meetings would be in Albany or New York City. Historically there have

been limited meetings regarding Lots 2 through 6 and meetings have been virtual.

23. Provide BRIM with consultation on risk concerns to the State including contracts within awarded

lot.

24. Review requirements in State contracts to ensure the State is adequately covered for risks within

Contractor’s awarded lot.

2.5 Lots

This RFP includes six lots. The six lots are as follows:

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

1. Lot 1 – Standard Lines

2. Lot 2 – Cyber Liability

3. Lot 3 – Fine Arts

4. Lot 4 – Aviation

5. Lot 5 – Ocean Marine

6. Lot 6 – Employee Benefits

2.5.1 Standard Lines Requirements

The Lot 1 Contractor will be responsible for consultation on the risk landscape, contract insurance requirement

reviews, recommendations, and policy placements in the following categories:

Standard Line Type

Details

Property, Inland Marine, Crime

Property

Computers and Equipment

Historic Properties

Bridges and Tunnels

Railroad Protective

Inland Marine

Crime

Employee Dishonesty Bonds

Builders Risk/Installation

Boiler/Machinery

Flood

Casualty Insurance

General Liability

Recreational Liability

Environmental Liability

Foreign Legal Liability

Excess Liability

Liquor Liability

Special Events

Motor Vehicle

Directors and Officers

Professional Liability, including Medical Malpractice

Employment Practices Liability

Stop-Loss, Excess, Umbrella

Construction insurance policies and programs

Surety and Performance Bond

Appeal, Bid, Payment and Performance Bonds

2.5.2 Specialized Lines Requirements

Lots 2 through 6 Contractors will be responsible for the following specialized types of coverages to include policy

placement, implementation, contract insurance requirement reviews, and recommendations, and consultation

on the risks, of the following policy types:

• Cyber Liability (Lot 2)

• Fine Arts (Lot 3)

• Aviation (Lot 4)

• Ocean Marine (Lot 5)

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

• Employee Benefits (Lot 6)

2.5.3 Additional Contract Requirements

Contractors may be required to assist BRIM in the marketing and placement of non-traditional types of insurance

and/or risk financing program, in the event that the State determines to institute such program.

2.6 Marketing and Placement of Insurance Policies

The Contractor shall not make an insurance placement without:

a. Receiving direction from BRIM in regard to insurance placement prior to the start of any marketing

for a renewal or new policy need.

b. All policies will be marketed to no fewer than three carriers in order to show comparable options in

the market. Any exception to this requirement will need to be approved by BRIM prior to the start of

marketing.

c. Provide renewal quotes to BRIM as soon as available, but no later than five business days prior to

the policy effective date in order to allow time for Agency Customer review and approval.

d. Providing written explanation and comparison of the options, quotations, and reasons for each

insurance placement in advance to BRIM including the quote from the insurance carrier and a

recommendation for binding. Comparison should include details on the expiring policy and all options

for renewal.

e. A marketing summary of each carrier that was approached and their response will be included with

each proposal quote. At a minimum, Marketing summary should include list of carriers marketed to,

quotes received, and an explanation for any declinations to provide a quote.

f. Obtaining written approval to proceed with the quoted policy from BRIM.

2.7 Knowledge Transfer

If knowledge transfer is needed, awarded contractor will be required to start transitional services on October 1,

2023. Transitional services will include review of current policies and marketing of policies that will need to be

renewed within 90 days after December 24, 2023.

2.8 OSHA (Occupational Safety & Health Administration) Training Requirements

OGS Facility Manager’s Obligations:

Prior to beginning contract work/work assignment, the OGS Facility Manager or Designee shall inform or make

available the Contractor/Contractor’s representative(s) of the known specific hazard(s) and chemical(s) they may

encounter while performing their contract obligations. For example, testing of materials may be performed or

previous reports may be available to inform on the location of Asbestos Containing Materials, lead or other

environmental concerns if present, and any site-specific work practices that may be necessary to conduct work

safely and in compliance with federal or state standards and OGS procedures such as those involving

Lockout/Tagout and electrical procedures.

The Contractor/Contractor’s Representative(s) shall also be provided with information about the use and

provisions for Personal Protective Equipment required for the work. Contractor/Contractor’s Representative shall

provide a signed acknowledgement to the OGS Facility Manager or OGS Designee that they were provided with

this information.

Contractor / Contract Employee Obligations

General Contract Obligations:

These requirements only apply to on-site work at a State property.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Prior to or upon first reporting to the work location for assignment, the Contractor/Contractor employee(s) and

employees of Sub-Contractors must present to the OGS Facility Manager or OGS Designee proof of completion

of the OSHA required training for the following, topic areas including but not limited to:

1. Hazard Communication,

2. Personal Protective Equipment.

For environmental health and safety emergencies, an emergency contact must be provided for the facility

manager or designee to contact prior to any work commencing. Any changes to this contact, including name and

or contact information must be communicated to the OGS Designee immediately.

Specific Field-of-Work Requirements

In circumstances where specific OSHA or NYS Department of Labor regulated work is required, the

Contractor/Contract Employee(s) shall have all pertinent and up-to-date certifications beyond the “awareness”

level as required by regulations for the specific work. Onsite employee will be trained to do the work, supervised

by higher knowledge/training,

It is the Contractor’s responsibility to provide the OGS Facility Manager or OGS Designee with all employee

updates and/or renewals for the above general contract obligations and specific field of work requirements

specified training.

The Contractor must coordinate with OGS to be informed of the site’s Emergency Action Plan.

Note: Contractor’s/Contractor’s Employee(s) and employees of Sub-Contractors failure to provide such

documentation to the OGS Facility Manager or OGS Designee upon or prior to employee reporting to their initial

work assignment may result in OGS rejecting the employee(s) until that documentation is provided.

2.9 Conflict of Interest

By entering in any contract resulting from this RFP, Contractor, and any proposed subcontractor, shall attest that

its performance of the services outlined in this RFP does not, and will not, create a conflict of interest with, nor

cause the bidder to breach any other contract currently in force with the State of New York.

Furthermore, Proposers shall attest that they will not act in any manner that is detrimental to any State project

on which the Proposer is rendering services and that:

1. The fulfillment of obligations by the bidder, as proposed in the response, does not violate any existing

contracts or agreements between the bidder and the State.

2. The fulfillment of obligations by the bidder, as proposed in the response, does not or will not create any

conflict of interest, or perception thereof, with any current role or responsibility the bidder has with regard

to any existing contracts or agreements between the bidder and the State.

3. The fulfillment of obligations by the bidder, as proposed in the response, does not and will not

compromise the bidder’s ability to carry out its obligations under any existing contracts between the

bidder and the State.

4. The fulfillment of any other contractual obligations that the bidder has with the State will not affect or

influence its ability to perform under any contract with the State resulting from this RFP.

5. During the negotiation and execution of any contract resulting from this RFP, the bidder will not

knowingly take any action or make any decision which creates a potential for conflict of interest or might

cause a detrimental impact to the State as a whole, including but not limited to, any action or decision

to divert resources from one State project to another: and,

6. In fulfilling obligations under each of its State contracts, including any contract which results from this

RFP, the bidder will act in accordance with the terms of each of its State contracts and will not knowingly

take any action or make any decision which might cause a detrimental impact to the State as whole

including, but not limited to, any action or decision to divert resources from one State project to another.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

2.10 Warranties

Contractor warrants that the services acquired under this Contract will be provided in a professional and

workmanlike manner in accordance with industry standards.

All materials and workmanship provided under this contract shall be warranted for a minimum of one year. Where

Contractor, Product manufacturer or service provider generally offers additional or more advantageous

warranties, such additional or more advantageous warranty shall apply. All warranties contained in this Contract

shall survive the termination of this Contract.

2.11 Contractors Compensatory Liability

In the event that the contractor fails to complete any of the specified services within the timeframe required, OGS

reserves the right to have such work completed either by another contractor or with in-house staff. In any such

event, the contractor shall be liable to reimburse OGS for all costs incurred to complete the work. OGS further

reserves the right to collect such reimbursement from any outstanding payments due to the contractor.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

3. PROPOSAL SUBMISSION

3.1 RFP Questions and Clarifications

There will be an opportunity for submission of questions and/or requests for clarification. Questions and/or

clarifications must be submitted via email to the Designated Contact:

Seth Stark

Contract Management Specialist II

NYS Office of General Services│Financial Administration│Agency Procurement Office

32nd Floor, Corning Tower Building, Empire State Plaza, Albany, NY 12242

518-486-2823│ [email protected]

www.ogs.ny.gov

All questions must cite the particular page, section, and paragraph number, where applicable. Please submit

questions as early as possible following receipt of the RFP. The final deadline for submission of any

questions/clarifications regarding this RFP is listed in Section 1.4– Key Events. Questions received after the

deadline may not be answered. OGS will post an addendum at

https://ogs.ny.gov/procurement/bid-

opportunities with all questions and responses on or about the date listed in Section 1.4– Key Events. Any

additional addenda will be posted to the same location.

3.2 Proposal Format and Content

In order for the State to evaluate bids fairly and completely, Proposers should follow the format set forth herein

and should provide all of the information requested in the same order as listed below. All items identified in the

following list should be addressed as concisely as possible in order for a bid to be considered complete. Failure

to conform to the stated requirements may necessitate rejection of the bid.

Proposers are encouraged to include all information that may be deemed pertinent to their proposal. Proposers

may be requested to provide clarification based on the State’s evaluation procedure. Any clarification will be

considered a formal part of the Proposer’s original proposal. If further clarification is needed during the evaluation

period, OGS will contact the Proposer.

Note: OGS reserves the right to request any additional information deemed necessary to ensure that the

Proposer is able to fulfill the requirements of the contract.

3.2.1 Cover Letter

The cover letter must confirm that the Proposer understands all the terms and conditions contained in this RFP

and will comply with all the provisions of this RFP. Further, should the contract be awarded to your company,

you would be prepared to begin services on the date indicated in Section 1.4. – Key Events. The cover letter

should contain a summary of the key aspects of the proposing company and highlight the distinguishing

characteristics of the proposal, as well as identify the lot(s) of coverage being proposed. The cover letter should

also include the full contact information of the proposer’s representative that OGS shall contact regarding the

bid. A bidder representative authorized to make contractual obligations must sign the cover letter.

3.2.2 Minimum Qualifications

Bidders must submit proof that they meet the minimum qualifications set forth in Section 1.3 - Minimum Proposer

Qualifications. Proposers should include the following evidence for each of the Minimum Proposer

Qualifications:

1. Proposers must be duly licensed by, and in good standing with, the New York State Department of Financial

Services: Please submit a copy of valid NYS license(s), as required by law, for any lot that you are submitting

a proposal for.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

2. Proposers must have at least five years’ experience in providing broker of record services for governmental

agencies. Please provide name of governmental agency, contract number(s) and term(s) (if applicable), and

at least one reference that may verify information being submitted.

3. Proposers must have at least five years’ experience in providing broker of record services for entities with

250 or more employees. Please provide name(s) of entities, length of time spent as BOR for the entity, types

of policies and annual value of policies brokered. Please also provide at least one reference that may verify

information being submitted.

4. Proposers must have at least five years’ experience in placing insurance for lines or coverages/exposures

indicated in Section 2 – Scope of Work, for which it is submitting a proposal. Information may overlap with

that submitted for Minimum Proposer Qualification #2. If policies were placed for a different entity, please

provide name(s) of entities, length of time spent as BOR for the agency, types of policies and annual number

and value of policies brokered. Please also provide at least one reference that may verify information being

submitted.

3.2.3 Technical Proposal

The purpose of the technical proposal is to provide bidders with an opportunity to demonstrate their qualifications,

competence and capacity to undertake the services described herein, in a manner which complies with the

requirements of this RFP. The technical proposal shall specifically detail the bidder’s qualifications and

experience in providing the services described herein.

The technical proposal shall include:

3.2.3.1 Proposer Experience and Qualifications

Provide a description of the proposing firm including:

1. General

a. History

b. Number of years the organization has been in business

c. Type of Services

d. Number of employees

e. An organization chart for the organization

f. Number of offices

g. Code of conduct and/or ethics protocols/program

2. Attributes

a. Is proposer’s firm publicly traded or privately held

b. State of Domicile

c. Controlling Person or Parent Company

d. Subsidiaries or Affiliates and description of function

e. Description of any primary and secondary businesses performed by the Proposer

3. Brokerage

a. Approximate total annual written premiums for Proposer’s firm in 2022 including P&C, Bonds,

Cyber, Flood, Fine Arts, Aviation, Ocean Marine, and Employee Benefits.

b. Indicate the P&C insurance companies with whom you write the largest total annual premiums

including the approximate value of those premiums and number insured.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

4. Summary

a. Describe, for each lot proposing, the capabilities of the proposing firm and the individuals that will

be assigned to the contract in providing the services requested herein. Proposers must identify

the specific professionals and their credentials who will work on State matters related to the

contract, if their company is selected as an Insurance Broker of Record for the State.

b. Describe, for each lot proposing, all prior relevant experience during the last five years.

Descriptions shall include project descriptions that have similar scope and complexity, examples

of work done for those clients and the results achieved by the client, including start and completion

dates.

c. Based on your experience with State agencies and other government entity’s risks and your

limited knowledge of OGS BRIM’s portfolio, what would you consider the top three strategic

challenges, in terms of insurance placement, that our organization is likely to face in the next three

to five years, and how can you help us surmount them?

5. Staff Experience

a. For each lot proposing, resumes for each of the staff members that will be assigned to this

contract, indicating which lot/line of coverage they will be assigned to. Resumes should include

a detailed description of all applicable qualifications and relevant work experience; and

i. Information regarding the main contact person, including:

1. Length of career in providing broker services.

2. Professional designations.

ii. Discussion of successful completion of similar projects; and

iii. Description of prior experience with the insurance portfolios of government entities.

3.2.3.2 Staffing and Management Plan

If proposing on multiple lots, Proposers should either submit a separate Staffing and Management Plans for each

lot or note how Staffing and Management Plans changes for each Lot proposing on. Proposers should include

the following in their Staffing and Management Plan:

1. Information regarding whether subcontractors will be used. If subcontractors will be used, list all

subcontractors including firm name and address, contact person, complete description of work to be

subcontracted. Include descriptive information regarding the subcontractor’s organization and

abilities and a statement from the subcontractors that they are capable and willing to carry out the

work.

2. A description of the staff that would be assigned to provide service described herein, including detail

of each person’s role.

3. A statement designed to confirm that the Proposer understands:

a. The objectives any contract resulting from this RFP is intended to achieve; and

b. The nature of the work and level of effort required to successfully provide the services required

by such contract.

4. A planned approach for the implementation and continuation of ongoing services as well as

confirmation that they are capable of fulfilling the goals and performing the scope of work set forth in

this RFP while providing the best value to the State and BRIM, Including:

a. A summary of the services that will be delivered. Include any recommended additional strategies

that could result in significant increases in cost savings.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

b. A plan for accomplishing the services that will be delivered. The plan shall include a detailed

narrative description of how the bidder would provide all the insurance brokerage services

required by OGS BRIM, in Section 2.4 Summary of Required Services.

c. Briefly describe your practical approach to providing placement and support services for our

program, including the following subject matters:

i. Risk identification and evaluation

ii. Contract insurance requirements analysis

iii. Providing and/or facilitating risk control services

iv. Informing us of current and expected insurance market conditions and industry

developments

v. Assisting in the preparation of insurance budgets and cost allocation mechanisms

vi. Managing the insurance renewal process

vii. Securing insurance coverage

viii. Preparing policy summaries and schedules of insurance

ix. Reviewing insurance policies

x. Preparing and issuing certificates of insurance as required

xi. Reporting and managing claims

xii. Providing loss information

xiii. Providing a quarterly state of the market report

d. OGS BRIM values innovative thinking that enhances operational and financial performance.

Although this RFP has been formatted to gather a wide range of information, there may be other

issues and opportunities that you wish to identify as being particularly important and relevant for

our benefit. We encourage you to identify such issues and opportunities, the potential impact that

would have upon our organization, and how you would work with them.

5. Information regarding reporting, administration, and marketing policies including but not limited to:

a. Sample reports that will be available to BRIM (please see RFP 2639 Section 2.3 Project

Administration and Reporting, fourth bullet.

b. A description of sophisticated, complex, and innovative insurance program(s) proposer has put

in place.

c. A description of non-traditional types of insurance and/or risk financing program(s) proposer has

put in place.

3.2.3.3 References

The Proposer shall provide a minimum of three references of similar scope which best represents their abilities

to satisfy the requirements of this RFP. References from current clients (those with which the Proposer has an

existing contractual relationship) are preferred. References should include a brief narrative description of the

project and discuss the scope of the services provided to the client. A minimum of three references shall also

be provided for any subcontractors listed as part of the bidder’s proposal.

1. References must be able to document:

a. The Proposer’s ability to manage large scale projects.

b. The quality and scope of services provided by the Proposer.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

i. Experience providing Insurance Broker of Record services for government

agencies.

ii. Experience providing Insurance Broker of Record services for large entities.

iii. Experience in dealing with major property/casualty insurance and reinsurance

companies.

iv. Experience in dealing with the specific lines of insurance being bid on as listed in

RFP 2639 Section 2.5 Lots.

v. Experience developing and implementing alternative risk financing programs (for

Lot 1).

vi. Use of technological resources to support Insurance Broker of Record services

that would assist the State and BRIM.

2. Provide the following information for each reference:

a. Name of the client.

b. Name, title and telephone number for the person at the client to be contacted.

c. Value, type and duration of contract with the client.

d. Services provided, including geographic area involved; a description of how the bidder

satisfied the client’s requirements and improvements made to the client’s systems as a

result of the bidder’s efforts; and

e. If applicable, an explanation of why the bidder is no longer providing services to the client.

The inability to contact a reference provided by the Proposer will be considered as part of the evaluation

process.

3.2.4 Administrative Proposal

1. All required completed forms from RFP Appendix B

2. Attachment 1 - Proposal Submission Checklist

3. Signed bid addenda (if any)

Important Notes:

1. Insurance – Proposers are reminded of the insurance requirements as described in RFP

Appendix D. The selected Proposer will be required to provide all necessary documentation

upon notification of selection.

2. M/WBE & EEO Requirements- Proposers are reminded of the requirements as described in

Appendix E.

3. SDVOB Requirements- Proposers are reminded of the requirements as described in Section

6.17.

4. Vendor Responsibility - Proposers are reminded of the requirement as described in Section

6.13 - NYS Vendor Responsibility Questionnaire and are requested to complete the online

questionnaire located on the Office of the State Comptroller’s (OSC) VendRep System

website prior to bid submission. If the vendor has previously certified responsibility online, it

shall ensure that the VRQ was recertified in the last six months.

5. Document Consistency - An award will only be made to the entity which has submitted the

proposal. All submitted documents must be consistent with official name of proposing entity,

FEIN and NYS Vendor ID number.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

3.3 Proposal Preparation

All proposals must be machine produced and signed in ink. Responses shall be listed in the same order as

requested in this RFP by Section 3.2– Proposal Format and Content.

3.4 Packaging of RFP Response

The Technical and Administrative proposals (see Section 3.2) should be separated and identified within

the submission package as follows:

1. Technical Proposal – One original and three exact copies. No overt statements about cost shall be

included in the Technical Proposal.

2. Administrative Proposal - One original of all required completed forms and information as stated in

Section 3.2.4.

Please provide one digital record (Thumb Drive) containing Technical, Administrative, and Cost

proposals. If there are any differences between the paper submission and the electronic submission, the paper

submission shall take precedence.

Originals contain a unique wet signature for each of the signed and notarized pages. Exact copies can be

photocopied and do not require a unique wet signature.

All proposal documents must be submitted by mail, hand delivery, overnight carrier or certified mail in a package

showing the following information on the outside:

• Proposer 's complete name and address

• Solicitation Number – 2639

• Proposal Due Date and Time: (as stated in Section 1.4 - Key Events)

• Proposal for Broker of Record

Failure to complete all information on the proposal envelope and / or packages may necessitate the

premature opening of the proposal and may compromise the submission of the proposal.

3.5 Instructions for Bid Submission

Note that these instructions supersede the generic instructions posted on the OGS website bid calendar.

Only those Proposers who furnish all required information and meet the mandatory requirements will be

considered.

Submit all required proposal documents including signed bid addenda if any, to the NYS Office of General

Services - Division of Financial Administration at the following address:

NYS Office of General Services

Financial Administration, Agency Procurement Office

32nd Floor, Corning Tower Building, Empire State Plaza

Albany, NY 12242

Attn: Seth Stark

RFP #2639

E-MAIL OR FAX BID SUBMISSIONS ARE NOT ACCEPTABLE AND WILL NOT BE CONSIDERED.

The State of New York will not be held liable for any cost incurred by the Proposer for work performed in the

preparation and production of a bid or for any work performed prior to the formal execution and approval of a

contract.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Bids must be received in the above office on or before 2:00 PM on the date indicated in Section 1.4 - Key Events.

Proposers assume all risks for timely, properly submitted deliveries. Proposers mailing their bid must allow

sufficient mail delivery time to ensure receipt of their bid at the specified location no later than the specified date

and time.

The received time of bids will be determined by the clock at the above noted location.

Any Bid received at the designated location after the established time will be considered a Late Bid. A

Late Bid may be rejected and disqualified from award. Notwithstanding the foregoing, a Late Bid may be

accepted in the Commissioner’s sole discretion where (i) no timely Bids meeting the requirements of the

Solicitation are received, or (ii) the Bidder has demonstrated to the satisfaction of the Commissioner

that the Late Bid was caused solely by factors outside the control of the Bidder. However, in no event

will the Commissioner be under any obligation to accept a Late Bid.

The basis for any determination to accept a Late Bid shall be documented in the procurement record.

