HomeMy WebLinkAboutSTOP DWI Program
RESOLUTION 2007-269
SCHEDULED
DOC ID: 2638
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2007-269 WAS
SCHEDULED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD
ON FEBRUARY 27, 2007:
RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs
Supervisor Scott A. Russell to execute an Aereement with the County of Suffolk for the
2007 STOP-DWI Proeram in an amount not to exceed $19,000.00, for the term January 1,
2007 through December 31,2007, all in accordance with the approval of the Town Attorney.
r~a~t:tI..
Elizabeth A. Neville
Southold Town Clerk
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DWI Enforcement Agreement
This Agreement, made between the County of Suffolk (County), a municipal corporation of the State of New York,
having its principal office at the County Center, Riverhead, New York I 190 I, acting through its duly constituted Snffolk
County Department ofProbation/STOP-DWI Program (Department), located at H. Lee Dennison Building, I I"' floor,
100 Veterans Memorial Highway, I-Iauppauge, New York (mailing address: Box 6100, Hauppauge, New York 11788-0099) and
the Town of Southold (Contractor), a New York municipal corporation, having its principal place of business at P.O. Box
1139, Southold, New York 11971-1682.
The parties hereto desire to make available to the County increased enforcement services (Services) of New York State
vehicle and traffic laws relating to drinking and driving. Sufficient funding exists in the 2007 Suffolk County Operating Budget.
Term of Agreement:
Shall be January 1,2007 through December 31,2007.
Total Cost of Agreement: Shall not exceed $19,000.00
Terms and Conditions: Shall be as set forth in Exhihit A through G; attached hereto and made a part hereof.
In Witness Whereof, the parties hereto have executed this Agreement as of the latest date written below.
The Honorable Scott A. Russell
Supervisor of Southold Town
County of Suffolk
By:
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[Please print name and title under signature
Fed. Taxpayer ill #: 1.- 0
Date:
By:
Paul Sabatino IT
Chief Deputy County Executive
Date:
Approved as to Legality:
Christine Malafi
Suffolk County Attorney
Approved:
By:
By:
Samantha N. McEachin
Assistant County Attorney
James Golbin
Chief Planner
Suffolk County Probation Department
Date:
Date:
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List of Exhibits
Exhibit A
General Terms and Conditions
1. Responsibilities of the Parties
2. Tenn and Tennination
3. Indemnification
4. Insurance
5. Independent Contractor
6. Severability
7. Merger; No Oral Changes
8. Set-affRights
9. Non-discrimination in Employment and Affinnative Action
10. Non-discrimination in Services
11. Governing Law
12. No Implied Waiver
13. Conflicts of Interest
14. Cooperation on Claims
15. Confidentiality
16. Assignment and Subcontracting
17. No Intended Third Party Beneficiaries
18. Publications and Publicity
19. Copyrights and Patents
20. Service Records
21. County Supervision
Exhibit B
Suffolk County Legislative Requirements
1. Contractor'sNendor's Public Disclosure Statement
2. Living Wage Law
3. Use of County Resources to Interfere with Collective Bargaining Activities Local Law No. 26-2003
4. Gratuities
5. Prohibition Against Contracting with Corporations that Reincorporate Overseas
6. Child Sexual Abuse Reporting Policy
7. Non Responsible Bidder
8. Use of Funds in Prosecution of Civil Actions Prohibited
9. Certification as to Relationships
10. Lawful Hiring of Employees Law
11. Suffolk County Local Laws Website Address
Exhibit C
Notices and Contact Persons
Exhibit 0
Description of Services / Workplan and Budget
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Exhibit E
Payment Terms
I. General Payment Terms and Conditions
2. Agreement Subject to Appropriation of Funds / Contingency
3. Financial Statements and Audit Requirements
Exhibit F
Suffolk County Stop DWI Reporting Forms (4 pages)
Exhibit G
Other Exhibit
"Suffolk County Legislative Requirements Exhibit for Contracts"
I Suffolk County Living Wage Requirements
Suffolk County Department of Labor - Living Wage Unit
Notice of Application for County Compensation Form LW-I (consists of 1 page)
Suffolk County Department of Labor . Living Wage Unit
CertiticationlDeclaration - Subject to Audit Form LW-38 (consists of 1 page)
II Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 3/30/04 (form consists of three
pages; requires signature & notarization)
Note: The Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 3/30/04,
III Union Organizing CertiticationlDeclaration - Subject to Audit; rev. 6/05
Form LO 1 (consists of 2 pages)
IV Lawful Hiring Compliance Requirements
Notice of Application to CertifY Compliance with Federal Law (8 U.S.C. Section I 324A) with Respect to Lawful
Hiring of Employees (consists of I page)
Affidavit of Compliance with the Requirements of (8 U.S.C. Section I 324A) with Respect to Lawful Hiring of
Employees (consists of 1 page)
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Exhibit A
General Terms and Conditions
1. Responsibilities of the Parties
The duties of Contractor shal] be to shall be to provide enhanced DWI enforcement services for the County, as more par-
ticularly described in Exhibit D, entitled "Description of Services." attached to and made part ofthis Agreement.
The Contractor shall perform such professional services as may be necessary to accomplish the work required to be per-
formed under and in accordance with this Agreement. The Contractor specifically represents and warrants that it has and
shall possess, and that its employees, agents and subcontractors have and shall possess, the required education, knowledge
and experience, if any, necessary to qualifY them individually for the particular duties they perform.
2. Term and Termination
a. Term
This Agreement shall cover the period set forth on page one of this Agreement, unless sooner terminated as provided
below. Upon receipt ofa Termination Notice, as that term is defmed below, pursuant to the following paragraphs, the
Contractor shall promptly discontinue all Services affected, unless otherwise directed by the Termination Notice.
b. Termination for Cause
This Agreement may be terminated in whole or in part in writing by the County in the event offailure by Contractor to
fulfill any of the terms and conditions under this Agreement; provided that no such termination shall be effective unless
Contractor is given five (5) calendar days' written notice of intent to terminate ("Notice of Intent to Terminate''), deliv-
ered personally or by certified mail, return receipt requested. During such five (5) day period, Contractor will be given
an opportunity for consultation with the County and an opportunity to cure all failures of its obligations prior to termi-
nation. Prior to issuance of a written termination notice ("Termination Notice") by the County, Contractor shall be
given an additional five (5) days to cure all failures to fulfill its obligations under this Agreement. In the event that the
Contractor has not cured all its failures to fulfill its obligations to the satisfaction of the County by the end of the com-
bined ten (10) day period, the County will issue a Termination Notice, effective immediately.
c. Termination for Convenience
i. The County shall have the right to terminate this Agreement at any time and for any reason deemed to be in its
best interest, provided that no such termination shall be effective unless the Contractor is given thirty (30) cal-
endar days' written notice of termination.
ii. Upon giving of a notice pursuant to the foregoing sub-paragraph, the Contractor shall promptly dis-
continue all services affected unless otherwise directed by the notice of termination.
iii. In such event of termination, the County shall pay the Contractor for the services rendered through the date of
termination.
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3. Indemnification
,
The Contractor agrees that it shall protect, indemnifY and hold harmless the County and its officers, officials, employees,
contractors, agents and other persons from and against all liabilities, fmes, penalties, actions, damages, claims, demands,
judgments, losses, costs, expenses, suits or actions and reasonable attorneys' fees, arising out of the acts or omissions or the
negligence of the Contractor in connection with the services described or referred to in this Agreement. The Contractor shall
defend the County and its officers, officials, employees, contractors, agents and other persons in any suit, including appeals,
or at the County's option, pay reasonable attorney's fees for defense of any such suit arising out of the acts or omissions or
negligence of the Contractor, its officers, officials, employees, subcontractors or agents, if any, in connection with the ser-
vices described or referred to in this Agreement.
