PROSPECTIVE BIDDERS NOTICE MINORITY AND WOMEN

Form 7557-121B

Page 1 of 3

PROSPECTIVE BIDDERS NOTICE

MINORITYANDWOMEN‐OWNEDBUSINESSENTERPRISEREQUIREMENTS:

CONSTRUCTIONCONTRACTS

To Prospective Bidders:

Consistent with the State University of New York (SUNY)’s commitment and in accordance with Article

15-A of the New York State Executive Law, contractors are required to ensure that good faith efforts ar

ade to include meaningful participation by Minority and Women-Owned Business Enterprises(MWBE

These

requirements apply to all SUNY construction contracts in excess of $100,000.

Receipt of the MWBE utilization plan is required within seven (7) business days after the bid opening,

for construction contracts only. The Contract Administrator shall provide MWBE Utilization Plan Form

(107) to the campus MWBE Program Coordinator for review and approval for the three apparent low

dders (“Contractor”). The MWBE forms identified below shall be submitted by all bidders.

a. MWBE Utilization Plan (7557-107)

b. MWBE-EEO Staffing Plan (7557-108)

c. MWBE-EEO Policy (7557-104) or the vendor/contractor’s own EEO Policy Statement

If the Contractor’s MWBE participation rate shown on its MWBE Utilization Plan is below the contract-

specific goals the campus MWBE Program Coordinator will provide a written notice of deficiency of the

Utilization Plan within twenty (20) business days of its submission to the contractor, as required under 5

NYCRR §142.4.

The notice will include, but not be limited to the following:

a. A list of NYS certified MWBEs that the contractor could potentially use within the contract scop

work;

b. The name of any MWBE which is not acceptable for the purpose of complying with the MW

articipation goals;

and

c. Any

other information which the MWBE Program Coordinator determines to be relevant to develo

approvable MWBE Utilization Plan

e contractor shall respond to the notice of deficiency by submitting a revised MWBE Utilization Plan

within seven (7) business days, as required by 5 NYCRR Part §142.6 (e) to the MWBE Program Coordinator.

If the deficiency is not corrected and the MWBE participation rate on the MWBE Utilization Plan is still

below 30%, the contractor should request a waiver.

The Waiver Request Form submitted by the Contractor will include, but not be limited to, the following:

a. A req

uest for partial or total waiver of MWBE goals as required by 5 NYCRR Part §142.6 (f) on

Request for Waiver Form (Form 7557-114) provided by the University-wide MWBE Program

Office.

b. Co

py of the deficient Utilizatio

n Plan.

c. Work

Scope of this contract. If there are subcontracting opportunities, please provide documentation

d, e, and f.

d. Screenshot of searching results for available MWBEs in NYS M/WBE Directory

e. Copy of email messages containing the request for quote, along with the responses from MWBEs.

f. Form

s required to obtain this information are:

7557-101 – MWBE Contractor Solicitation

Letter

7557-102 – MWBE Participation Quote 7557-103 – MWBE Contractor Unavailability Certification

Form 7557-121B

Page 2 of 3

Please submit the above d

ocumentations by email:

Stony Brook University Hospital

Michael Schmitt, MWBE/SDVOB Program Coordinator

2000 Ocean Avenue; Suite 1

Ronkonkoma, NY 11779

Tel: (631)-444-6361

Cel: (516)-506-9748

Email: [email protected]

Information regarding this legislation may be found at: Participation by Minority Group Members and

Women (MWBEs) with Respect to State University of New York Contracts on the State University of New

York web site.

STATEUNIVERSITYOFNEWYORK

MWBE UTILIZATION PLAN INSTRUCTIONS

(FOR ALL CONTRACT TYPES)

A letter of explanation and documentation of efforts should accompany any MBE/WBE Utilization Plan that falls short

of the stated goals. Without an approved MBE/WBE Utilization Plan, SUNY’s Notice of Award and Contract may be

withheld.

If you have questions or need assistance related to the SUNY’s Minority and Women’s Business requirements call the

University-wide MWBE Program Office at 518-320-1189 or email [email protected].

1. The three low

bidding contractors (“Contractors”) are required to submit a Utilization Plan (107) to the MWBE

Program Coordinator within seven (7) calendar days after the opening of bids for construction contracts exceeding

$100,000.