Bids must remain open and valid for 180 days from the due date, unless the time for awarding the contract is

extended by mutual consent of NYS OGS and the Proposer. A bid shall continue to remain an effective offer,

firm and irrevocable, subsequent to such 180-day period until either tentative award of the contract(s) by issuing

Office is made or withdrawal of the bid in writing by Proposer. Tentative award of the contract(s) shall consist of

written notice to that effect by the issuing Office to the successful Proposer. This RFP remains the property of

the State at all times, and all responses to this RFP, once delivered, become the property of the State.

Important Building Access Procedures for Delivered Bids:

Building Access procedures are in effect at the Corning Tower. Photo identification is required. All visitors must

designated contact at 518-486-2823 at least 24 hours prior to arrival. Pre-registered visitors are to report to

the visitor desk located at the Concourse level of the Corning Tower. Upon presentation of appropriate photo

identification, the visitor will be allowed access to the building.

Upon arrival at the visitor desk, visitors that have not pre-registered will be directed to a designated phone to call

the OGS Finance Office. The Finance Office will then enter the visitor’s information into the building access

system. Access will not be allowed until the system has been updated. Visitors are encouraged to pre-register

to ensure timely access to the building. Vendors who intend to deliver bids or conduct business with OGS should

allow extra time to comply with these procedures. These procedures may change or be modified at any time.

Visitor parking information can be viewed at the following OGS web site: https://empirestateplaza.ny.gov/parking

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

4. Evaluation and Selection Process

4.1 Proposal Evaluation

Proposals will be evaluated for best value to the State. A team of OGS employees will evaluate each proposal

and initially determine whether a proposal is responsive to the requirements of the Solicitation and if proposer

meets the minimum qualifications to propose. Responsive proposals will be evaluated and scored based upon

the criteria set forth in this Section.

Proposals determined responsive will be evaluated using a 1000 Point Scale. Percentages listed in categories

A through D in RFP 2639 Section 4.1.1 – Evaluation Categories will determine how many points a proposal is

given for each Evaluation Category. For example, Category A –Experience and Proposer Qualifications is worth

45% of total available point or 450 Points.

Responsive Technical Proposals will be sent to a Technical Evaluation Team (TET). The TET will be responsible

for evaluating Evaluation Categories A, B, and C as described in RFP 2639 Section 4.1.1 – Evaluation

Categories. Each TET member will score proposals on a 1 to 10 scale. TET Member’s scores are referred to as

Individual Scores. The average of Individual Scores will be used to determine the percentage of possible points

a proposal will receive. For example, if the average Individual Score for Evaluation Category A is 7, then that

proposal would receive 315 points for Evaluation Category A (1000 total points x 45% (weight of A) = 450

possible points x 70% (Average Individual Score) = 315 awarded points).

For Item D, proposers will receive 5% (or 50 points) of possible evaluation points if proper certification declaring

MWBE, SDVOB, and/or Small Business criteria is met.

OGS also reserves the right to conduct reference checks. In such cases, the Proposer shall be responsible for

the availability of the reference contacts.

4.1.1 Evaluation Categories

A. Proposer’s Experience and Qualifications - 450 points

Each Proposer will be evaluated as to its qualifications, pursuant to this RFP, demonstrating its ability to

provide and perform the services sought by the RFP. This shall include an evaluation of project

descriptions that have similar scope, examples of work done for clients, and the credentials of specific

professionals, a summary of Proposer’s expertise including staff dedicated to the contract, and prior

relevant experience during the last five years. References shall also be considered.

B. Staffing / Management Plan - 400 points

Each Proposal will be evaluated for the completeness of, and the extent to which, the proposing firm’s

organizational information and management plan, including professional staff and experience, meet the

goals and requirements of this RFP.

C. Quality and Completeness of Proposal - 100 points

Each Proposal will be evaluated for the level of thoughtfulness it demonstrates in satisfying and

addressing the RFP goals and requirements. Consideration also will be given to the overall organization

of, and ease of navigation of the submitted proposal.

D. MWBE, SBE, or SDVOB status - 50 points

• The Proposer is a New York State Certified Minority-Owned Business or

• The Proposer is a New York State Certified Women-Owned Business or

• The Proposer is a Small Business as defined in Executive Law Section 310(20) or

• The proposer is a New York State Certified Service-Disabled Veteran-Owned Business as defined

in Executive Law Section 369–h (1)

Note: Although, a Proposer may meet more than one of the criteria, credit is to be awarded for only one

category, not multiple categories. Proposer will either receive full credit or no credit for this category.

A technical evaluation committee will evaluate and score each responsive proposal for items A - C listed above.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Scores from each of the Proposers, including items A – D listed above, will be totaled and the Proposer having

the highest score will be ranked number one; the Proposer with the second highest total score will be ranked

number two and so on.

4.2 Notification of Award

After evaluation of all proposals, all bidders will be notified of the name of the selected Proposer(s). The selected

Proposer(s) will be notified that their proposal has been selected and that a contract will be forthcoming for

execution. The original submitted bid and any additions or deletions to the same become part of the contract.

Public announcements or news releases pertaining to any contract resulting from this RFP shall not be made

without prior approval from OGS.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

5. Administrative Information

5.1 Issuing Office

This RFP is being released by the New York State Office of General Services Division of Financial Administration

on behalf OGS Bureau of Risk and Insurance Management.

5.2 Method of Award

There are six different Lots which proposers may submit a proposal for. One award will be made for each lot.

The lots are 1) Standard Lines, 2) Cyber Liability, 3) Fine Arts, 4) Aviation, 5) Ocean Marine, and 6) Employee

Benefits. Proposers may submit proposals for one or more of the lots. Award(s) shall be made to the responsive

and responsible Proposer(s) who offer the best value based on the evaluation criteria as set forth in Section 4.1

Proposal Evaluation.

Upon determination of the proposer(s) affording the best value to the State, (a) contract(s) between OGS and

the successful Proposer(s) for signature and shall be returned to the issuing office for all necessary State

approvals. Upon final approval, a completely executed contract will be delivered to the Contractor.

A discount for early payment does not affect bid amounts nor is it considered in making awards, except that a

discount may be considered in resolving tie bids.

5.3 Notification of Award

After the evaluation, all Proposers will be notified of the name of the selected Proposer. The selected Proposer

will be notified that their submitted proposal has been selected and that a contract will be forthcoming for

execution. The original proposal, and any additions or deletions to the proposal become part of the contract.

Public announcements or news releases pertaining to any contract resulting from this solicitation shall not be

made without prior approval from the Issuing Office.

5.4 Price

There are no evaluation points being awarded based on costs or commissions for insurance policies. An

Insurance Broker of Record selected pursuant to this RFP will not receive fees or other compensation from the

State or any State Agency for its services relating to insurance placements on behalf of the State or any State

agency. Compensation to a selected Insurance Broker of Record for such services should come from

commissions or other types of payments, including prospective or potential payments, from insurance carriers

as a result of insurance placements on behalf of the State or Agency Customer.

5.5 Method of Payment

5.5.1 Payment Procedures

For the purposes of this contract an invoice must be used. Invoices for payment shall be submitted on a company

invoice as policies are placed and/or services are satisfactorily completed. Each invoice must have a unique

invoice number and contain sufficient data including, but not limited to the Contract ID number (i.e.: OGS01-

C000XXX-1140000), PO number, PO line description, routing number, recipient name, invoice date, named

insured (State Agency/Authority), policy period, effective date of policy, description of coverage, insurance

carrier, policy number, type of placement and transaction amount.

Invoices shall be submitted to the OGS Business Services Center (BSC) Accounts Payable Unit the address

shown below with a Cc to [email protected]

and all appropriate staff. Invoices will be reviewed for

accuracy by BRIM and then processed in accordance with established procedures of the Office of General

Services and the Office of the State Comptroller (OSC) and payments will be subject to the prompt payment

provisions of Article XI-A of the New York State Finance Law.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Invoices without the above stated information will be returned to Contractor to be completed as required above.

Payment will not be issued and will not be due and owing until a corrected invoice is received and approved by

BRIM.

All invoices must be submitted for payment to either:

BSC / Accounts Payable

1220 Washington Ave., Bldg. 5, 5

Fl -Or- Account[email protected]

Albany, New York 12226

With a Cc to ogs.sm.brim@ogs.ny.gov.

5.5.2 Payment Methodology

Payment will be made as follows:

1. Commission Basis: An Insurance Broker of Record selected pursuant to this RFP will not directly receive

fees or other compensation from the State or any Agency Customer for its services relating to insurance

placements on behalf of the State or any Agency Customer. Any invoices including these fees will be

rejected and returned to the contractor for correction.

Therefore, compensation to a selected Insurance

Broker of Record for such services shall come from commissions or other types of payments, including

prospective or potential payments, from insurance carriers as a result of insurance placed on behalf of

the State or Agency Customer.

• Specifically, payment to the Contractor is made via the insurance premium. The insurance

company providing the coverage charges a premium for that coverage. A percentage

commission (based on prevailing market rates) of the premium charged is paid to the Contractor

by the insurance company. The State will compensate the Contractor for the full amount of the

insurance premium for each policy, as verified by appropriate documentation from the insurance

company, including the insurance policy and endorsements. The Contractor makes payment to

the insurance company, net of its commission.

• The Contractor agrees that from the effective date of the contract until contract termination, the

commissions received by the Contractor on behalf of NYS OGS will be equal to or lower than

any commissions received by the Contractor from other customers for like services.

5.6 Electronic Payments

Contractor shall provide complete and accurate billing invoices in order to receive payment. Billing invoices

submitted must contain all information and supporting documentation required by the contract, the agency, and

the State Comptroller. Payment for invoices submitted by the Contractor shall only be rendered electronically

unless payment by paper check is expressly authorized by the Commissioner, in the Commissioner’s sole

discretion, due to extenuating circumstances. Such electronic payment shall be made in accordance with

ordinary State procedures and practices. The Contractor shall comply with the State Comptroller’s procedures

to authorize electronic payments. Information is available at the following website:

http://www.sfs.ny.gov/index.php/vendors , by e-mail at [email protected]

, or by phone at 518-457-7717.

Contractor acknowledges that it will not receive payment on any invoices submitted under this Contract if it does

not comply with the State Comptroller’s electronic payment procedures, except where the Commissioner has

expressly authorized payment by paper check as set forth above.

Please note that in conjunction with New York State’s implementation of a new Statewide financial system, the

Office of the State Comptroller requires all vendors doing business with New York State agencies to complete a

substitute W-9 form. Vendors registering for electronic payment can complete the W-9 form when they register.

Vendors already registered for electronic payment are requested to go to the above website and complete the

Substitute W-9 form and submit following the instructions provided.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

5.7 Term of Contract

The contractor is responsible for completing all work assigned to them, or related to policies placed by them,

prior to the termination of the contract, even if that requires the contractor to continue work after the end of the

contract term.

The term of this contract will be five years plus any knowledge transfer period. Whether or not there will be a

knowledge transfer period allows for two possible scenarios.

5.7.1 No Knowledge Transfer Term

Shall be in effect if incumbent contractor is awarded this contract. The “No Knowledge Transfer” term would be

12/24/2023 through 12/23/2028.

5.7.2 Knowledge Transfer Term

Shall be in effect if contractor awarded this contract is a vendor other than incumbent. The “Knowledge Transfer”

term would be 10/01/2023 through 12/23/2028, with the knowledge transfer period being 10/01/2023 through

12/23/2023.

5.8 Past Practice

The failure to exercise any right hereunder in the past shall not operate as a waiver of such right. No breach of

this Agreement shall be deemed waived unless such waiver shall be in writing and signed by the party claimed

to have waived said right. No waiver of any breach of the Agreement at any time in the past shall constitute a

waiver of subsequent breach.

5.9 Exceptions and Extraneous Terms

The Issuing Office will consider all requests to waive any solicitation requirement. The term “solicitation

requirement” as used herein shall include any and all terms and conditions included in the solicitation documents.

Bidders should be aware that failure to obtain a waiver of any proposal requirement in advance of bid submission,

and/or inclusion of extraneous terms in the form of exceptions, assumptions, qualifiers, ranges, modifications,

etc. with bid submission, may result in rejection of Bidder’s proposal and disqualification from the bidding

process.

Bidders wishing to obtain an exemption or waiver for any part of this solicitation must contact the Issuing Office

in writing by the questions due date as identified in the Key Events section. The request must cite the specific

section and requirement in question, and clearly identify any proposed alternative. Requests will be considered

and responded to in writing, either with the answers to questions as identified in the Key Events section (if the

response results in a change to the solicitation), or directly to the requesting vendor.

5.10 Dispute Resolution

It is the policy of the Office of General Services’ Financial Administration to provide vendors with an opportunity

to administratively resolve disputes, complaints or inquiries related to proposal solicitations, contract awards,

and contract administration. OGS Financial Administration encourages vendors to seek resolution of disputes

informally, through consultation with OGS Financial Administration staff, prior to commencing a formal dispute

process. All such matters will be accorded full, impartial and timely consideration. A copy of the OGS Financial

Administration Dispute Resolution Procedures for Vendors may be obtained by contacting the designated

contact person identified in the solicitation.

During the term of the contract, if either party notifies the other of a dispute or dissatisfaction, the other party will

make a good faith effort to solve or settle dispute amicably, including meeting with the other party to diligently

attempt to reach a satisfactory result. In the event of a dispute, the parties will continue to fulfill their obligations

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

hereunder during the dispute resolution process. The parties agree to proceed in good faith to avoid disputes

and resolve disputes that cannot be avoided at the lowest level possible. If party representatives are unable to

resolve the dispute or reach a satisfactory result within twenty days of written notice of a dispute, the dispute will

be referred to successive higher levels of each organization for final decision.

5.11 Examination of Contract Documents

1. Each Proposer is under an affirmative duty to inform itself by personal examination of the

specifications of the proposed work and by such other means as it may select, of the character,

quality and extent of the work to be performed and the conditions under which the contract is to be

executed.

2. Each Proposer shall examine specifications and all other data or instruction pertaining to the work.

No pleas of ignorance of conditions that may be encountered or of any other matter concerning the

work to be performed in the execution of the contract will be accepted by the State as an excuse for

any failure or omission on the part of the Proposer to fulfill every detail of all the requirements of the

documents governing the work. The Proposer, if awarded the contract, will not be allowed any extra

compensation by reason of any matter or thing concerning which such proposer might have fully

informed itself prior to bidding.

3. Any Proposer in doubt as to the true meaning of any part of the specification or the proposed contract

documents shall submit to Seth Stark, Division of Financial Administration, 32nd Floor, Corning

Tower Building, Empire State Plaza, Albany, New York 12242 e-mail: [email protected]

written request for an interpretation thereof. If a major change is involved to which all proposers must

be informed, such request for interpretation shall be delivered, in writing, no later than the question

due date listed in Section

1.4 – Key Events. Any interpretation of the proposed documents will be

made only by an addendum duly issued. A copy of such addendum will be e-mailed to proposers

who have registered Intent to Submit a Proposal.

4. Any addendum issued prior to the proposal due date must be acknowledged by signature, dated

and be submitted as part of the Administrative Proposal. In awarding a contract, any addenda will

become a part thereof.

5. Any verbal information obtained from, or statements made by, representatives of the Commissioner

of General Services at the time of examination of the documents, pre-bid conference, or site visit

shall not be construed as in any way amending contract documents. Only such corrections or

addenda as are issued, in writing, to all Proposers shall become a part of the contract.

5.12 Rules of Construction

Words of the masculine and feminine genders shall be deemed and construed to include the neuter gender.

Unless the context otherwise indicates, the singular number shall include the plural number and vice versa, and

words importing persons shall include corporations and associations, including public bodies, as well as natural

persons. The terms “hereby,” “hereof,” “hereto,” “herein,” “hereunder,” and any similar terms, as used in this

RFP, refer to this RFP.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

6. CONTRACT CLAUSES AND REQUIREMENTS

6.1 Appendix A / Order of Precedence

Appendix A — Standard Clauses for New York State Contracts, dated October 2019 attached hereto, is hereby

expressly made a part of this solicitation document as fully as if set forth at length herein. The agreement

resulting from a successful award will include the following documents. Conflicts between these documents will

be resolved in the following descending order of precedence:

1. Appendix A (dated October 2019)

2. Contract Agreement

3. OGS RFP Number 2639 (This Document) Including any Addenda

4. Selected Contractor’s Bid

6.2 Summary of Policy and Prohibitions on Procurement Lobbying

Pursuant to State Finance Law §139-j and §139-k, this Solicitation includes and imposes certain restrictions on

communications between OGS and a Vendor during the procurement process. A Vendor is restricted from

making contacts from the earliest posting, on a governmental entity’s website, in a newspaper of general

circulation, or in the procurement opportunities newsletter of intent to solicit offers/bids through final award and

approval of the Procurement Contract by OGS and, if applicable, the Office of the State Comptroller (“Restricted

Period”) to other than designated staff unless it is a contact that is included among certain statutory exceptions

set forth in State Finance Law §139-j(3)(a). Designated staff, as of the date hereof, is identified on the first page

and in Section 1.2. OGS employees are also required to obtain certain information when contacted during the

restricted period and make a determination of the responsibility of the Vendor pursuant to these two statutes.

Certain findings of non-responsibility can result in rejection for contract award and in the event of two findings

within a four-year period; the Vendor is debarred from obtaining governmental Procurement Contracts. Further

information about these requirements can be found on the OGS website: http://www.ogs.ny.gov/acpl/

6.3 Confidentiality

Contractor agrees to keep confidential and not to disclose to third parties any information provided by the OGS

or learned by the Contractor during the performance of the Contract unless Contractor has received the prior

written consent of the OGS to make such disclosure. This provision shall survive the expiration and termination

of this Contract. The Contractor warrants that all of its operations are compliant with all federal, state and local

laws, rules and regulations pertain to the privacy and/or security of personal and confidential information.

6.4 Ethics Compliance

All proposers/contractors and their employees must comply with the requirements of §§73 and 74 of the Public

Officers Law, other state codes, rules, regulations, and executive orders establishing ethical standards for the

conduct of business with New York State. In signing any contract resulting from this RFP, the Contractor certifies

full compliance with those provisions for any present or future dealings, transactions, sales, contracts, services,

offers, relations, etc., involving New York State and/or its employees. Failure to comply with those provisions

may result in disqualification from the bidding process, termination of contract, and/or other civil or criminal

proceedings as required by law.

6.5 Tax and Finance Clause

TAX LAW § 5-A:

Section 5-a of the Tax Law, as amended, effective April 26, 2006, requires certain contractors awarded state

contracts for commodities, services and technology valued at more than $100,000 to certify to the Department

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

of Taxation and Finance (DTF) that they are registered to collect New York State and local sales and

compensating use taxes. The law applies to contracts where the total amount of such contractors’ sales

delivered into New York State are in excess of $300,000 for the four quarterly periods immediately preceding

the quarterly period in which the certification is made, and with respect to any affiliates and subcontractors whose

sales delivered into New York State exceeded $300,000 for the four quarterly periods immediately preceding the

quarterly period in which the certification is made.

This law imposes upon certain contractors the obligation to certify whether or not the contractor, its affiliates, and

its subcontractors are required to register to collect state sales and compensating use tax and contractors must

certify to DTF that each affiliate and subcontractor exceeding such sales threshold is registered with DTF to

collect New York State and local sales and compensating use taxes. The law prohibits the State Comptroller, or

other approving agency, from approving a contract awarded to a contractor meeting the registration requirements

but who is not so registered in accordance with the law.

Contractor certification forms and instructions for completing the forms are attached to this RFP. Form ST-220-

TD must be filed with and returned directly to DTF. Unless the information upon which the ST-220-TD is based

changes, this form only needs to be filed once with DTF. If the information changes for the contractor, its

affiliate(s), or its subcontractor(s) a new Form ST-220-TD must be filed with DTF.

Form ST-220-CA must be filed with the bid and submitted to the procuring covered agency certifying that the

contractor filed the ST-220-TD with DTF. Proposed contractors should complete and return the certification

forms within two business days of request (if the forms are not completed and returned with bid submission).

Failure to make either of these filings may render a Proposer non-responsive and non-responsible. Proposers

shall take the necessary steps to provide properly certified forms within a timely manner to ensure compliance

with the law.

Vendors may call DTF at 1-800-698--2909 for any and all questions relating to Section 5-a of the Tax Law and

relating to a company's registration status with the DTF. For additional information and frequently asked

questions, please refer to the DTF web site: http://www.nystax.gov

6.6 Freedom of Information Law / Trade Secrets

During the evaluation process, the content of each proposal will be held in confidence and details of any proposal

will not be revealed (except as may be required under the Freedom of Information Law or other State law). The

Freedom of Information Law (FOIL) provides for an exemption from disclosure for trade secrets or information

the disclosure of which would cause injury to the competitive position of commercial enterprises. This exception

would be effective both during and after the evaluation process. Should you feel your firm’s proposal contains

any such trade secrets or other confidential or proprietary information, you must submit a request to except such

information from disclosure. Such request must be in writing, must state the reasons why the information should

be excepted from disclosure and must be provided at the time of submission of the subject information. This can

be accomplished by completion of the applicable question on the Contractor Information page in Appendix B

hereto. Requests for exemption of the entire contents of a proposal from disclosure have generally not been

found to be meritorious and are discouraged. Kindly limit any requests for exemption of information from

disclosure to bona fide trade secrets or specific information, the disclosure of which would cause a substantial

injury to the competitive position of your firm.

6.7 General Requirements

1. The Proposer agrees to adhere to all State and Federal laws and regulations in connection with the

contract.

2. The Proposer agrees to notify OGS of any changes in the legal status or principal ownership of the

firm 45 days in advance of said change.

3. The Proposer agrees that in any contract resulting from this RFP it shall be completely responsible

for its work, including any damages or breakdowns caused by its failure to take appropriate action.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

4. The Proposer agrees that any contract resulting from this RFP may not be assigned, transferred,

conveyed or the work subcontracted without the prior written consent of OGS.

