Off-island ppa
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- ______________________________________ ___________________________ President ______________________________________ ___________________________
- Potential Consultant: ______________________________________________________________ Street Address: ______________________________________________________________
- Joint or combined bids by companies or firms must be certified on behalf of each participant: ________________________________________________________________________
- NONDISCRIMINATION IN EMPLOYMENT IN NORTHERN IRELAND: MACBRIDE FAIR EMPLOYMENT PRINCIPLES
- Offerer Disclosure of Prior Non-Responsibility Determinations
- CONTINGENT FEE CERTIFICATION
- _______________________________________________
______________________________________ ___________________________ President ______________________________________ ___________________________ Secretary ______________________________________ ___________________________ Treasurer ______________________________________ ___________________________ President ______________________________________ ___________________________ Secretary ______________________________________ ___________________________ Treasurer Identifying Data: Potential Consultant: ______________________________________________________________ Street Address: ______________________________________________________________ City, Town, etc. ______________________________________________________________ Telephone: ____________________ Title: __________________________ ________________________________________________ If applicable, Responsible Corporate Officer Name ________________________________________________ Title
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Legal name of person, firm or corporation Legal name of person, firm or corporation By _____________________________________ By ___________________________ (Name) … (Name) ________________________________________________________________________ Title Title ________________________________________________________________________ Street Address Street Address ________________________________________________________________________ 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 in the bidder, either: (answer yes or no to one or both of the following, as applicable), (1) has business operations in Northern Ireland; Yes___ or No___ If yes: (2) shall take lawful steps in good faith to conduct any business operations that it has 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___ ____________________________ Signature Offerer Disclosure of Prior Non-Responsibility Determinations ************************************************************************ Name of Individual or Entity Seeking to Enter into the Procurement Contract: Address: Name and Title of Person Submitting this Form: Contract Procurement Number: Date: 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? (Please circle): No Yes 2. If yes, was the basis for the finding of non-responsibility due to a violation of State Finance Law § 139-j? (Please circle): 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? (Please circle): No Yes 4. If yes, please provide details regarding the finding of non-responsibility below. Governmental Entity: ____________________________________________________ Date of Finding of Non-Responsibility: ______________________________________ Basis of Finding of Non-Responsibility: ______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Offerer certifies that all information provided to the Long Island Power Authority with respect to State Finance Law § 139-k in complete, true and accurate. By: Date:__________________________ Signature
Proposer has not employed or retained and will not employ or retain any individual or entity for the purpose of soliciting or securing any Long Island Power Authority contract or any amendment or modification thereto pursuant to any agreement or understanding for receipt of any form of compensation which in whole or in part is contingent or dependent upon the award of any such contract or any amendment or modification thereto; and Proposer will not seek or be paid an additional fee that is contingent or dependent upon the completion of a transaction by the Long Island Power Authority. ************************************************************************ FAILURE TO PROVIDE THIS CERTIFICATION WILL BE GROUNDS FOR DISQUALIFICATION IN THE PROCUREMENT PROCESS. VIOLATION OF EITHER (1) OR (2) OF THIS CERTIFICATION SHALL RESULT IN: disqualification of Proposer from the procurement process; and prohibition of the Proposer from being awarded any contract for a period of three years from the commencement of the procurement process. ************************************************************************ Certified as of the ______ day of _____________, 20__. _______________________________________________ Name of person, firm or corporation By _____________________________________ (Name and Title) Directory: proposals proposals -> Title 157 State Fire Marshal Chapter 8 permissible fireworks in the state of nebraska for 2008 2009 proposals -> Online Course Proposal Form proposals -> Course Title & Number: Bus 14 Business Communication Faculty Name: Melissa Patterson Course Delivery Method (check one) proposals -> IPad/Mobile Learning Strategies: iLearn, iPractice, and iEvaluate proposals -> Computational X: Integrating Computational Thinking across Disciplines Austin Cory Bart, Dennis Kafura proposals -> Title 435 private detective licensing act numerical table of contents proposals -> Bif 400 – Bioinformatics Senior Seminar Generic Syllabus proposals -> Contact Information 1102 Education Tower Download 0.54 Mb. Share with your friends:
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