2. The MWBE Program Coordinator is required to submit the mandatory MWBE documentation to the University-

wide MWBE Program Office web based contract management system for commodity, service and construction

related consultant service contracts exceeding $25,000 for construction project exceeding $100,000 upon contract

execution.

3. The MBE and WBE goals are separate and not to be treated as one combined goal.

4. The MBE and WBE firms included are businesses the bidder seriously expects to include in the project activity.

5. The contractor reasonably commits to the dollar values included in the plan for participation by MBE and WBE

subcontractors and suppliers.

6. MBE and WBE firms must be certified by the New York State Department of Economic Development, Division

of Minority and Women Business Development. A directory of certified minority and women-owned business

enterprises is available on the internet at https://ny.newnycontracts.com/FrontEnd/VendorSearchPublic.asp.

7. Contractors utilizing MWBE firms for supplies/materials/equipment whose NYS certification profile designates

them as Broker will receive an MWBE utilization credit for the actual monetary value of the broker fees or the

actual markup percentage of the items brokered.

8. MBE and WBE Participation:

The actual services provided by the MBE or WBE must be essential in the performance of the scope of work for the

applicable contract.

Utilization of a certified MBE or WBE as a conduit or pass through for participation credit is

Form 7557-121B

Page 3 of 3

strictly prohibited. It is the discretion of University-wide MWBE Program to determine whether services are

essential in the performance of the scope of work and offer a determination of the appropriateness of work allowed

for lower tier subcontracting in accordance with practices generally accepted in the construction industry. The

services the MBE or WBE will provide must be among those explicitly identified in the profile (codes) of firm as

listed in the NYS Empire State Development Directory of Certified MWBEs. Firms submitted or who participate in

the project outside of these conditions and without specific prior approval by SUNY will not be credited toward the

MWBE Utilization Plan and goals for the contract.

9. Prior to submitting the Plan, the bidders should confirm the following:

a. MBE and WBE firms are NYS certified;

b. MBE or WBE designation ~ Dual certified firms may be used as either but not both;

c. MBE and WBE firms are being used for item(s) within their certification product codes;

d. MBE and WBE firms will perform work for which they have been submitted; and

e. 2nd tier subcontractors and/or suppliers are noted as such and the purchaser of the product identified (i.e.

purchase by electrical sub)

The prime Contractor is responsible for ensuring participation provided by subcontractors for 2nd and 3rd tier MBE and

WBE participation.

Submission of a Utilization Plan which fails to meet or exceed each goal shall be accompanied by documentation of

specific efforts undertaken both pre and post bid. The campus MWBE Program Coordinator will review and notify

Contractor of its assessment.

The University-wide MWBE Program Office in collaboration with the campus MWBE Program Coordinator will review

the Utilization Plan and notify the contractor of any deficiencies and determine necessary actions to bring the Utilization

Plan into compliance. The University-wide MWBE Program Office reserves the right to require the contractor to provide

sufficient documentation of the efforts made in the development of the Plan. The documentation should meet the good

faith efforts standard under 5 NYCRR Part §141.6, and demonstrate the contractor’s commitment to providing

opportunities for MBE and WBE firms in the development of the plan.

A copy of the approved Utilization Plan will be provided to the contractor after issuance of Notice of Award.

MWBE FORM (107) INSTRUCTIONS

Requested information must be completed and submitted within seven (7) days after the bid opening.

Subcontractor Name & Address

Name & Address of each MBE/WBE subcontractor or supplier

MBE or WBE

Minority (MBE) or Women (WBE) Designation

Federal ID

Provide accurate Federal ID number of each MBE/WBE subcontractor or supplier

Dollar Value of Subcontract or Purchase Order

This is the total value of the signed subcontract. If this value is different from the amount in the approved

MBE/WBE utilization plan, an explanation should be provided.

Description of Work or Supplies

Brief description of work performed or supplies provided by the MBE/WBE subcontractor or supplier

Schedule

This is the anticipated start and completion dates for each MBE/WBE subcontractor or supplier.

Do not include the construction schedule for the life of the entire project.

Signature

To be signed by an Officer of the Company

 The information included on the form is subject to verification by the campus MWBE Program Coordinator.

 The campus MWBE Program Coordinator must be notified prior to changes made to the approved

MBE/WBE Utilization Plan.

Questions regarding this form should first be directed to the campus MWBE Program Coordinator.