5. For reasons of safety and public policy, in any contract resulting from this RFP, the use of illegal

drugs and/or alcoholic beverages by the Contractor or its personnel shall not be permitted while

performing any phase of the work herein specified.

6. For purposes of any contract resulting from this RFP, the State will not be liable for any expense

incurred by the Contractor for any parking fees or as a consequence of any traffic infraction or

parking violations attributable to employees of the Contractor.

7. OGS interpretation of specifications shall be final and binding upon the Contractor.

8. The Commissioner of OGS will make no allowance or concession to the Proposer for any alleged

misunderstanding because of quantity, quality, character, location or other conditions.

9. Should it appear that there is a real or apparent discrepancy between different sections of

specifications concerning the nature, quality or extent of work to be furnished, it shall be assumed

that the Proposer has based its bid on the more expensive option. Final decision will rest with OGS.

10. INSPECTION – For purposes of any contract resulting from this RFP the quality of service is subject

to inspection and may be made at any reasonable time by the State of New York. Should it be found

that quality of services being performed is not satisfactory and that the requirements of the

specifications are not being met, OGS may terminate the contract and employ another Contractor

to fulfill the requirements of the contract. The existing Contractor shall be liable to the State of New

York for costs incurred on account thereof.

11. STOP WORK ORDER – OGS reserves the right to stop the work covered by this RFP and any

contract(s) resulting there from at any time that it is deemed the Contractor is unable or incapable

of performing the work to the State’s satisfaction. In the event of such stopping, OGS shall have

the right to arrange for the completion of the work in such manner as it may deem advisable and if

the cost thereof exceeds the amount of the proposal, the Contractor shall be liable to the State of

New York for any such costs on account thereof. In the event that OGS issues a stop work order

for the work as provided herein, the Contractor shall have ten working days to respond thereto

before any such stop work order shall become effective. Provided, however, that if an emergency

situation exists, as reasonably determined by OGS, then the stop work order shall be effective

immediately.

12. OGS reserves the right to reject and bar from the facility any employee hired by the Contractor.

6.8 Subcontractors

The State will contract only with the successful Proposer who is the Prime Contractor. The Issuing Office

considers the Prime Contractor, the sole Contractor with regard to all provisions of the solicitation and the

contract resulting from the solicitation. Any known / planned use of subcontractors must be disclosed in detail

with the proposal. If subcontractors are to be used for base scope services, it shall be understood that the bid

price includes the cost of the subcontractor, and no additional markups will be allowed.

No subcontract entered into by the Contractor shall relieve the Contractor of any liabilities or obligations in this

RFP or the resultant contract. The Contractor accepts full responsibility for the actions of any employee or

subcontractor/subcontractor’s employee(s) who carry out any of the provisions of any contract resulting from this

RFP.

The Contractor’s use of subcontractors shall not diminish the Contractor’s obligations to complete the work in

accordance with the contract. The Contractor shall coordinate and control the work of the subcontractors.

The Contractor shall be responsible for informing the subcontractors of all terms, conditions, and requirements

of the contract documents.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

During the term of the Contract, before any part of the contract shall be sublet, the Contractor shall submit to

OGS BRIM, 32

Floor Corning Tower, ESP, Albany, NY 12242 in writing, the name of each proposed

subcontractor and obtain written consent to such subcontractor. The names shall be submitted in ample time to

permit acceptance or rejection of each proposed subcontractor without causing delay in the work of this contract.

The Contractor shall promptly furnish such information as the Deputy Commissioner may require concerning the

proposed subcontractor's ability and qualifications.

OGS shall be free to accept or reject any proposal/subcontract submitted for State’s approval, and Contractor

shall provide OGS with copies of all documentation OGS may request in relation to such approval rights.

6.9 Procurement Rights

The State of New York reserves the right to:

1. Reject any and all proposals received in response to this Solicitation.

2. Disqualify a Proposer from receiving the award if the Proposer, or anyone in the Proposer's employ, has

previously failed to perform satisfactorily in connection with public bidding or contracts.

3. Correct Proposers’ mathematical errors and waive or modify other minor irregularities in proposals

received, after prior notification to the Proposer.

4. Adjust any Proposer's expected costs of the bid price based on a determination of the evaluation team

that the selection of the said Proposer will cause the State to incur additional costs.

5. Utilize any and all ideas submitted in the proposals received.

6. Negotiate with Proposers responding to this Solicitation within the Solicitation requirements to serve the

best interests of the State.

7. Begin contract negotiations with another Proposer(s) in order to serve the best interests of the State of

New York should the State of New York be unsuccessful in negotiating a contract with the selected

winning Proposer within 21 days of selection notification.

8. Waive any non-material requirement not met by all Proposers.

9. Not make an award from this Solicitation.

10. Make an award under this Solicitation in whole or in part.

11. Make multiple contract awards pursuant to the Solicitation.

12. Have any service completed via separate competitive bid or other means, as determined to be in the best

interest of the State.

13. Seek clarifications of proposals.

14. Disqualify any Proposer whose conduct and/or proposal fails to conform to the requirements of the RFP.

15. Prior to the bid opening, amend the RFP specifications to correct errors or oversights, or to supply

additional information, as it becomes available.

16. Waive any requirements that are not material.

17. If two or more proposals are found to be substantially equivalent, the Commissioner of OGS, at her sole

discretion, will determine award using the pre-established process. For best value procurements, cost

will be the determining factor.

Note: The State is not liable for any cost incurred by a Proposer in the preparation and production of a proposal

or for any work performed prior to the issuance of a contract.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

6.10 Extent of Services

OGS reserves the right to re-negotiate at its discretion and to reduce the amount of services provided under any

contract resulting from this solicitation. This reduction in services shall be effectuated by written amendment to

the contract and subject to approval by the Office of the State Comptroller.

6.11 Debriefings

Pursuant to Section 163(9)(c) of the State Finance Law, any unsuccessful Bidder may request a debriefing

regarding the reasons that the Bid submitted by the Bidder was not selected for award. Requests for a debriefing

must be made within 15 calendar days of notification by OGS that the bid submitted by the Bidder was not

selected for award. Requests should be submitted in writing to a designated contact identified in the Solicitation.

6.12 Termination

A. Termination

The Office of General Services may, upon 30 days’ notice, terminate any contract resulting from this solicitation

in the event of the awarded Bidder’s failure to comply with any of the proposal’s requirements unless the awarded

Bidder obtained a waiver of the requirement.

In addition, OGS may also terminate any contract resulting from this solicitation upon ten days’ written notice if

the Contractor makes any arrangement for assignment for the benefit of creditors.

Furthermore, OGS shall have the right, in its sole discretion, at any time to terminate a contract resulting from

this solicitation, or any unit portion thereof, with or without cause, by giving 30 days’ written notice of termination

to the Contractor.

B. Procurement Lobbying Termination

The Office of General Services reserves the right to terminate this Agreement in the event it is found that the

certification filed by the Contractor in accordance with New York State Finance Law §139-k was intentionally

false or intentionally incomplete. Upon such finding, the Office of General Services may exercise its termination

right by providing written notification to the Contractor in accordance with the written notification terms of this

Agreement.

C. Effect of Termination

Any termination by OGS under this Section shall in no event constitute or be deemed a breach of any contract

resulting from this solicitation and no liability shall be incurred by or arise against the Office of General Services,

its agents and employees therefore for lost profits or any other damages.

6.13 NYS Vendor Responsibility Questionnaire

OGS conducts a review of prospective contractors (“Proposers”) to provide reasonable assurances that the

Proposer is responsive and responsible. A For-Profit Business Entity Questionnaire (hereinafter “Questionnaire”)

is used for non-construction contracts and is designed to provide information to assess a Proposer’s

responsibility to conduct business in New York based upon financial and organizational capacity, legal authority,

business integrity, and past performance history. By submitting a bid, Proposer agrees to fully and accurately

complete the Questionnaire. The Proposer acknowledges that the State’s execution of the Contract will be

contingent upon the State’s determination that the Proposer is responsible, and that the State will be relying

upon the Proposer’s responses to the Questionnaire when making its responsibility determination.

OGS recommends each Proposer file the required Questionnaire online via the New York State VendRep

System. To enroll in and use the VendRep System, please refer to the VendRep System Instructions and User

Support for Vendors available at the Office of the State Comptroller’s (OSC) website,

https://www.osc.state.ny.us/vendrep/index.htm

or to enroll, go directly to the VendRep System online at

https://www.osc.state.ny.us/vendrep/info_vrsystem.htm .

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

OSC provides direct support for the VendRep System through user assistance, documents, online help, and a

help desk. The OSC Help Desk contact information is located at

http://www.osc.state.ny.us/portal/contactbuss.htm

. Proposers opting to complete the paper questionnaire can

access this form and associated definitions via the OSC website at:

http://www.osc.state.ny.us/vendrep/forms_vendor.htm .

In order to assist the State in determining the responsibility of the Proposer prior to Contract Award, the Proposer

must complete and certify (or recertify) the Questionnaire no more than six months prior to the bid due date. A

Proposer’s Questionnaire cannot be viewed by OGS until the Proposer has certified the Questionnaire. It is

recommended that all Proposers become familiar with all of the requirements of the Questionnaire in advance

of the bid opening to provide sufficient time to complete the Questionnaire.

The Proposer agrees that if it is awarded a Contract the following shall apply:

The Contractor shall at all times during the Contract term remain responsible. The Contractor agrees, if

requested by the Commissioner of OGS or her designee, to present evidence of its continuing legal authority to

do business in New York State, integrity, experience, ability, prior performance, and organizational and financial

capacity.

The Commissioner of OGS or her designee, in her sole discretion, reserves the right to suspend any or all

activities under this Contract, at any time, when she discovers information that calls into question the

responsibility of the Contractor. In the event of such suspension, the Contractor will be given written notice

outlining the particulars of such suspension. Upon issuance of such notice, the Contractor must comply with the

terms of the suspension order. Contract activity may resume at such time as the Commissioner of OGS or her

designee issues a written notice authorizing a resumption of performance under the Contract.

Upon written notice to the Contractor, and a reasonable opportunity to be heard with appropriate OGS officials

or staff, the Contract may be terminated by the Commissioner of OGS or her designee at the Contractor’s

expense where the Contractor is determined by the Commissioner of OGS or her designee to be non-

responsible. In such event, the Commissioner of OGS or her designee may complete the contractual

requirements in any manner she may deem advisable and pursue available legal or equitable remedies for

breach.

In no case shall such termination of the Contract by the State be deemed a breach thereof, nor shall the State

be liable for any damages for lost profits or otherwise, which may be sustained by the Contractor as a result of

such termination.

6.14 New York State Vendor File Registration

Prior to being awarded a contract pursuant to this Solicitation, the Bidder(s) must be registered in the New York

State Vendor File (Vendor File) administered by the Office of the State Comptroller (OSC). This is a central

registry for all vendors who do business with New York State Agencies and the registration must be initiated by

a State Agency. Following the initial registration, unique New York State ten-digit vendor identification numbers

will be assigned to your company for usage on all future transactions with New York State. Additionally, the

Vendor File enables vendors to use the Vendor Self-Service application to manage all vendor information in

one central location for all transactions related to the State of New York. If Bidder is already registered in the

New York State Vendor File, list the ten-digit vendor ID number on the Contractor Information page included in

Appendix B of this solicitation.

If the Bidder is not currently registered in the Vendor File and is recommended for award, OGS shall request

completion of OSC Substitute W-9 Form. A fillable form with instructions can be found at the link below. The

Office of General Services will initiate the vendor registration process for all Bidders recommended for Contract

Award. Once the process is initiated, registrants will receive an email from OSC that includes the unique ten-

digit vendor identification number assigned to the company and instructions on how to enroll in the online Vendor

Self-Service application. For more information on the vendor file please visit the following website:

http://www.osc.state.ny.us/vendors/index.htm

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Forms to be completed: https://www.osc.state.ny.us/sites/default/files/vendors/2017-11/vendor-form-

ac3237s-fe.pdf

6.15 Indemnification

The Contractor shall assume all risks of liability for its performance, or that of any of its officers, employees,

subcontractors or agents, of any contract resulting from this solicitation and shall be solely responsible and liable

for all liabilities, losses, damages, costs or expenses, including attorney's fees, arising from any claim, action or

proceeding relating to or in any way connected with the performance of this Agreement and covenants and

agrees to indemnify and hold harmless the State of New York, its agents, officers and employees, from any and

all claims, suits, causes of action and losses of whatever kind and nature, arising out of or in connection with its

performance of any contract resulting from this solicitation, including negligence, active or passive or improper

conduct of the Contractor, its officers, agents, subcontractors or employees, or the failure by the Contractor, its

officers, agents, subcontractors or employees to perform any obligations or commitments to the State or third

parties arising out of or resulting from any contract resulting from this solicitation. Such indemnity shall not be

limited to the insurance coverage herein prescribed.

6.16 Force Majeure

Neither party hereto will be liable for losses, defaults, or damages under any contract resulting from this

solicitation which result from delays in performing, or inability to perform, all or any of the obligations or

responsibilities imposed upon it pursuant to the terms and conditions of this solicitation, due to or because of

acts of God, the public enemy, acts of government, earthquakes, floods, strikes, civil strife, fire or any other

cause beyond the reasonable control of the party that was so delayed in performing or so unable to perform

provided that such party was not negligent and shall have used reasonable efforts to avoid and overcome such

cause. Such party will resume full performance of such obligations and responsibilities promptly upon removal

of any such cause.

6.17 Participation Opportunities For New York State Certified Service-Disabled

Veteran-Owned Businesses

Article 17-B of the New York State Executive Law provides for more meaningful participation in public

procurement by certified Service-Disabled Veteran-Owned Businesses (“SDVOBs”), thereby further integrating

such businesses into New York State’s economy. OGS recognizes the need to promote the employment of

service-disabled veterans and to ensure that certified service-disabled veteran-owned businesses have

opportunities for maximum feasible participation in the performance of OGS contracts.

In recognition of the service and sacrifices made by service-disabled veterans and in recognition of the economic

activity such businesses offer, Bidders/Contractors are strongly encouraged and expected to consider SDVOBs

in the fulfillment of the requirements of the Contract. Such participation may be as subcontractors or suppliers,

as protégés, or in other partnering or supporting roles.

For purposes of this procurement, OGS conducted a comprehensive search and determined that the Contract

does not offer sufficient opportunities to set specific goals for participation by SDVOBs as subcontractors, service

providers, and suppliers to Contractor. Nevertheless, Bidder/Contractor is encouraged to make good faith efforts

to promote and assist in the participation of SDVOBs on the Contract for the provision of services and materials.

The directory of New York State Certified SDVOBs can be viewed at: https://ogs.ny.gov/veterans/

Bidder/Contractor is encouraged to contact the Office of General Services’ Division of Service-Disabled

Veteran’s Business Development at 518-474-2015 or [email protected]

to discuss methods of

maximizing participation by SDVOBs.

6.18 Encouraging Use of NYS Businesses

New York State businesses have a substantial presence in State contracts and strongly contribute to the

economies of the state and the nation. In recognition of the economic activity and leadership such businesses

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

offer, Contractors are strongly encouraged and expected to consider New York State businesses in the fulfillment

of the requirements of this agreement. Such partnering may be as subcontractors, suppliers, protégés or other

supporting roles.

Bidders/proposers need to be aware that all authorized users of this contract will be strongly encouraged, to the

maximum extent practical and consistent with legal requirements, to use responsible and responsive New York

State businesses in purchasing commodities that are of equal quality and functionality and in utilizing services

and technology. Furthermore, bidders/proposers are reminded that they must continue to utilize small, minority

and women-owned businesses, consistent with current State law.

Utilizing New York State businesses in State contracts will help create more private sector jobs, rebuild New

York’s infrastructure, and maximize economic activity to the mutual benefit of the contractor and its New York

State business partners. New York State businesses will promote the contractor’s optimal performance under

the contract, thereby fully benefiting the public sector programs that are supported by associated procurements.

Public procurements can drive and improve the State’s economic engine through promotion of the use of New

York businesses by its contractors. The State therefore expects bidders/proposers to provide maximum

assistance to New York businesses in their use of the contract. The potential participation by all kinds of New

York businesses will deliver great value to the State and its taxpayers.

6.19 Information Security Breach

In accordance with the Information and Security Breach Notification Act (ISBNA) (Chapter 442 of the Laws of

2005, as amended by Chapter 491 of the Laws of 2005), a Contractor with OGS shall be responsible for all

applicable provisions of the ISBNA and the following terms herein with respect to any private information (as

defined in the ISBNA) received by or on behalf of OGS under this Contract.

a. Contractor shall supply OGS with a copy of its notification policy, which shall be modified to be in

compliance with this provision, as well as OGS’s notification policy.

b. Contractor must encrypt any database fields and backup tapes that contain private data elements, as set

forth in the ISBNA.

c. Contractor must ensure that private data elements are encrypted in transit to / from their systems.

d. In general, Contractor must ensure that private data elements are not displayed to users on computer

screens or in printed reports; however, specific users who are authorized to view the private data

elements and who have been properly authenticated may view/receive such data.

e. Contractor must monitor for breaches of security to any of its systems that store or process private data

owned by OGS.

f. Contractor shall take all steps as set forth in ISBNA to ensure private information shall not be released

without authorization from OGS.

g. In the event a security breach occurs as defined by ISBNA Contractor shall immediately notify OGS and

commence an investigation in cooperation with OGS to determine the scope of the breach.

h. Contractor shall also take immediate and necessary steps needed to restore the information security

system to prevent further breaches.

i. Contractor shall immediately notify OGS following the discovery that OGS’s system security has been

breached.

j. Unless the Contractor is otherwise instructed, Contractor is to first seek consultation and receive

authorization from OGS prior to notifying the individuals whose personal identity information was

compromised by the breach of security, the New York State Chief Information Security Office, the

Department of State Division of Consumer Protection, the Attorney General’s Office or any consuming

reporting agencies of a breach of the information security system or concerning any determination to

delay notification for law enforcement investigations.

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

k. Contractor shall be responsible for providing all notices required by the ISBNA and for all costs associated

with providing said notices.

l. This policy and procedure shall not impair the ability of the Attorney General to bring an action against

the Contractor to enforce all provisions of the ISBNA or limit the Contractor’s liability for any violations of

the ISBNA.

6.20 Sexual Harassment Prevention

Pursuant to N.Y. State Finance Law § 139-l, every bid made on or after January 1, 2019 to the State or any

public department or agency thereof, where competitive bidding is required by statute, rule or regulation, for work

or services performed or to be performed or goods sold or to be sold, and where otherwise required by such

public department or agency, shall contain a certification that the bidder has and has implemented a written

policy addressing sexual harassment prevention in the workplace and provides annual sexual harassment

prevention training to all of its employees. Such policy shall, at a minimum, meet the requirements of N.Y. State

Labor Law § 201-g.

N.Y. State Labor Law § 201-g provides requirements for such policy and training and directs the Department of

Labor, in consultation with the Division of Human Rights, to create and publish a model sexual harassment

prevention guidance document, sexual harassment prevention policy and sexual harassment prevention training

program that employers may utilize to meet the requirements of N.Y. State Labor Law § 201-g. The model

sexual harassment prevention policy, model sexual harassment training materials, and further guidance for

employers, can be found online at the following URL: https://www.ny.gov/combating-sexual-harassment-

workplace/employers.

Pursuant to N.Y. State Finance Law § 139-l, any bid by a corporate bidder containing the certification required

above shall be deemed to have been authorized by the board of directors of such bidder, and such authorization

shall be deemed to include the signing and submission of such bid and the inclusion therein of such statement

as the act and deed of the bidder.

If the Bidder cannot make the required certification, such Bidder shall so state and shall furnish with the bid a

signed statement that sets forth in detail the reasons that the Bidder cannot make the certification. After review

and consideration of such statement, OGS may reject the bid or may decide that there are sufficient reasons to

accept the bid without such certification.

The certification required above can be found on Appendix B – NYS Required Certifications, which Bidder must

submit with its bid.

October 2019

APPENDIX A

STANDARD CLAUSES FOR NEW YORK STATE CONTRACTS

PLEASE RETAIN THIS DOCUMENT

FOR FUTURE REFERENCE.

STANDARD CLAUSES FOR NYS CONTRACTS APPENDIX A

Page 2 October 2019

TABLE OF CONTENTS

Page

1. Executory Clause 3

2. Non-Assignment Clause 3

3. Comptroller’s Approval 3

4. Workers’ Compensation Benefits 3

5. Non-Discrimination Requirements 3

6. Wage and Hours Provisions 3-4

7. Non-Collusive Bidding Certification 4

8. International Boycott Prohibition 4

9. Set-Off Rights 4

10. Records 4

11. Identifying Information and Privacy Notification 4

12. Equal Employment Opportunities For Minorities and Women 4-5

13. Conflicting Terms 5

14. Governing Law 5

15. Late Payment 5

16. No Arbitration 5

17. Service of Process 5

18. Prohibition on Purchase of Tropical Hardwoods 5-6

19. MacBride Fair Employment Principles 6

20. Omnibus Procurement Act of 1992 6

21. Reciprocity and Sanctions Provisions 6

22. Compliance with Breach Notification and Data Security Laws 6

23. Compliance with Consultant Disclosure Law 6

24. Procurement Lobbying 7

25. Certification of Registration to Collect Sales and Compensating Use Tax by Certain 7

State Contractors, Affiliates and Subcontractors

26. Iran Divestment Act 7

27. Admissibility of Contract 7

STANDARD CLAUSES FOR NYS CONTRACTS APPENDIX A

Page 3 October 2019

STANDARD CLAUSES FOR NYS CONTRACTS

The parties to the attached contract, license, lease, amendment

or other agreement of any kind (hereinafter, "the contract" or

"this contract") agree to be bound by the following clauses

which are hereby made a part of the contract (the word

"Contractor" herein refers to any party other than the State,

whether a contractor, licenser, licensee, lessor, lessee or any

other party):

1. EXECUTORY CLAUSE. In accordance with Section 41

of the State Finance Law, the State shall have no liability under

this contract to the Contractor or to anyone else beyond funds

appropriated and available for this contract.

