Bidder Response Forms Appendix E

Bidder Response Forms Appendix E

Group 79008 Bank Card Services

Electronic Value Transfer

Request for Proposal # 22325

BID PROPOSAL COVER SHEET

PART I - TECHNICAL QUALIFICATIONS

AND

SERVICE REQUIREMENTS

*** Important - Failure to Furnish All Required Information may render the Bid Non-Responsive ***

Bidder’s Legal Name: ______

Bidder’s Federal Identification No.: ______

Name of Preparer: ______

Telephone Number of Preparer: ______

Signature:______

Name:______

Title:______

CORPORATE ACKNOWLEDGMENT

STATE OF }

: ss.:

COUNTY OF }

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

______

Notary Public

Bid Submittal Checklist

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

Format of Bid Proposal

Check to indicate compliance with each requirement.

Proposal is bound.
Proposal is submitted in two (2) separately sealed parts:
Part I, Technical Qualifications & Service Requirements (i.e., response to Section VI)
Part II, Financial Requirements (i.e., response to Section VII)
Proposal has a Table of Contents and indexed tabs for Part I, following the order set forth in the RFP.
Proposal pages are numbered consecutively from beginning to end.
Bidder has enclosed:
1.  Three written and signed originals of Part I, Technical Qualifications & Service Requirements
2.  Three written and signed originals of Part II, Financial Requirements
3.  Five electronic diskette containing Part I, Technical Requirements, labeled with Bidder name, RFP # and “Part I”
4.  Five electronic diskette containing Part II, Financial Requirements, labeled with Bidder name, RFP # and “Part II”
Bidder has completed all information and provided original signatures as appropriate on the:
1. Request for Proposal Form (page 2)
2. Mandatory Contractor Questionnaire (Appendix E)
·  MacBride Certification
·  Non-Collusive Bidding Certification
·  Submitted Documentation Establishing Legal Status
·  Submitted List of Directors, Officers, etc.
Bidder has completed and submitted Affirmations for Qualifying Technical Requirements (Appendix E)
Bidder has completed and submitted Responses for Technical Requirements (Appendix E)
Extraneous Terms are fully detailed in a separate section of the Bid Proposal (Tab #3).
Table of Conflicting Association Rules completed
Affirmation that all known conflicts between Association Rules & RFP have been included.
Bidder agrees to extend use of contract in accordance with RFP, Appendix B, Clause 39 (c )
ST-220 - NY State Taxation and Finance Forms
ST-220-CA is enclosed
ST-220-TD sent to NY State Taxation and Finance Department
Bidder will provide within 5 business days of written request by OGS
Vendor Responsibility Questionnaire for-profit businesses.
Bidder has filed the Vendor Responsibility Questionnaire on-line
If Bidder submitted on-line, certification (or recertification) is less than six months old.
Bidder has submitted a hard copy of the Vendor Responsibility Questionnaire
Workers Compensation Requirements
Bidder has submitted current NY State Workers Compensation Insurance and Disability certificates.
Bidder has submitted a NY State exemption certificate.
Bidder will provide within 10 business days of written request by OGS
MANDATORY CONTRACTOR QUESTIONNAIRE
[BIDDER MUST ANSWER ALL QUESTIONS]
Page 1 of 4
1. Are you a New York State resident business? / Yes_____ / No_____
2. Total number of people employed by your firm: /
3. Total number of people employed by your firm in New York State: /
4. Is your company independently owned and operated? / Yes_____ / No______
5. Place of manufacture or development of Product(s) offered
(Please indicate “Yes” or “No” for A, B or C):
A. All NYS manufacture/development?
OR
B. All manufactured/developed outside NYS?
OR
C. Manufactured/developed in NYS and outside NYS? / Yes_____
Yes _____
Yes_____ / No______
No______
No______
6. Is your firm at least 51% owned and controlled by women, or 51% owned and controlled by minority group members, i.e., Black Hispanic, Asian, Pacific Islander, American Indian, Alaskan Native?
If yes, _____Minority Owned ______Women Owned
If yes, have you been certified or registered? ____Yes _____No
If yes, List certification or registration authority:
______/ Yes_____ / No______
7. Do any of the Products offered herein incorporate recycled materials? / Yes_____ / No____
N/A___
8. Do any of the Products offered herein contain remanufactured components? / Yes_____ / No____
N/A ___
9. Are any of the Products offered herein Energy Star Compliant?
If yes, which Products?______/ Yes_____ / No____
N/A ___
10.  BIDDER/OFFERER DISCLOSURE OF PRIOR NON-RESPONSIBILITY DETERMINATIONS
Pursuant to Procurement Lobbying Law (SFL §139-j)
A. Has any Governmental Entity made a finding of non-responsibility regarding the individual or entity seeking to enter into the Procurement Contract in the previous four years? / Yes_____ / No____
N/A ___
If yes, please answer the following: question:
B. Was the basis for the finding of non-responsibility due to a violation of State Finance Law §139-j? / Yes_____ / No____
N/A ___
C. If yes, was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a governmental entity? / Yes_____ / No____
N/A ___
If yes, please provide details regarding the finding of non-responsibility:
Governmental Entity: / ______
Date of Finding of Non-responsibility: / ______
Basis of Finding of Non-Responsibility:
(add additional pages if necessary)
D. Has any governmental agency terminated or withheld a procurement contract with the above-named individual or entity due to the intentional provision of false or incomplete information? / Yes_____ / No______
If yes, please provide details:
Governmental Entity: / ______
Date of Termination or Withholding of Contract: / ______
Basis of Termination or Withholding:
(add additional pages if necessary) / ______
Signature: / ______
Printed Name: / ______
Date: / ______
11. Are prices quoted the same as or lower than those quoted other corporations, institutions and government agencies (including GSA/VA contracts) on similar products, quantities, terms and conditions?
See "Best Pricing Offer" in Appendix B, OGS General Specifications.
If "NO", please explain on a separate sheet. / Yes_____ / No______
A. Do you have a contract with the General Services Administration (GSA) or Veterans Affairs (VA) for products offered? (Check all that apply.) / GSA
Yes_____ / No______
VA
Yes_____ / No______
B. If yes, will you offer New York State your GSA or VA pricing or better? / GSA
Yes_____ / No______
VA
Yes_____ / No______
C. If yes, a copy of the GSA or VA schedule is required.
Have you included a copy? / GSA
Yes_____ / No______
VA
Yes_____ / No______
12. Will you offer a Cash Discount for payment within 15 days of delivery and/or receipt of voucher? / Yes_____
_____ % / No______
13. Will you offer a Cash Discount for payment within 30 days of delivery and/or receipt of voucher? / Yes_____
_____ % / No______