4. Insurance
a. The Contractor agrees to procure, pay the entire premium for and maintain throughout the term of this Agree-
ment, insurance in amounts and types specified by the County and as may be mandated and increased from
time to time. The Contractor agrees to require that all of its subcontractors, in connection with work performed
for the Contractor related to this Agreement, procure, pay the entire premium for and maintain throughout the
term of this Agreement insurance in amounts and types equal to that specified by the County for the Contrac-
tor. Unless otherwise specified by the County and agreed to by the Contractor, in writing, such insurance shall
be as follows:
i. Commercial General Liability insurance, including contractual liability coverage, in an amount not
less than Two Million Dollars ($2,000,000.00) per occurrence for bodily injury and Two Million Dol-
lars ($2,000,000.00) per occurrence for property damage.
ii. Automobile Liability insurance (if any vehicles are used by the Contractor in the performance of this
Agreement) in an amount not less than Five Hundred Thousand Dollars ($500,000.00) per person, per
accident, for bodily injury and not less than One Hundred Thousand Dollars ($100,000.00) for prop-
erty damage per occurrence.
iii. Worker's Compensation and Employer's Liability insurance in compliance with all applicable New
York State laws and regulations and Disability Benefits insurance, if required by law. Contractor
shall furnish to the County, prior to its execution of this Agreement, the documentation required by the
State of New York Workers' Compensation Board of coverage or exemption from coverage pursuant
to ~~57 and 220 of the Workers' Compensation Law. In accordance with General Municipal Law
~ I 08, this Agreement shall be void and of no effect unless the Contractor shall provide and maintain
coverage during the term of this Agreement for the benefit of such employees as are required to be
covered by the provisions of the Workers' Compensation Law.
iv. Professional Liability insurance in an amount not less than Two Million Dollars ($2,000,000.00) on
either a per occurrence or claims made coverage basis.
b. All policies providing such coverage shall be issued by insurance companies with an A.M. Best rating of A- or
better.
c. The Contractor shall furnish to the County Declaration Pages for each such policy of insurance and upon re-
quest, a true and certified original copy of each such policy, evidencing compliance with the aforesaid insur-
ance requirements. In the case of commercial general liability insurance, the County of Suffolk shall be named
as an additional insured and the Contractor shall furnish a Declaration Page and endorsement page evidencing
the County's status as an additional insured on said policy.
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d. All such Declaration Pages, certificates and other evidence of insurance shall provide for the County of Suffolk
to be notified in writing thirty (30) days prior to any cancellation, nonrenewal or material change in said poli-
cies. Such Declaration Pages, certificates, policies and other evidence of insurance and notices shall be mailed
to the Department at its address as set forth in this Agreement in the paragraph entitled "Notices and Contact
Persons" or at such other address of which the County shall have given the Contractor notice in writing.
e. In the event Contractor shall fail to provide the Declaration Pages or certificates of insurance or to maintain any
insurance required by this Agreement, the County may, but shall not be required to, obtain such policies and
deduct the cost thereof from payments due Contractor under this Agreement or any other agreement between
the County and Contractor.
f. If the Contractor is a town or other municipal corporation and has a self-insurance program under which it acts
as a self-insurer for any of such required coverage, it may provide self-funded coverage and certificates or other
evidence of such self-insurance in lieu of insurance issued by insurance companies.
5. Independent Contractor
It is expressly agreed that the Contractor status hereunder is that of an independent contractor. Neither the Contractor, nor
any person hired by the Contractor shall be considered employees of the County for any purpose.
6. Severability
It is expressly agreed that if any term or provision of this Agreement, or the application thereof to any person or circum-
stance, shall be held invalid or unenforceable to any extent, the remainder of this Agreement, or the application of such term
or provision to persons or circumstances other than those as to which it is held invalid or unenforceable, shall not be af-
fected thereby, and every other term and provision of this Agreement shall be valid and shall be enforced to the fullest ex-
tent permitted by law.
7. Merger; No Oral Changes
It is expressly agreed that this Agreement represents the entire agreement ofthe parties, that all previous understandings are
merged in this Agreement. No modification of this Agreement shall be valid unless written in the form of an Amendment
and executed by both parties. .
8. 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 moneys due to the Contractor under this contract
up to any amounts due and owing to the County with regard to this contract and/or any other contract with any County de-
partment or agency, including any contract for a term commencing prior to the term of this contract, plus any amounts due
and owing to the County for any other reason including, without limitation, tax delinquencies, fee delinquencies or mone-
tary penalties relative thereto. The County shall exercise its set-off rights in accordance with normal County practices in-
cluding, in cases of set-off pursuant to an audit, the finalization of such audit by the County agency, its representatives, or
the County Comptroller, and only after legal consultation with the County Attorney.
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9. Non-discrimi~ation in Employment and Affirmative Action
The Contractor agrees in connection with the performance of this Agreement that the Contractor shall not discriminate
against employees or applicants for employment because of race, creed, color, national origin, sex, age, disability, sexual
orientation, military status or marital status, and will undertake or continue existing programs of affirmative action to ensure
that women and minority group members are afforded equal employment opportunities without discrimination. Affirmative
action shall mean recruitment, employment, job assignment, promotion, upgrading, demotion, transfer, layoff, or termina-
tion and rates of payor other forms of compensation.
10. Non-discrimination in Services
During the performance of this Agreement:
a. The Contractor shall not, on the grounds of race, creed, color, national origin, sex, age, disability, sexual orien-
tation, military status or marital status:
i. deny any individual any services or other benefits provided pursuant to this Agreement; or
ii. provide any services or other benefits to an individual that are different, or are provided in a different
manner, from those provided to others pursuant to this Agreement; or
iii. subject an individual to segregation or separate treatment in any matter related to the individual's receipt of
any service(s) or other benefits provided pursuant to this Agreement; or
iv. restrict an individual in any way in the enjoyment of any advantage or privilege enjoyed by others receiv-
ing any services or other benefits provided pursuant to this Agreement; or
v. treat an individual differently from others in determining whether or not the individual satisfies any eligi-
bility or other requirements or condition which individuals must meet in order to receive any aid, care, ser-
vice(s) or other benefits provided pursuant to this Agreement.
b. The Contractor shall not utilize criteria or methods of administration which have the effect of subjecting indi-
viduals to discrimination because of their race, creed, color, national origin, sex, age, disability, sexual orienta-
tion, military status or marital status, or have the effect of defeating or substantially impairing accomplishment
of the objectives of this Agreement in respect to individuals of a particular race, creed, color, national origin,
sex, age, disability, sexual orientation, military status or marital status, in determining:
i. the types of service(s) or other benefits to be provided, or
ii. the class of individuals to whom, or the situations in which, such service(s) or other benefits will be
provided; or
iiL the class of individuals to be afforded an opportunity to receive services.
11. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the State of New York, without re-
gard to conflict oflaws. Venues shall be designated in Suffolk County, New York or the United States District Court
for the Eastern District of New York.
12. No Implied Waiver
No waiver shall be inferred from any failure or forbearance of the County to enforce any provision of this Agreement in
any particular instance or instances, but the same shall otherwise remain in full force and effect notwithstanding any
such failure or forbearance.
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13. Conflicts of Interest
a. The Contractor agrees that it will not during the term of this Agreement engage in any activity that is contrary to
and/or in conflict with the goals and purposes of the County.
b. The Contractor is charged with the duty to disclose to the County the existence of any such adverse interests,
whether existing or potential. This duty shall continue so long as the Contractor is retained on behalf of the County.
The determination as to whether or when a conflict exists or may potentially exist shall ultimately be made by the
County Attorney after full disclosure is obtained.
14. Cooperation on Claims
Each of the parties hereto agrees to render diligently to the other party, without additional compensation, any and all
cooperation, that may be required to defend the other party, its employees and designated representatives against any
claim, demand or action that may be brought against the other party, its employees or designated representatives in con-
nection with this Agreement.
15. Confidentiality
Any records, reports or other documents of the County or any of its agencies used by Contractor pursuant to this
Agreement or any documents created as a part of this Agreement shall remain the property of the County and shall be
kept confidential in accordance with applicable laws, rules and regulations.
