[1] LEGAL NOTICE Notice is hereby given that the Finance Committee of the Steuben County Legislature and the Commissioner of Finance will receive sealed proposals for a Section 457 Deferred Compensation Plan, document # GC-18-003-P. Specifications, proposal forms and general provisions are available at the Purchasing Department, 3 East Pulteney Square, Bath, New York 14810. The telephone number is 607-664-2484. These documents are also available on the Steuben County website, www.steubencony.org. Interested parties assume all responsibility to acquire information and forms. To be considered, proposals must be submitted on the Steuben County forms supplied and delivered in a sealed opaque envelope. Proposals will be received at the Purchasing Department until 1:30 P.M. local time on March 22, 2018; at which time proposals will be opened and acknowledged as received. Steuben County retains the right to reject any or all proposals and to withdraw this solicitation at any time. Dated: February 15, 2018 ___________________ Andrew G. Morse Director of Purchasing P U R C H A S I N G D E P A R T M E N T COUNTY OF STEUBEN 3 EAST PULTENEY SQUARE BATH, NEW YORK 14810-1510 (607) 664-2484
Transcript
[1]
LEGAL NOTICE Notice is hereby given that the Finance Committee of the Steuben County Legislature and the Commissioner of Finance will receive sealed proposals for a Section 457 Deferred Compensation Plan, document # GC-18-003-P.
Specifications, proposal forms and general provisions are available at the Purchasing Department, 3 East Pulteney Square, Bath, New York 14810. The telephone number is 607-664-2484. These documents are also available on the Steuben County website, www.steubencony.org. Interested parties assume all responsibility to acquire information and forms. To be considered, proposals must be submitted on the Steuben County forms supplied and delivered in a sealed opaque envelope. Proposals will be received at the Purchasing Department until 1:30 P.M. local time on March 22, 2018; at which time proposals will be opened and acknowledged as received. Steuben County retains the right to reject any or all proposals and to withdraw this solicitation at any time. Dated: February 15, 2018 ___________________ Andrew G. Morse Director of Purchasing
Request for Proposals: Section 457 deferred compensation plan; document #GC-18-003-P OBJECTIVE The purpose of the proposed deferred compensation plan will be to provide eligible employees with a convenient way to provide for a long-term retirement program and to encourage broad-based participation of employees in the plan. We do not want to imply that any specified amount of contributions will be made, but we do want to assure that this additional benefit is recognized by all employees, that they have the opportunity to receive one-on-one counseling and voluntarily participate. The plan is intended to qualify as an “eligible deferred compensation plan” under Section 457 (“Section 457”) of the Internal Revenue Code of 1986 (“Code”), as now in effect or hereinafter amended. To become an “eligible deferred compensation plan” in the State of New York, you must meet the requirements of the “Rules and Regulations” [Parts 9000 to 9006 of Subtitle II of Title 9 NYCRR (“Subtitle II”)] (the “Regulations”) promulgated by the New York State Deferred Compensation Board (the “Board”) pursuant to the authority granted by the State Finance Law, Article 2, Section 5. This document constitutes a request from qualified Administrative Service Agencies and/or Financial Organization relating to (1) trust service, (2) administration and/or (3) funding of an “eligible deferred compensation plan”. If you are “qualified” according to the Regulations to administer, maintain records and accounts of plans and/or if you have appropriate trust services and/or products available for use as funding media and are interested in making those services and/or products available, you are requested to complete this invitation for proposal. REFERENCES Any response to this request for proposal shall contain as a minimum at least three (3) references with contact names and phone numbers where the proposer has completed projects similar in nature. SELECTION PROCESS Section 9001.2(b) of the Regulations, recognizes that we have appointed a committee to act on our behalf, to the extent permitted or required by the Regulations and the Model Plan. Section 9003.3(c): before any contract or agreement entered into by the committee may become effective, the committee must submit in writing, to the President of the New York State Civil Service Commission (“the President”), the name of such selected bidder(s) and a “certification” signed by the chief executive officer and
[3]
chief legal officer stating that such bidder(s) has been duly selected to provide services in accordance with provisions of the Regulations. Contracts or agreements cannot be awarded before the expiration of ninety (90) days from date of our announcement publication in the State Register and local paper. Invitations may be made for oral presentations. Any award of a contract or agreement as a result of this invitation will be made by written notification. We reserve the right to reject any or all proposals or parts thereof. We reserve the right to establish a deferred compensation plan by any of the methods prescribed by Section 9001.2(a) of the Regulations. TERM OF AGREEMENT Pursuant to Section 9003.5(a) of the Regulations, we expect to enter into a written contractual arrangement(s) of up to five (5) years in duration. All contracts and agreements entered into shall impose no penalties or surrender charges for the transfer of assets or responsibilities on expiration of the contract or agreement. Upon the expiration or termination of any contract(s) or agreement(s), the committee shall follow procedures set forth in the Regulations in Part 9003 for awarding new contracts and entering into new agreements. CANCELLATION OF CONTRACT: Steuben County reserves, as its right, the right to cancel the contract(s) resulting from an award of this solicitation at any time during the contract period, without penalty to Steuben County and without stated reason, by delivering a written ten (10) day notice of intent to the contractor(s) or its representative(s). Said notification mailed to the contractor or its representative via the US Postal Service; First Class Mail shall be considered sufficient and delivered. ASSIGNABILITY The contractor shall not assign, transfer, convey, subcontract, sublet or other-wise dispose of all or portions of the contract; and/or work to be performed as a result of the contract; or its right, title or interest therein, or its power to execute such contract, or its responsibility therein to any other person, company or corporation, without the prior written consent of the Steuben County Administrator and the Administration Committee. INSURANCE a) This quote document includes an information sheet entitled “Steuben County
Standard Insurance Requirements”. These requirements establish the minimum insurance(s) which the awardee(s)
shall have in effect prior to entering into a contract to do business with Steuben
[4]
County. Said insurance(s) are required to remain in effect throughout the term of the contract(s).
In the event that the awardee’s insurance lapses during the term of the contract,
the County reserves, as its right, the right to cancel the awardee’s contract(s) and to purchase the contracted product(s)/service(s) on the open market; with any increase in cost(s) to Steuben County being charged to the awardee. Credit shall not be issued to the awardee where open market cost(s) to the County are less than the cost(s) contracted with the awardee.
b) Steuben County shall be named as an additional insured in the contractor’s policy
for all intents and purposes of contract(s) issued as a result of an award of this quote. The quote document number and quote title shall be referenced in the description/additional comments section of the certificate of insurance form.
Additional insured and certificate holder must only read: Steuben County, 3 E.