BIDDER IS REQUIRED TO SIGN BOTH SECTIONS BELOW

MacBride Certification

NON-DISCRIMINATION IN EMPLOYMENT IN NORTHERN IRELAND:

MACBRIDE FAIR EMPLOYMENT PRINCIPLES

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

(1) have business operations in Northern Ireland,

Yes___ or No ___

if yes:

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

Yes ___ or No ___

______

(Bidder’s Signature) (Name of Business)

Non-Collusive Bidding Certification

NON-COLLUSIVE BIDDING CERTIFICATION

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

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

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

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

______

(Bidder’s Signature) (Name of Business)

Contact Information (for Contract Administration Purposes)
Company Name:
Company Headquarters Address:
(From first page of Contract)
FEDERAL ID #:
Type of Company:
(Legal entity for
contractual purposes) / Corporation Partnership Joint Venture Other (explain)
If Joint Venture Name of Lead Entity: ______
Provide documentation establishing the legal status of the bidder (see VI.1.A
Attach a list of all directors, officers, members, partners, joint venturers, etc. of bidder (see VI.1.A)
2. Contract ADMINISTRATION
Contract Administrator Name:
Title:
Mailing Address:
“Toll” Free Phone Number:
Telephone Number:
E-mail:
FAX:
3. SALES/BILLING
Contact Name:
Title:
Address:
Telephone Number:
E-mail:
FAX:
4. HELP DESK/ SERVICE
Contact Name:
Title:
Address:
E-mail:
WWW Address:
Telephone Number: / FAX:
Contract “Toll” Free Support Phone Number: / Hours of Availability:

Bidder’s Response to Qualifying Technical Requirements (Pass / Fail)

In addition to providing the following affirmations, Bidder must respond to the requirements as specified in this RFP. Responses should follow this document in Tab #1. A Microsoft Word® version of this Response Form is available on the OGS website at http://www.ogs.state.ny.us/purchase/Bidcalendarlv.asp