16. Assignment and Subcontracting
a. The Contractor shall not assign, transfer, convey, sublet, or otherwise dispose of this Agreement, or any of its right,
title or interest therein, or its power to execute the Agreement, or assign all or any portion of the monies that may
be due or become due hereunder, to any other person or corporation, without the prior consent in writing of the
County, and any attempt to do any of the foregoing without such consent shall be of no effect.
b. The Contractor shall not enter into subcontracts for any of the work contemplated under this Agreement without
obtaining prior written approval of the County. Such subcontracts shall be subject to all of the provisions of this
Agreement and to such other conditions and provisions as the County may deem necessary, provided, however, that
notwithstanding the foregoing, unless otherwise provided in this Agreement, such prior written approval shall not
be required for the purchase of articles, supplies, equipment and services which are incidental to, but necessary for,
the performance of the work required under this Agreement. No approval by the County of any subcontract shall
provide for the incurrence of any obligation by the County in addition to the total agreed upon price. The Contrac-
tor shall be responsible for the performance of any subcontractor for the delivery of service.
17. No Intended Third Party Beneficiaries
This Agreement is entered into solely for the benefit of County and Contractor. No third party shall be deemed a bene-
ficiary of this Agreement, and no third party shall have the right to make any claim or assert any right under this
Agreement.
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18. Publications ~nd Publicity
a. The Contractor shall not issue or publish any book, article, report or other publication related to the Services proded
pursuant to this Agreement without fIrst obtaining written prior approval from the County. Any such printed matter or
other publication shall contain the following statement in clear and legible print:
"This publication is fully or partially funded by SUFFOLK COUNTY STOP-DWI."
b. Furthermore, the STOP-DWI logo shall be prominently displayed on any publication, sign or other printed materials.
c. The Department shall have the right of prior approval of press releases and any other information provided totheroo-
dia, -in any form, concerning the Services provided pursuant to this Agreement.
19. Copyrights and Patents
a. Copyrights
If the work of the Contractor under this Agreement should result in the production of original books, manuals, fIlms or other
materials for which a copyright may be granted, the Contractor may secure copyright protection. However, the County re-
serves, and the Contractor hereby gives to the County, and to any other municipality or government agency or body desig-
nated by the County, a royalty-free, nonexclusive license to produce, reproduce, publish, translate or otherwise use any such
materials.
b. Patents
If the Contractor under this Agreement makes any discovery or invention in the course of or as a result of work performed
under this Agreement, the Contractor may apply for and secure for itself patent protection. However, the County reserves,
and the Contractor hereby gives to the County, and to any other municipality or government agency or body designated by
the County, a royalty-free, nonexclusive license to produce or otherwise use any item so discovered or patented.
20. Service Records
The contractor shall maintain, or cause to be maintained, service and time records for each service provided under this
agreement, which will permit the reporting of the progress of each service on a monthly basis. Such reports shall be submit-
ted on forms to be provided or approved by the county in accordance with the instructions therefore. Such reports shall be in
the format attached as Exhibit F, but shall not necessarily be limited to the information specifIed.
21. County Supervision
It is agreed that the nature and extent of the services provided pursuant to this agreement shall be subjectto the general su-
pervision of the county's STOP-DWI Coordinator's Office. The Contractor further agrees to conduct the aforementioned
program in a skillful manner to the best of its ability, and agrees to comply fully with the rules and regulations, criteria and
guidelines for expenditure controls heretofore adopted or to be adopted by the County.
End of Text for Exhibit A
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Exhibit B
Suffolk County Legislative Requirements
1. Contractor'sNendor's Public Disclosure Statement
The Contractor represents and warrants that it has filed with the Comptroller of Suffolk County the verified public disclo-
sure statement required by Suffolk County Administrative Code Article V, Section A5-7 and shall file an update of such
statement with the said Comptroller on or before the 31 st day of January in each year of this Agreement's duration. The
Contractor acknowledges that such filing is a material, contractual and statuto!)' duty and that the failure to file such state-
ment shall constitute a material breach of this Agreement, for which the County shall be entitled, upon a determination that
such breach has occurred, to damages, in addition to all other legal remedies, of fifteen percent (15%) of the amount of the
Agreement.
Required Form:
Suffolk County Form SCEX 22; entitled "Contractor'sNendor's Public Disclosure Statement"
2. Living Wage Law
This Agreement is subject to the Living Wage Law of the County of Suffolk. The law requires that, unless specific exemp-
tions apply all employers (as defined) under service contracts and recipients of County financial assistance, (as defmed)
shall provide payment of a minimum wage to employees as set forth in the Living Wage Law. Such rate shall be adjusted
armually pursuant to the terms of the Suffolk County Living Wage Law of the County of Suffolk. Under the provisions of
the Living Wage Law, the County shall have the authority, under appropriate circumstances, to terminate this Agreement
and to seek other remedies as set forth therein, for violations of this Law.
The Contractor represents and warrants that it has read and shall comply with the requirements of Suffolk County Code
Chapter 347, Suffolk County Local Law No. 12-200], the Living Wage Law.
Required Form:
Suffolk County Living Wage Form L W-38; entitled "Suffolk County Department of Labor - Living
Wage Unit, Living Wage Certification/Declaration - Subject To Audit"
3. Use of County Resources to Interfere with Collective Bargaining Activities
Local Law No. 26-2003
The Contractor represents and warrants that it has read and is familiar with the requirements of Chapter 466, Article I of the
Suffolk County Local Laws, "Use of County Resources to Interfere with Collective Bargaining Activities". County
Contractors (as defined) shall comply with all requirements of Local Law No. 26-2003 including the following prohibitions:
a. The Contractor shall not use County funds to assist, promote, or deter union organizing.
b. No County funds shall be used to reimburse the Contractor for any costs incurred to assist, promote, or deter union or-
ganizing.
c. The County of Suffolk shall not use County funds to assist, promote, or deter union organizing.
d. No employer shall use County property to hold a meeting with employees or supervisors if the purpose of such meeting
is to assist, promote, or deter union organizing.
If Contractor services are performed on County property the Contractor must adopt a reasonable access agreement, a neu-
trality agreement, fair communication agreement, non-intimidation agreement and a majority authorization card agreement.
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If Contractor services are for the provision of human services and such services are notto be performed on County property,
the Contractor'must adopt, at the least, a neutrality agreement.
Under the provisions of Local Law No. 26-2003, the County shall have the authority, under appropriate circumstances, to
terminate this Agreement and to seek other remedies as set forth therein, for violations of this Law.
Required Form: Suffolk County Labor Law Form DOL-LO I; entitled "Suffolk County Department of Labor _
Labor Mediation Unit Union Organizing CertificationlDeclaration - Subject to Audit"
4. Gratuities
The Contractor represents and warrants that it has not offered or given any gratuity to any official, employee or agent of
Suffolk County or New York State or of any political party, with the purpose or intent of securing an agreement or securing
favorable treatment with respect to the awarding or amending of an agreement or the making of any determinations with re-
spect to the performance of an agreement, and that the signer of this Agreement has read and is familiar with the provisions
of Local Law No. 32-1980 of Suffolk County (Chapter 386 of the Suffolk County Code).
5. Prohibition Against Contracting with Corporations that Reincorporate Overseas
The Contractorrepresents that it is in compliance with Suffolk County Administrative Code Article IV, ~~A4-13 and A4-
14, found in Suffolk County Local Law No. 20-2004, entitled "A Local Law To Amend Local Law No. 5-1993, To Prohibit
The County of Suffolk From Contracting With Corporations That Reincorporate Overseas." Such law provides that no con-
tract for consulting services or goods and services shall be awarded by the County to a business previously incorporated
within the U.S.A. that has reincorporated outside the U.S.A.
6. Child Sexual Abuse Reporting Policy
The Contractor agrees to comply with Chapter 577, Article IV, of the Suffolk County Code, entitled "Child Sexual Abuse
Reporting Policy", as now in effect or amended hereafter or of any other Suffolk County Loca1 Law that may become appli-
cable during the term of this Agreement with regard to child sexual abuse reporting policy.