Pulteney Square, Bath, NY 14810. c) Each awardee shall submit an original of its Certificate of Insurance, which
indicates the contractor’s compliance with the above sections a) and b) to Steuben County Purchasing Department, 3 E. Pulteney Square, Bath, NY 14810.
d) The Certificate of Insurance must be approved by the County Risk Manager prior
to the contractor’s acting on and/or performing any of the obligations it incurred as a result of the award and/or contract.
e) Self-employed awardees must carry Worker’s Compensation coverage as directed
by the Steuben County Risk Manager. Awardee shall submit an original Certificate of NYS Worker’s Compensation Insurance Coverage form WC 88 31 21 C, which indicates the contractor’s compliance, to be approved by the County Risk Manager prior to the contractor’s acting on and/or performing any of the obligations it incurred as a result of the award and/or contract.
Worker’s Compensation Insurance Exemption: Contractors claiming to be exempt from the requirement to carry/provide Workers’ Compensation Insurance shall submit a fully executed CE-200 form; the form to be complete, notarized, and stamped as received by the New York State Workers’ Compensation Board. NON-COLLUSIVE BIDDING CLAUSE AND CERTIFICATE: a) Clause –
“By submission of this bid, each contractor and each person signing on behalf of any contractor 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 knowledge and belief:
1) The prices in this bid have been arrived at independently without
[5]
collusion, consultation, communication or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other contractor 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 contractor and will not knowingly be disclosed by the contractor 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 contractor to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition.”
b. The contractor shall submit a signed and dated Non-Collusive Bidding Certificate with its bid. Said certificate is mandated by Chapter 956 of the Laws of New York State, pursuant to Section 103-D of the General Municipal Law. Reference the “NON-COLLUSIVE BIDDING CERTIFICATE” form included in this bid document.
HOLD HARMLESS CLAUSE AND FORM:
a) Clause – “The contractor agrees that it shall at all times save harmless the County of Steuben from all claims, damages or judgements or for the defense or payment thereof, based on any claim, action or cause of action whatsoever, including any action for libel, slander, or personal injury, or any affiliated claims, by reason of any act or failure to properly act on the part of the contractor and in particular as may arise from the performance under this contract. In the event of an injury by the subcontractor or its employees, they shall cause notice to be served upon the County within twenty-four (24) hours of any such injury.”
b) The contractor shall submit a signed and dated Hold Harmless Clause form with its bid. Reference the “HOLD HARMLESS CLAUSE” form included in this bid document.
IRANIAN ENERGY SECTOR DIVESTMENT CERTIFICATION: Contractor hereby represents that said contractor is in compliance with New York State General Municipal Law Section 103-g entitled “Iranian Energy Sector Divestment”.
By submission of this proposal, each contractor and each person signing on behalf of any contractor certifies and in the case of a joint proposal, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and belief, that each contractor is not on the list created pursuant to NYS Finance Law Section 165-a(3)(b).
[6]
The contractor shall submit a signed, notarized and dated Iranian Energy Sector Divestment Certification with its proposal. Said certificate is mandated by Section 103-g of the General Municipal Law. Reference the Iranian Energy Sector Divestment Certificate form included in this document.
ADDENDUM/ADDENDA
If an addendum has been issued prior to the County’s receipt of proposals, Steuben County shall attempt to notify potential respondents known to have received the proposal documents and whose contact information is on file with the County. Steuben County does not ensure the potential respondent receipt of addendum. It shall be the responsibility of each proposer, prior to submitting its proposal to contact the Director of Purchasing, 607-664-2484, to determine if an addendum has been issued.
CIVIL RIGHTS The County of Steuben, in accordance with the provisions of Title VI of the Civil Rights Act of 1964 and New York State Labor Law; Article 8 - Public Work, Section 220e hereby notifies all proposers that it will affirmatively ensure that any contract awarded as a result of this proposal solicitation will be awarded without discrimination on the grounds of race, color, sex or natural origin. SUBMISSION OF PROPOSALS
a) The proposer shall submit four (4) sets of its proposal (one original and three copies), including all required documents.
b) The proposal shall be submitted in a sealed opaque envelope marked on the outside with: the respondent’s name and address and the designation: “Sealed Proposal: Section 457 Deferred Compensation Plan”.
The envelope shall be addressed to Andrew G. Morse, Director of Purchasing, Steuben County Office Building, 3 East Pulteney Square, Bath, New York 14810.
c) Proposals shall be received at the Purchasing Department until 1:30 P.M. local
time on Thursday, March 22, 2018, at which time proposals shall be opened and acknowledged as received.
d) Facsimile transmitted proposals are not acceptable and shall be rejected.
e) Security procedures are in effect at the Steuben County Office Building. Interested parties, especially respondents who intend to hand deliver, should allow sufficient time for any delay that may arise as a result of security
[7]
procedures. To be considered “delivered on time”, a submission must be received at the Purchasing Department by the appointed hour.
f) All proposals will become property of the County once the advertised date and time of the proposal opening has arrived. The County will have the right to disclose all or any part of a proposal to public inspection based on its determination of what disclosure will serve the public interest. Prospective offerors are further advised that, except for trade secrets and certain personnel information (both of which the County has reserved the right to disclose), all parts of proposals must be disclosed to those members of the general public making inquiry under the New York State Freedom of Information Law (NYS Public Officers Law, Article 6). Should an offeror wish to request exemption from public access to information contained in its proposal, the offeror must at the time of submission of its offer, specifically, identify in their submission the information and explain in detail why public access to the information would be harmful to the offeror.
LATE PROPOSALS Proposer shall bear sole responsibility for the delivery of their proposal in a timely manner. Reliance upon the U.S. Postal Service or other carriers is at the proposer’s risk. Late proposals shall not be considered and shall be returned unopened. RIGHT TO SEEK CLARIFICATION, ACCEPT OR REJECT PROPOSAL(S) Steuben County reserves as its right to require clarification for the purpose of assuring a full understanding of the bidder’s responsiveness to the solicitation requirements.
The County of Steuben reserves the right to accept or reject any or all proposals received as a result of this request, to negotiate with all qualified proposers, or to cancel the entire or any part of this RFP, if it is deemed in the best interest of the County to do so. INFORMATION TO BE INCLUDED IN THE PROPOSAL: Attached you will find: the “Rules and Regulations” (effective June 21, 2006), hereafter referred to as the “Regulations”, and the Model Plan (including amendments through May 21, 2004) promulgated by the Board for which you are to rely on for responding to this invitation for proposal. Failure to conform to or satisfy any requirement of these documents will result in immediate rejection of the proposal.
Must include a fully complete questionnaire, restating each statement or question in Section I through Section V inclusive, and by recording your response directly below each statement or question.
