Instructions: The Designated Contact of a program office will complete the following certification for procurement contracts falling under the jurisdiction of State Finance Law §139-k(4). The certification will be delivered to contract administration together with the technical scoring of a RFP.
Program Office Certification of Contacts Under State Finance Law §139-k(4)
To: Contract Administration Unit
Name of Governmental Entity: State Education Department
Subject: Record of Contact under State Finance Law §139-k(4)
Title and RFP Number
Name of Offerer (defined below):
From:
(Print name and title of program office designated person)
Signature:
(program office designated person)
Date:
(Check the appropriate box below and complete as necessary. Make additional copies of this form as required.)
Except as described below, to the best of my knowledge, information and belief, there have been (i) no impermissible “Contacts” during the “Restricted Period” of this “Procurement Contract,” as such terms are defined in State Finance Law §§ 139-j and 139-k and (ii) all Contacts have been recorded in the procurement record.
[ ] No impermissible Contacts
[ ] The following impermissible Contacts were reported to the Contract Administration Unit:
Describe Contact (date, name of offerer, subject matter), date of notification of Contract Administration Unit and attach Record of Contact.
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