7. Non Responsible Bidder
The Contractor represents and warrants that it has read and is familiar with the provisions of Suffolk County Code Chapter
143, Article II, ~~ 143-5 through 143-9. Upon signing this Agreement the Contractor certifies that he, she, it, or they have
not been convicted of a criminal offense within the last ten (10) years. The term "conviction" shall mean a finding of guilty
after a trial or a plea of guilty to an offense covered under the provision of Section 143-5 of the Suffolk County Code under
"Nonresponsible Bidder."
8. Use of Funds in Prosecution of Civil Actions Prohibited
Pursuant to the Suffolk County Code Section ~590-3, the Contractor represents that it shall not use any of the moneys re-
ceived under this Agreement, either directly or indirectly, in connection with the prosecution of any civil action against the
County of Suffolk or any of its programs, funded by the County, in part or in whole, in any jurisdiction or any judicial or
administrative forum.
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9. Certification ~s to Relationships
Pursuant to the Suffolk County Code Chapter 143, Article II, and Suffolk County Code!i I 43-6(B) specifically, the parties
to this Agreement hereby certifY that, other than the funds provided in this Agreement and other valid Agreements with the
County, there is no known relationship within the third degree of consanguinity, life partner, or business, commercial, eco-
nomic, or financial relationship between the parties, the signatories to this Agreement, and any partners, members, directors,
or shareholders of five percent (5%) (or more) of any party to this Agreement.
10. Lawful Hiring of Employees Law
This Agreement is subjectto the Lawful Hiring of Employees Law of the County of Suffolk (Local Law 52-2006). It pro-
vides that all covered employers, (as defined), and the owners thereof, as the case may be, that are recipients of compensa-
tion from the County through any grant, loan, subsidy, funding, appropriation, payment, tax incentive, contract, subcontract,
license agreement, lease or other financial compensation agreement issued by the County or an awarding agency, where
such compensation is one hundred percent (100%) funded by the County, shall submit a completed sworn affidavit (under
penalty of perjury), the fonn of which is attached, certifYing that they have complied, in good faith, with the requirements of
Title 8 of the United States Code Section 1324a with respectto the hiring of covered employees (as defined) and with re-
spect to the alien and nationality status of the owners thereof. The affidavit shall be executed by an authorized representa-
tive of the covered employer or owner, as the case may be; shall be part of any executed contract, subcontract, license
agreement, lease or other financial compensation agreement with the County; and shall be made available to the public upon
request.
All contractors and subcontractors (as defined) of covered employers, and the owners thereof, as the case may be, that are
assigned to perform work in connection with a County contract, subcontract, license agreement, lease or other financial
compensation agreement issued by the County or awarding agency, where such compensation is one hundred percent
(100%) funded by the County, shall submit to the covered employer a completed swom affidavit (under penalty of perjury),
the form of which is attached, certifYing that they have complied, in good faith, with the requirements of Title 8 of the
United States Code Section 1324a with respect to the hiring of covered employees and with respect to the alien and nation-
ality status of the owners thereof, as the case may be. The affidavit shall be executed by an authorized representative of the
contractor, subcontractor, or owner, as the case may be; shall be part of any executed contract, subcontract, license agree-
ment, lease or other financial compensation agreement between the covered employer and the County; and shall be made
available to the public upon request.
An updated affidavit shall be submitted by each such employer, owner, contractor and subcontractor no later than January ]
of each year for the duration of any contract and upon the renewal or amendment of the contract, and whenever a new con-
tractor or subcontractor is hired under the terms of the contract.
The Contractor acknowledges that such filings are a material, contractual and statutory duty and that the failure to file any
such statement shall constitute a material breach of this agreement.
Under the provisions of the Lawful Hiring of Employees Law, the County shall have the authority to tenninate this Agree-
ment for violations of this Law and to seek other remedies available under the law.
The Contractor represents and warrants that it has read, is in compliance with, and shall comply with the requirements of
Suffolk County Code Chapter 234, Suffolk County Local Law No. 52-2006, the Lawful Hiring of Employees Law.
Required Forms: "Suffolk County Department of Labor - Notice Of Application To CertifY Compliance
With Federal Law (8 U.S.C. SECTION 1324A) With Respect To Lawful Hiring of Employees"
and
"Affidavit Of Compliance With The Requirements Of8 U.S.C. Section 1324a With Respect To
Lawful Hiring Of Employees"
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11. Suffolk County Local Laws
Suffolk County Local Laws, Rules and Regulations can be found on the Suffolk County web site at
www.suffolkcountyny.gov.Click on "Laws of Suffolk County" under "Suffolk County Links".
End of Textfor Exhibit B
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Exhibit C
Notices and Contact Persons
1. Notices Relating to Payments, Reports, Insurance, or Other Submissions
Any communication, notice, claim for payment, report, insurance, or other submission necessary or required to be made by
the parties regarding this Agreement shall be in writing and shall be given to the County or the Contractor or their desig-
nated representative at the following addresses or at such other address that may be specified in writing by the parties and
must be delivered as follows:
For the Department:
By Regular Mail Qr Nationally Recognized Courier
Maria Perez-Lent, STOP-OWl Coordinator
H. Lee Dennison Bldg., 11 th FIr
100 Veterans Memorial Hwy
P.O. Box 6100
Hauppauge, NY 11788
For the Contractor:
By Regular Mail or Nationally Recognized Courier
At the address set forth on page one of this Agreement, attention of the person who
executed this Agreement or such other designee as the parties may agree in writing.
2. Notices Relating to Termination and/or Litigation
In the event the Contractor receives a notice or claim or becomes a party (plaintiff, petitioner, defendant, respondent, third
party complainant, third party defendant) to a lawsuit or any legal proceeding related to this Agreement, the Contractor shall
immediately deliver to the County Attorney, at the address set forth below, copies of all papers filed by or against the Con-
tractor.
Any communication or notice regarding termination shall be in writing and shall be given to the County or the Contractor or
their designated representative at the following addresses or at such other addresses that may be specified in writing by the
parties and must be delivered as follows:
For the County:
By Regular and Certified Mail in Postpaid Envelope or by
Nationally Recognized Courier Service
Maria Perez-Lent, STOP-OWl Coordinator
H. Lee Dennison Bldg., 11 th Flr
100 Veterans Memorial Hwy
P.O. Box 6100
Hauppauge, NY 11788
and
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Christine Malafi, County Attorney
Suffolk County Department of Law
H. Lee Dennison Building
100 Veterans Memorial Highway
Hauppauge, New York 11788
For Contractor:
By Regular and Certified Mail in Postpaid Envelope or by
Nationally Recognized Courier Service
At the address set forth on page one of this Agreement, attention to the person who
executed this Agreement or such other designee as the parties may agree in writing.
3. Notices sent shall be deemed delivered on the date they are mailed or deposited with a nationally recognized overnight
courier service.
4. Each party shall give prompt written notice to the other party of the appointment of successor(s) to the designated
contact person(s) or his or her designated successorCs).
End of Text for Exhibit C
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Exhibit D
Description of Services
Workplan 1 Budget
Workplan:
The primary goal of this project is the suppression of drunk driving through intensified police patrols to identity vehicle and
traffic violations related to drunk driving. This will result in an increased number of arrests for driving while intoxicated and a
reduction of alcohol related crashes and fatalities.
Funding will be used by this agency to schedule police officers for overtime to patrol duties exclusively to identity and arrest the
intoxicated driver, as well as related training and warrant enforcement. The hours of enforcement shall include times and days
which have historically reflected high incidences of drunk driving, alcohol related crashes and fatalities. Scheduling may be
organized due to seasonal traffic considerations and other activities related to incidences of drinking and driving. Scheduling of
personnel will be dependent upon availability of staff.