Must respond to all questions in the “Contractual Requirements” section (Section I) and must conform to the specifications set forth in this Request for Proposal (“RFP”). If recordkeeping services are provided by a “person” (defined by the
[8]
Regulations) that is neither the parent nor subsidiary company of the Financial Organization, then separate and complete responses must be received by each company
Must include a transmittal letter on the Company’s official letterhead signed by an official of the Company who is authorized to commit the organization to perform the services outlined in the submitted proposal: you must indicate such commitment. The transmittal letter must contain a representation that the proposal complies with all requirement of the Regulations and the Model Plan.
MODIFICATION OR WITHDRAWAL OF PROPOSALS: a) A proposal may be modified or withdrawn by an appropriate document duly executed in the manner that a bid must be executed and delivered to the place where proposals are to be submitted at any time prior to the scheduled time for opening of proposals. b) No proposal may be modified, withdrawn or canceled for a period of one hundred twenty (120) days after the date of the proposal opening and all proposals shall be subject to acceptance by the County during this period. RESPONSIBILITIES FOR WORK: The contractor assumes full responsibility for the acts and omissions of all his employees and all sub-contractors, their agents and employees and all other persons performing work under the contract. CONSIDERATION OF PROPOSAL; ACCEPTANCE OF PROPOSAL (AWARD): a) The award of contract will be made by written notice of award signed by a duly authorized representative of the County and no other act of the County shall constitute the acceptance of a bid. b) The acceptance of the proposal shall bind the successful contractor to execute a contract. EXECUTION OF CONTRACT/CERTIFICATE OF INSURANCE: The contractor to whom the award is made shall assist and cooperate with the County as necessary in preparing the standard County agreement for execution. COMMENCEMENT OF WORK: Notwithstanding any delay in the preparation and execution of the agreement, the successful contractor shall be prepared, upon receipt of the notice of award, to commence work within a time period mutually acceptable to contractor and the County.
SUPPORTIVE SPECIFICATIONS: The contractor shall be responsible for obtaining all permits required to fulfill this contract and shall comply with all laws, ordinances, rules and regulations of the
[9]
jurisdictions in which the work is performed.
SALES TAX EXEMPTION: The County is exempt from payment of sales and compensating use taxes of the State of New York and of cities and counties within the State of New York. PROTECTION FROM CLAIM AGAINST “OR EQUAL”: In the event of any claim by an unsuccessful contractor concerning or relating to the issue of “equal or better” or “or equal” the successful contractor agrees to hold the County of Steuben free and harmless for any and all claims for loss or damage arising out of this transaction for any reason whatsoever. The County is to be free and harmless for any and all legal fees and court costs. EVALUATION PROCESS: In selecting, we will use criteria which comply with the requirements of the Regulations, including section 9003.3(a)(1 through 7) of the Regulations. All qualified proposals, sought in conjunction with the requirements of Section 9003.2 of the Regulations, will be evaluated and awards made to the bidder or bidders whose bid is determined to be in the best interest of the plan participants. QUESTIONS:
Contractor’s questions will be accepted until March 14, 2018 and shall be submitted in
writing to Andrew G. Morse, Director of Purchasing, Steuben County Purchasing
Department, 3 E. Pulteney Square, Bath, NY 14810. No questions will be accepted after
this date.
[10]
SECTION I CONTRACTUAL REQUIREMENTS
“Agree” or ”Disagree” must be indicated for each of the following specifications. The following specifications can be found in either the regulations or the Model Plan, all of which should have been enclosed as attachments. Please include reasons for any rejection or disagreement of any specification and alternative options, if applicable. There should be neither elaboration nor qualification for “agree” unless otherwise requested.
Specifications of the Regulations
1. Section 9000.2(b)(4)- As a Financial Organization authorized to do business (provide investment products) in New York State, you agree that your firm is one of the following: (a) a Registered Investment Advisor, (b) a Bank or (c) an Insurance Company qualified under the laws of more than one state. If you are an Insurance Company acting through a subsidiary in New York State, then the Subsidiary Insurance Company must certify that it (the Subsidiary Insurance Company) is qualified to do business under the laws of more than one state.
2. Section 9001.2(b) – We have a appointed a deferred compensation committee to act on our behalf and you agree to interface with this committee. Additionally, we may decide to be the grantor of our own trust, then you also agree to interface with the trust and trustee: all funding contracts, of whatever nature, will be “issued to, owned and retained by the trustee”.
3. Section 9001.4(a) through (d) – You agree to abide by all four (4) provisions, especially not allowing annuity type payouts.
4. Section 9002.2(a)(5) – You will provide evidence that bonds and insurance have been secured by you pursuant to the Regulations.
5. Section 9002.2(a)(6) – You will acknowledge in writing that you will act as a fiduciary under Section 457(g) of the Code and under State and common trust law principles with respect to all trusteeship, administrative, or investment matters for which you assume responsibility. Additionally, you agree to indemnify our Plan as a result of any cause of action brought against it as a result of acts or omissions together with the reasonable costs of litigation arising therefrom.
6. Section 9003.3(a) – Your proposal shall be in writing and contain a representation that the proposal complies with all the requirements of the Regulations and clearly indicate all direct fees, indirect fees and charges.
[11]
7. Section 9003.5(c) - All contracts and/or agreements shall be in writing, shall be awarded on the basis of a competitive bid, and shall not exceed five (5) years in duration, and shall impose no penalties or surrender charges for the transfer of any asset(s) or responsibilities on expiration of the contract or agreement.
8. Section 9003.5(b) – You will not permit any other Trustee, Administrative Service Agency, Financial Organization, independent consultant or person to provide services in respect to the Model Plan we have adopted.
9. Section 9003.7 – You will not permit an investment of any amount, in any annuity contract providing for a term which could exceed five (5) years or which is measured by one or more natural lives or any life insurance or other contract providing traditional death benefits.
10. Section 9004.1 – All information obtained by your position will remain confidential and you will neither solicit nor provide products other than deferred compensation.
11. Section 9005.3 – Statements to participants will be provided at least quarterly, even in situations where no contributions are being made but funds are on deposit. You also agree to provide, at least annually, an additional statement to participants disclosing all fees and expenses are paid out or charged against plan assets.
12. Section 9005.4 – Agree to satisfy the bonding and insurance requirements of this Section and provide evidence of such.
13. Section 9006.2 – You agree to include in your contracts and agreements a provision that the contracts and agreements are subject to the Regulations and the Model Plan and that such Regulation and the Model Plan are made part thereof.