UNIVERSITY-WIDE MWBE PROGRAM

UTILIZATION PLAN

Form 7557-107, July, 2014 Page 1 of ___

SUNY Project No. ____________________

Bid Date:

Clickheretoenteradate.

Agreement/Contract Value: ___________________

Contractor: _________________________ Primary Contact: _________________________________________________

Address: _________________________

City: ____________________ State: ____________________ Zip Code: ___________

Phone Number: _______________________ Fax Number: _________________ E-Mail: ___________________________

GOALS: MBE % WBE % Campus: ___________________________________

SUBCONTRACTOR FEDERAL ID #

DOLLAR VALUE OF

CONTRACT OR

PURCHASE ORDER

DESCRIPTION OF WORK OR SUPPLIES

SUBCONTRACTOR/SUPPLIER

SCHEDULE

START DATE

COMPLETION

DATE

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Check One: MBE ☐ WBE ☐

Clickhereto

enteradate.

Clickhereto

enteradate.

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Check One: MBE ☐ WBE ☐

Clickhereto

enteradate.

Clickhereto

enteradate.

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Check One: MBE ☐ WBE ☐

Clickhereto

enteradate.

Clickhereto

enteradate.

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Check One: MBE ☐ WBE ☐

Clickhereto

enteradate.

Clickhereto

enteradate.

In accordance with the SUNY Contract Documents and Executive Law Article 15-A, my firm seriously expects to use the NYS certified MBE/WBE certified firms

listed above. The Contractor shall immediately notify and request approval prior to any changes to this plan from the University-wide MWBE Program Office.

NAME: TITLE: COMPANY OFFICER’S SIGNATURE DATE:

______________________________________ _____________________________________ _____________________________________

Clickheretoenteradate.

APPROVED: DEFICIENT: MWBE PROGRAM COORDINATOR: ________________________________ DATE:______________

MWBE Form 108

EEO STAFFING PLAN

Instructions on page 2

Solicitation No.:

eporting Entity: Report includes Contractor’s/Subcontractor’s:

□

Work

force to be utilized on this cont

ract

□ Total wo

rk force

Offeror’s Name: □ Offerer

□

Subcontractor

Subcontractor’s name

________________

Offeror’s Address:

Enter the total number of employees for each classification in each of the EEO-Job Categories identified

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)

Native

American

(M) (F)

Disabled

(M) (F)

Veteran

(M) (F)

Officials/Administrators

Professionals

Technicians

Sales Workers

Office/Clerical

Craft Workers

Laborers

Service Workers

Temporary /Apprentices

Totals

PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type): Submit completed with bid or proposal

MWBE Form 108

General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (ADM/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 and/or subcontractor’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 and/or subcontractor’s total work force, the Offeror shall complete this form for the contractor’s and/or subcontractor’s

total work force.

Instructions 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 work force to be utilized on the contract or the Offerors’ total work force.

4. Enter the total work force by EEO

job category.

5. Break

down the anticipated total work force by gender and enter under the heading ‘Work force by Gender’

6. Break down the anticipated total work force by race/ethnic identification and enter under the heading ‘Work force by Race/Ethnic Identification’. Contact the

M/WBE

Perm

issible contact(s) for the solicitation if you have any questions.

7. Enter information on disabled or veterans included in the anticipated work force under the appropriate headings.

8. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes.

RACE/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 form,

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:

 WHITE (No

t 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.

 HISPANIC a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of

race.

 ASI

AN & PACIFIC a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.

ISL

ANDER

 NATIVE INDIAN (NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal

AME

RICAN/ ALASKAN affiliation or community recognition.

NATIVE)

OTHER CATEGORIES

 DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies)

- has a record of such an impairment; or

- is regarded as having such an impairment

 VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975.

 GENDER Male or Female

Form 7564-121B

Page 1 of 3

PROSPECTI

VE BIDDERS NOTICE

SERVICEDISABLEDVETERAN‐OWNEDBUSINESSENTERPRISEREQUIREMENTS:

CONSTRUCTIONCONTRACTS



To Prospective Bidders:

Consistent with the State University of New York (SUNY) ’s commitment and in accordance with Article

17-B of the New York State Executive Law and its implementing regulations, state agenci

es and

cont

ractors are required to ensure that good faith efforts are made to include meaningful participation

Ser

vice Disabled Veteran-Owned Business (SDVOB). The requirements apply to all SUNY construction

contracts in excess of

$100,000.