2. NON-ASSIGNMENT CLAUSE. In accordance with

Section 138 of the State Finance Law, this contract may not be

assigned by the Contractor or its right, title or interest therein

assigned, transferred, conveyed, sublet or otherwise disposed of

without the State’s previous written consent, and attempts to do

so are null and void. Notwithstanding the foregoing, such prior

written consent of an assignment of a contract let pursuant to

Article XI of the State Finance Law may be waived at the

discretion of the contracting agency and with the concurrence

of the State Comptroller where the original contract was subject

to the State Comptroller’s approval, where the assignment is

due to a reorganization, merger or consolidation of the

Contractor’s business entity or enterprise. The State retains its

right to approve an assignment and to require that any

Contractor demonstrate its responsibility to do business with

the State. The Contractor may, however, assign its right to

receive payments without the State’s prior written consent

unless this contract concerns Certificates of Participation

pursuant to Article 5-A of the State Finance Law.

3. COMPTROLLER'S APPROVAL. In accordance with

Section 112 of the State Finance Law (or, if this contract is with

the State University or City University of New York, Section

355 or Section 6218 of the Education Law), if this contract

exceeds $50,000 (or the minimum thresholds agreed to by the

Office of the State Comptroller for certain S.U.N.Y. and

C.U.N.Y. contracts), or if this is an amendment for any amount

to a contract which, as so amended, exceeds said statutory

amount, or if, by this contract, the State agrees to give

something other than money when the value or reasonably

estimated value of such consideration exceeds $25,000, it shall

not be valid, effective or binding upon the State until it has been

approved by the State Comptroller and filed in his office.

Comptroller's approval of contracts let by the Office of General

Services is required when such contracts exceed $85,000 (State

Finance Law § 163.6-a). However, such pre-approval shall not

be required for any contract established as a centralized contract

through the Office of General Services or for a purchase order

or other transaction issued under such centralized contract.

4. 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.

5. NON-DISCRIMINATION REQUIREMENTS. To the

extent required by Article 15 of the Executive Law (also known

as the Human Rights Law) and all other State and Federal

statutory and constitutional non-discrimination provisions, the

Contractor will not discriminate against any employee or

applicant for employment, nor subject any individual to

harassment, because of age, race, creed, color, national origin,

sexual orientation, gender identity or expression, military

status, sex, disability, predisposing genetic characteristics,

familial status, marital status, or domestic violence victim status

or because the individual has opposed any practices forbidden

under the Human Rights Law or has filed a complaint, testified,

or assisted in any proceeding under the Human Rights Law.

Furthermore, in accordance with Section 220-e of the Labor

Law, if this is a contract for the construction, alteration or repair

of any public building or public work or for the manufacture,

sale or distribution of materials, equipment or supplies, and to

the extent that this contract shall be performed within the State

of New York, Contractor agrees that neither it nor its

subcontractors shall, by reason of race, creed, color, disability,

sex, or national origin: (a) discriminate in hiring against any

New York State citizen who is qualified and available to

perform the work; or (b) discriminate against or intimidate any

employee hired for the performance of work under this contract.

If this is a building service contract as defined in Section 230 of

the Labor Law, then, in accordance with Section 239 thereof,

Contractor agrees that neither it nor its subcontractors shall by

reason of race, creed, color, national origin, age, sex or

disability: (a) discriminate in hiring against any New York

State citizen who is qualified and available to perform the work;

or (b) discriminate against or intimidate any employee hired for

the performance of work under this contract. Contractor is

subject to fines of $50.00 per person per day for any violation

of Section 220-e or Section 239 as well as possible termination

of this contract and forfeiture of all moneys due hereunder for

a second or subsequent violation.

6. WAGE AND HOURS PROVISIONS. 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, effective April

28, 2008, if this is a public work contract covered by Article 8

of the Labor Law, the Contractor understands and agrees that

the filing of payrolls in a manner consistent with Subdivision 3-

STANDARD CLAUSES FOR NYS CONTRACTS APPENDIX A

Page 4 October 2019

a of Section 220 of the Labor Law shall be a condition precedent

to payment by the State of any State approved sums due and

owing for work done upon the project.

7. NON-COLLUSIVE BIDDING CERTIFICATION. In

accordance with Section 139-d of the State Finance Law, if this

contract was awarded based upon the submission of bids,

Contractor affirms, under penalty of perjury, that its bid was

arrived at independently and without collusion aimed at

restricting competition. Contractor further affirms that, at the

time Contractor submitted its bid, an authorized and responsible

person executed and delivered to the State a non-collusive

bidding certification on Contractor's behalf.

8. INTERNATIONAL BOYCOTT PROHIBITION. In

accordance with Section 220-f of the Labor Law and Section

139-h of the State Finance Law, if this contract exceeds $5,000,

the Contractor agrees, as a material condition of the contract,

that neither the Contractor nor any substantially owned or

affiliated person, firm, partnership or corporation has

participated, is participating, or shall participate in an

international boycott in violation of the federal Export

Administration Act of 1979 (50 USC App. Sections 2401 et

seq.) or regulations thereunder. If such Contractor, or any of

the aforesaid affiliates of Contractor, is convicted or is

otherwise found to have violated said laws or regulations upon

the final determination of the United States Commerce

Department or any other appropriate agency of the United

States subsequent to the contract's execution, such contract,

amendment or modification thereto shall be rendered forfeit and

void. The Contractor shall so notify the State Comptroller

within five (5) business days of such conviction, determination

or disposition of appeal (2 NYCRR § 105.4).

9. SET-OFF RIGHTS. The State shall have all of its common

law, equitable and statutory rights of set-off. These rights shall

include, but not be limited to, the State's option to withhold for

the purposes of set-off any moneys due to the Contractor under

this contract up to any amounts due and owing to the State with

regard to this contract, any other contract with any State

department or agency, including any contract for a term

commencing prior to the term of this contract, plus any amounts

due and owing to the State for any other reason including,

without limitation, tax delinquencies, fee delinquencies or

monetary penalties relative thereto. The State shall exercise its

set-off rights in accordance with normal State practices

including, in cases of set-off pursuant to an audit, the

finalization of such audit by the State agency, its

representatives, or the State Comptroller.

10. RECORDS. The Contractor shall establish and maintain

complete and accurate books, records, documents, accounts and

other evidence directly pertinent to performance under this

contract (hereinafter, collectively, the "Records"). The Records

must be kept for the balance of the calendar year in which they

were made and for six (6) additional years thereafter. The State

Comptroller, the Attorney General and any other person or

entity authorized to conduct an examination, as well as the

agency or agencies involved in this contract, shall have access

to the Records during normal business hours at an office of the

Contractor within the State of New York or, if no such office is

available, at a mutually agreeable and reasonable venue within

the State, for the term specified above for the purposes of

inspection, auditing and copying. The State shall take

reasonable steps to protect from public disclosure any of the

Records which are exempt from disclosure under Section 87 of

the Public Officers Law (the "Statute") provided that: (i) the

Contractor shall timely inform an appropriate State official, in

writing, that said records should not be disclosed; and (ii) said

records shall be sufficiently identified; and (iii) designation of

said records as exempt under the Statute is reasonable. Nothing

contained herein shall diminish, or in any way adversely affect,

the State's right to discovery in any pending or future litigation.

11. IDENTIFYING INFORMATION AND PRIVACY

NOTIFICATION. (a) Identification Number(s). Every

invoice or New York State Claim for Payment submitted to a

New York State agency by a payee, for payment for the sale of

goods or services or for transactions (e.g., leases, easements,

licenses, etc.) related to real or personal property must include

the payee's identification number. The number is any or all of

the following: (i) the payee’s Federal employer identification

number, (ii) the payee’s Federal social security number, and/or

(iii) the payee’s Vendor Identification Number assigned by the

Statewide Financial System. Failure to include such number or

numbers may delay payment. Where the payee does not have

such number or numbers, the payee, on its invoice or Claim for

Payment, must give the reason or reasons why the payee does

not have such number or numbers.

(b) Privacy Notification. (1) The authority to request the above

personal information from a seller of goods or services or a

lessor of real or personal property, and the authority to maintain

such information, is found in Section 5 of the State Tax Law.

Disclosure of this information by the seller or lessor to the State

is mandatory. The principal purpose for which the information

is collected is to enable the State to identify individuals,

businesses and others who have been delinquent in filing tax

returns or may have understated their tax liabilities and to

generally identify persons affected by the taxes administered by

the Commissioner of Taxation and Finance. The information

will be used for tax administration purposes and for any other

purpose authorized by law. (2) The personal information is

requested by the purchasing unit of the agency contracting to

purchase the goods or services or lease the real or personal

property covered by this contract or lease. The information is

maintained in the Statewide Financial System by the Vendor

Management Unit within the Bureau of State Expenditures,

Office of the State Comptroller, 110 State Street, Albany, New

York 12236.

12. EQUAL EMPLOYMENT OPPORTUNITIES FOR

MINORITIES AND WOMEN. In accordance with Section

312 of the Executive Law and 5 NYCRR Part 143, if this

contract is: (i) a written agreement or purchase order

instrument, providing for a total expenditure in excess of

STANDARD CLAUSES FOR NYS CONTRACTS APPENDIX A

Page 5 October 2019

$25,000.00, whereby a contracting agency is committed to

expend or does expend funds in return for labor, services,

supplies, equipment, materials or any combination of the

foregoing, to be performed for, or rendered or furnished to the

contracting agency; or (ii) a written agreement in excess of

$100,000.00 whereby a contracting agency is committed to

expend or does expend funds for the acquisition, construction,

demolition, replacement, major repair or renovation of real

property and improvements thereon; or (iii) a written agreement

in excess of $100,000.00 whereby the owner of a State assisted

housing project is committed to expend or does expend funds

for the acquisition, construction, demolition, replacement,

major repair or renovation of real property and improvements

thereon for such project, then the following shall apply and by

signing this agreement the Contractor certifies and affirms that

it is Contractor’s equal employment opportunity policy that:

(a) The Contractor will not discriminate against employees or

applicants for employment because of race, creed, color,

national origin, sex, age, disability or marital status, shall make

and document its conscientious and active efforts to employ and

utilize minority group members and women in its work force

on State contracts and will undertake or continue existing

programs of affirmative action to ensure that minority group

members and women are afforded equal employment

opportunities without discrimination. Affirmative action shall

mean recruitment, employment, job assignment, promotion,

upgradings, demotion, transfer, layoff, or termination and rates

of pay or other forms of compensation;

(b) at the request of the contracting agency, the Contractor shall

request each employment agency, labor union, or authorized

representative of workers with which it has a collective

bargaining or other agreement or understanding, to furnish a

written statement that such employment agency, labor union or

representative will not discriminate on the basis of race, creed,

color, national origin, sex, age, disability or marital status and

that such union or representative will affirmatively cooperate in

the implementation of the Contractor's obligations herein; and

advertisements for employees, that, in the performance of the

State contract, all qualified applicants will be afforded equal

employment opportunities without discrimination because of

race, creed, color, national origin, sex, age, disability or marital

status.

Contractor will include the provisions of "a," "b," and "c"

above, in every subcontract over $25,000.00 for the

construction, demolition, replacement, major repair,

renovation, planning or design of real property and

improvements thereon (the "Work") except where the Work is

for the beneficial use of the Contractor. Section 312 does not

apply to: (i) work, goods or services unrelated to this contract;

or (ii) employment outside New York State. The State shall

consider compliance by a contractor or subcontractor with the

requirements of any federal law concerning equal employment

opportunity which effectuates the purpose of this clause. The

contracting agency shall determine whether the imposition of

the requirements of the provisions hereof duplicate or conflict

with any such federal law and if such duplication or conflict

exists, the contracting agency shall waive the applicability of

Section 312 to the extent of such duplication or conflict.

Contractor will comply with all duly promulgated and lawful

rules and regulations of the Department of Economic

Development’s Division of Minority and Women's Business

Development pertaining hereto.

13. CONFLICTING TERMS. In the event of a conflict

between the terms of the contract (including any and all

attachments thereto and amendments thereof) and the terms of

this Appendix A, the terms of this Appendix A shall control.

14. GOVERNING LAW. This contract shall be governed by

the laws of the State of New York except where the Federal

supremacy clause requires otherwise.

15. LATE PAYMENT. Timeliness of payment and any

interest to be paid to Contractor for late payment shall be

governed by Article 11-A of the State Finance Law to the extent

required by law.

16. NO ARBITRATION. Disputes involving this contract,

including the breach or alleged breach thereof, may not be

submitted to binding arbitration (except where statutorily

authorized), but must, instead, be heard in a court of competent

jurisdiction of the State of New York.

17. SERVICE OF PROCESS. In addition to the methods of

service allowed by the State Civil Practice Law & Rules

("CPLR"), Contractor hereby consents to service of process

upon it by registered or certified mail, return receipt requested.

Service hereunder shall be complete upon Contractor's actual

receipt of process or upon the State's receipt of the return

thereof by the United States Postal Service as refused or

undeliverable. Contractor must promptly notify the State, in

writing, of each and every change of address to which service

of process can be made. Service by the State to the last known

address shall be sufficient. Contractor will have thirty (30)

calendar days after service hereunder is complete in which to

respond.

18. 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

STANDARD CLAUSES FOR NYS CONTRACTS APPENDIX A

Page 6 October 2019

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.

19. MACBRIDE FAIR EMPLOYMENT PRINCIPLES. In

accordance with the MacBride Fair Employment Principles

(Chapter 807 of the Laws of 1992), the Contractor hereby

stipulates that the Contractor either (a) has no business

operations in Northern Ireland, or (b) shall take lawful steps in

good faith to conduct any business operations in Northern

Ireland in accordance with the MacBride Fair Employment

Principles (as described in Section 165 of the New York State

Finance Law), and shall permit independent monitoring of

compliance with such principles.

20. OMNIBUS PROCUREMENT ACT OF 1992. It is the

policy of New York State to maximize opportunities for the

participation of New York State business enterprises, including

minority- and women-owned business enterprises as bidders,

subcontractors and suppliers on its procurement contracts.

Information on the availability of New York State

subcontractors and suppliers is available from:

NYS Department of Economic Development

Division for Small Business

Albany, New York 12245

Telephone: 518-292-5100

Fax: 518-292-5884

email: [email protected]y.gov

A directory of certified minority- and women-owned business

enterprises is available from:

NYS Department of Economic Development

Division of Minority and Women's Business Development

633 Third Avenue

New York, NY 10017

212-803-2414

email: mwbecerti[email protected]

https://ny.newnycontracts.com/FrontEnd/VendorSearchPu

blic.asp

The Omnibus Procurement Act of 1992 (Chapter 844 of the

Laws of 1992, codified in State Finance Law § 139-i and Public

Authorities Law § 2879(3)(n)–(p)) requires that by signing this

bid proposal or contract, as applicable, Contractors certify that

whenever the total bid amount is greater than $1 million:

(a) The Contractor has made reasonable efforts to encourage

the participation of New York State Business Enterprises as

suppliers and subcontractors, including certified minority- and

women-owned business enterprises, on this project, and has

retained the documentation of these efforts to be provided upon

request to the State;

(b) The Contractor has complied with the Federal Equal

Opportunity Act of 1972 (P.L. 92-261), as amended;

notification to New York State residents of employment

opportunities on this project through listing any such positions

with the Job Service Division of the New York State

Department of Labor, or providing such notification in such

manner as is consistent with existing collective bargaining

contracts or agreements. The Contractor agrees to document

these efforts and to provide said documentation to the State

upon request; and

(d) The Contractor acknowledges notice that the State may seek

to obtain offset credits from foreign countries as a result of this

contract and agrees to cooperate with the State in these efforts.

21. RECIPROCITY AND SANCTIONS PROVISIONS.

Bidders are hereby notified that if their principal place of

business is located in a country, nation, province, state or

political subdivision that penalizes New York State vendors,

and if the goods or services they offer will be substantially

produced or performed outside New York State, the Omnibus

Procurement Act 1994 and 2000 amendments (Chapter 684 and

Chapter 383, respectively, codified in State Finance Law

§ 165(6) and Public Authorities Law § 2879(5)) ) require that

they be denied contracts which they would otherwise obtain.

NOTE: As of October 2019, the list of discriminatory

jurisdictions subject to this provision includes the states of

South Carolina, Alaska, West Virginia, Wyoming, Louisiana

and Hawaii.

22. COMPLIANCE WITH BREACH NOTIFICATION

AND DATA SECURITY LAWS. Contractor shall comply

with the provisions of the New York State Information Security

Breach and Notification Act (General Business Law § 899-aa

and State Technology Law § 208) and commencing March 21,

2020 shall also comply with General Business Law § 899-bb.

23. COMPLIANCE WITH CONSULTANT

DISCLOSURE LAW. If this is a contract for consulting

services, defined for purposes of this requirement to include

analysis, evaluation, research, training, data processing,

computer programming, engineering, environmental, health,

and mental health services, accounting, auditing, paralegal,

legal or similar services, then, in accordance with Section 163

(4)(g) of the State Finance Law (as amended by Chapter 10 of

the Laws of 2006), the Contractor shall timely, accurately and

properly comply with the requirement to submit an annual

employment report for the contract to the agency that awarded

the contract, the Department of Civil Service and the State

Comptroller.

STANDARD CLAUSES FOR NYS CONTRACTS APPENDIX A

Page 7 October 2019

24. PROCUREMENT LOBBYING. To the extent this

agreement is a "procurement contract" as defined by State

Finance Law §§ 139-j and 139-k, by signing this agreement the

contractor certifies and affirms that all disclosures made in

accordance with State Finance Law §§ 139-j and 139-k are

complete, true and accurate. In the event such certification is

found to be intentionally false or intentionally incomplete, the

State may terminate the agreement by providing written

notification to the Contractor in accordance with the terms of

the agreement.

25. CERTIFICATION OF REGISTRATION TO

COLLECT SALES AND COMPENSATING USE TAX BY

CERTAIN STATE CONTRACTORS, AFFILIATES AND

SUBCONTRACTORS.

To the extent this agreement is a contract as defined by Tax Law

§ 5-a, if the contractor fails to make the certification required

by Tax Law § 5-a or if during the term of the contract, the

Department of Taxation and Finance or the covered agency, as

defined by Tax Law § 5-a, discovers that the certification, made

under penalty of perjury, is false, then such failure to file or

false certification shall be a material breach of this contract and

this contract may be terminated, by providing written

notification to the Contractor in accordance with the terms of

the agreement, if the covered agency determines that such

action is in the best interest of the State.

26. IRAN DIVESTMENT ACT. By entering into this

Agreement, Contractor certifies in accordance with State

Finance Law § 165-a that it is not on the “Entities Determined

to be Non-Responsive Bidders/Offerers pursuant to the New

York State Iran Divestment Act of 2012” (“Prohibited Entities

List”) posted at: https://ogs.ny.gov/list-entities-determined-be-

non-responsive-biddersofferers-pursuant-nys-iran-divestment-

act-2012

Contractor further certifies that it will not utilize on this

Contract any subcontractor that is identified on the Prohibited

Entities List. Contractor agrees that should it seek to renew or

extend this Contract, it must provide the same certification at

the time the Contract is renewed or extended. Contractor also

agrees that any proposed Assignee of this Contract will be

required to certify that it is not on the Prohibited Entities List

before the contract assignment will be approved by the State.

During the term of the Contract, should the state agency receive

information that a person (as defined in State Finance Law

§ 165-a) is in violation of the above-referenced certifications,

the state agency will review such information and offer the

person an opportunity to respond. If the person fails to

demonstrate that it has ceased its engagement in the investment

activity which is in violation of the Act within 90 days after the

determination of such violation, then the state agency shall take

such action as may be appropriate and provided for by law, rule,

or contract, including, but not limited to, imposing sanctions,

seeking compliance, recovering damages, or declaring the

Contractor in default.

The state agency reserves the right to reject any bid, request for

assignment, renewal or extension for an entity that appears on

the Prohibited Entities List prior to the award, assignment,

renewal or extension of a contract, and to pursue a

responsibility review with respect to any entity that is awarded

a contract and appears on the Prohibited Entities list after

contract award.

27. ADMISSIBILITY OF REPRODUCTION OF

CONTRACT. Notwithstanding the best evidence rule or any

other legal principle or rule of evidence to the contrary, the

Contractor acknowledges and agrees that it waives any and all

objections to the admissibility into evidence at any court

proceeding or to the use at any examination before trial of an

electronic reproduction of this contract, in the form approved

by the State Comptroller, if such approval was required,

regardless of whether the original of said contract is in

existence.

Appendix B – Required Forms

Solicitation

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 1 of 30

2639

Required Forms – Table of Contents

The following required forms are to be submitted with the proposer’s proposal. The forms

include:

 Contractor Information Page

 Corporate Acknowledgement (must be notarized)

 Offerer’s Affirmation of Understanding of and Agreement pursuant to New York State

Finance Law §139-j (3) and §139-j (6) (b)

 Offerer Disclosure of Prior Non-Responsibility Determinations

 Offerer’s Certification of Compliance with State Finance Law §139-k(5)

 NYS Required Certifications

• Nondiscrimination In Employment In Northern Ireland Macbride Fair Employment Principles

• Non-Collusive Bidding Certification

• Diesel Emission Reduction Act

• Executive Order No 177 Certification

• State Finance Law § 139-l Certification

• Small Business Certification

 Certification Under Executive Order No. 16- Prohibiting State Agencies and Authorities

from Contracting with Businesses Conducting Business in Russia

 ST-220 -TD Taxation & Finance Contractor Certification

(Submitted directly to Taxation & Finance)

 ST-220 -CA Taxation and Finance Covered Agency Certification

 EEO 100- Equal Employment Opportunity Staffing Plan

 Contract Consultant Forms A and B

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 2 of 30

Contractor Information

Solicitation Number

Offerer affirms that it understands and agrees to comply with the procedures of the Government Entity relative to

permissible contacts as required by New York State Finance Law §139-j (3) and §139-j (6) (b).