Specifications of the Model Plan 1. Section 3.2(a) – The Model Plan requires a minimum deferral amount
to be $260 for any plan year. Your proposal will state this minimum requirement wherever requested.
2. Section 4.1 – You acknowledge that the amounts of compensation deferred by the participants will be invested, according to the participant’s investment directions, no later than two (2) business days following receipt thereof, in the appropriate investment funds.
3. Section 4.7(a) – The entire value of each participant’s account, including any annuities will be set aside and held by the trustee, in trust, and that your contracts and agreements will recognize and reflect such.
[12]
SECTION II. TRUSTEE SERVICES
NOTE: You may skip this section entirely if you are not a Financial Organization bidding to become Trustee. You do not need to copy any of the questions. Move to next applicable Section.
Section 9002.1(a) of the Regulations states that assets must be held by one or more trustees pursuant to one or more trust agreements. Such agreements must satisfy all the requirements of Section 9002.1(b). Section 9002.1(b) also indicates who may be trustee. We reserve the right to create our own trust as provided by this Section 9002.1(b) but desire to explore the alternative of a Financial Organization acting as trustee. Please respond to each of the following statements if you desire to be considered as trustee. If any statement does not apply, please indicate so by responding “Not Applicable”.
Requested Information A. The name of your firm, address, name of primary contact person and
telephone number. B. Whether your firm has provided trust services to any New York State
municipality for their Code Section 457(b) deferred compensation plan. List names of all such municipalities.
C. Description of trust services you would provide acting as a Financial Organization rendering only trust services. Please specify all fees, expenses, charges and costs for the trustee services. Please provide disclosure of any compensation structure.
D. If you are selected as the Financial Organization acting as our trustee and desire to additionally respond to performing the duties of an Administrative Service Agency, as described in Sections 9000.2(b)(1) and 9002.1(b) (4) of the Regulations, please indicate your intention here. If you respond affirmatively, then it will be necessary for you to complete the questions in Section III and IV addressed to the Administrative Service Agency bidder. However, in addition to stating your intention to bid, it is requested that you indicate here the effect this would have on any fees, expenses, charges and costs as distinguished from those previously stated in this Section.
E. The trustee will also be requested to acknowledge in writing that it is a fiduciary with respect to all administrative or investment matters for which it has assumed responsibility as outlined in Section 9002.2(a)(6) and 9003.6 of the Regulations.
F. Referring to Section 9005.4 of the Regulation, describe the type of bond and its limits that you will be furnishing. Include “cost disclosure” if it your intention for us to satisfy any part of this obligation.
[13]
G. Do you intend to supply us with a sample trust agreement for our consideration? If so, do you attest that this agreement meets all of the requirements applicable to trusts as stated in Section 9002.1(b) of the Regulations and Section 457(g) of the Code?
[14]
SECTION III ADMINISTRATIVE SERVICE AGENCY/FINANCIAL
ORGANIZATION (Excluding Trustee)
Please respond to each of the following statements if you desire to be considered as either the Administrative Service Agency and/or the Financial Organization. If you feel any statement does not apply, please indicate so by responding: “Not Applicable” and provide your reasoning.
Company Background
A. The name of your firm, home office address, New York State address (if any), and the name (including title) address and phone number of your primary contact person whom we may contact about your proposal.
B. Give a very brief description of your company and its history of participation in similar public employee Code Section 457(b) deferred compensation plans for state and local government employers. In New York State such plans first materialized in 1985. Include your specific experience in similar plans in New York since that time.
C. How many public employee elective deferral retirement plans and deferred compensation plans to you currently provide administrative services and/or investment products for? How many of these plans are New York plans?
D. In the past three (3) years has any public employee Code Section 457(b) deferred compensation plan/program, regardless of geographic location, terminated your (parent, subsidiary or affiliate) services either through the competitive bid process or for cause? IF so, buy whom and under what circumstances?
E. List ten (10) client Code Section 457(b) deferred compensation plan references for which your organization provides services and/or investment products similar to those requested in this proposal. It would be preferable if five (5) of the references could represent different size clients (based on assets) from New York State, if possible. Please include contact person name, title, address and telephone number, number of participants and approximate size of plan assets and the number of years you have been providing services. Spreadsheet format preferred.
F. What professional liability coverages are maintained by your company for errors and omissions or any other act?
G. Financial Organizations should provide appropriate “ratings” from the following: A. M. Best, Standard & Poor’s, Moody’s and Fitch (formerly Duff and Phelps). Has your rating in any of these agencies fallen below “A-“ in the last three (3) years? If yes, give complete details. If, as a Financial Organization, you have no ratings by any of these agencies,
[15]
please explain. H. Provide any additional information that would distinguish your firm.
[16]
SECTION IV SERVICES
Please respond to each of the following statements if you desire to be considered as the Administrative Service Agency. If you feel any statement does not apply, please indicate so by responding: “Not Applicable” and provide your reasoning.
Marketing and Enrollment Services
1. Briefly describe the marketing and employee communication strategy which will be used with our plan. Indicate the use and capabilities of laptop computers, if utilized.
2. Briefly describe the types of marketing/promotional materials to be utilized. How will you work to develop a marketing program unique to our needs?
3. Do you provide communications to participants on a regular basis? If so, please describe.
4. Will these services and materials be prepared and distributed at your cost?
5. What educational materials will be provided to the Plan to maintain compliance?
6. Briefly describe how you propose to conduct group enrollment meetings and ongoing educational sessions so that all interested employees have an opportunity to attend at a convenient time and location. How often are these type sessions proposed? Indacate the use and capabilities of laptop computers, if used.
7. Please describe, in detail, your one-on-one counseling sessions. Your response should emphasize how you plan to satisfy “the individual one-on-one demand availability” of your enrollment specialist especially at times and locations convenient to our employees.
8. What educational services are provided for retirees? 9. Describe your approach to asset allocation and diversification. 10. How do you follow-up with or contact employees that did not have
an opportunity to attend a group session or with an employee subsequently hired after that meeting date? Your comments on the one-on-one availability of your enrollment specialists for this function are important.
11. Briefly describe your continuing education program, if any. 12. Do you attest that these Enrollment Services are provided only by
a properly licensed representative: licensed to meet both Federal and New York State requirements?
[17]
Administrative Services
A. Services offered to the Plan Sponsor
1. Do you offer a dedicated toll-free Plan Sponsor line? 2. How does your organization provide assistance with revisions to the
New York State Model Plan Document? 3. Does your company provide loans to participants? 4. Will your company withhold, remit and report income taxes deducted
from distributions? Does this service include the production and distribution of all income tax reports to all the necessary parties as required by federal and state laws?