Technical Requirements – Qualifying Criteria / Bidder’s Affirmation /
Section III.12, Additional Contract Conditions
Bidder agrees to conform to and comply with all local, state and federal statutes and regulations governing Authorized Users and their contractors throughout the contract term. / Yes / No
Section VI.1.A, Qualified Bidder
Bidder can provide all Financial Services Processing and Transaction Interface services requested. The Bidder affirms it provides Credit/Charge Card and On-line and Off-line Debit Card processing services. All other services can be provided by prospective subcontractors of the Bidder. / Yes / No
Section VI.1.B.1, Authorized Financial Services Processing Provider
Bidder affirms that it meets all applicable PCI DSS standards. / Yes / No
Section VI.1.B.1, Authorized Financial Services Processing Provider
Bidder affirms authorization to provide FSP services for Credit/Charge Cards and Debit Cards. / Yes / No
Section VI.1.B.1, Authorized Financial Services Processing Provider
Bidder agrees to seek authorization for future payment devices requested by Authorized Users. / Yes / No
Section VI.1.B.2, Authorized Financial Services Processing Provider
Bidder affirms that all Transaction Interfaces to be provided under the Contract are certified by the Bidder for FSP processing. / Yes / No
Section VI.1.B.3, Authorized Financial Services Processing Provider
Bidder affirms that that they will work with Authorized User and their contractors to develop and maintain interfaces between such entities and the Bidder for the purpose of capturing, processing, reporting and reconciling electronic value transfer transactions. / Yes / No
Section VI.1.B.4,a & b, Financial Services Processing Bank (Member)
Bidder affirms that the bank to be utilized for processing electronic payment transactions is a State or Federal Chartered bank with a branch in New York State. / Yes / No
Section VI.1.B.4,c, Financial Services Processing Bank (Member)
Bidder affirms that the bank to be utilized for processing electronic payment transactions has an organization rating of at least 30 as published in the most current issue of Sheshonoff’s Banking Organization Quarterly or a LACE Financial Rating of at least C+, a Moody’s rating of BAA, a Fitch rating of BBB or a Standard & Poors rating of BBB. / Yes / No
Section VI.1.B.4,d, Financial Services Processing Bank (Member)
Bidder affirms that the necessary steps will be taken upon award of a contract to file with the Office of the State Comptroller a “State of New York Undertaking for Bank Deposits and Assignment Securities” and that such filing will be maintained throughout the term of the contract. / Yes / No
Section VI.1.C.2 Financial Statement Summary
Bidder affirms to include for the Bidder and any subcontractor, audited or reviewed financial statements for the last three years (or covering the period from the creation of the entity if less than three years), prepared by a CPA in conformance with GAAP. / Yes / No
Section VI.1.C.2 Financial Statement Summary
Bidder affirms to provide copies of any parent or subsidiary of the Bidder and subcontractors audited or reviewed financial statements for the last three years (or covering the period from the creation of the entity if less than three years), prepared by a CPA in conformance with GAAP, upon request by OGS. / Yes / No
Section VI.1.D. Use of Subcontractors
Bidder affirms to comply with the ”Use of Subcontractors” requirements. / Yes / No
Section VI.2.A.1.a, FSP Services
Bidder affirms to be able to process the following types of electronic payments: (1) Credit/Charge Cards and (2) On-line and Off-line Debit Cards. / Yes / No
Section VI.2.A.2, Types of Card-Based Electronic Payments
Bidder accepts the four nationally recognized Credit/Charge Cards, Off-line Debit Cards and national and regional On-line Debit Cards networks and other forms of card-based electronic payment devices as may be added during the contract term. / Yes / No
Section VI.2.A.4.a & b, Statutory Notice Requirements for State Agencies
Bidder agrees to support processing of transactions in a manner that enables Authorized Users to notify Device Users of any Surcharge and/or Convenience Fee and agrees to support separate transactions for the underlying amount of the transaction and the surcharge/convenience fee. / Yes / No
Section VI.2.A.5.a, Payment Devices
Bidder agrees to provide and support financial processing services and data exchanges through the listed data capture/transmission devices and other devices as may be added upon mutual agreement of the parties. / Yes / No
Section VI.2.A.5.d, Authorized User Unique Field
Bidder agrees to support the provision of a 20 character alpha-numeric unique field at the option of the Authorized User. / Yes / No
Section VI.2.A.8, Reporting
Bidder recognizes and agrees to provide only the appropriate reporting information specific to each Authorized User in the format and timeframe required. / Yes / No
Section VI.2.C.1, Training
Bidder agrees to develop and implement a New York State specific training program covering initial and follow-up training, to include on-site training at locations designated by the Authorized reseller to include requirements detailed in this RFP. / Yes / No
Section VI.2.D.1, Method of Payment of Contractor Fee
Bidder agrees to receive reimbursement through (1) invoicing, (2) Surcharge or Convenience fees to Device Users, (3) Deduction Net-Billing and (4) Direct ACH Debit. / Yes / No
If your system cannot currently accept ACH payments, indicate if your system can be modified to interface with the State Comptroller’s system. Confirm such change would be at no cost to the State. / Yes / No
Section VI.2.D.3.C.1a Security Plan
Bidder affirms that they have a Security Plan in place. / Yes / No
Section VI.2.D.3.C.3 Internal Control Plan
Bidder affirms that they have an Internal Control Plan in place. / Yes / No
Section VI.2.D.3.C.4 Business Continuity Disaster Recovery
Bidder affirms that they have a Business Continuity Disaster Recovery Plan in place. / Yes / No
Section VI.2.D.3.C.5 Implementation Plans
Bidder agrees to the terms and conditions in this section. / Yes / No

Bidder’s Response to Technical Requirements

Bidder should refer to the RFP for detailed Technical Requirements and Specifications when preparing their bid responses. The following tables are provided as a convenience for preparing responses. The information provided only summarizes the Technical Requirements and the associated Specifications. The Bidder should refer to the detailed requirements as specified within the text of the RFP. The following response forms were prepared to facilitate the review process. The sections are basically arranged in order of the RFP. A Bidder should prepare their responses to the sections designated as Technical Requirements using the table below. A Microsoft Word® version of these Response Forms are available on the OGS website at: http://www.ogs.state.ny.us/purchase/Bidcalendarlv.asp.