Authorized Signature

Date

Print Name

Title

Company Name

Federal ID Number

NYS Vendor ID Number

Address

City

State

Zip

County

Telephone Number

Ext

Toll Free Telephone

Ext

Fax Number

Toll Free Fax Number

Email of Designated Contact

Please ident

ify if any of the following apply:

New York State Small Business as defined in Executive Law Section

310(20) and as detailed in the “New York State Required

Certifications” included in Appendix B herein.

Yes No

New York State Certified Minority Owned Business

Yes No

New York State Certified Woman Owned Business

Yes No

New York State Certified Service-Disabled Veteran-Owned Business

Yes No

Do you understand and is your firm capable of meeting the insurance

requirements to enter into a contract with New York State?

Yes No

Will New York State Businesses be used in the performance of this

contract?

Yes No

If yes, identify New York State Business(es) that will be used;

(Attach identifying information).

Does your proposal meet all the requirements of this solicitation?

Yes No

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 3 of 30

2639

Is your firm making a claim that any portions of its bid should be exempt

from release under the Freedom of Information Law, as they constitute

trade secrets, or information the disclosure of which would cause a

substantial injury to your firm’s competitive position? (Please review

the clause entitled “Freedom of Information Law / Trade Secrets”

of this Solicitation before answering).

Yes No

If “Yes”, please identify the specific portions of your bid for which you

are claiming this exemption, and the

reasons for such claimed

exemption. Attach additional sheets, if necessary

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 4 of 30

INDIVIDUAL, CORPORATION, PARTNERSHIP, OR LLC ACKNOWLEDGMENT

STATE 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 _he resides at

_________________________________________________,

Town of __________________________________________ ,

County of _______________________________ ,

State of ______________________________ ; and further that:

[Check One]

( If an individual): _he executed the foregoing instrument in his/her name and on his/her own behalf.

( If a corporation): __he is the _________________________ of ______________________________

, the corporation described in said instrument; that, by authority of the Board of Directors of said

corporation, __he is authorized to execute the foregoing instrument on behalf of the corporation for

purposes set forth therein; and that, pursuant to that authority, __he executed the foregoing instrument

in the name of and on behalf of said corporation as the act and deed of said corporation.

( If a partnership): __he is the __________________________ of ____________________________,

the partnership described in said instrument; that, by the terms of said partnership, __he is authorized

to execute the foregoing instrument on behalf of the partnership for purposes set forth therein; and that,

pursuant to that authority, __he executed the foregoing instrument in the name of and on behalf of said

partnership as the act and deed of said partnership.

( If a limited liability company): __he is a duly authorized member of __________________________,

LLC, the limited liability company described in said instrument; that __he is authorized to execute the

foregoing instrument on behalf of the limited liability company for purposes set forth therein; and that,

pursuant to that authority, __he executed the foregoing instrument in the name of and on behalf of said

limited liability company as the act and deed of said limited liability company.

Notary Public

Registration No.

State of:

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 5 of 30

Offerer’s Affirmation of Understanding of and Agreement pursuant to New York State

Finance Law §139-j (3) and §139-j (6) (b)

New York State Finance Law §139-j(6)(b) provides that:

Every Governmental Entity shall seek written affirmations from all Offerers as to the Offerer’s understanding of and

agreement to comply with the Governmental Entity’s procedures relating to permissible contacts during a

Governmental Procurement pursuant to subdivision three of this section.

Offerer affirms that it understands and agrees to comply with the procedures of the Government Entity relative to

permissible contacts as required by New York State Finance Law §139-j (3) and §139-j (6) (b).

Authorized Signature

Date

Print Name

Title

Company Name

Address

City

State

Zip

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 6 of 30

Offerer Disclosure of Prior Non-Responsibility Determinations

Background:

New York State Finance Law §139-k(2) obligates a Governmental Entity to obtain specific information regarding prior

non-responsibility determinations with respect to State Finance Law §139-j. This information must be collected in

addition to the information that is separately obtained pursuant to State Finance Law §163(9). In accordance with

State Finance Law §139-k, an Offerer must be asked to disclose whether there has been a finding of non-responsibility

made within the previous four (4) years by any Governmental Entity due to: (a) a violation of State Finance Law §139-

j or (b) the intentional provision of false or incomplete information to a Governmental Entity. The terms “Offerer” and

“Governmental Entity” are defined in State Finance Law § 139-k(1). State Finance Law §139-j sets forth detailed

requirements about the restrictions on Contacts during the procurement process. A violation of State Finance Law

§139-j includes, but is not limited to, an impermissible Contact during the restricted period (for example, contacting a

person or entity other than the designated contact person, when such contact does not fall within one of the

exemptions).

As part of its responsibility determination, State Finance Law §139-k(3) mandates consideration of whether an Offerer

fails to timely disclose accurate or complete information regarding the above non-responsibility determination. In

accordance with law, no Procurement Contract shall be awarded to any Offerer that fails to timely disclose accurate

or complete information under this section, unless a finding is made that the award of the Procurement Contract to

the Offerer is necessary to protect public property or public health safety, and that the Offerer is the only source

capable of supplying the required Article of Procurement within the necessary timeframe. See State Finance Law

§§139-j (10)(b) and 139-k(3).

Instructions:

A Governmental Entity must include a disclosure request regarding prior non-responsibility determinations in

accordance with State Finance Law §139-k in its solicitation of proposals or bid documents or specifications or

contract documents, as applicable, for procurement contracts. The attached form is to be completed and submitted

by the individual or entity seeking to enter into a Procurement Contract. It shall be submitted to the Governmental

Entity conducting the Governmental Procurement.

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 7 of 30

Offerer Disclosure of Prior Non-Responsibility Determinations

Name of Individual or Entity Seeking to Enter into the Procurement Contract

Address

City

State

Zip

Person Submitting this Form

Title

Date

Contract Procurement Number

1. Has any Governmental Entity made a finding of non-responsibility

regarding the individual or entity seeking to enter into the Procurement

Contract in the previous four years?

No Yes

If yes, please answer questions 2-4 before proceeding to question 5. If no, please go to question 5.

2. Was the basis for the finding of non-responsibility due to a violation of

State Finance Law §139-j

No Yes

3. Was the basis for the finding of non-responsibility due to the intentional

provision of false or incomplete information to a Governmental Entity?

No Yes

4. If you answered yes to any of the above questions, please provide details regarding the finding of

non-responsibility below.

Governmental Entity

Date of Finding of Non-responsibility

Basis of Finding of Non-Responsibility (Add additional pages as necessary)

5. Has any Governmental Entity or other governmental agency terminated

or withheld a Procurement Contract with the above-named individual or

entity due to the intentional provision of false or incomplete information?

No Yes

6. If yes, please provide details below.

Governmental Entity Date of Termination or Withholding of Contract

Basis of Termination or Withholding (Add additional pages as necessary)

Offerer certifies that all information provided to the Governmental Entity with respect to State Finance Law §139-k is

complete, true and accurate.

By: ________________________________________________________ Date: ___________________

Signature

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 8 of 30

2639

Offerer’s Certification of Compliance with State Finance Law §139-k(5)

New York State Finance Law §139-k(5) requires that every Procurement Contract award subject to the provisions of

State Finance Law §§139-k or 139-j shall contain a certification by the Offerer that all information provided to the

Office of General Services with respect to State Finance Law §139-k is complete, true and accurate.

Offerer Certification:

I certify that all information provided to the Office of General Services with respect to State Finance Law §139-k

is complete, true and accurate.

Authorized Signature

Date

Print Name

Title

Company Name

Address

City

State

Zip

Procurement Lobbying Termination

The Office of General Services reserves the right to terminate this contract in the event it is found that the certification

filed by the Offerer in accordance with New York State Finance Law §139-k was intentionally false or intentionally

incomplete. Upon such finding, the Office of General Services may exercise its termination right by providing written

notification to the Offerer in accordance with the written notification terms of this contract.

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 9 of 30

NYS REQUIRED CERTIFICATIONS

Nondiscrimination In Employment In Northern Ireland

Macbride Fair Employment Principles

In accordance with Section 165 of the State Finance Law, the bidder, by submission of this bid, certifies

that it or any individual or legal entity in which the bidder holds a 10% or greater ownership interest, or any

individual or legal entity that holds a 10% or greater ownership interest in the bidder, either (answer yes or

no to one or both of the following, as applicable):

1. have business operations in Northern Ireland No Yes , and if yes:

2. shall take lawful steps in good faith to conduct any business operations in Northern Ireland in

accordance with the MacBride Fair Employment Principles relating to nondiscrimination in

employment and freedom of workplace opportunity regarding such operations in Northern Ireland,

and shall permit independent monitoring of compliance with such principles.

No Yes

Non-Collusive Bidding Certification

In accordance with Section 139-d of the State Finance Law, by submitting its bid each bidder and each

person signing on behalf of any other bidder certifies, and in the case of a joint bid, each party thereto

certifies as to its own organization, under penalty of perjury, that to the best of his or her knowledge and

belief:

1. The prices in this bid have been arrived at independently without collusion, consultation,

communication, or agreement, for the purpose of restricting competition, as to any matter relating to

such prices with any other bidder or with any competitor.

2. Unless otherwise required by law, the prices which have been quoted in this bid have not been

knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to opening,

directly or indirectly, to any other bidder or to any competitor.

3. No attempt has been made or will be made by the bidder to induce any other person, partnership or

corporation to submit or not to submit a bid for the purpose of restricting competition.

In the event that the Bidder is unable to certify as stated above, the Bidder shall provide a signed statement

which sets forth in detail the reasons why the Bidder is unable to furnish the certificate as required in

accordance with State Finance Law § 139-d(1)(b).

Diesel Emission Reduction Act

Pursuant to N.Y. Environmental Conservation Law § 19-0323 (the “Law”) it is a requirement that heavy

duty diesel vehicles in excess of 8,500 pounds use the best available retrofit technology (“BART”) and ultra-

low sulfur diesel fuel (“ULSD”). The requirement of the Law applies to all vehicles owned, operated by or

on behalf of, or leased by State agencies and State or regional public authorities. It also requires that such

vehicles owned, operated by or on behalf of, or leased by State agencies and State or regional public

authorities with more than half of its governing body appointed by the Governor utilize BART.

The Law may be applicable to vehicles used by contract vendors “on behalf of” State agencies and public

authorities and require certain reports from contract vendors. All heavy duty diesel vehicles must have

BART by the deadline provided in the Law. The Law also provides a list of exempted vehicles. Regulations

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 10 of 30

set forth in 6 NYCRR Parts 248 and 249 provide further guidance. The Bidder hereby certifies and warrants

that all heavy duty vehicles, as defined in the Law, to be used under this contract, will comply with the

specifications and provisions of the Law, and 6 NYCRR Parts 248 and 249.

Executive Order No. 177 Certification

The New York State Human Rights Law, Article 15 of the Executive Law, prohibits discrimination and

harassment based on age, race, creed, color, national origin, sex, pregnancy or pregnancy-related

conditions, sexual orientation, gender identity, disability, marital status, familial status, domestic violence

victim status, prior arrest or conviction record, military status or predisposing genetic characteristics.

The Human Rights Law may also require reasonable accommodation for persons with disabilities and

pregnancy-related conditions. A reasonable accommodation is an adjustment to a job or work environment

that enables a person with a disability to perform the essential functions of a job in a reasonable manner.

The Human Rights Law may also require reasonable accommodation in employment on the basis of

Sabbath observance or religious practices.

Generally, the Human Rights Law applies to:

 all employers of four or more people, employment agencies, labor organizations and

apprenticeship training programs in all instances of discrimination or harassment;

 employers with fewer than four employees in all cases involving sexual harassment; and,

 any employer of domestic workers in cases involving sexual harassment or harassment based on

gender, race, religion or national origin.

In accordance with Executive Order No. 177, the Bidder hereby certifies that it does not have institutional

policies or practices that fail to address the harassment and discrimination of individuals on the basis of

their age, race, creed, color, national origin, sex, sexual orientation, gender identity, disability, marital

status, military status, or other protected status under the Human Rights Law.

Executive Order No. 177 and this certification do not affect institutional policies or practices that are

protected by existing law, including but not limited to the First Amendment of the United States Constitution,

Article 1, Section 3 of the New York State Constitution, and Section 296(11) of the New York State Human

Rights Law.

State Finance Law § 139-l Certification

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the

case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that the

bidder has and has implemented a written policy addressing sexual harassment prevention in the

workplace and provides annual sexual harassment prevention training to all of its employees. Such policy

shall, at a minimum, meet the requirements of section two hundred one-g of the labor law.

If the bidder cannot make the foregoing certification, such bidder shall so state and shall furnish with the

bid a signed statement that sets forth in detail the reasons that the bidder cannot make the certification.

Small Business Certifications

State Finance Law § 163(1)(j) (Authorizes Award of Quantitative Factor Credit for Small Business

Status in Evaluation for Best Value Contracts)

For purposes of New York State Finance Law § 163(1)(j), the contractor certifies that it:

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 11 of 30

__ IS NOT

a Small Business as defined in New York State Executive Law § 310(20).

__ IS a Small Business as defined in New York State Executive Law § 310(20).

“Small Business" is defined under New York State Executive Law § 310(20) as a business that:

A. has a significant business presence in New York demonstrated through one of the following:

1. pays taxes in New York State, or

2. purchases New York State products or materials, or

has any payroll in New York State

B. is independently owned and operated;

C. is not domin

ant in its field; and,

D. employs less than 300 persons.

State Finance Law § 163(6) (Authorizes Discretionary Purchases of Commodities or Services from

Small Business Concerns)

For purposes of New York State Finance Law § 163(6), the contractor certifies that it:

__ IS NOT a Small Business Concern or Small Business as defined in New York State Finance

Law § 160(8).

__ IS a Small Business Concern or Small Business as defined in New York State Finance Law

§ 160(8).

“Small Business Concern” or “Small Business" is defined under New York State Finance Law § 160(8) as

a business that:

A. is resident in New York State;

B. is independently owned and operated;

C. is not dominant in its field; and

D. employs 100 or less persons.

By signing you certify your express authority to sign on behalf of yourself, your company, or

other entity and full knowledge and acceptance of this Certifications document and that all

information provided is complete, true and accurate.

uthorized Si

nature Date

Print Name Title

Compan

Name

D/B/A

–

Doin

Business As

(

if applicable

)

ddress

Cit

State Zip

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 12 of 30

Certification Under Executive Order No. 16- Prohibiting State Agencies and Authorities

from Contracting with Businesses Conducting Business in Russia

Executive Order No. 16 provides that “all Affected State Entities are directed to refrain from entering into

any new contract or renewing any existing contract with an entity conducting business operations in

Russia.” The complete text of Executive Order No. 16 can be found here.

The Executive Order remains in effect while sanctions imposed by the federal government are in effect.

Accordingly, vendors who may be excluded from award because of current business operations in Russia

are nevertheless encouraged to respond to solicitations to preserve their contracting opportunities in case

the sanctions are lifted during a solicitation or even after award in the case of some solicitations.

As defined in Executive Order No. 16, an “entity conducting business operations in Russia” means an

institution or company, wherever located, conducting any commercial activity in Russia or transacting

business with the Russian Government or with commercial entities headquartered in Russia or with their

principal place of business in Russia in the form of contracting, sales, purchasing, investment, or any

business partnership.

Is Vendor an entity conducting business operations in Russia, as defined above? Please answer by

checking one of the following boxes:

1. No, Vendor does not conduct business operations in Russia within the meaning of Executive

Order No. 16.

2.a. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order

No. 16 but has taken steps to wind down business operations in Russia or is in the process of

winding down business operations in Russia. (Please provide a detailed description of the wind

down process and a schedule for completion.)

2.b. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order

No. 16 but only to the extent necessary to provide vital health and safety services within Russia

or to comply with federal law, regulations, executive orders, or directives. (Please provide a

detailed description of the services being provided orthe relevant laws, regulations, etc.)

3. Yes, Vendor conducts business operations in Russia within the meaning of Executive Order

No. 16.

The undersigned certifies under penalties of perjury that they are knowledgeable about the Vendor’s

business and operations and that the answer provided herein is true to the best of their knowledge and

belief.

Authorized Signature Date

Print Name Title

Company Name

Address

City State Zip

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 13 of 30

NYS Department o

f Taxation and Finance - FORMS

CONTRACTOR CERTIFICATION (ST-220-TD 12/11)

CONTRACTOR CERTIFICATION TO COVERED AGENCY

(ST-220-CA 12/11)

New York State – Office of General Services

Solicitation 2639 Insurance Broker of Record

Appendix B- Required Forms

Page 14 of 30

Need help?

Telephone assistance

Sales Tax Information Center: (518) 485-2889

To order forms and publications: (518) 457-5431

Text Telephone (TTY) Hotline (for persons with

hearing and speech disabilities using a TTY): (518) 485-5082

accessible to persons with disabilities.

If you have questions

about special

accommodations for persons with disabilities, call the

information center.

Persons with disabilities: In compliance with the

Americans with Disabilities Act, we will ensure that our

lobbies, ofces, meeting rooms, and other facilities are

Visit our Web site at www.tax.ny.gov

• get information and manage your taxes online

• check for new online services and features

Department of Taxation and Finance

Contractor Certication

(Pursuant to Tax Law Section 5-a, as amended,

effective April 26, 2006)

ST-220-TD

(4/15)

Contractor name

Contractor’s principal place of business City State ZIP code

Contractor’s mailing address (if different than above) City State ZIP code

Contractor’s federal employer identication number (EIN) Contractor’s sales tax ID number (if different from contractor’s EIN) Contractor’s telephone number

( )

Covered agency or state agency Contract number or description Covered agency telephone number

( )

Covered agency address City State ZIP code

Is the estimated contract value over the full term of the contract (but not including renewals) more than $100,000?

Yes No Unknown at this time

For information, consult Publication 223, Questions and Answers Concerning Tax Law Section 5-a (see Need help? below).

General information

Tax Law section 5-a, as amended, effective April 26,

2006, requires certain contractors awarded certain state

contracts valued at more than $100,000 to certify to the Tax

Department that they are registered to collect New York

State and local sales and compensating use taxes, if they

made sales delivered by any means to locations within

New York State of tangible personal property or taxable

services having a cumulative value in excess of $300,000,

measured over a specied period. In addition, contractors

must certify to the Tax Department that each afliate and

subcontractor exceeding such sales threshold during a

specied period is registered to collect New York State

and local sales and compensating use taxes. Contractors

must also le Form ST-220-CA, Contractor Certication to

Covered Agency, certifying to the procuring state entity that

they led Form ST-220-TD with the Tax Department and that

the information contained on Form ST-220-TD is correct and

complete as of the date they le Form ST-220-CA.

All sections must be completed including all elds on the top

of this page, all sections on page 2, Schedule A on page 3, if

applicable, and Individual, Corporation, Partnership, or LLC

Acknowledgement on page 4. If you do not complete these

areas, the form will be returned to you for completion.

For more detailed information regarding this form and

Tax Law section 5-a, see Publication 223, Questions and

Answers Concerning Tax Law Section 5-a, (as amended,

effective April 26, 2006). See Need help? for more

information on how to obtain this publication.

Note: Form ST-220-TD must be signed by a person

authorized to make the certication on behalf of the

contractor, and the acknowledgement on page 4 of this form

must be completed before a notary public.

Mail completed form to:

NYS TAX DEPARTMENT

DATA ENTRY SECTION

W A HARRIMAN CAMPUS

ALBANY NY 12227-0826

Privacy notication

New York State Law requires all government agencies that

maintain a system of records to provide notication of the

legal authority for any request, the principal purpose(s) for

which the information is to be collected, and where it will

be maintained. To view this information, visit our Web site,

or, if you do not have Internet access, call and request

Publication 54, Privacy Notication. See Need help? for the

Web address and telephone number.

Page 2 of 4 ST-220-TD (4/15)

Complete Sections 1, 2, and 3 below. Make only one entry in each section.

Section 1 – Contractor registration status

G The contractor has made sales delivered by any means to locations within New York State of tangible personal property or taxable

services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax

quarter in which this certication is made. The contractor is registered to collect New York State and local sales and compensating use

taxes with the Commissioner of Taxation and Finance pursuant to Tax Law sections 1134 and 1253, and is listed on Schedule A of this

certication.

G The contractor has not made sales delivered by any means to locations within New York State of tangible personal property or taxable

services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax

quarter in which this certication is made.

Section 2 – Afliate registration status

G The contractor does not have any afliates.

G To the best of the contractor’s knowledge, the contractor has one or more afliates having made sales delivered by any means to

locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000

during the four sales tax quarters which immediately precede the sales tax quarter in which this certication is made, and each afliate

exceeding the $300,000 cumulative sales threshold during such quarters is registered to collect New York State and local sales and

compensating use taxes with the Commissioner of Taxation and Finance pursuant to Tax Law sections 1134 and 1253. The contractor

has listed each afliate exceeding the $300,000 cumulative sales threshold during such quarters on Schedule A of this certication.

G To the best of the contractor’s knowledge, the contractor has one or more afliates, and each afliate has not made sales delivered by

any means to locations within New York State of tangible personal property or taxable services having a cumulative value in excess of

$300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certication is made.

Section 3 – Subcontractor registration status

G The contractor does not have any subcontractors.

G To the best of the contractor’s knowledge, the contractor has one or more subcontractors having made sales delivered by any means to

locations within New York State of tangible personal property or taxable services having a cumulative value in excess of $300,000 during

the four sales tax quarters which immediately precede the sales tax quarter in which this certication is made, and each subcontractor

exceeding the $300,000 cumulative sales threshold during such quarters is registered to collect New York State and local sales and

compensating use taxes with the Commissioner of Taxation and Finance pursuant to Tax Law sections 1134 and 1253. The contractor

has listed each subcontractor exceeding the $300,000 cumulative sales threshold during such quarters on Schedule A of this certication.