5. Specify all reports that will be issued to us, our participants and governmental agencies.
6. The Committee anticipates plan expenses related to the administration of the Plan. Would you be willing to reimburse the Committee for these expenses and if so, to what level?
B. Services offered to participants
1. Describe your voice response telephone system. Identify all
available services including customer service options as well as “Voice Response Systems” or automated options. Include security features and voice options, if applicable.
2. Can your customer service representatives assist non-English speaking participants?
3. Describe your internet strategy. What features are currently available on your website? What services are you developing for the near future? What security safeguards are used?
4. Please describe the settlement options available to each participant at retirement, voluntary termination and death. Please state your compliance to reflect the Board’s continued prohibition on annuity distribution options. (Section 9001.4 of the Regulations).
5. In the event you are asked to administer our plan alongside another provider(s), please describe your required process for assisting with participant requests to transfer plan assets from your program to one of the other carriers. Describe in detail the forms, signatures and overall process that you require.
Recordkeeping System
1. Specify the basic recordkeeping system to be provided for our plan, with
particular reference to the ability to receive, disburse, control and audit deductions, and to ensure timeliness, accuracy and confidentiality of records and describe the software used.
[18]
2. Briefly describe data processing operations, including the media by which your company can receive payroll deduction information, and its security provisions. Include a statement about your disaster recovery plan and its site location. Identify any subcontracting requirements for your primary administration responsibilities and comment on how this is possible in light of Section 9003.5(b) of the Regulations.
3. Indicate all interfacing: payroll deduction inputs, required certifications and any other transactions, specifying all direct and indirect costs. Specify how payroll deduction information is to be supplied. Indicate ability to interface with internal data processing systems.
[19]
SECTION V INVESTMENTS
Please respond to each of the following statements if you desire to be considered as the Financial Organization. If you feel any statement does not apply, please indicate so by responding: “Not Applicable” and provide your reasoning.
Fund Offerings Information should be for the most recent calendar quarter completed.
1. Describe fully the various attributes of each investment option your
company has to offer. For each option include an Investment Options Summary sheet which includes the funds objective, portfolio statistics, asset allocation, top 10 holdings, and industry diversification.
2. Describe fully your “fixed” investment option. Include a one-page summary including applicable rates for the current calendar year, asset composition, and rating methodology.
3. Does your company offer a self-directed brokerage window as a potential option? Please fully describe the services and fees associated with administration of the brokerage accounts.
4. Illustrate in spreadsheet format provided, (see Exhibit A) the “variable” values for each equity type investment. Please give annualized returns for ‘year-to-date’, ‘one year’,’ three year’, ‘five year’, and ‘since inception’ values.
5. Illustrate in spreadsheet format provided, (see Exhibit B) all charges including loading coast, policy fees, surrender charges, actuarial margins, asset fees, transfer charges, distribution charges, withdrawal fees, redemption fee, commission, termination/withdrawal of contract fees, etc.
Investment Flexibility
1. Describe fully all matters related to the exchange/transfer limitations or conditions, termination/withdrawal of contract provisions, any other restrictions or penalties etc. Include any information on “unrestricted” and/or “free” transfers or plan transfer limitations.
2. Identify any other charges or limitations not described in the previous responses.
[20]
SECTION VI CONVERSION SERVICES
NOTE: The following questions are to be answered only by an Administrative Service Agency bidding on an existing case that is administered by another provider: not on cases where you are the incumbent or on new cases that haven’t had a prior plan. If these questions do not apply, you may skip to the next section without copying the questions.
Experience
1. Provide a detailed description and complete history of Code Section 457(b) plans that you have been successful in taking over completely. Include entity name and date of takeover, the name of the former provider, the asset size of the plan, the number of participants, transition time, staffing requirement and other detail you believe is significant.
Process
1. Fully describe transition activities stating the time frame for a complete transition. Identify any cost to us or to our participants for each step or phase: for the complete conversion.
2. What on-site support will be provided during the transition? Who will provide this service? Would the key individuals be willing to meet with the Plan?
3. What impact, if any, would there be on our plan if you were to be appointed the sole administrator? For example, would fees be reduced? Would we qualify for additional services? Etc.
4. Please provide references for three plans you recently transitioned. If possible, please provide those located within New York.
[21]
Exhibit A
Fund Offerings – Section V, question 3
Illustrate in spreadsheet format provided, the “variable” values for each equity type investment. Please give annualized returns for ‘year-to-date’, ‘one year’, ‘three year’, ‘five year’, and ‘since inception’ values. Fund performance should be net of all administrative charges, fund level expenses, and other fees or charges assessed.
Investment Performance - As of 12/31/17
Investment Choices
Month 3 Mo.
YTD 1 Year
3 Year
5 Year
Since Inception
Inception Date
[22]
Exhibit B
Fund Offerings – Section V, question 4 Illustrate in spreadsheet format provided, all charges, including loading costs, policy fees, surrender charges, actuarial margins, asset fees, transfer charges, distribution charges, withdrawal fees, redemption fees, commission, termination/withdrawal of contract fees, etc.
Fee Schedule
Carrier Fees
Mutual Fund Level Charges
Fund/Account Name
Admin. Fee Mort & Exp.
Invst. Mgt. Fee
Other Fees 12b-1 Fees Total Fees
[23]
Request for Proposal
Section 457 deferred compensation plan Document #GC-18-003-P FILE DAY, DATE & TIME: Thursday, March 22, 2018; 1:30 P.M. local time Submission may be mailed or hand delivered. SUBMIT TO: Andrew G. Morse, Director of Purchasing Steuben County Purchasing Department 3 East Pulteney Square Bath, New York 14810 The undersigned, having an integral understanding of the objective, terms and conditions, specifications and contractor’s responsibility as stated in these documents, does hereby submit a quote for the provision of services as stated below and pursuant to the Request for Proposal.
PLEASE PRINT OR TYPE:
Company Name:
Federal Employer ID:
Company Address:
Name:
Title:
Signature:
Date:
Telephone Number:
Fax Number:
E-mail Address:
[24]
Attachment “D” Certification Pursuant to Section 103-g
Of the New York State
General Municipal Law
IRANIAN ENERGY SECTOR DIVESTMENT
1. Contractor/proposer hereby represents that said contractor/ proposer is in compliance with New
York State General Municipal Law Section 103-g entitled “Iranian Energy Sector Divestment”, in that said contractor/proposer has not:
a) Provided goods or services of $20 million or more in the energy sector of Iran including
but not limited to the provision of oil or liquefied natural gas tankers or products used to
construct or maintain pipelines used to transport oil or liquefied natural gas for the energy sector of Iran; or
b) Acted as a financial institution and extended $20 million or more in credit to another
person for forty-five (45) days or more, if that person’s intent was to use the credit to
provide goods or services in the energy sector in Iran.