Receipt of

the SDVOB Utilization Plan is required within seven (7) business days after the bid opening,

for construction contracts. The SDVOB Utilization Plan Form No. 7654-107 shall be submitted by the

three apparent low bidders (“Contractor”) to the campus MWBE Program Coordinator.

If the Contractor’s SDVOB participation rate shown on its SDVOB Utilization Plan is below 6%, the campus

MWBE Program Coordinator will provide a written notice of deficiency of the Utilization Plan within twenty

(20)

siness days of its submission to the Contractor, as required under 9 NYCRR § 252.2(l)(4

The notice will include but not be limited to the following:

a. A list of NYS certified SDVOBs that the Contractor could potentially use within the contract scope

of work;

b. The name of any SDVOB that is not acceptable for the purpose of complying with the SDVOB

participation goals;

and

c. Any

other information which the MWBE Program Coordinator determines to be relevant to

developing an approvable Utilization

Plan.

e Contractor shall respond to the notice of deficiency by submitting a revised SDVOB Utilization Plan

within seven (7) business days, as required by 9 NYCRR § 252.2(l) (5) to the MWBE Program Coordinator.

If the deficiency is not corrected and the SDVOB participation rate on the SDVOB Utilization Plan remains

below 6%, the Contractor should request a waiver.

The Waiver Request Form submitted by the Contractor will include but not limited to the following:

a. A request for partial or total waiver of SDVOB goals are required by (9 NYCRR § 252.2(m) (2) on

Request for Waiver Form (Form 7564-114) provided by the University-wide MWBE Program

Office.

b. Co

py of the deficient Utilizatio

n Plan.

c. Work

Scope of this contract. If there are subcontracting opportunities, please provide documentation

d, e, and f.

d. Screenshot of searching result for available SDVOBs in Directory of NYS Certified SDVOBs

e. Copy of email messages containing the request for quote along with the responses from MWBEs.

f. Form

s required to obtain this information are:

7564-101 – SDVOB Contractor Solicitation

Letter

7564-102 – SDVOB Participation Quote

7564-103 – SDVOB Contractor Unavailability Certification

Form 7564-121B

Page 2 of 3

Please subm

it the above documentations by e-mail:

Please submit the above documentation to the campus MWBE Program Coordinator:

Stony Brook University Hospital

Michael Schmitt, MWBE/SDVOB Program Coordinator

2000 Ocean Avenue; Suite 1

Ronkonkoma, NY 11779

Tel: (631)-444-6361

Cel: (516)-506-9748

Email: [email protected]

Information regarding this legislation may be found at: Division of Service-Disabled Veterans’

Business Development on the New York State Office General Services web site.

STATE UNIVERSITY OF NEW YORK

SDVOB UTILIZATION PLAN

A letter of explanation and documentation of efforts must accompany any SDVOB Utilization Plan that falls short of the

stated goals. Without an approved SDVOB Utilization Plan, SUNY’s Notice of Award and Contract may be withheld.

If you have questions or need assistance related to the SUNY’s Service-Disabled Veteran-Owned Business requirem

nts call

the University-wide MWBE Program Office at 518-320-1452 or email [email protected].

1. The three low

bidding contractors (“Contractors”) are required to submit a Utilization Plan (Form 7564-107) to the

MWBE Program Coordinator within seven (7) calendar days after the opening of bids for construction contracts

exceeding $100,000.

2. The MWBE Program Coordinator is required to submit the mandatory

SDVOB documentation to the University

-wide

MWBE Program Office web based contract management system for commodity, service and construction related

consultant service contracts exceeding $25,000 and for construction project exceeding $100,000 upon contract

execution .

3. The SDVOB firms included are businesses the Contractor s

eriously expects to include in the project activity.

4. The Contractor must reasonably commit to the dollar values included in the Utilization Plan for participation by

SDVOB subcont

ractors and suppliers.

5. SDVOB firms must be c

rtified by the Division of Service-Disabled Veterans’ Business Development. A directory of

certified minority and women-owned business enterprises is available on the internet at

http://ogs.ny.gov/Core/Docs/CertifiedNYS_SDVOB.pdf. If you would like to receive an excel file containing the

current the List of NYS Certified Service-Disabled Veteran-Owned Businesses and sign up to receive updates

whenever we certify new businesses, please send a request to [email protected]y.gov.