G To the best of the contractor’s knowledge, the contractor has one or more subcontractors, and each subcontractor has not made sales

delivered by any means to locations within New York State of tangible personal property or taxable services having a cumulative value in

excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this certication is made.

Sworn to this day of , 20

(sign before a notary public) (title)

I, , hereby afrm, under penalty of perjury, that I am

(name) (title)

of the above-named contractor, and that I am authorized to make this certication on behalf of such contractor.

ST-220-TD (4/15) Page 3 of 4

Relationship

contractor

Name

Address

Federal ID number

Sales tax ID number

Registration

in progress

Column A – Enter C in column A if the contractor; A if an afliate of the contractor; or S if a subcontractor.

Column B – Name - If the entity is a corporation or limited liability company, enter the exact legal name as registered with the NY Department

of State, if applicable. If the entity is a partnership or sole proprietor, enter the name of the partnership and each partner’s given

name, or the given name(s) of the owner(s), as applicable. If the entity has a different DBA (doing business as) name, enter that

name as well.

Column C – Address - Enter the street address of the entity’s principal place of business. Do not enter a PO box.

Column D – ID number - Enter the federal employer identication number (EIN) assigned to the entity. If the entity is an individual, enter the

social security number of that person.

Column E – Sales tax ID number - Enter only if different from federal EIN in column D.

Column F – If applicable, enter an X if the entity has submitted Form DTF-17 to the Tax Department but has not received its certicate of

authority as of the date of this certication.

Schedule A – Listing of each entity (contractor, afliate, or subcontractor) exceeding $300,000

cumulative sales threshold

List the contractor, or afliate, or subcontractor in Schedule A only if such entity exceeded the $300,000 cumulative sales threshold during the

specied sales tax quarters. See directions below. For more information, see Publication 223.

Page 4 of 4 ST-220-TD (4/15)

Individual, Corporation, Partnership, or LLC Acknowledgment

STATE 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

he resides at ,

Town of ,

County of ,

State of ; and further that:

(Mark an X in the appropriate box and complete the accompanying statement.)

G (If an individual): _he executed the foregoing instrument in his/her name and on his/her own behalf.

G (If a corporation): _he is the

of , the corporation described in said instrument; that, by authority of the Board

of Directors of said corporation, _he is authorized to execute the foregoing instrument on behalf of the corporation for

purposes set forth therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and

on behalf of said corporation as the act and deed of said corporation.

G (If a partnership): _he is a

of , the partnership described in said instrument; that, by the terms of said

partnership, _he is authorized to execute the foregoing instrument on behalf of the partnership for purposes set forth

therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on behalf of said

partnership as the act and deed of said partnership.

G (If a limited liability company): _he is a duly authorized member of

LLC, the limited liability company described in said instrument; that _he is authorized to execute the foregoing instrument

on behalf of the limited liability company for purposes set forth therein; and that, pursuant to that authority, _he executed

the foregoing instrument in the name of and on behalf of said limited liability company as the act and deed of said limited

liability company.

Notary Public

Registration No.

New York State Department of Taxation and Finance

Contractor Certiﬁcation to Covered Agency

(Pursuant to Section 5-a of the Tax Law, as amended, effective April 26, 2006)

ST-220-CA

(12/11)

Contractor name

Contractor’s principal place of business City State ZIP code

Contractor’s mailing address (if different than above)

Contractor’s federal employer identiﬁcation number (EIN) Contractor’s sales tax ID number (if different from contractor’s EIN)

Contractor’s telephone number Covered agency name

Covered agency address

I, , hereby afﬁrm, under penalty of perjury, that I am

(name) (title)

of the above-named contractor, that I am authorized to make this certiﬁcation on behalf of such contractor, and I further certify

that:

(Mark an X in only one box)

G The contractor has ﬁled Form ST-220-TD with the Department of Taxation and Finance in connection with this contract and, to the best of

contractor’s knowledge, the information provided on the Form ST-220-TD, is correct and complete.

G The contractor has previously ﬁled Form ST-220-TD with the Tax Department in connection with

(insert contract number or description)

and, to the best of the contractor’s knowledge, the information provided on that previously ﬁled Form ST-220-TD, is correct and complete

as of the current date, and thus the contractor is not required to ﬁle a new Form ST-220-TD at this time.

Sworn to this day of , 20

(sign before a notary public) (title)

For covered agency use only

Contract number or description

Estimated contract value over

the full term of contract (but not

including renewals)

Covered agency telephone number

For information, consult Publication 223, Questions and Answers Concerning Tax Law Section 5-a (see Need Help? on back).

Instructions

General information

Tax Law section 5-a was amended, effective April 26, 2006. On or

after that date, in all cases where a contract is subject to Tax Law

section 5-a, a contractor must ﬁle (1) Form ST-220-CA, Contractor

Certiﬁcation to Covered Agency, with a covered agency, and

(2) Form ST-220-TD with the Tax Department before a contract

may take effect. The circumstances when a contract is subject to

section 5-a are listed in Publication 223, Q&A 3. See Need help?

for more information on how to obtain this publication. In addition, a

contractor must ﬁle a new Form ST-220-CA with a covered agency

before an existing contract with such agency may be renewed.

Note: Form ST-220-CA must be signed by a person authorized to make

the certiﬁcation on behalf of the contractor, and the acknowledgement

on page 2 of this form must be completed before a notary public.

When to complete this form

As set forth in Publication 223, a contract is subject to section 5-a, and

you must make the required certiﬁcation(s), if:

i. The procuring entity is a covered agency within the meaning of the

statute (see Publication 223, Q&A 5);

ii. The contractor is a contractor within the meaning of the statute (see

Publication 223, Q&A 6); and

iii. The contract is a contract within the meaning of the statute. This is

the case when it (a) has a value in excess of $100,000 and (b) is a

contract for commodities or services, as such terms are deﬁned for

purposes of the statute (see Publication 223, Q&A 8 and 9).

Furthermore, the procuring entity must have begun the solicitation to

purchase on or after January 1, 2005, and the resulting contract must

have been awarded, amended, extended, renewed, or assigned on or

after April 26, 2006 (the effective date of the section 5-a amendments).

Need help?

Telephone assistance

Sales Tax Information Center: (518) 485-2889

To order forms and publications: (518) 457-5431

Text Telephone (TTY) Hotline (for persons with

hearing and speech disabilities using a TTY): (518) 485-5082

accessible to persons with disabilities.

If you have questions

about special

accommodations for persons with disabilities, call the

information center.

Persons with disabilities: In compliance with the

Americans with Disabilities Act, we will ensure that our

lobbies, ofces, meeting rooms, and other facilities are

Visit our Web site at www.tax.ny.gov

• get information and manage your taxes online

• check for new online services and features

Individual, Corporation, Partnership, or LLC Acknowledgment

STATE 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

he resides at ,

Town of ,

County of ,

State of ; and further that:

[Mark an X in the appropriate box and complete the accompanying statement.]

G (If an individual): _he executed the foregoing instrument in his/her name and on his/her own behalf.

G (If a corporation): _he is the

of , the corporation described in said instrument; that, by authority of the Board

of Directors of said corporation, _he is authorized to execute the foregoing instrument on behalf of the corporation for

purposes set forth therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on

behalf of said corporation as the act and deed of said corporation.

G (If a partnership): _he is a

of , the partnership described in said instrument; that, by the terms of said

partnership, _he is authorized to execute the foregoing instrument on behalf of the partnership for purposes set forth

therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on behalf of said

partnership as the act and deed of said partnership.

G (If a limited liability company): _he is a duly authorized member of ,

LLC, the limited liability company described in said instrument; that _he is authorized to execute the foregoing instrument

on behalf of the limited liability company for purposes set forth therein; and that, pursuant to that authority, _he executed

the foregoing instrument in the name of and on behalf of said limited liability company as the act and deed of said limited

liability company.

Notary Public

Registration No.

Page 2 of 2 ST-220-CA (12/11)

Privacy notiﬁcation

The Commissioner of Taxation and Finance may collect and maintain

personal information pursuant to the New York State Tax Law, including but

not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, 1096,

1142, and 1415 of that Law; and may require disclosure of social security

numbers pursuant to 42 USC 405(c)(2)(C)(i).

This information will be used to determine and administer tax liabilities

and, when authorized by law, for certain tax offset and exchange of tax

information programs as well as for any other lawful purpose.

Information concerning quarterly wages paid to employees is provided

to certain state agencies for purposes of fraud prevention, support

enforcement, evaluation of the effectiveness of certain employment and

training programs and other purposes authorized by law.

Failure to provide the required information may subject you to civil or

criminal penalties, or both, under the Tax Law.

This information is maintained by the Manager of Document Management,

NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone

(518) 457-5181.

EQUAL EMPLOYMENT OPPORTUNITY STAFFING

PLAN

General instructions: Contact the Designated Contact(s) for the solicitation if you have any questions. All Offerors must complete an EEO Staffing Plan

(EEO 100) and submit it as part of the bid or proposal package. Where the work force to be utilized in the performance of the State contract can be separated

out from the contractor’s total work force, the Offeror shall complete this form only for the anticipated work force to be utilized on the State contract. Where the

work force to be utilized in the performance of the State contract cannot be separated out from the contractor’s total work force, the Offeror shall complete this

form for the contractor’s total work force. Subcontractors awarded a subcontract over $25,000 for the construction, demolition, replacement, major repair,

renovation, planning or design of real property and improvements thereon (the "Work") except where the Work is for the beneficial use of the Contractor must

complete this form upon request of OGS.

nstructions for completing:

1. Enter the Solicitation Number that this report applies to along with the name and address of the Offeror.

2. Check off the appropriate box to indicate if the Offeror completing the report is the contractor or a subcontractor.

3. Check off the appropriate box to indicate if the work force being reported is just for the contract or the Offerors’ total work force.

4. Enter the total work force by EEO job category.

5. Break down the total work force by gender and enter under the heading “Work force by Gender.”

6. Break down the total work force by race/ethnic background and enter under the heading “Work force by Race/Ethnic Identification.” Enter the name,

title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes.

ACE/ETHNIC IDENTIFICATION

Race/ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. For the

purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as

belonging. However, no person should be counted in more than one race/ethnic group. The race/ethnic categories for this survey are:

HITE - (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

BLACK - A person, not of Hispanic origin, who has origins in any of the black racial groups of the original peoples of Africa.

ISPANIC - A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

SIAN & PACIFIC - A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.

ISLANDER

ERICAN INDIAN - A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal

OR ALASKAN affiliation or community recognition.

NATIVE (Not of Hispanic Origin)

EEO100_Instructions Rev02

EQUAL EMPLOYMENT OPPORTUNITY STAFFING PLAN

SUBMIT WITH BID OR PROPOSAL or within a reasonable time thereafter as requested by OGS, but prior to Contract Award.

Solicitation No.:

Reporting Entity:

Contractor

Subcontractor

Report includes Contractor’s

Contractor’s work force to be utilized on this contract

Contractor’s total work force

Subcontractor’s work force to be utilized on this contract

Subcontractor’s total work force

Contractor/Subcontractor’s Name:

Contractor/Subcontractor’s Address:

FEIN:

Enter the total number of employees for each classification:

EEO Job Category Total

Work

Force

Work force by

Gender

Work force by

Race/Ethnic Identification

Total

Male

(M)

Total

Female

(F)

White

(M) (F)

Black

(M) (F)

Hispanic

(M) (F)

Asian

(M) (F)

American

Indian or

Alaskan Native

(M) (F)

Veteran

(M) (F)

Executive/Senior level

Officials & Managers

First/Mid-level officials

& Managers

Professionals

Technicians

Sales Workers

Administrative Support

Workers

Craft Workers

Operatives

Laborers and Helpers

Service Workers

Totals

PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type):

EEO 100 Rev05

2639

Employee Information To Be Reported By Certain Consultant Contractors

Instructions for Completing Form A and B

Form A and Form B should be completed for contracts for consulting services in accordance with the

following

Form A - Contractor’s Planned Employment (to be completed and submitted with bid/quote)

• Employment Category: enter the specific occupation(s), as listed in the O*NET occupational

classification system, which best describe the planned employees to provide services under the

contract.

(Note: Access the O*NET database, which is available through the US Department of Labor’s Employment

and Training Administration, on-line at online.onetcenter.org

to find a list of occupations.)

• Number of Employees: enter the total number of employees in the employment category to be

employed to provide services under the contract including part time employees and employees of

subcontractors.

• Number of hours: enter the total number of hours to be worked by the employees in the

employment category.

• Amount Payable under the Contract: enter the total amount payable by the State to the State

contractor under the contract, for work by the employees in the employment category.

Form B – Contractor’s Annual Employment Report. (to be completed by May 1

of each year for each

consultant contract in effect at any time between the preceding April 1

through March 31

fiscal year and

submitted to the Department of Civil Service, Office of the State Comptroller and Office of General Services)

• Scope of Contract: choose a general classification of the single category that best fits the

predominate nature of the services provided under the contract.

• Employment Category: enter the specific occupation(s), as listed in the O*NET occupational

classification system, which best describe the employees providing services under the contract.

(Note: Access the O*NET database, which is available through the US Department of Labor’s Employment

and Training Administration, on-line at online.onetcenter.org

to find a list of occupations.)

• Number of Employees: enter the total number of employees in the employment category

employed to provide services under the contract during the report period, including part time

employees and employees of subcontractors.

• Number of hours: enter the total number of hours worked during the report period by the

employees in the employment category.

• Amount Payable under the Contract: enter the total amount paid by the State to the State

contractor under the contract, for work by the employees in the employment category, for services

provided during the report period.

OSC Use Only:

Reporting Code:

Category Code:

Date Contract Approved:

FORM A

State Consultant Services - Contractor's Planned Employment

From Contract Start Date Through The End Of The Contract Term

State Agency Name:

Agency Code:

Contractor Name:

Contract Number:

Contract Start Date: / /

Contract End Date: / /

O*Net Employment Category

(see O*Net on-line at online.onetcenter.org)

Number of

Employees

Number of hours to

be worked

Amount Payable Under

the Contract

Total this page

$ 0.00

Grand Total

Name of person who prepared this report:

Title:

Phone #:

Preparer's Signature:

Date Prepared: / /

(Use additional pages, if necessary)

Page of

FORM B

OSC Use Only:

Reporting Code:

Category Code:

State Consultant Services

Contractor’s Annual Employment Report

Report Period: April 1, to March 31,

Contracting State Agency Name: Agency Code:

Contract Number:

Contract Term: / / to / /

Contractor Name:

Contractor Address:

Description of Services Being Provided:

Scope of Contract (Choose one that best fits):

Analysis Evaluation Research Training

Data Processing Computer Programming Other IT consulting

Engineering Architect Services Surveying Environmental Services

Health Services Mental Health Services

Accounting Auditing Paralegal Legal Other Consulting

O*Net Employment Category

(see O*Net on-line at online.onetcenter.org)

Number of Employees Number of Hours Worked

Amount Payable Under

the Contract

Total this page

$ 0.00

Grand Total

Name of person who prepared this report:

Preparer's Signature:___________________________________________________

Title:

Phone #:

Date Prepared: / /

Use additional pages if necessary)

Page of

543

RFP Appendix C

Sample Contract

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

STATE OF NEW YORK

OFFICE OF GENERAL SERVICES

AGREEMENT FOR

INSURANCE BROKER OF RECORD

WITH

(CONTRACTOR)

_________CONTRACT #OGS01-C00XXXX-1140000_________

THIS AGREEMENT, made this ____ day of ___________, 20__ by and between the People of

the State of New York, acting by and through the Commissioner of General Services, whose office

is in the Corning Tower Building, at the Governor Nelson A. Rockefeller Empire State Plaza,

Albany, New York 12242 (hereinafter “Commissioner”, "OGS" or "State"), and (Company Name),

(hereinafter "Contractor"), with an office at __________________________.

W I T N E S S E T H:

WHEREAS, the OGS is responsible for the marketing and placement of insurance policies for

OGS and its customers and in fulfilling its responsibility deems it necessary to obtain an insurance

broker of record therefore, and

WHEREAS, OGS has determined after having solicited proposals from proposers willing to supply

these services, that the Contractor submitted the proposal affording the State the best value for

such services and that the Contractor possesses the necessary capacity, experience and

expertise for provision of insurance broker of record services, and that Contractor is ready, willing

and able to perform such services on the terms hereinafter set forth.

NOW THEREFORE, in consideration of the mutual covenants herein contained, the parties do

hereby agree as follows:

1. CONSIDERATION

OGS shall pay the Contractor for all insurance broker of record fees and other fees and expenses

in accordance with the amounts and rates put forth in the Contractor’s proposal attached hereto

as Appendix "C", which Appendix C is hereby incorporated by reference and made a part hereof

as fully as if set forth as length herein. This contract will be established with a not to exceed value

of $__________. Services performed beyond this amount will not be compensated.

2. TERM

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

Five years plus any knowledge transfer period

3. SERVICES

The Contractor agrees to perform this Agreement and to furnish the services, labor and materials

required in connection therewith in accordance with all the specifications, conditions, covenants

and representations contained in the Request for Proposals No. 2639, which is annexed as

Appendix "B" hereto, and the Contractor’s bid, annexed as Appendix “C” hereto, except as such

Appendices B and C have been revised by the terms hereof. Appendix B is hereby incorporated

by reference and made a part hereof with the same force and effect as if set forth at length herein.

4. TERMINATION

This Agreement may be terminated in accordance with the termination provisions set forth in the

solicitation attached hereto as Appendix B hereof.

5. RECORDS

The Contractor will maintain accurate records and accounts of services performed and monies

expended under this Agreement. Such records will be maintained for six (6) years following the

close of the State fiscal year to which they pertain and will be made available to representatives

of OGS or the New York State Comptroller, as may be necessary for auditing purposes, upon

request.

6. TAXES

The Contractor will be responsible for all applicable Federal, State and Local taxes and all FICA

contributions.

7. INDEPENDENT CONTRACTOR

It is understood and agreed that the legal status of the Contractor, its subcontractors, agents,

officers and employees is that of an independent contractor and in no manner shall they be

deemed employees or agents of the State of New York and, therefore, are not entitled to any of

the benefits associated with such employment or designation.

8. APPENDIX A

Appendix A, Standard Clauses for New York State Contracts, attached hereto, is hereby

expressly made a part of this Agreement as fully as if set forth at length herein.

9. ASSIGNMENT

Contractor agrees that it will not assign this Agreement, or any interest therein without the prior

written consent of the Commissioner of General Services.

10. LAW

This Agreement shall be governed by the laws of the State of New York.

11. CONDITIONS PRECEDENT

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

This Agreement shall not be deemed executed, valid or binding unless and until approved in

writing by the Attorney General and the State Comptroller.

12. ENTIRE AGREEMENT

This Agreement constitutes the entire Agreement between the parties hereto and no statement,

promise, condition, understanding, inducement or representation, oral or written, expressed or

implied, which is not contained herein shall be binding or valid and this Agreement shall not be

changed, modified or altered in any manner except by an instrument in writing executed by both

parties hereto.

13. EXECUTORY CLAUSE

This Agreement shall be deemed executory only to the extent of money available to the State for

performance of the terms hereof and no liability on account thereof shall be incurred by the State

of New York beyond moneys available for purposes thereof.

14. INCONSISTENCIES

In the event of any discrepancy, disagreement or ambiguity between this contract agreement and

Appendix B "Solicitation" and/or Appendix C "Bid", or between any Appendices, the documents

shall be given preference in the following order to interpret and to resolve such discrepancy,

disagreement or ambiguity:

1. Appendix A

2. This Contract Agreement

3. Appendix B – Solicitation #2639 including Addenda

4. Appendix C – Contractor’s Bid

The parties understand and agree that any and all deviations or exceptions taken by Contractor

to the State's Invitation to Bid are hereby withdrawn except only to the extent that such exceptions

or deviations have been explicitly incorporated into this contract agreement.

15. FORCE MAJEURE

Neither party hereto will be liable for losses, defaults, or damages under this Agreement which

result from delays in performing, or inability to perform, all or any of the obligations or

responsibilities imposed upon it pursuant to the terms and conditions of this Agreement, due to

or because of acts of God, the public enemy, acts of government, earthquakes, floods, strikes,

civil strife, fire or any other cause beyond the reasonable control of the party that was so delayed

in performing or so unable to perform provided that such party was not negligent and shall have

used reasonable efforts to avoid and overcome such cause. Such party will resume full

performance of such obligations and responsibilities promptly upon removal of any such cause.

16. ASSIGNMENT BY STATE

The State agrees not to assign this Agreement without prior notice to and reasonable consent of

the Contractor provided, however, that this Agreement may be assigned without such consent to

another agency or subdivision of the State pursuant to a governmental reorganization or

assignment of functions under which the pertinent functions of OGS as an agency are transferred

to a successor agency or subdivision of the State.

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

17. NOTICES

All notices, demands, designations, certificates, requests, offers, consents, approvals and other

instruments given pursuant to this Agreement shall be in writing and shall be validly given when

mailed by registered or certified mail, overnight carrier or hand delivered, (i) if to the State,

addressed to the State at its address set forth above, and (ii) if to Contractor, addressed to

Contractor at its address set forth above. The parties may from time to time, specify any address

in the United States as its address for purpose of notices under this Agreement by giving fifteen

(15) days written notice to the other party. The parties agree to mutually designate individuals as

their respective representatives for the purposes of this Agreement.

18. CAPTIONS

The captions contained in this Agreement are intended for convenience and reference purposes

only and shall in no way be deemed to define or limit any provision thereof.

19. SEVERABILITY

In the event that any one or more of the provisions of this Agreement shall for any reason be

declared unenforceable under the laws or regulations in force, such provision will not have any

effect on the validity of the remainder of this Agreement, which shall then be construed as if such

unenforceable provision had never been written or was never contained in this Agreement.