2. Any contractor/proposer who has undertaken any of the above and is identified on a list created pursuant to Section 165-a (3) (b) of the New York State Finance Law as a person engaging in
investment activities in Iran, shall not be deemed a responsible bidder pursuant to Section 103 of the New York State General Municipal Law.
3. Except as otherwise specifically provided herein, every contractor/ proposer submitting a bid/proposal in response to this request for bids/request for proposals must certify and affirm the
following under penalties of perjury:
a) “By submission of this bid, each bidder and each person signing on behalf of any bidder
certifies and in the case of a joint bid, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and belief, that
each bidder is not on the list created pursuant to NYS Finance Law Section 165-a (3) (b).”
Steuben County will accept this statement electronically in accordance with the provisions of Section 103 of the General Municipal Law.
4. Except as otherwise specifically provided herein, any bid/proposal that is submitted without
having complied with subdivision (a) above, shall not be considered for award. In any case where the bidder/proposer cannot make the certification as set forth in subdivision (a) above, the
bidder/proposer shall so state and shall furnish with the bid a signed statement setting forth in
detail the reasons therefore. The County reserves its rights, in accordance with General Municipal Law Section 103-g to award the bid/proposal to any bidder/proposer who cannot make
the certification, on a case-by-case basis under the following circumstances:
a) The investment activities in Iran were made before April 12, 2012, the
investment activities in Iran have not been expanded or renewed after April 12, 2012 and the bidder/proposer has adopted, publicized and is implementing a formal plan to cease
the investment activities in Iran and to refrain from engaging in any new investments in Iran; or
[25]
Attachment “D”
Certification Pursuant to Section 103-g Of the New York State
General Municipal Law
IRANIAN ENERGY SECTOR DIVESTMENT
Page 2
b) The County of Steuben has made a determination that the goods or services are
necessary for the County to perform its functions and that, absent such an exemption, the County of Steuben would be unable to obtain the goods or services for which the
bid/proposal is offered. Such determination shall be made by the County in writing and shall be a public document.
_________________________________ ________________________________ Signature Title
On the ________ day of ____________________ in the year __________ 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
[26]
NON-COLLUSIVE CERTIFICATE By submission of this proposal, each contractor and each person signing on behalf of any contractor certifies, and in the case of a joint proposal, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of knowledge and belief: 1. The prices in this proposal 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 contractor or with any competitor; 2. Unless otherwise required by law, the prices which have been proposed in
this proposal have not been knowingly disclosed by the contractor and will not knowingly be disclosed by the contractor prior to opening, directly or in-directly, to any other contractor or to any competitor; and
3. No attempt has been made or will be made by the contractor to induce
any other person, partnership or corporation to submit or not to submit a proposal for the purpose or restricting competition.
NAME:_______________________________________________________________ ADDRESS:____________________________________________________________ SIGNED BY:_______________________________TITLE:_______________________ NAME PRINTED/TYPED:_________________________________________________ TELEPHONE NUMBER:_______________________DATE:_______________________ PROPOSAL TITLE:_______________________________________________________
[27]
HOLD HARMLESS CLAUSE As a successful contractor, I shall hold harmless the County of Steuben and representatives thereof from all suits, actions or claims of any kind brought on account of any injuries or damages sustained by any person or property in consequence of any neglect in safe-guarding contract work or on account of any act or omission by the contractor or his employees, or from any claims or amounts arising or recovered under any law, ordinance, regulation or decree. NAME OF COMPANY:___________________________________________________ SIGNED:_____________________________________________________________ NAME:_______________________________________________________________ TITLE:_________________________________DATE:_________________________ PROPOSAL TITLE:______________________________________________________
[28]
AGREEMENT
THIS AGREEMENT made effective the DAY day of MONTH, YEAR by and between the COUNTY OF STEUBEN, a municipal corporation organized and existing under and by virtue of the Laws of the State of New York and being one of its political subdivisions, having its principal place of business in the Village of Bath, Steuben County, State of New York, through its Department, herein after called the “County”, and Company Name, a Company Type, with an address of , hereinafter called the “Agent.”
WITNESSETH:
WHEREAS, the County has sought to procure ; and WHEREAS, the County and Agent are desirous of entering into an agreement for said purpose, and WHEREAS, the Agent has the knowledge, skills, and experience necessary to perform these services, NOW THEREFORE, in consideration of the mutual promises and covenants hereinafter contained the
parties agree as follows: 1. SCOPE OF WORK. . 2. TERM. The term shall be . 3. CONSIDERATION. Consideration shall not exceed . 4. INSURANCE. The Agent agrees to maintain insurance as specified by attached Appendix “A” and
shall provide the Steuben County Risk Manager with a certificate of insurance naming Steuben County as an additional insured for purposes of coverage on a direct, primary, and non-contributory basis. All certificates of insurance shall provide that County be given thirty (30) days notice of any intent to cancel coverage. Self-employed persons must carry such Worker’s Compensation coverage as directed by the Steuben County Risk Manager.
5. COMPLIANCE WITH RULES, REGULATIONS AND LAWS. It is mutually agreed that all
rules, regulations and laws pertaining hereto shall be deemed to be part of this Agreement, and anything contained herein that may be in whole or in part inconsistent therewith shall be deemed to be hereby amended and modified to comply with such legislation, rules, regulations and laws, for and during such time the same shall be in effect, but at no other time. If any provision contained herein is found now or during the life of this Agreement to be null and void, in whole or in part as a matter of law, then said clause or part hereof shall be deemed to be severed and deleted from this Agreement leaving all other clauses or parts thereof in full force and effect. It is further agreed that there shall be no gap in the coverage or applicability of said remaining clauses or parts thereof.
The Agent agrees to comply with the Federal Commercial Drivers License Drug and Alcohol Testing Program
requirements set forth in 49 CFR Parts 40 and 382. In acceptance of this Agreement, the Agent covenants and certifies that he will comply in all respects
with all Federal, State, County or other Municipal Law which pertains hereto regarding work on municipal contracts, matters of employment, length of hours, workers’ compensation and human rights.
6. CONFIDENTIALITY. Information relating to individuals who may receive services pursuant to
this Agreement shall be confidential and maintained and used only for the purposes intended under this Agreement, in accordance with any applicable State or Federal laws, rules and regulations. The Agent specifically covenants and certifies that it will comply in all respects with the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the HIPAA Privacy Rule and the HIPAA Security Rule with respect to the Protected Health Information (“PHI”) of clients of the County. For purposes of HIPAA, the Agent shall be referred to as a “Business Associate.” Any Agent who, as part of the work to be performed under this Agreement, will use, disclose or otherwise come into contact with PHI will be required to execute a Business Associate Agreement, which is hereby incorporated herein and made a part hereof.