6. Contractors utilizing SDVOB firms for supplies/materials/equipment whose NYS certification profile designates them

as Broker will receive an SDVOB utilization credit for the actual monetary value of the broker fees or the actual

markup percentage of the items brokered.

7. SDVOB Participation:

The actual services provided by the SDVOB must be essential in the performance of the scope of work for the

applicable

contract. Utilization of a certified SDVOB as a conduit or pass through for participation credit is strictly prohibited. It is

the discretion of SUNY University-wide MWBE Program to determine whether services are essential in the performance

of the scope of work and to offer a determination of the appropriateness of work allowed for lower tier subcontracting,

in accordance with practices generally accepted in the construction industry. The services the SDVOB will provide must

be among those explicitly identified in the profile (codes) of the firm as listed in the SDVOB directory Division of

Service-Disabled Veterans’ Business Development. Firms submitted or firms that participate in the project outside of

Form 7564-121B

Page 3 of 3

these conditions and without specific prior approval by SUNY will not be credited toward the SDVOB Utilization Plan

and goals for the contract.

8. Prior to submitting the Utilizatio

n Plan, the bidders should confirm the following:

a. SDVOB firms are NYS certified;

b. SDVOB firms are being used

for item(s) within their certification product codes as indicated in their SDVOB

Directory firm profile;

c. SDVOB firms will perform work for which they have been submitted; and

d. 2nd tier subcontractors and/or suppliers are identified as such and SDVOB Utilization credit shall be given for 60%

of the total contract value of supply purchases or services rendered (for example, when an electrical subcontractor

purchases from a 3rd party supplier an SDVOB utilization credit will be given for 60% of the total contract value).

The prime Contractor is responsible for

ensuring participation provided by subcontractors for 2nd and 3rd tier SDVOB

participation.

Submission of a Utilization Plan which fails to meet or exceed each goal shall be accompanied by documentation of specific

efforts und

ertaken both pre- and post-bid. The campus MWBE Program Coordinator will review and notify Contractor of its

assessment.

The University-wide MWBE Program Office in collaboration with the campus MWBE Program Coordinator

will review the

Utilization Plan and notify the Contractor of any deficiencies and determine necessary actions to bring the Plan into

compliance. The University-wide MWBE Program Office reserves the right to require the Contractor to provide sufficient

documentation of the efforts made in the development of the Utilization Plan. The documentation should meet the good faith

efforts standard under 9 NYCRR § 252.2, and demonstrate the Contractor’s commitment to providing opportunities for

SDVOB firms in the development of the Utilization Plan.

A copy of the approved Utilization Plan will be provided to the Contractor after issuance of Notice of Award.

SDVOB FORM (7564-107) UTILIZATION PLAN INSTRUCTIONS

Requested information must be completed and submitted within seven (7) days after the bid opening.

Subcontractor Name & Address

Name & Address of each SDVOB subcontractor or supplier.

Federal ID

Provide accurate Federal ID number of each SDVOB subcontractor or supplier.

Dollar Value of Subcontract or Purchase Order

This is the total value of the signed subcontract. If this value is different from the amount in the approved

SDVOB Utilization Plan, an explanation should be provided.

Description of Work or Supplies

Brief description of work performed or supplies provided by the SDVOB subcontractor or supplier.

Schedule

This is the anticipated start and completion dates for each SDVOB subcontractor or supplier. Do not

include the construction schedule for the life of the entire project.

Signature

To be signed by an Officer of the Company.

 The information included on the Form 7564-107 is subject to verification by the campus MWBE Program

Coordinator.

 The campus MWBE Program Coordinator must be notified prior to changes made to the approved

SDVOB Utilization Plan.

Questions regarding this form should be directed to the campus MWBE Program Coordinator.

UNIVERSITY-WIDE SDVOB PROGRAM

UTILIZATION PLAN

Form 7564-107, June, 2016 Page 1 of ___

SUNY Project No. ____________________

Bid Date:

Clickheretoenteradate.

Agreement/Contract Value: ___________________

Contractor: _________________________ Primary Contact: _________________________________________________

Address: _________________________

City: ____________________ State: ____________________ Zip Code: ___________

Phone Number: _______________________ Fax Number: _________________ E-Mail: ___________________________

GOALS: SDVOB % Campus: ___________________________________

SUBCONTRACTOR FEDERAL ID #

DOLLAR VALUE OF

CONTRACT OR

PURCHASE ORDER

DESCRIPTION OF WORK OR SUPPLIES

SUBCONTRACTOR/SUPPLIER

SCHEDULE

START DATE

COMPLETION

DATE

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Clickhereto

enteradate.