20. INFORMATION SECURITY BREACH

In accordance with the Information and Security Breach Notification Act (ISBNA) (Chapter 442 of

the Laws of 2005, as amended by Chapter 491 of the Laws of 2005), a Contractor with OGS shall

be responsible for all applicable provisions of the ISBNA and the following terms herein with

respect to any private information (as defined in the ISBNA) received by or on behalf of OGS

under this Agreement.

• Contractor shall supply OGS with a copy of its notification policy, which shall be modified

to be in compliance with this provision, as well as OGS’s notification policy.

• Contractor must encrypt any database fields and backup tapes that contain private data

elements, as set forth in the ISBNA.

• Contractor must ensure that private data elements are encrypted in transit to / from their

systems.

• In general, contractor must ensure that private data elements are not displayed to users

on computer screens or in printed reports; however, specific users who are authorized to

view the private data elements and who have been properly authenticated may

view/receive such data.

• Contractor must monitor for breaches of security to any of its systems that store or process

private data owned by OGS.

• Contractor shall take all steps as set forth in ISBNA to ensure private information shall not

be released without authorization from OGS.

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

• In the event a security breach occurs as defined by ISBNA Contractor shall immediately

notify OGS and commence an investigation in cooperation with OGS to determine the

scope of the breach.

• Contractor shall also take immediate and necessary steps needed to restore the

information security system to prevent further breaches.

• Contractor shall immediately notify OGS following the discovery that OGS’s system

security has been breached.

• Unless the Contractor is otherwise instructed, Contractor is to first seek consultation and

receive authorization from OGS prior to notifying the individuals whose personal identity

information was compromised by the breach of security, the New York State Chief

Information Security Office, the Department of State Division of Consumer Protection, the

Attorney General’s Office or any consuming reporting agencies of a breach of the

information security system or concerning any determination to delay notification for law

enforcement investigations.

• Contractor shall be responsible for providing all notices required by the ISBNA and for all

costs associated with providing said notices.

• This policy and procedure shall not impair the ability of the Attorney General to bring an

action against the Contractor to enforce all provisions of the ISBNA or limit the Contractor’s

liability for any violations of the ISBNA.

21. CONTRACTOR RESPONSIBILITY

The Contractor shall at all times during the Contract term remain responsible. The Contractor

agrees, if requested by the Commissioner of OGS or her designee, to present evidence of its

continuing legal authority to do business in New York State, integrity, experience, ability, prior

performance, and organizational and financial capacity.

The Commissioner of OGS or her designee, in his or her sole discretion, reserves the right to

suspend any or all activities under this Contract, at any time, when he or she discovers information

that calls into question the responsibility of the Contractor. In the event of such suspension, the

Contractor will be given written notice outlining the particulars of such suspension. Upon issuance

of such notice, the Contractor must comply with the terms of the suspension order. Contract

activity may resume at such time as the Commissioner of OGS or her designee issues a written

notice authorizing a resumption of performance under the Contract.

Upon written notice to the Contractor, and a reasonable opportunity to be heard with appropriate

OGS officials or staff, the Contract may be terminated by the Commissioner of OGS or her

designee at the Contractor’s expense where the Contractor is determined by the Commissioner

of OGS or her designee to be non-responsible. In such event, the Commissioner of OGS or her

designee may complete the contractual requirements in any manner he or she may deem

advisable and pursue available legal or equitable remedies for breach.

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

In no case shall such termination of the Contract by the State be deemed a breach thereof, nor

shall the State be liable for any damages for lost profits or otherwise, which may be sustained by

the Contractor as a result of such termination.

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

CONTRACT NO. C00XXXX

IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day

and year first above written.

Agency Certification

"In addition to the acceptance of this Contract, I

also certify that original copies of this signature

page will be attached to all other exact copies of

this contract."

(Company Name) THE PEOPLE OF THE STATE OF NEW YORK

By:____________________________ By:____________________________

Name: Name:

Title: Title:

Federal I.D. No.: Date:

Date:

APPROVED AS TO FORM APPROVED

Attorney General State Comptroller

STATE OF )

) ss.:

COUNTY OF ______________ )

On the _____ day of ___________ in the year 20__, before me, the undersigned, personally appeared

__________________________ personally known to me or proved to me on the basis of satisfactory

evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and

acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by

his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the

individual(s) acted, executed the instrument.

_____________________

Notary Public

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

Sample Contract

Appendix A

STANDARD CLAUSES FOR NEW YORK STATE

CONTRACTS

[Text not included at this time because it is included

elsewhere in the solicitation. Will be added when contract

is finalized]

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

Sample Contract

Appendix B

Request for Proposals

2639

New York State – Office of General Services

Solicitation 2639- Insurance Broker of Record

Appendix C- Sample Contract

Sample Contract

Appendix C

Contractor’s Proposal

RFP Appendix D

Insurance Requirements

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

Insurance Requirements

The Bidder shall be required to procure, at its sole cost and expense, all insurance required by this

Attachment.

The Bidder shall be required to provide proof of compliance with the requirements of this Attachment,

as follows:

• Proof of all insurance required by Section B below shall be provided in accordance with the

provisions hereof;

• After award, the Contractor shall be required to provide proof of all insurance after renewal or

upon request according to the timelines set forth in Section A.13 below.

Contractors shall be required to procure, at their sole cost and expense, and shall maintain in force

at all times during the term of any Contract resulting from this Solicitation, policies of insurance as

required by this Attachment. All insurance required by this Attachment shall be written by companies

that have an A.M. Best Company rating of “A-,” Class “VII” or better. In addition, companies writing

insurance intended to comply with the requirements of this Attachment should be licensed or

authorized by the New York State Department of Financial Services to issue insurance in the State

of New York. OGS may, in its sole discretion, accept policies of insurance written by a non-

authorized carrier or carriers when certificates and/or other policy documents are accompanied by a

completed Excess Lines Association of New York (ELANY) affidavit or other documents

demonstrating the company’s strong financial rating. If, during the term of a policy, the carrier’s A.M.

Best rating falls below “A-,” Class “VII,” the insurance must be replaced, on or before the renewal

date of the policy, with insurance that meets the requirements above.

Bidders and Contractors shall deliver to OGS evidence of the insurance required by this Solicitation

and any Contract resulting from this Solicitation in a form satisfactory to OGS. Policies must be

written in accordance with the requirements of the paragraphs below, as applicable. While

acceptance of insurance documentation shall not be unreasonably withheld, conditioned or delayed,

acceptance and/or approval by OGS does not, and shall not be construed to, relieve Bidders or

Contractors of any obligations, responsibilities or liabilities under this Solicitation or any Contract

resulting from this Solicitation.

The Contractor shall not take any action, or omit to take any action that would suspend or invalidate

any of the required coverages during the term of the Contract.

A. General Conditions Applicable to Insurance. All policies of insurance required by this

Solicitation or any Contract resulting from this Solicitation shall comply with the following

requirements:

1. Coverage Types and Policy Limits. The types of coverage and policy limits required

from Bidders and Contractors are specified in Paragraph B Insurance Requirements below.

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

2. Policy Forms. Except as otherwise specifically provided herein, or agreed to in the

Contract resulting from this Solicitation, all policies of insurance required by this Attachment

shall be written on an occurrence basis. In the event that occurrence-based coverage is not

commercially available, claims-made policy forms will be considered provided that, at

minimum, it includes provisions that allow for (a) reporting circumstances or incidents that

may give rise to future claims and (b) an extended reporting period of not less than three (3)

years with respect to events that occurred but were not reported during the term of the policy.

3. Certificates of Insurance/Notices. Bidders and Contractors shall provide OGS with

a Certificate or Certificates of Insurance, in a form satisfactory to OGS as detailed below, and

pursuant to the timelines set forth in Section A.13. below. Certificates shall name The New

York State Office of General Services, Agency Procurement Office, 32

Floor, Corning

Tower, Empire State Plaza, Albany, New York 12242 as the certificate holder.

Certificates of Insurance shall:

• Be in the form acceptable to OGS and in accordance with the New York State Insurance

Law (e.g., an ACORD 25 certificate);

• Disclose any deductible, self-insured retention, aggregate limit or exclusion to the policy

that materially changes the coverage required by this Solicitation or any Contract resulting

from this Solicitation;

• Be signed by an authorized representative of the referenced insurance carriers; and

• Contain the following language in the Description of Operations / Locations / Vehicles

section of the Certificate or on a submitted endorsement: Additional insured protection

afforded is on a primary and non-contributory basis. A waiver of subrogation is

granted in favor of the additional insureds.

Only original documents (certificates of insurance and any endorsements and other attachments)

or electronic versions of the same that can be directly traced back to the insurer, agent or broker

via e-mail distribution or similar means will be accepted.

OGS requires Contractors to submit only certificates of insurance and additional insured

endorsements. Contractors should refrain from submitting entire insurance policies. If an entire

insurance policy is submitted but not requested, OGS shall not be obligated to review and shall

not be chargeable with knowledge of its contents. In addition, submission of an entire insurance

policy not requested by OGS does not constitute proof of compliance with the insurance

requirements and does not discharge Contractors from submitting the requested insurance

documentation. OGS reserves the right to request other proof of insurance, including, but not

limited to, policies, and Contractors agree to comply with all reasonable requests.

4. Primary Coverage. All Commercial General Liability, Business Automobile Liability,

and Excess Umbrella Liability insurance policies shall provide that the required coverage

shall be primary and non-contributory to other insurance available to the People of the State

of New York, the New York State Office of General Services, and their officers, agents, and

employees. Any other insurance maintained by the People of the State of New York, the New

York State Office of General Services, and their officers, agents, and employees shall be

excess of and shall not contribute with the Bidder/Contractor’s insurance.

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

5. Breach for Lack of Proof of Coverage. The failure to comply with the requirements

of this Attachment at any time during the term of the Contract shall be considered a breach

of the terms of the Contract and shall allow the People of the State of New York, the New

York State Office of General Services, and their officers, agents, and employees to avail

themselves of all remedies available under the Contract or at law or in equity.

6. Self-Insured Retention/Deductibles. Certificates of Insurance must indicate the

applicable deductibles/self-insured retentions for each listed policy. Deductibles or self-

insured retentions above $100,000.00 are subject to approval from OGS. Such approval shall

not be unreasonably withheld, conditioned or delayed. Bidders and Contractors shall be

solely responsible for all claim expenses and loss payments within the deductibles or self-

insured retentions. If the Bidder/Contractor is providing the required insurance through self-

insurance, evidence of the financial capacity to support the self-insurance program along with

a description of that program, including, but not limited to, information regarding the use of a

third-party administrator shall be provided upon request.

7. Subcontractors. Prior to the commencement of any work by a Subcontractor, the

Contractor shall require such Subcontractor to procure policies of insurance as required by

this Attachment and maintain the same in force during the term of any work performed by that

Subcontractor. An Additional Insured Endorsement CG 20 38 12 19 (or the equivalent)

evidencing such coverage shall be provided to the Contractor prior to the commencement of

any work by a subcontractor and pursuant to the timelines set forth in Section A.13. below,

as applicable. For subcontractors that are self-insured, the subcontractor shall be obligated

to defend and indemnify the above-named additional insureds with respect to Commercial

General Liability and Business Automobile Liability, in the same manner that the

subcontractor would have been required to pursuant to this section had the subcontractor

obtained such insurance policies.

8. Waiver of Subrogation. For all Commercial General Liability, Business Automobile

Liability, Excess/Umbrella Liability policies and the workers’ compensation insurance required

below, the Bidder/Contractor shall cause to be included in its policies insuring against loss,

damage or destruction by fire or other insured casualty a waiver of the insurer’s right of

subrogation against The People of the State of New York, the New York State Office of

General Services, and their officers, agents, and employees, or, if such waiver is unobtainable

(i) an express agreement that such policy shall not be invalidated if the Contractor waives or

has waived before the casualty, the right of recovery against The People of the State of New

York, the New York State Office of General Services, and their officers, agents, and

employees or (ii) any other form of permission for the release of The People of the State of

New York, the New York State Office of General Services, and their officers, agents, and

employees. A Waiver of Subrogation Endorsement shall be provided upon request. A blanket

Waiver of Subrogation Endorsement evidencing such coverage is also acceptable.

9. Additional Insured. The Contractor shall cause to be included in each of the

Commercial General Liability, Business Automobile Liability, and Excess/Umbrella Liability

policies required below for ongoing work and operations naming as additional insured (via

ISO form CG 20 10 12 19 and form CA 20 48 10 13, or a form or forms that provide equivalent

coverage): The People of the State of New York, the New York State Office of General

Services, and their officers, agents, and employees. An Additional Insured Endorsement, or

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

the equivalent, evidencing such coverage shall be provided to OGS pursuant to the timelines

set forth in Section A.13. below. A blanket Additional Insured Endorsement evidencing such

coverage is also acceptable. For Contractors who are self-insured, the Contractor shall be

obligated to defend and indemnify the above-named additional insureds with respect to

Commercial General Liability and Business Automobile Liability, in the same manner that the

Contractor would have been required to pursuant to this Attachment had the Contractor

obtained such insurance policies.

10. Excess/Umbrella Liability Policies. Required insurance coverage limits may be

provided through a combination of primary and excess/umbrella liability policies. If coverage

limits are provided through excess/umbrella liability policies, then a Schedule of underlying

insurance listing policy information for all underlying insurance policies (insurer, policy

number, policy term, coverage and limits of insurance), including proof that the

excess/umbrella insurance follows form must be provided upon request.

11. Notice of Cancellation or Non-Renewal. Policies shall be written so as to include

the requirements for notice of cancellation or non-renewal in accordance with the New York

State Insurance Law. Within five (5) business days of receipt of any notice of cancellation or

non-renewal of insurance, the Contractor shall provide OGS with a copy of any such notice

received from an insurer together with proof of replacement coverage that complies with the

insurance requirements of this Solicitation and any Contract resulting from this Solicitation.

12. Policy Renewal/Expiration Upon policy renewal/expiration, evidence of renewal or

replacement of coverage that complies with the insurance requirements set forth in this

Solicitation and any Contract resulting from this Solicitation shall be delivered to OGS. If, at

any time during the term of any Contract resulting from this Solicitation, the coverage

provisions and limits of the policies required herein do not meet the provisions and limits set

forth in this Solicitation or any Contract resulting from this Solicitation, or proof thereof is not

provided to OGS, the Contractor shall immediately cease work. The Contractor shall not

resume work until authorized to do so by OGS.

13. Deadlines for Providing Insurance Documents after Renewal or Upon Request.

As set forth herein, certain insurance documents must be provided to the OGS Agency

Procurement Office contact identified in the Contract Award Notice after renewal or upon

request. This requirement means that the Contractor shall provide the applicable insurance

document to OGS as soon as possible but in no event later than the following time periods:

• For certificates of insurance: 5 business days;

• For information on self-insurance or self-retention programs: 15 calendar days from

request or renewal;

• For other requested documentation evidencing coverage: 15 calendar days from

request or renewal;

• For additional insured and waiver of subrogation endorsements: 30 calendar days

from request or renewal; and

• For notice of cancellation or non-renewal and proof of replacement coverage that

complies with the requirements of this section: 5 business days from request or

renewal.

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

Notwithstanding the foregoing, if the Contractor shall have promptly requested the insurance

documents from its broker or insurer and shall have thereafter diligently taken all steps

necessary to obtain such documents from its insurer and submit them to OGS, OGS shall

extend the time period for a reasonable period under the circumstances, but in no event shall

the extension exceed 30 calendar days.

B. Insurance Requirements

Bidders and Contractors shall obtain and maintain in full force and effect, throughout the term of

any Contract resulting from this Solicitation, at their own expense, the following insurance with

limits not less than those described below and as required by the terms of any Contract resulting

from this Solicitation, or as required by law, whichever is greater:

Insurance Type

Proof of

Coverage is

Due

Commercial General Liability

No less than $1,000,000 each occurrence

Upon notification

of award and

updated in

accordance with

Contract

General Aggregate

$2,000,000

Products-Completed Operations Aggregate

$2,000,000

Personal and Advertising Injury

$100,000

Business Automobile Liability Insurance

No less than $1,000,000 each claim

Professional Liability

No less than $2,000,000 each claim

Data Breach/Cyber Liability

No less than $2,000,000 each claim

Workers’ Compensation

With bid

submission

Disability Benefits

1. Commercial General Liability Insurance: Such liability shall be written on the current

edition of ISO occurrence form CG 00 01, or a substitute form providing equivalent coverage.

Policy shall include bodily injury, property damage and broad form contractual liability

coverage.

• General Aggregate

• Products-Completed Operations Aggregate

• Personal and Advertising Injury

• Each Occurrence

Coverage shall include, but not be limited to, the following:

• Premises liability arising from operations;

• Independent contractors;

• Blanket contractual liability, including tort liability of another assumed in a contract;

• Defense and/or indemnification obligations, including obligations assumed under the

Contract;

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

• Cross liability for additional insureds; and

• Products/completed operations for a term of no less than one (1) year, commencing

upon acceptance of the work, as required by the Contract.

2. Business Automobile Liability Insurance: Such insurance shall cover liability arising

out of automobiles used in connection with performance under the Contract, including owned,

leased, hired and non-owned automobiles bearing or, under the circumstances under which

they are being used, required by the Motor Vehicles Laws of the State of New York to bear,

license plates.

In the event that the Contractor does not own, lease or hire any automobiles used in

connection with performance under the Contract, the Contractor does not need to obtain

Business Automobile Liability Insurance, but must attest to the fact that the Contractor does

not own, lease or hire any automobiles used in connection with performance under the

Contract on a form provided by OGS. If, however, during the term of the Contract, the

Contractor acquires, leases or hires any automobiles that will be used in connection with

performance under the Contract, the Contractor must obtain Business Automobile Liability

Insurance that meets all of the requirements of this section and provide proof of such

coverage to OGS in accordance with the insurance requirements of any Contract resulting

from this Solicitation.

3. Professional Liability: Such insurance shall apply to professional errors, acts, or

omissions arising out of the scope of services (i.e. professional services, professional advice,

failure to offer appropriate coverage or adequate limits on policies).

• Such insurance shall apply to professional errors, acts, or omissions arising out of the

scope of services.

• If coverage is written on a claims-made policy, the Contractor warrants that any applicable

retroactive date precedes the start of work; and that continuous coverage will be

maintained, or an extended discovery period exercised, throughout the performance of

the services and for a period of not less than one (1) year from the time work under any

Contract resulting from this Solicitation is completed or must agree to insure for one year

following any Contract under award. Written proof of this extended reporting period or

agreement must be provided to OGS upon request.

• The policy shall cover professional misconduct or lack of ordinary skill for those positions

defined in the Scope of Services of any Contract resulting from this Solicitation.

If coverage is provided as underlying coverage of another policy, all requirements must be

met within the primary policy.

4. Data Breach/Cyber Liability: Contractors are required to maintain during the term of

any Contract resulting from this Solicitation and as otherwise required herein, Data Breach

and Privacy/Cyber Liability Insurance, including coverage for failure to protect confidential

information and failure of the security of the Contractor’s computer systems or the Authorized

Users’ systems due to the actions of the Contractor which results in unauthorized access to

the Authorized User(s) or their data.

Said insurance shall provide coverage for damages arising from, but not limited to the

following:

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

• Breach of duty to protect the security and confidentiality of nonpublic proprietary

corporate information;

• Personally identifiable nonpublic information (e.g., medical, financial, or personal in

nature in electronic or non-electronic form);

• Privacy notification costs;

• Regulatory defense and penalties;

• Website media liability; and

• Cyber theft of customer’s property, including but not limited to money and securities.

If the policy is written on a claims-made basis, the policy shall provide the option to purchase

an Extended Reporting Period (“tail coverage”) providing coverage for no less than one (1)

year after work is completed in the event that coverage is cancelled or not renewed or must

agree to insure for one year following any Contract under award. This requirement applies to

both primary and excess liability policies, as applicable.

If coverage is provided as underlying coverage of another policy, all requirements must be

met within the primary policy.

5. Workers’ Compensation Insurance and Disability Benefits Requirements

Sections 57 and 220 of the New York State Workers’ Compensation Law require the heads

of all municipal and state entities to ensure that businesses applying for contracts have

appropriate workers’ compensation and disability benefits insurance coverage. These

requirements apply to both original contracts and renewals. Failure to provide proper proof

of such coverage or a legal exemption will result in a rejection of a Bid or any contract

renewal. A Bidder will not be awarded a Contract unless proof of workers’

compensation and disability insurance is provided to OGS. Proof of workers’

compensation and disability benefits coverage, or proof of exemption must be submitted to

OGS at the time of notification of tentative award, policy renewal, contract renewal and upon

request. Proof of compliance must be submitted on one of the following forms designated by

the New York State Workers’ Compensation Board. An ACORD form is not acceptable

proof of New York State workers’ compensation or disability benefits insurance

coverage.

Proof of Compliance with Workers’ Compensation Coverage Requirements:

• Form CE-200, Certificate of Attestation for New York Entities With No Employees and

Certain Out of State Entities, That New York State Workers’ Compensation and/or

Disability Benefits Insurance Coverage is Not Required, which is available on the Workers’

Compensation Board’s website (www.businessexpress.ny.gov);

• Form C-105.2 (9/15), Certificate of Workers’ Compensation Insurance, sent to OGS by

the Contractor’s insurance carrier upon request, or if coverage is provided by the New

York State Insurance Fund, they will provide Form U-26.3 to OGS upon request from the

Contractor; or

• Form SI-12, Certificate of Workers’ Compensation Self-Insurance, available from the New

York State Workers’ Compensation Board’s Self-Insurance Office, or

• Form GSI-105.2, Certificate of Participation in Workers’ Compensation Group Self-

Insurance, available from the Contractor’s Group Self-Insurance Administrator.