[29]
7. CONFLICT OF INTERESTS. The Agent hereby stipulates and certifies that there is no member of the Steuben County Legislature or other Steuben County Officer or employee forbidden by law to be interested in the Agreement directly or indirectly, who will benefit therefrom or who is a party thereto.
8. LICENSES. The Agent hereby agrees that he will obtain, at his own expense, all licenses or permits
necessary for this work, if any are necessary prior to the commencement of said work and shall be solely responsible for paying any and all fines or penalties incurred as a result of any improper or unlicensed services.
9. INDEPENDENT CONTRACTOR STATUS. The Agent covenants and agrees that he will
conduct himself consistent with his status, said status being that of an independent contractor and that himself, his employees or agents will neither hold themselves out as, nor claim to be an officer or employee of the County of Steuben, for such purposes as, but not limited to, Workers’ Compensation coverage, Unemployment Insurance Benefits, Social Security or Retirement membership or credit. The Agent shall have exclusive responsibility for the means, manner, and methods of performing its obligations under this Agreement. For sole purposes of the HIPAA Privacy Rule, the Agent shall be considered a Business Associate.
10. HOLD HARMLESS. The Agent shall at all times defend, indemnify and hold harmless the County
of Steuben and its employees from any and all claims, damages or judgments or for the defense or payment thereof, based on any claim, action or cause of action whatsoever, including any action for libel, slander, or personal injury, or any affiliated claims, by reason of any act or failure to properly act on the part of Agent and in particular as may arise from the performance under this contract. Such obligation to the County shall not be construed to negate, abridge or reduce other rights of indemnity which would otherwise exist. This provision shall supersede any other provision in this Agreement deemed to be in conflict, unless specifically stated otherwise.
11. SET-OFF RIGHTS. The County shall have all of its common law, equitable and statutory rights of set-off. These rights shall include, but not be limited to, the County’s option to withhold for the purposes of set-off any money due to the Agent under this Agreement up to any amounts due and owing to the County with regard to any contract with any County department, office or agency.
12. AUDIT. The Agent shall take such action, if applicable and as necessary and appropriate, to comply
with Federal Circular A-128 or Circular A-133 relative to Single Audit of Federal Financial Assistance. In any event, the Agent shall provide the County with appropriate documentation should the County wish to conduct an audit relative to the expenditure of the funds pursuant to this Agreement.
13. RECORDS. The Agent shall submit to County upon request such schedule of quantities and costs,
progress schedules, payrolls, reports, estimates, records, and other data that the County may request concerning work performed or to be performed under this Agreement. All books and records of the Agent shall be available upon request for inspection and/or audit by the County during the time hereof and for a period of six (6) years hereafter.
14. EXAMINATION OF BUDGET AND APPROPRIATION OF FUNDS. It is expressly
understood by and between the parties that any and all payments made pursuant to the within contract may not be in an amount in excess of the sum appropriated therefore in the Budget. The Agent specifically acknowledges his responsibility to examine the Budget to assure himself that the within contract price complies with the amount appropriated therefore. The within contract shall be unenforceable, unless approved by a roll call vote of the Steuben County Legislature, should the contract price exceed the amount appropriated for the object purpose of the contract. The contract shall be deemed executory only to the extent of money available to the County of Steuben for the performance of the terms hereof and the County of Steuben beyond monies available thereof shall incur no liability on account for the purpose thereof.
The preceding clause shall not apply to contracts for provision of services where the State of New
York or the U.S. Government mandates the payment and/or amount thereof. In that event, the Department Head represents that there is a funding source sufficient to pay for services provided pursuant to the contract.
The Agent agrees that the County shall have no liability under this Contract to the Agent or to anyone else
beyond funds appropriated and available for this contract.
[30]
15. ASSIGNABILITY. This contract may not be assigned, transferred, conveyed, sublet or disposed of without the previous consent, in writing, of the County of Steuben. To the extent assignment is granted in accordance with the terms of this paragraph, this Agreement shall be binding on the parties, their successors, heirs, and assigns.
16. AMENDMENTS. No waiver, modification, or amendment of this Agreement or any part thereof shall be valid unless in writing and duly executed by the parties hereto. A waiver of any breach hereof shall not prevent a forfeiture for any succeeding breach.
17. ENTIRE AGREEMENT. This Agreement contains the sole and entire Agreement between the
parties relating to the services provided hereunder and shall supersede any and all other Agreements between the parties. Any other statements or representations made by either party are void and have no force or effect. Agreement shall be governed by the laws of the State of New York and any claims brought hereunder shall be brought in and under the jurisdiction of the State of New York.
18. TERMINATION. County may terminate this agreement at any time upon 30 days written notice.
19. CORPORATE COMPLIANCE. The Agency has received a copy of the Steuben County Corporate Compliance Plan. Additionally, the Agent has reviewed and signed the Independent Contractor / Agents / Vendors Acknowledgement Form attached hereto as Appendix B and incorporated herein.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above written.
COUNTY OF STEUBEN AGENT
BY: BY: Dated: Dated: Approved as to Form: ______________________________________________ (Deputy) County Attorney STATE OF NEW YORK) COUNTY OF STEUBEN) ss: On this day of , before me, the undersigned, personally appeared to me known, who being by me duly sworn, did depose and say that he/she resides in , New York; that he/she is the of the County of Steuben described in and which executed the above instrument; and that he/she signed his/her name thereto by order of the Steuben County Legislature. _____________________________________________ Notary Public STATE OF NEW YORK) COUNTY OF STEUBEN) ss: On the ________ day of ______________ in the year _____ 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
[31]
Appendix A
STEUBEN COUNTY STANDARD INSURANCE REQUIREMENTS
Prior to commencement of work, delivery of services, acquisition of merchandise or equipment a Certificate of Insurance and a
policy endorsement covering items A, B & C must be delivered to the County Department responsible for the agreement, and to the
County Risk Manager. A Certificate of insurance may be used to show coverage only.
ITEMS:
A. Steuben County, 3 East Pulteney Square, Bath, N.Y., 14810 shall be named as an additional insured (for the purposes of
coverage but not the payment of premium).
B. ACKNOWLEDGEMENT: The insurance companies providing coverage acknowledge that the named insured is
entering into a contract with Steuben County in which the named insured agrees to defend, hold harmless, and indemnify the
County, its officials, employees and agents against all claims resulting from work performed, material handled and services
rendered. The contractual liability coverage evidenced will cover the liability assumed under the County-Contractor
agreement.