Budget:
ITEMIZED EXPENDITURE CATEGORIES
Personnel Services - Salaries:
Fringe Benefits:
$19,000.00 (Overtime)
$0,000.00
(Police Officer(s) at various rates established by public employees' contracts)
Total of Personnel Services: $19,000.00
Total of All Services: $19,000.00
The total amount of this contract is to be expended on or prior to 12/31/07 in accordance with this Work Plan or any ap-
proved revisions/modifications to the Work Plan and/or Budget as provided by the contract between the County and the
Contractor.
All other costs related to administration, staff support and related operational equipment are in-kind contributed by the
Contractor.
The Contractor will be responsible for issuing timely reports in oral presentations and in writing on the status of pending and
proposed activities, as may reasonably be requested by the Department. Depending upon the nature of the services provided UD-
der this Agreement, the parties may meet from time to time; the meeting time, place and attendees shall be as mutually agreed
upon by the parties. All written reports will also be made available to the County in electronic format.
-- END OF EXHIBIT D ---
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Exhibit E
Payment Terms
1. General Payment Terms
a. The Contractor shall prepare and present a claim form supplied by the County and approved for payment by the
County ("Suffolk County Payment Voucher"). Payment by the County will be made within thirty (30) days after
approval by the Comptroller of the County of Suffolk.
b. The Contractor agrees that it shall be entitled to no more than the fees set forth in this Exhibit E for the completion
of all work, labor and services contemplated in this Agreement.
c. The charges payable to Contractor under this Agreement are exclusive offederal, state and local taxes, the County
being a municipality exempt from payment of such taxes.
d. The acceptance by the Contractor of full payment of all billings made on the final approved Suffolk County Pay-
ment Voucher under this Agreement shall operate as and shall be a release to the County from all claims and liabil-
ity to the Contractor, its successors, legal representatives and assigns, for services rendered under this Agreement.
2. Agreement Subject to Appropriation of Fnnds / Contingency
This Agreement is subject to the amount of funds appropriated and any subsequent modifications thereof by the Suffolk
County Legislature. This Agreement is further subject to and contingent upon the County of Suffolk's continuance as a par-
ticipatingCounty in the New York State STOP-DWl Program as provided by Section 1197 of the Vehicle and Traffic Law
and upon approval of the County's STOP-DWI Plan for the County Operating Budget year referred to on the first page of
this Agreement by the Commissioner of Motor Vehicles of the State of New York.
No liability shall be incurred by the County under this Agreement beyond the amount of funds appropriated by the Legisla-
ture for the Services covered by this Agreement.
3. Financial Statements and Audit Requirements
a. Notwithstanding any other reporting or certification requirements of Federal, State or local authorities, the Contrac-
tor shall obtain the services of an independent licensed public accountant or certified public accountant (the "Audi-
tor") to audit its financial statements for each Contractor fiscal year in which the Contractor has received, or will
receive, $300,000 or more from the County, whether under this Agreement or otherwise, and shall submit a report
on the overall fmancial condition and operations of the Contractor, including a balance sheet and statement of in-
come and expenses, attested by the Auditor as fairly and accurately reflecting the accounting records of the Con-
tractor in accordance with generally accepted accounting principles. The Contractor is encouraged to solicit re-
quests for proposals (RFPs) from a number of qualified accounting firms and to review carefully the costs of, and
qualifications for, this type of work before selecting the Auditor.
b. The Auditor should be required to meet the following minimum requirements:
i. a current license issued by the New York State Education Department;
ii. sufficient auditing experience in the nonprofit, governmental or profit-making areas, as applicable; and
iii. a satisfactory peer review issued within not more than three years prior to the date when the Auditor
was selected to conduct the audit.
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c. The audit must be conducted in accordance with generally accepted governmental auditing standards (GAGAS).
Financial statements must clearly differentiate between County-funded programs and other programs that the Con-
tractor may be operating. The use of subsidiary schedules should be encouraged for this purpose. The Auditor must
also prepare a management letter based on the audit.
d. Furthermore, if the Contractor is a non-profit organization or unit of local government and expends $500,000 or
more of Federal monies, whether as a recipient expending awards received directly from Federal awarding agen-
cies, or as a subrecipient expending Federal awards received from a pass-through entity, such as New York State or
Suffolk County, during any fiscal period within which it receives funding under this Agreement ("fiscal year"), the
audit must be conducted, and the audit report ("Single Audit Report") must be, in accordance with OMB Circular
No. A-133 (revised June 27,2003). Single Audit Reports must also be submitted to the designated clearinghouse,
cognizant agency and/or pass-through entity, to the extent required by the OMB Circular just referred to.
e. The Contractor must submit a statement in writing, certified by its chief financial officer, which states the amount
of Federal funding expended by the Contractor during such fiscal year. The Contractor must mail or deliver the cer-
tified statement to the Department and to Executive Director of Auditing Services, Suffolk County Department of
Audit and Control, H. Lee Dennison Building, 100 Veterans Memorial Highway, P. O. Box 6100, Hauppauge,
New York I 1788-0099, as soon as possible after the end of the Contractor's fiscal year. The statement should in-
clude ALL Federal funding received directly from the Federal government and ALL Federal funds passed through
from the County and other pass-through entities.
f. Copies of all financial statements, management letters, Single Audit Reports (if applicable) and other audit reports,
ifrequired, must be transmitted to the Department and to the Executive Director of Auditing Services at the address
just set forth. The reports must be submitted within thirty (30) days after completion of the audit, but in no event
later than nine (9) months after the end of the Contractor's fiscal period to which the audit relates.
g. These requirements do not preclude the Department or the Suffolk County Comptroller or their authorized repre-
sentatives or Federal or State auditors from auditing the records of the Contractor. Therefore, the records of the
Contractor must be made available to authorized representatives of Federal, State or County government for that
purpose.
The provisions of the foregoing subparagraphs (a) through (g) of this paragraph shall survive the expiration or termination
of this Agreement.
End of Text for Exhibit E
Law No.
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EXHIBIT F
SUFFOLK COUNTY STOP.DWI
REPORTING FORMS
EXHIBIT F consists of a total four pages,
this page and four one page fOnDs.
Suffolk County STOP-DWI Claim
Payroll Register
Month of , 20_
Personal Services - Page 1
Voucher #:
Claiming Agency:
Instructions: Use this form to detail all Salary/Wage Expenses for your project, for the period claimed. Submit
this form together with a Standard Suffolk County Voucher to insure prompt processing.
Check
Date Number Payee Job Title Service Period Amount
CERTIFICATION: I certifY that the above information is just, true and correct; that no part thereof has been previously reported, and
that such expenditures are proper and necessary.
Project Director or Fiscal Officer:
Date: _/----.!_
Signature and Title
Note: This register is NOT sufficient verification to support your claims. YOU MUST send additional verifYing material such as time
cards, check stubs, etc. You must maintain such documents on file as well to support interim or post-audit of project expenses. Use
Page 2 of this form to record fringe benefit and Consultant costs for this project only if they are part of your contract budget.
Suffolk County STOP-DWI Claim
Payroll Register
Month of , 20_
Personal Services - Page 2
Voucher #:
Claiming Agency:
Instructions: Use this form to detail all Fringe Benefit Expenses for your project, for the period claimed. Submit
this form together with a Standard Suffolk County Voucher to insure prompt processing. Fringe Benefit
Expenses must be part of your original contract to be considered valid expenses.
Check
Date Number Pavee Job Title Service Period Amount
.
CERTIFICATION: I certify that the above infonnation is just, true and correct; that no part thereof has been previously reported, and
that such expenditures are proper and necessary.
Project Director or Fiscal Officer:
Date: I I
---
Signature and Title
Note: This register is NOT sufficient verification to support your claims. YOU MUST send additional verifying material such as time
cards, check stubs, etc. You must maintain such documents on file as well to support interim or post-audit of project expenses. Use
Page I of this form to record SalarylWage costs for this project.