Clickhereto

enteradate.

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Clickhereto

enteradate.

Clickhereto

enteradate.

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Clickhereto

enteradate.

Clickhereto

enteradate.

Company Name: _________________________

Street Address: _________________________

Contact Name: _________________________

E-Mail Address: _________________________

Clickhereto

enteradate.

Clickhereto

enteradate.

In accordance with the SUNY Contract Documents and Executive Law Article 17-B, my firm seriously expects to use the NYS certified SDVOB certified firms listed above. The Contractor shall

immediately notify and request approval prior to any changes to this plan from the Campus MWBE Program Coordinator.

NAME: TITLE: COMPANY OFFICER’S SIGNATURE DATE:

______________________________________ _____________________________________ _____________________________________

Clickheretoenteradate.

APPROVED: DEFICIENT: MWBE PROGRAM COORDINATOR: ________________________________ DATE: ______________

SDVOB Form 108

EEO STAFFING PLAN

Instructions on page 2

Solicitation No.:

eporting Entity: Report includes Contractor’s/Subcontractor’s:

□

Work

force to be utilized on this cont

ract

□ Total wo

rk force

Offeror’s Name: □ Offerer

□

Subcontractor

Subcontractor’s name

________________

Offeror’s Address:

Enter the total number of employees for each classification in each of the EEO-Job Categories identified

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)

Native

American

(M) (F)

Disabled

(M) (F)

Veteran

(M) (F)

Officials/Administrators

Professionals

Technicians

Sales Workers

Office/Clerical

Craft Workers

Laborers

Service Workers

Temporary /Apprentices

Totals

PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type): Submit completed with bid or proposal

SDVOB Form 108

General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (ADM/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 and/or subcontractor’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 and/or subcontractor’s total work force, the Offeror shall complete this form for the contractor’s and/or subcontractor’s

total work force.

Instructions 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 work force to be utilized on the contract or the Offerors’ total work force.

4. Enter the total work force by EEO

job category.

5. Break

down the anticipated total work force by gender and enter under the heading ‘Work force by Gender’

6. Break down the anticipated total work force by race/ethnic identification and enter under the heading ‘Work force by Race/Ethnic Identification’. Contact the

M/WBE

Perm

issible contact(s) for the solicitation if you have any questions.

7. Enter information on disabled or veterans included in the anticipated work force under the appropriate headings.

8. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes.

RACE/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 form,

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:

 WHITE (No

t 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.

 HISPANIC a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of

race.

 ASI

AN & PACIFIC a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.

ISL

ANDER

 NATIVE INDIAN (NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal

AME

RICAN/ ALASKAN affiliation or community recognition.

NATIVE)

OTHER CATEGORIES

 DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies)

- has a record of such an impairment; or

- is regarded as having such an impairment

 VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975.

 GENDER Male or Female

SDVOB Form 104

MINORITY AND WOMEN’S AND SERVICE-DISABLED VETERAN BUSINESS

EQUAL EMPLOYMENT

OPPORTUNITY PROGRAM POLICY STATEMENT

Policy Statement

The _____________________commits to carrying out the intent of the New York State

(Name of Campus, Consultant, Contractor)

Executive Law, Articles 15-A and 17-B which assures the meaningful participation of service

disabled Veteran’s business and minority and women business enterprises in contracting and the

meaningful participation of service disabled veterans and minority and women in the workforce

on activities financed by public funds.

Minority Business Officer

________________________is designated as the Minority Business Enterprise Officer

(Name of Designated Officer)

responsible for administering the Minority and Women’s Business and Service Disabled

Veteran-Equal Employment Opportunity (M/WBE-EEO) program.

Phone____________________________________________________________

Email____________________________________________________________

M/WBE Contract Goals

_____% Minority Business Enterprise Participation

_____% Women’s Business Enterprise Participation

_____% Service Disabled Veteran Enterprise Participation

EEO Contract Goals

10% Minority Labor Force Participation

10% Female Labor Force Participation

____________________________________

(Authorized Representative)

Title: ________________________________

Date: ________________________________