C. Prior to non-renewal, cancellation or a change of converge on this policy, at least thirty (30) days advance written notice
shall be given to Steuben County Risk Manager at Steuben County Offices, 3 Pulteney Square East, Bath, N.Y. 14810
Workers' Compensation Coverage will be required for anyone doing any kind of work for Steuben County. This includes self-
employed individuals. The Steuben County Risk Manager may waive this requirement. Proof of Workers’ Compensation
Coverage must be submitted on NYS Workers’ Compensation Board Approved Forms.
MINIMUM COVERAGES AND LIMITS ARE
TYPE OF CONTRACT COVERAGES REQUIRED LIMITS REQUIRED
PROFESSIONAL SERVICES
PROFESSIONAL LIABILITY MINIMUM $1,000,000 AUTO LIABILITY TO INCLUDE:OWNED,HIRED & NON OWNED MINIMUM $1,000,000 WORKERS COMPENSATION STATUTORY EMPLOYERS LIABILITY STATUTORY
DISABILITY BENEFITS STATUTORY
CONSTRUCTION &
MAINTENANCE
COMPREHENSIVE GENERAL LIABILITY TO INCLUDE:PREMISES & OPERATIONS ,PRODUCTS & COMPLETED OPERATIONS , INDEPENDENT
CONTRACTOR, CONTRACTUAL,BROAD FORM PROPERTY DAMAGE,(XCU
HAZARDS)
MINIMUM $1,000,000
AUTO LIABILITY TO INCLUDE: OWNED,HIRED,& NON OWNED MINIMUM $1,000,000 WORKERS' COMPENSATION STATUTORY
EMPLOYERS LIABILITY STATUTORY
DISABILITY BENEFITS STATUTORY
ACQUISITION OF SUPPLIES
OR EQUIPMENT
COMPREHENSIVE GENERAL LIABILITY TO INCLUDE:PRODUCTS &
COMPLETED OPERATIONS , CONTRACTUAL,BROAD FORM PROPERTY MINIMUM $1,000,000
WORKERS' COMPENSATION STATUTORY
EMPLOYERS LIABILITY STATUTORY
DISABILITY BENEFITS STATUTORY
COUNTY PROPERTY USED
BY OTHERS
COMPREHENSIVE GENERAL LIABILITY TO INCLUDE:PREMISES &
AUTO LIABILITY TO INCLUDE: OWNED,HIRED,& NON OWNED MINIMUM $1,000,000
WORKERS' COMPENSATION STATUTORY
EMPLOYERS LIABILITY STATUTORY
DISABILITY BENEFITS STATUTORY
Bid specifications, particular contracts, leases or agreements may require increased limits and or
additional coverages. If there are questions please contact the Steuben County Risk Manager 607-664-
2104.
[32]
APPENDIX B
INDEPENDENT CONTRACTOR / AGENTS / VENDORS ACKNOWLEDGEMENT FORM
Steuben County has developed a Corporate Compliance Plan (the “Plan”) that states that the County, its employees, contractors, and County Legislators will adhere to applicable federal, state and local laws and regulations and internal policies and procedures. The Plan is a combination of policy and procedure that assists the County to monitor, detect and correct actions that are not in compliance with applicable laws or County policies and procedures. As our Agent, we expect that you will act in compliance with the laws that are applicable to the County and in compliance with County policies and procedures that set forth the overarching principles for conducting County business with integrity based on sound ethical and legal standards. As our Agent, we also expect you to report any suspected or potential violations of law or County policies and procedures of which you become aware by contacting the County Manager at (607) 664-2245, the Corporate Compliance Officer at (607) 664-2244, or our Corporate Compliance Hotline at (607) 664-2550. As our Agent, we expect you to understand your role in the Plan and we expect you to review any policies and procedures that are applicable to you and your organization. You may contact the County Manager or the Corporate Compliance Officer for any questions or clarifications of your responsibilities. As an Agent of the County of Steuben, I hereby acknowledge the following:
I acknowledge that on behalf of myself and my organization that I have read, have had an opportunity to ask questions about and that I understand the policies and procedures of the Plan that are applicable to the services that are provided to the department.
I understand and agree that I and all those in my organization who provide services to Steuben County must comply with the Plan and all laws, regulations, policies, procedures and other guidance applicable to the services.
I agree on behalf of myself and my organization to fully cooperate with the implementation of the Plan, to participate in any auditing or monitoring processes and to report any instances of possible violations of law, regulations or policies that are applicable to Steuben County of which I become aware.
I acknowledge that Steuben County maintains a hotline for the purpose of receiving notifications of possible violations of law, regulation and the Plan.
I understand that my failure to report any concerns regarding possible violations of law, regulations or the Plan may result in corrective action, up to and including termination of my agreement with Steuben County.
I attest on behalf of myself, my organization, and my employees, that I am not currently excluded from participation in federal or state health care programs, am not the subject of any pending exclusion proceeding, and have not been adjudicated or
[33]
deemed to have committed any action that could subject me or my organization to exclusion from government programs such as Medicare or Medicaid.
I will notify Steuben County within three (3) business days of receipt of notice of (a) exclusion or proposed exclusion from a state or federal health care program, or (b) adjudication or other determination that I, my organization, or the organization employees, have committed any action which could lead to exclusion from a government program.
I acknowledge that I will be responsible to make the County whole for any federal or state imposed losses that were a result of federal or state exclusions of our agency or employees.
I acknowledge that Steuben County may terminate my contract immediately upon notice that I or my organization has been excluded from participation in a state or federal health care program or that I or my organization have been adjudicated or determined to have committed an action which could subject it to mandatory exclusion.
__________________________________
Agency Signature
___________________________________
Print name
___________________________________
Title
___________________________________
Date
[34]
STATE OF NEW YORK
WORKERS’ COMPENSATION BOARD
CERTIFICATE OF NYS WORKERS’ COMPENSATION INSURANCE COVERAGE
1a. Legal Name & Address of Insured (Use street address only)
Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap-Up Policy)
1b. Business Telephone Number of Insured
1c. NYS Unemployment Insurance Employer Registration Number of Insured
1d. Federal Employer Identification Number of Insured or Social Security Number
2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder)
3e. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box “3" insures the business referenced above in box “1a” for workers’ compensation under the New York State Workers’ Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box “2".
The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box “3c", whichever is earlier.
Please Note: Upon the cancellation of the workers’ compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law.
Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form.
Approved by: (Print name of authorized representative or licensed agent of insurance carrier)
Approved by: (Signature) (Date)
Title:
Telephone Number of authorized representative or licensed agent of insurance carrier: Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it.