Monthly Expenditure Report
Program Title:
To: Suffolk County STOP-DWI Program
From:
Contract Period: From:
To:
Total Ex ended to Date
Balance Remainin
PERSONAL SERVICES
SUBTOTAL
$ $ $ $
$ $ $ $
$ $ $ $
WAGES/SALARIES
FRINGE BENEFITS
OTHER THAN PERSONAL
SERVICES
TRAVEL
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
SUPPLIES/MA TERIALS
EQUIPMENT PURCHASE
ALL OTHER COSTS
SUB TOTAL
TOTAL PROJECT COSTS
CERTIFICATION: I certifY that the above information is a complete, accurate, and up-to-date portrayal of actual necessary expenditures made for my project during the time
period indicated.
Project Director or Fiscal Officer:
Signature and Title
Date: / /
---
INSTRUCTIONS: The Project Director or Project Fiscal Officer must submit a Monthly Expenditure Report to the STOP-DWI Coordinator within ten days afier the close of each
month. Such report, when submitted in conjunction with "Standard Vouchers", will help monitor overall project progress, ensure proper cash flow to maintain the project, and
help you plan and control expenditures for the duration of the project. All expenditures submitted should reflect only those incurred for the montltly period submitted.
BUDGET AMMENDMENTS: You may not exceed the Total Project Budgeted Amount or Project Budget Category Amounts without written approval, as per conditions of the
contract. Expenditures may be disallowed if they exceed lintitations without prior written approval from the County.
Suffolk County STOP-DWI Monthly Arrest Report
Reporting Agency:
Month:
Year:
Total # of oersons charl!ed with 1192 Violations:
Males
Females
Total 1192 Violations bv al!e l!rOUDS:
Under 18
18
19
20
21-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 & Over
Total # of chames for:
1192.1
1192.2
1192.2 & 3
1192.3
1192.4
IQ!!lli.
Total 1192 Violations bv Dav of Week
Sunday
Monday
Tuesday
Wednesday
Tbursday
Friday
Saturday
Total 1192 Violations bv B.A.C.
# ofrefusals
# of "results unavail."
Total 1192 Violations bv time intervals:
6:01am to 6:00 pm
6:01pm to 9:00 pm
9:01 pm to 12:00 am
12:01 am to 3:00 am
3:01 am to 6:00 am
.05 .18
.06 .19
.07 .20
.08 .21
.09 .22
.10 .23
.11 .24
.12 .25
.13 .26
.14 .27
.15 .28
.16 .29
.17 .30 or greater
Law No.
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Exhibit G
Suffolk County Legislative Requirements Exhibit for Contracts
This exhibit is attached to and is made part of the contract executed with the County.
I Suffolk County Living Wage Requirements
Suffolk County Department of Labor - Living Wage Unit
Certification/Declaration - Subject to Audit Form L W. 38 (consists of I page)
II Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 3/30/04
(form consists ofthree pages; requires signature & notarization)
Note: The Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 3/30/04,
III Union Organizing Certification/Declaration - Subject to Audit; rev. 6/05
Form LOI (consists of2 pages)
IV Lawful Hiring Compliance Requirements
Notice of Application to CertifY Compliance with Federal Law (8 U.S.c. Section] 324A)
with Respect to Lawful Hiring of Employees (consists of I page)
Affidavit of Compliance with the Requirements of(8 U.S.C. Section 1324A)
with Respect to Lawful Hiring of Employees (consists of I page)
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 5/20/05
.,
Pursuant'to Section 6 of Chapter 347 of the Suffolk County Local Law No. 12-2001, "A Local Law to
Implement Living Wage Policy for the County of Suffolk" (the "Living Wage Law"), all RFPs, County
contracts and financial compensation agreements subject to the law shall contain the following two
paragraphs or substantially equivalent language:
This Agreement is subject to the Living Wage Law of the County of Suffolk.
The law requires that, unless specific exemptions apply all employers (as
defined) under service contracts and recipients of County financial
compensations, (as defined) shall provide payment of a minimum wage to
employees as set forth in the Living Wage Law. Such rate shall be adjusted
annually pursuant to the terms of the Suffolk County Living Wage Law of the
County of Suffolk.
Under the provisions of the Living Wage Law, the County shall have the
authority, under appropriate circumstances, to terminate this Agreement and to
seek other remedies as set forth therein, for violations of this Law.
Forms for Completion and/or Signature (as applicable)
. Suffolk County Department of Labor - Living Wage Unit
Notice of Application for County Compensation (Contract)
Form LW-1 (consists of 1 page)
· Suffolk County Department of Labor - Living Wage Unit
. CertificationlDeclaration - Subject to Audit
Form LW-38 (consists of 1 page) (Replaces LW2, LW3 and LW33)
. Suffolk County Department of Labor - Living Wage Unit
Request for General Living Wage Exemption
Form LW4 (consists of 1 page)
. Suffolk County Department of Labor - Living Wage Unit
Request for Specific Living Wage Exemption
Form LW-5 (consists of 2 pages)
1 of 2 pages
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 5/20/05
Note: Pursuant to Section 7 of Local Law NO.18- 2002, "A Local Law to
Implement Living Wage Policy for County of Suffolk", all covered employers
subject to the provisions of the Living Wage Law shall submit a completed and
sworn (under penalty of pe~ury) Certification/Declaration - Subject to Audit Form
LW-38, signed by an authorized representative, as part of an executed contract
with the County of Suffolk. The complete Certification/Declaration - Subject to
Audit Form LW-38 shall be made a part of any executed contract or project
agreement and made available to the public upon request.
---------------....------------..----
· To certify Living Wage compliance: Return Forms LW-1 and LW-38.
or
· To certify non-applicability of Living Wage law: Return Form LW-38.
or
· To request and document a general living wage exemption: Return Forms LW-1,
LW-38 and LW-4.
or
. To request and document a specific living wage exemption: Return Forms LW-1,
LW-38 and LW-5.
..-----
-----
· In the event that there is a change in circumstances, it is the Contractor's
responsibility to submit to the County additional Living Wage forms which
either replace or supplement prior submissions of Living Wage forms.
· Living Wage Law Information Fact Sheet, text of the Local Law, Frequently
Asked Questions, Forms, and Rules and Regulations can be found on the Suffolk
County web site at www.co.suffolk.nv.us
Click: Department Directory
Labor
Living Wage Law Info
. Suffolk County Department of Labor Living Wage Unit Tel. (631) 853-3808
End of Text for Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 5/20/05
2 of 2 pages
SUFFOLK COUNTY DEPARTMENT OF LABOR - LIVING WAGE UNIT
UVING WAGE CERTIFICATlONIDECLARATlON - SUBJECT TO AUDIT
If either of the following definitions of 'compensation' (Living Wage Law Chapter 347 _ 2) applies to the contractor's/recipient's
business or transao,pon with Suffolk County, the contractor/recipient must complete Sections 1,3,4 below; and Form LW-I
(Notice of Application for County Compensation). If the following definitions do not apply, the contractor/recipient must
complete Sections 2, 3 and 4 below. Completed forms must he submitted to the awarding agency.
"Any grant, loan, tax incentive or abatement, bond financing subsidy or other form of compensation of more that $50,000 which is
realized by or provided to an employer of at least ten (10) employees by or through the authority or approval of the County of Suffolk," or
"Any service contract or subcontract let to a contractor with ten (10) or more employees by the County of Suffolk for the furnishing of
services to or for the County of Suffolk (except contracts where services are incidental to the delivery of products, equipment or
commodities) which involve an expenditure equal to or greater than $10,000. For the purposes of this definition, the amount of
expenditure for more than one contract for the same service shall be aggregated. A contract for the purchase or lease of goods, products,
equipment, supplies or other property is not 'compensation' for the purposes of this definition."
Section I
Description of project or service:
Section IV
I declare under penalty of perjury under
and that the above is true and c
.~
D
Check if
app]icable
Section II
o
Check if
applicable
Section III
Contractor Name:
Contractor Address:
Contractor Phone #:
The Living Wage Law applies to this contract. I1we hereby agree to comply with all the provisions of Suffolk County
Local Law No. 12-2001, the Suffolk County Living Wage Law (the Law) and, as such, will provide to all full, part-time
or temporary employed persons who perform work or render services on or for a project, matter, contract or subcontract
wbere this company has received compensation, from the County of Suffolk as defined in the Law (compensation) a
wage rate of no less than S9.64 (S8.50 for child care providers) per hour worked with health benefits, as described in the
Law, or otherwise S10.98 ($9.75 for child care providers) per hour or the rates as may be adjusted annually in
accordance with the Law. (Chapter 347-3 B)
I1we further agree that any tenant or leaseholder of this company that employs at least ten (10) persons and occupies
property or uses equipment or property that is improved or developed as a result of compensation or any contractor or
subcontractor of this company tbat employs at least ten (10) persons in producing or providing goods or services to this
company that are used in the project or matter for which this company has received compensation shall comply with
all the provisions of the Law, including those specified above. (Chapter 347-2)
I1we further agree to permit access to work sites and relevant payroll records by authorized County representatives for
the purpose of monitoring compliance with regulations under this Chapter of the Suffolk County Code, investigating
employee complaints of noncompliance and evaluating the operation and effects of this Chapter, including the
production for inspection & copying of payroll records for any or all employees for the term of the contract or for five
(5) years, whichever period of compliance is longer. All payroll and benefit records required by the County will be
maintained for inspection for a similar period oftime. (Chapter 347-7 D)
The County Department of Labor shall review the records of any Covered Emp]oyer at least once every three years to
verity compliance with the provisions of the Law. (Chapter 347-4 C)
The Living Wage Law does not apply to this contract for the following reason(s):
Town of Southold
Federal Emp]oyer ID#:
116001939
$19,000.00
53095 Route 25 - POR 1179
Southold, NY 11 971
Amount of compensation:
Vendor #:
(631) 76'5--2600
STOP DWI
the State of Ne",york that the undersigned is authorized to provide this certification,
a!A/P'f}
Date v , ~
Authorized Signature
Carlisle E. Cochran, Jr., Chief of
Print Name and Title of Authorized Representative
Police
LW 38 (revised 7-05, replaces forms LW2, LW3, and LW33)
II
Contractor'sNendor's Public Disclosure
Statement Documents
1
Suffolk County Form 22
Contractor'sNendor's Public Disclosure Statement
Pursuant to Section A5-7 of the Suffolk County Administrative Code, this Public Disclosure Statement
must be completed by all contractors/vendors that have a contract with Suffolk County. In the event
contractor/vendor is exempt from completing paragraphs numbered I through ]] below, so indicate at
paragraph number 12 below setting forth the reason for such exemption. Notwithstanding such exempt
status, you must execute this form below before a notary public.
1. Contractor'sNendor's Name Town of Southolcl
Address 53095 Route 25 - POB 1179
City and State Southold, NY Zip Code 11971
2. Contracting Department's Name Southold Town Police Department
Address 41405 Route 25, POB 911, Peconic, NY 11958
3. Payee Identification or Social Security No.
4. Type of Business_Corporation Jartnership _Sole Proprietorship_Other
5.a Is contractor/vendor entering into or has contractor/vendor entered into a contract with Suffolk
County in excess of$I,OOO? _Yes_No.
5.b Has contractor/vendor entered into three or more contracts, including the one for which you are
now completing this form, with Suffolk County, any three of which, when combined, exceed
$1,000? _Yes_No.
6. Table of Organization. List names and addresses of all principals; that is, all individuals serving
on the Board of Directors or comparable body, names and addresses of all partners, and names
and addresses of all corporate officers. Conspicuously identify any person in this table of
organization who is also an officer or an employee of Suffolk County. (Attach additional sheet if
necessary.)
7. List all names and addresses of those individual shareholders holding more than five percent
(5%) interest in the contractor/vendor. Conspicuously identify any shareholder who is also an
officer or an employee of Suffolk County. (Attach additional sheet if necessary).
8. Does contractor/vendor derive 50% or more of its total revenues from its contractual or vendor
relationship with Suffolk County? _Yes_No.
9. If you answered yes to 8 above, you must submit with this disclosure statement, a complete
financial statement listing all assets and liabilities as well as a profit and loss statement. These
statements must be certified by a Certified Public Ac (Strike this out if not applicable.)
10. The undersigned shal] include this Contractor'sNendor's Public Disclosure Statement with the
contract. (Describe general nature of the contract.)
Page 1 of 3 Public Disclosure Form
11. Remedies. The failure to file a verified public disclosure statement as required under local law
shall constitute a material breach of contract. Suffolk County may resort, use or employ any
remedies contained in Article II of the Uniform Commercial Code of the State of New York. In
addition to all legal remedies, Suffolk County shall be entitled, upon a determination that a
breach has occurred, to damages equal to fifteen percent (J 5%) of the amount of the contract.
12. If you are one of the entities listed below at a) through c) or you qualifY under d) below, you are
exempt from completing paragraphs numbered I through II herein:
a) Hospital
xx b) Educational or governmental entities
_ c) Not-for-profit corporations
_ d) Contracts providing for foster care, family day-care providers or child protective
services
Please check to the left side of the appropriate exemption.
13. Verification. This section must be signed by an officer or principal of the contractor/vendor
authorized to sign for the company for the purpose of executing contracts. The undersigned
being sworn, affirms under the penalties of perjury, that he/she has read and understood the
foregoing statements and that they are, to his/her own knowledge, true.
Dated: ,,-,If,) b '> Signed: ~~
PrintedNameofSiiner: Carl~e E. Cochran, Jr.
Title of Signer: Chief of Police
Name ofContractorNendor: Southold Town Police Department
UNIFORM CERTIFICATE OF ACKNOWLEDGMENT
(Within New York State)
STATE OF NEW YORK)
COUNTY OF Suffolk) sS.:
On the _ day of February in the year 2007 before me, the undersigned, personally appeared
Carlisle E. Cochran, Jr. , 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/herltheir 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.
(signature and office of individual taking acknowledgement)
Page 2 of 3 Public Disclosure Form
;;
UNIFORM CERTIFICATE OF ACKNOWLEDGEMENT
(Without New York State)
STATE OF
)
)ss.:
)
COUNTY OF
On the day of in the year 2007 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, and that such individual(s) made such appearance before
the undersigned in
(Insert the city or other political subdivision and the state or country or other place the acknowledgement
was taken)
(signature and office of individual taking acknowledgement)
Contractor'sNendor's Public Disclosure Statement Form (Rev. 3/04)
Page 3 of 3 Public Disclosure Form
C:\Misc\SuffCo Exbibit Pub Disc FormSOP 06.doc
Suffolk County, New York
Deparbnent of Labor
,;.
SlWFOLK COUNTY DEPARTMENT OF LABOR - LABOR MEDIA nON UNIT
UNION ORGANIZING CERnFlCAnONIDECLARA nON - SUBJECT TO AUDIT
If the following definition of "County Contractor" (Union Organizing Law Chapter 466~2) applies to the contractor'slbeneficiary's
business or transaction with Suffolk County, the contractorlbeneficiary must complete Sections I, ill, and IV below. If the
following definitions do not apply, the contractorlbeneficiary must complete Sections n, III and IV below. Completed forms must
be submitted to tbe awarding agency.
County Contractor: "Any employer that receives more than $50,000 in County funds for supplying goods or services pursuant to a
written contract with the County of Suffolk or any of its agencies; pursuant to a Suffolk County grant; pursuant to a Suffolk County
program; pursuant to a Suffolk County reimbursement for services provided in any calendar year; or pursuant to a subcontract with any of
the above,"
Section I
The Union Organizing Law applies to this contract. Uwe hereby agree to comply with all the provisions of Suffolk
Couoty Local Law No. 26-2003, the Suffolk County Union Organizing Law (the law) and, as such shall not use
County funds to assist, promote, or deter union organizing (Chapter 466.3 A), nor seek reimbursement from the
County for costs incurred to assist, promote, or deter union organizing. (Chapter 466-3 B)
Check if
Applicable
I/we further agree to take all action necessary to ensure that County funds are not used to assist, promote, or deter
union organizing. (Chapter 466-3 H)
D
I/we further agree that if any expenditures or costs incurred to assist, promote, or deter union organizing are made,
Uwe shall maintain records sufficient to show that no County funds were used for those expenditures and, as
applicable, that no reimbursement from County funds bas been sought for such costs. I/we agree that such records
shall be made available to the pertinent County agency or authority, the County Comptroller, or the County
Depar1ment of Law upon request. (Chapter 466--3 I)
I/we further affinn to the following:
. I/we will not express to employees any false or misleading information that is intended to influence the
determination of employee preferences regarding union representation;
. I/we will not coerce or intimidate employees, explicitly or implicitly, in selecting or not selecting a bargaining
representative;
. I/we will not require an employee, individually or in a group, to attend a meeting or an event that is intended to
influence his or her decision in selecting or not selecting a bargaining representative;
. I/we understand my/our obligation 10 limit disruptions caused by prerecognition labor disputes through the
adoption of nonconfrontational procedures for the resolution of prerecognition labor disputes with employees
engaged in the production of goods or the rendering of services for the County; and
. I/we have or will adopt any or all of the above.referenced procedures, or their functional equivalent, to ensure the
efficient, timely, and quality provision of goods and services to the County. I/we shall include a list of said
procedures in such certification.
I/we further agree that every County contract for the provision of services, when such services will be performed on
County property, shall include a requirement that l/we adopt a reasonable access agreement, a neutrality agreement,
fair communication agreement, no intimidation agreement, and a majority authorization card agreement
I1we further agree that every County contract for the provision of human services, when such services are not to be
performed on County property, shall include a requirement that I/we adopt, at the least, a neutrality agreement
Vwe understand that the efficient, timely, and nondisruptive provision of goods and services is a paramount fInancial
interest of the County of Suffolk and as such, the County expects the potential County contractor to protect the
County's fmancial interest by adopting nonconfrontational procedures for the orderly resolution of labor disputes,
including, but not limited to, neutrality agreements. majority authorization card agreements, binding arbitration
agreements. fair communication agreements, nonintimidation agreements, and reasonable access agreements.
Section II The Union Organizing Law does not apply to this contract for the following reason(s):
0"
Check if
Applicable
Section III
Contractor Name:
Town of Southold
Federal Employer ID#:
116001939
Contractor Address:
53095 Route 25 - POB 1179
Southold, NY 11971
Amount of Assistance:
$19,000.00
Vendor #:
Contractor Phone #:
(631) 765-2600
Description of project or service: STOP IlWI
Section IV
I declare under penalty of peJjury under the Laws
certification, and that the ab ect.
te of New York that the undersigned is authorized to provide this,
(}//) $)
. , ,
Date
Carlisle E. Cochran, Jr., Chief of Police
Print Name and Title of Authorized Representative
;;
IV
Lawful Hiring Compliance Requirements
SUFFOLK COUNTY DEPARTMENT OF LABOR
NOTICE OF APPLICATION TO CERTIFY COMPLIANCE WITH FEDERAL LAW
(8 U.S.C. SECTION 1324A)
WITH RESPECT TO LAWFUL HlRING OF EMPLOYEES
Suffolk County Code, Chapter 234 (2006)
To Be Completed By Applicant! Covered EmployerllOwner
,
EMPLOYERlCORP./BUSINESS/COMPANY NAME:
I) ADDRESS:
2) NOT-FOR-PROFlT:
3) VENDOR #:
(If known)
5) CONTACT:
YES_ NO_ (SUBMIT CERTIFICATE OF INCORPORATION)
4) CONTRACT ID:
(If known)
6) TELEPHONE #:
7) TERM OF CONTRACT OR EXTENSION (pROVIDE DATES):
8) BRIEF DESCRIPTION OF COMPENSATION, PROJECT OR SERVICE
SUBCONTRACTOR:
I) ADDRESS:
2) VENDOR#:
4) CONTACT:
5) DESCRIPTION OF COMPENSATION, PROJECT OR SERVICE
3) TELEPHONE #:
EVIDENCE OF COMPLIANCE:
COPIES OF THE FOLLOWING MUST BE MAINTAINED BY COVERED EMPLOYERS OR THE
OWNERS THEREOF FOR EACH EMPLOYEE FOR THE TIME PERIODS SET FORTH IN SUFFOLK
COUNTY CODE SECTION ( ):
A. United States passport; or
B. resident alien card or alien registration card; or
C. birth certificate indicating that person was born in the United States; or
D. (I) a driver's license, if it contains a photograph of the individual; and
(2)a social security account number card (other than such a card which
specifies on its face that the issuance of the card does not authorize
employment in the United States); or
E. employment authorization documents such as an H-IB visa, H-2B visa,
and L-I visa, or other work visa as may be authorized by the United
States Government at the time the County contract is awarded for all
covered employees.
LHE-I ( 01/07)
,
AFFIDA VID OF COMPLIANCE
WITH THE REQillREMENTS OF
8 D.S.C. SECTION 13248
WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES
State of New York
)
ss:
County of
)
(Print Name of Deponent)
, being duly sworn, deposed and says:
1. I am owner/authorized representative of
(Name of Corp., Business, Company)
2. I certify that I have complied, in good faith, with the requirements of Title 8 of the United
States Code (D.S.C.) section 1324a (Aliens and Nationality) with respect to the hiring of
covered employees and with respect to the alien and nationality status of the owners
thereof, as set forth in Suffolk County Code Chapter 234 (2006).
(Signature of Deponent)
Sworn to before me this _ day
of
,20
(Notary Public)
LHE-2
(01107)
SUFFOLK COUNTY DEPARTMENT OF LABOR - LIVING WAGE UNIT
NOTICE OF APPLICATION FOR COUNTY ASSISTANCE(Contract)
Living Wage Law, Suffolk County Code, Chapter 347 (2001)
To Be Completed By Applicant! Em loyer/Contractor
1) NAME: Southold Town Police Department
2) VENDOR #: 11-6001939 3) CONTRACT ID #:
(If known) (Irknown)
4) CONTACT: Carlisle E.Cochran, Jr. 5) TELEPHONE #: (631) 765-2600
Chief of Police
6) ADDRESS: 4]405 Route 25 - P.O. Box 911
Peconic, NY 11958
7) TERM OF CONTRACT (DATES): 1/1/07 to 12/31/07
8) PROJECT NAME: (IF DIFFERENT FROM #1) STOP-DWI
9) AMOUNT: $19,000.00
10) AWARDING AGENCY: Suffolk County STOP-DWI
ll) BRIEF DESCRIPTION OF PROJECT OR SERVICE:
STOP-DWI Enforcement
12) PROJECTED EMPLOYMENT NEEDS: (attach a statement listing, by job
classification, the total workforce dedicated to performing this contract or service, including
calculation of estimated net increase or decrease in jobs as a result of funding).
13) PROJECTED WAGE LEVELS: (attach a statement listing projected wage levels,
compensated days off and medical benefits for total workforce dedicated to fulfilling the terms
of this contract, broken down annually for each year ofthe term ofthe contract).
L W -I (revised 4/04)
POLICE DEPAQTMENT
TOWN Of 8OUTIIOLD
Telephone Emergency Dial 971
CARLISLE E. COCHRAN,]lt
Chief of Police
Suffolk County Department of Law
Addendum to LW.]
To comply with Sections 12 & 13
At this time Southold Town Police Department employs 49 full time police
officers. The minimum hourly wage for a police officer is $19.29 per hour. In
addition each officer receives full medical benefits with a minimum annual
premium of$6,357.12, and a minimum of34 compensated days off. Compensated
days off include holiday, vacation and personal days, sick time is not included in
this total. While the total workforce may change it will not be as a result of this
contract. No other personnel other than full time police officers will be used to
comply with this contract.
41405 ROllte25. P.O. Box 911. Pecon;c, N.Y. 11958
Administraril'C (631) 765-2600/2601 . Fax (631) 765.2715