Proof of Compliance with Disability Benefits Coverage Requirements:

New York State – Office of General Services

Solicitation 2639-Broker of Record

Appendix D- Insurance Requirements

• Form CE-200, Certificate of Attestation for New York Entities With No Employees and

Certain Out of State Entities, That New York State Workers’ Compensation and/or

Disability Benefits Insurance Coverage is Not Required, which is available on the Workers’

Compensation Board’s website (www.businessexpress.ny.gov);

• Form DB-120.1, Certificate of Disability Benefits Insurance, sent to OGS by the

Contractor’s insurance carrier upon request; or

• Form DB-155, Certificate of Disability Benefits Self-Insurance, available from the New

York State Workers’ Compensation Board’s Self-Insurance Office.

Information clarifying the New York State Workers’ Compensation Law requirements is

available at the New York State Workers’ Compensation Board’s website,

http://www.wcb.ny.gov/content/main/Employers/requirements-businesses-applying-

government-permits-licenses-contracts.pdf .

Contractor acknowledges that failure to obtain and/or keep in effect any or all required

insurance on behalf of OGS constitutes a material breach of contract and subjects it

to liability for damages, indemnification and all other legal remedies available to OGS.

Contractor’s failure to obtain and/or keep in effect any or all required insurance shall

also provide the basis for OGS’ immediate termination of any contract resulting from

this Solicitation, subject only to a five (5) business day cure period. Any termination

by OGS under this section shall in no event constitute or be deemed a breach of any

contract resulting from this Solicitation and no liability shall be incurred by or arise

against the Office of General Services, its agents and employees therefore for lost

profits or any other damages.

RFP Appendix E

M/WBE and EEO Requirements

New York State – Office of General Services

Solicitation 2639 – Insurance Broker of Record

Appendix E- M/WBE and EEO Requirements

CONTRACTOR REQUIREMENTS AND PROCEDURES FOR PARTICIPATION BY NEW

YORK STATE CERTIFIED MINORITY- AND WOMEN-OWNED BUSINESS ENTERPRISES

AND EQUAL EMPLOYMENT OPPORTUNITIES FOR MINORITY GROUP MEMBERS AND

WOMEN

I. New York State Law

Pursuant to New York State Executive Law Article 15-A and Parts 140-145 of Title 5 of the New York Codes,

Rules and Regulations (“NYCRR”), the New York State Office of General Services (“OGS”) is required to

promote opportunities for the maximum feasible participation of New York State-certified Minority- and

Women-Owned Business Enterprises (“MWBEs”) and the employment of minority group members and

women in the performance of OGS contracts.

II. General Provisions

A. OGS is required to implement the provisions of New York State Executive Law Article 15-A and

5 NYCRR Parts 140-145 (“MWBE Regulations”) for all State contracts as defined therein, with a value

(1) in excess of $25,000 for labor, services, equipment, materials, or any combination of the foregoing

or (2) in excess of $100,000 for real property renovations and construction.

B. The Contractor agrees, in addition to any other nondiscrimination provision of the Contract and

at no additional cost to OGS, to fully comply and cooperate with OGS in the implementation of New

York State Executive Law Article 15-A and the regulations promulgated thereunder. These

requirements include equal employment opportunities for minority group members and women (“EEO”)

and contracting opportunities for MWBEs. Contractor’s demonstration of “good faith efforts” pursuant

to 5 NYCRR § 142.8 shall be a part of these requirements. These provisions shall be deemed

supplementary to, and not in lieu of, the nondiscrimination provisions required by New York State

Executive Law Article 15 (the “Human Rights Law”) or other applicable federal, State, or local laws.

C. Failure to comply with all of the requirements herein may result in a finding of non-

responsiveness, a finding of non-responsibility, breach of contract, withholding of funds, suspension or

termination of the Contract, and/or such other actions or enforcement proceedings as allowed by the

Contract and applicable law.

III. Equal Employment Opportunity (EEO)

A. The provisions of Article 15-A of the Executive Law and the rules and regulations promulgated

thereunder pertaining to equal employment opportunities for minority group members and women shall

apply to all Contractors, and any subcontractors, awarded a subcontract over $25,000 for labor,

services, including legal, financial and other professional services, travel, supplies, equipment,

materials, or any combination of the foregoing, to be performed for, or rendered or furnished to, the

contracting State agency (the “Work”) except where the Work is for the beneficial use of the Contractor.

1. Contractor and subcontractors shall undertake or continue existing EEO programs to ensure that

minority group members and women are afforded equal employment opportunities without

discrimination because of race, creed, color, national origin, sex, age, disability, or marital status.

For these purposes, EEO shall apply in the areas of recruitment, employment, job assignment,

promotion, upgrading, demotion, transfer, layoff or termination, and rates of pay or other forms of

compensation. This requirement does not apply to: (i) the performance of work or the provision of

New York State – Office of General Services

Solicitation 2639 – Insurance Broker of Record

Appendix E- M/WBE and EEO Requirements

services or any other activity that is unrelated, separate, or distinct from the Contract; or (ii)

employment outside New York State.

2. By entering into this Contract, Contractor certifies that the text set forth in clause 12 of Appendix

A, attached hereto and made a part hereof, is Contractor’s equal employment opportunity policy.

In addition, Contractor agrees to comply with the Non-Discrimination Requirements set forth in

clause 5 of Appendix A.

B. Form EEO 100 – Staffing

To ensure compliance with this section, the Contractor agrees to submit, or has submitted with the Bid,

a staffing plan on Form EEO 100 to OGS to document the composition of the proposed workforce to

be utilized in the performance of the Contract by the specified categories listed, including ethnic

background, gender, and federal occupational categories.

C. Form EEO - 101 - Workforce Utilization Reporting Form (Commodities and Services) (“Form

EEO-101-Commodities and Services”)

1. The Contractor shall submit, and shall require each of its subcontractors to submit, a Form EEO-

101-Commodities and Services to OGS to report the actual workforce utilized in the performance

of the Contract by the specified categories listed including ethnic background, gender, and Federal

occupational categories. The Form EEO-101-Commodities and Services must be submitted

electronically to OGS at EEO_CentCon@ogs.ny.gov on a quarterly basis during the term of the

Contract by the 10th day of April, July, October, and January.

2. Separate forms shall be completed by Contractor and all subcontractors.

3. In limited instances, the Contractor or subcontractor may not be able to separate out the

workforce utilized in the performance of the Contract from its total workforce. When a separation

can be made, the Contractor or subcontractor shall submit the Form EEO-101-Commodities and

Services and indicate that the information provided relates to the actual workforce utilized on the

Contract. When the workforce to be utilized on the Contract cannot be separated out from the

Contractor's or subcontractor's total workforce, the Contractor or subcontractor shall submit the

Form EEO-101-Commodities and Services and indicate that the information provided is the

Contractor's or subcontractor’s total workforce during the subject time frame, not limited to work

specifically performed under the Contract.

D. Contractor shall comply with the provisions of the Human Rights Law and all other State and

federal statutory and constitutional non-discrimination provisions. Contractor and subcontractors shall

not discriminate against any employee or applicant for employment because of race, creed (religion),

color, sex, 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 and conviction

and prior arrest.

IV. Contract Goals

A. For purposes of this procurement, OGS conducted a comprehensive search and determined that

the Contract does not offer sufficient opportunities to set goals for participation by MWBEs as

subcontractors, service providers, or suppliers to Contractor. Contractor is, however, encouraged to

make every good faith effort to promote and assist the participation of MWBEs on this Contract for the

provision of services and materials. The directory of New York State Certified MWBEs can be viewed

New York State – Office of General Services

Solicitation 2639 – Insurance Broker of Record

Appendix E- M/WBE and EEO Requirements

at: https://ny.newnycontracts.com/FrontEnd/VendorSearchPublic.asp?TN=ny&XID=2528.

Additionally, following Contract execution, Contractor is encouraged to contact the Division of Minority

and Women’s Business Development ((518) 292-5250; (212) 803-2414; or (716) 846-8200) to discuss

additional methods of maximizing participation by MWBEs on the Contract.

B. Good Faith Efforts

Pursuant to 5 NYCRR § 142.8, evidence of good faith efforts shall include, but not be limited to, the

following:

1. A list of the general circulation, trade, and MWBE-oriented publications and dates of publications

in which the Contractor solicited the participation of certified MWBEs as subcontractors/suppliers,

copies of such solicitations, and any responses thereto.

2. A list of the certified MWBEs appearing in the Empire State Development (“ESD”) MWBE

directory that were solicited for this Contract. Provide proof of dates or copies of the solicitations

and copies of the responses made by the certified MWBEs. Describe specific reasons that

responding certified MWBEs were not selected.

3. Descriptions of the Contract documents/plans/specifications made available to certified MWBEs

by the Contractor when soliciting their participation and steps taken to structure the scope of work

for the purpose of subcontracting with, or obtaining supplies from, certified MWBEs.

4. A description of the negotiations between the Contractor and certified MWBEs for the purposes

of complying with the MWBE goals of this Contract.

5. Dates of any pre-bid, pre-award, or other meetings attended by Contractor, if any, scheduled by

OGS with certified MWBEs whom OGS determined were capable of fulfilling the MWBE goals set

in the Contract.

6. Other information deemed relevant to the request.

V. Fraud

Any suspicion of fraud, waste, or abuse involving the contracting or certification of MWBEs shall be

immediately reported to ESD’s Division of Minority and Women’s Business Development at (855) 373-

4692.

ALL FORMS ARE AVAILABLE AT: https://ogs.ny.gov/mwbe/forms

RFP Attachment 1

Proposer Submission Checklist

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

In order for the State to evaluate bids fairly and completely, proposers are strongly encouraged to provide all of the information requested.

Proposers should indicate in the column "Proposal Location" the page number of their proposal that addresses each stated checklist item.

Covered by RFP

2639 Section

Checklist Item

Quote Location

(pg #)

Technical Proposal‐

Cover Letter

Section 3.2.1

Did you state in your Cover Letter that you understand and will comply with all the provisions of this RFP?

Sections 1.4 and 3.2.1

Have you addressed how your company will be prepared to start services in accordance with the date as indicated on Section 1.5 – Key Events

of the RFP?

Section 3.2.1

Did you include the full contact information of your designated contact? Did you include the name of the principal(s) of the company

responsible for this contract if awarded including their function, title?

Section 3.2.1

Did you include a summary of the key aspects of the proposing company and highlight the distinguishing characteristics of the proposal, as

well as identify the lot(s) of coverage being proposed?

Section 3.2.1

Did a Proposer Representative authorized to make contractual obligations sign the Cover Letter?

Minimum Requirements

Section 3.2.2

Did you provide a copy of NYS licence(s)?

Section 3.2.2

Did you provide name of governmental agency, contract number(s) and term(s) (if applicable), and at least one reference that may verify information

being submitted?

Section 3.2.2

Did you provide name(s) of entities, length of time spent as BOR for the entity, types of policies and annual value of policies brokered. Did you also

provide at least one reference that may verify information being submitted?

Section 3.2.2

Did you provide name(s) of entities, length of time spent as BOR for the agency, types of policies and annual number of policies brokered? Did you also

provide at least one reference that may verify information being submitted? Information may overlap with that submitted for Minimum Qualifications 2

and 3.

Proposer Experience and Qualifications

Section 3.2.3.1

Did you provide general details of organization as requested in referenced section bullet #1?

Section 3.2.3.1

Did you provide attributes of organization as requested in referenced section bullet #2?

Section 3.2.3.1

Did you provide brokerage details of organization as requested in referenced section bullet #3?

Section 3.2.3.1

Did you provide a summary of organization as requested in referenced section bullet #4?

Section 3.2.3.1

Did you provide details of proposed staff experience as requested in referenced section bullet #5?

Staffing and Management Plan

Section 3.2.3.2

Did you identify use of any Subcontractors and the functions they will perform?

Section 3.2.3.2

Did you describe your staffing plan and role of each staff member?

Section 3.2.1.4

Did you include a statement of your understanding of contract requirements?

Section 3.2.1.4

Did you describe how your approach for providing required services?

Section 3.2.1.4

Did you provide information regarding reporting, administration, and marketing policies?

References

Section 3.2.3.3

Did you provide at least three references that can confirm submitted information and details described in referenced section

Section 3.2.1.5

Did you contact references to make them aware OGS would be contacting them?

Administrative Proposal

Appendix B

Contractor Information Page

NYS Office of General Services

RFP 2639 – Insurance Broker(s) of Record

Corporate Acknowledgement (must be notarized)

Offerer’s Affirmation of Understanding of and Agreement pursuant to New

York State Finance Law

Offerer Disclosure of Prior Non‐Responsibility Determinations

Offerer’s Certification of Compliance with State Finance Law §139‐k(5)

NYS Required Certifications

Certification Under Executive Order No. 16

Submit ST‐220‐TD directly to Taxation and Finance

ST‐220‐CA

EEO100 Staffing Plan

Consultant Form A

Addenda

Online

Are all bid addendums signed and included with the bid?

One Last Check

Did you submit the page number in the column "Proposal Location" for

each of the criteria above?

Did you submit an original copies each of the Technical Proposal, the Cost Proposal, and Administrative Proposal? (Originals contain a “wet”

signature on each of the signed pages)

Did you submit one digital copy (thumb drive) of the complete RFP Response? If there are any differences between the paper submission and

the electronic submission, the paper submission shall take precedence.

I certify, with my signature below, that all required information listed above is completed and

included in this bid submission.

Authorized Signature:

Date:

Print Name and Title:

Company represented:

RFP Attachment 2

Insurance Schedules per Lot

Policy Effective Date

Policy Term

General Liability 2/28/2022 2022-23

Garage Keepers Legal Liability 2/28/2022 2022-23

OCP 2/28/2022 2022-23

Umbrella Excess 2/28/2022 2022-23

General Liability 4/1/2022 2022-23

Excess GL 4/1/2022 2022-23

Auto 4/1/2022 2022-23

Builders Risk 9/15/2019 2019-22

Crime 10/1/2021 2021-22

Inland Marine 7/1/2022 2022-24

Commercial Property 8/1/2022 2022-23

Commercial Property 12/14/2021 2021-22

General Liability 12/14/2021 2021-22

Commercial Auto 12/14/2021 2021-22

D&O 12/14/2021 2021-22

Umbrella 12/14/2021 2021-22

Auto 6/30/2022 2022-23

Crime 6/30/2022 2022-23

Public Officials/Employment practices 6/30/2022 2022-23

Exc Public Officials/Employment practices 6/30/2022 2022-23

TULIP 6/30/2022 2022-23

Umbrella Excess Liability 6/30/2022 2022-23

$15 MM Commercial Property Pier A 6/30/2022 2022-23

Commercial Properties 6/30/2022 2022-23

$48 MM Excess Property 6/30/2022 2022-23

$37 MM over $63 MM Excess 6/30/2022 2022-23

Excess Flood Pier A Seawall 6/30/2022 2022-23

Inland Marine 6/30/2022 2022-23

TRIA 6/30/2022 2022-23

Boiler & Machinery Equipment Breakdown 6/30/2022 2022-23

Lot 1 - Standard Lines

Flood for 75 Battery place 1/29/2022

2022-23

General Liability 6/30/2022 2022-23

Excess Flood QS $15MM X 15MM 6/30/2022 2022-23

Public Officials (D&O) 8/31/2021 2021-22

Umbrella 12/1/2021 2021-22

Commercial Package (GL & Auto) 12/1/2021 2021-22

Auto 12/1/2021 2021-22

GL/Equipment 12/1/2021 2021-22

Professional Liability w/ GL 7/1/2022 2022-23

Inland Marine 1/14/2022 2022-23

General Liability for PRISM 12/1/2021 2021-22

Media Liability 1/26/2022 2022-23

General Liability 1/26/2022 2022-23

Builders Risk 2/15/2022 2022-23

Auto 4/1/2022 2022-23

LTD 12/1/2021 2021-22

PFL 2/1/2022 2022-23

Crime 4/1/2022 2022-23

Business Owners Policy 9/1/2021 2021-22

EPL 5/27/2022 2022-23

Builder's Risk - project Uplift 8/8/2021 2021-22

General Liability 7/21/2022 2022-23

5MM Excess Liability 7/21/2022 2022-23

5MM xs $5mm Excess Liability 7/21/2022 2022-23

Surety Bond 12/31/2021 2021-22

Primary

10/1/2021 2021-22

Excess Crime - $25MM xs $25MM 10/1/2021 2021-22

Excess Crime - $25MM xs $50MM 10/1/2021 2021-22

Excess Crime - $25MM xs $75MM 10/1/2021 2021-22

Excess Crime - $15MM xs $100MM 10/1/2021 2021-22

Excess Crime - $25MM xs $115MM 10/1/2021 2021-22

Excess Crime - $3MM xs $140MM 10/1/2021 2021-22

IM/Commercial Property Package 12/1/2021

2021-22

GL 12/1/21-22 2021-22

GL - Construction 12/1/2021 2021-22

GL Excess $4mm x Primary- Construction 12/1/2021 2021-22

GL Excess $5mm x $4mm- Construction 12/1/2021 2021-22

GL Excess $5mm x $9mm- Construction 12/1/2021 2021-22

GL Excess $10mm x $14mm- Construction 12/1/2021 2021-22

Commercial Umbrella Excess $2 mm 12/1/2021 2021-22

GL Excess $2 mm x $2 mm 12/1/2021 2021-22

GL Excess $3 mm x $4 mm 12/1/2021 2021-22

GL Excess $7 mm x $7 mm 12/1/2021 2021-22

GL Excess $10 mm x $14 mm 12/1/2021 2021-22

GL Excess $5 mm x $25 mm 12/1/2021 2021-22

GL Excess $10M part of $20M x $29M 12/1/2021 2021-22

GL Excess $10M part of $20M x $30M. 12/1/2021 2021-22

GL Excess $15M part of $25M x $50M. 12/1/2021 2021-22

GL Excess $10M part of $25M x $50M. 12/1/2021 2021-22

GL Excess $12.5 part of $25M x $75M 12/1/2021 2021-22

Auto 4/1/2022 2022-23

NFIP Flood 4/11/2022 2022-23

Excess Flood 5/23/2022 2022-23

Flood for 205 12th Ave 5/13/2022 2022-23

Directors' & Officers' 7/1/2022 2022-23

Employed Lawyer's Liability 10/5/2021 2021-22

D&O (USDA) 11/21/2021 2021-22

D&O (LIPA) 11/30/2021 2021-22

ERISA Bond (

Fidelity Bonds

)

1/31/2022 2022-25

Package/Umb/Excess 10/1/2019 2019-22

Builder's Risk for 44628/46628 rebid 5/23/2017 5/23/17-6/18/22

Builder's Risk for 44798 8/9/2019 8/9/19-5/30/23

Builder's Risk for 45429 8/10/2020 8/10/20-9/12/22

Builder's Risk for 45608 9/24/2018

9/24/18-7/12/22

Builder's Risk for 45763 6/14/2018 6/14/18-5/1/22

Builder's Risk for 45837 3/28/2022 3/28/22-10/30/23

Builders Risk for 45857 5/28/2021 5/28/21-10/2/23

Builders Risk for 45877 2/24/2021 2/24/21-7/1/23

Builder's Risk for 45944 2/13/2020 2/13/20-8/9/22

Builders Risk for 46086 9/30/2020 9/30/20-12/8/23

Builder's Risk for 46136 9/4/2020 9/4/20-5/16/22

Builder's Risk for 46135 5/17/2021 5/17/21-11/13/22

Builder's Risk for 45858 12/17/2021 12/17/21-9/18/25

Individual Builders Risk policies varrious varrious

Master TULIP 8/26/2021 2021-22

General Liability 2/28/2022 2022-23

General Liability 8/30/2021 2021-22

Crime 4/1/2022 2022-23

D&O 9/24/2021 2021-22

Bond 12/20/2021 2021-24

Property & GL Package 2/28/2022 2022-23

Commercial/Excess (Umbrella) 2/28/2022 2022-23

Auto 4/1/2022 2022-23

Crime 1/31/2022 2022-23

Auto 4/1/2022 2022-23

Crime 4/1/2022 2022-25

Directors and Officers with EPL 2/2/2022 2022-23

General Liability and Excess 7/1/2022 2022-23

Crime 1/14/2022 2022-23

DMEPOS Bond 2/1/2022 2022-23

Crime Bond 3/11/2022 2021-24

DMEPOS Bond 3/16/2022 2022-23

Pharmacy Bond 7/19/2022 2022-23

Commercial Package 7/7/2022 2022-23

Flood & Earthquake 7/7/2022 2022-23

D & O 7/7/2022

2022-23

$19,800,000.00

Cyber Liability 6/30/2022 2022-23

Cyber Liability 6/7/2022 2022-23

Cyber Liability 3/29/2022 2022-23

Cyber Liability 6/1/2022 2022-23

$200,000.00

Inland Marine (Fine Arts) 7/1/2022 2022-23

Fine Arts 7/1/2022 2022-23

$45,000.00

Aircraft/Aviation Liability 9/18/2021 2021-22

Airport Liability 9/18/2021 2021-22

$205,000.00

Marine Hull / P&I 4/26/2022 2022-23

Excess Marine Liability 4/26/2022 2022-23

Pollution 9/28/2020 2021-22

Hull/Machinery (Marine) 9/28/2020 2021-22

$55,000.00

Dental (monthly billing) 1/1/2022 2022-23

Workers Comp 9/19/2021 2021-22

Disability 9/19/2021 2021-22

Workers Comp 9/1/2021 2021-22

Approximate annual premium:

Lot 2 - Cyber

Approximate annual premium:

Lot 3 - Fine Arts

Approximate annual premium:

Lot 4 - Aviation

Approximate annual premium:

Lot 5 - Ocean Marine

Approximate annual premium:

Lot 6 - Employee Benefits

Disability 9/1/2022

2022-23

Disability 10/1/2021 2021-22

Workers Comp 11/18/2021 2021-22

Workers Comp 2/17/2022 2022-23

ADD 11/30/2021 2020-23

Workers Comp 7/1/2022 2022-23

$150,000.00

Approximate annual premium: