The Dasny Compliance Report form serves as a critical tool for prime contractors, consultants, and vendors involved in projects, ensuring that all financial and subcontracting activities are transparent and in line with state regulations. This comprehensive document captures essential details such as total amounts paid from prior requisitions, providing a chronological financial history that aids in tracking project expenses. It requires the listing of all utilized subcontractors and suppliers, including those classified under Minority Business Enterprises (MBE), Women-owned Business Enterprises (WBE), and Service-Disabled Veteran-Owned Businesses (SDVOB), emphasizing the state's commitment to inclusive contracting. The form also mandates the inclusion of non-MBE/WBE/SDVOB subcontractors or suppliers for transactions exceeding $10,000, ensuring a broad scope of compliance beyond diversity program targets. To maintain integrity and accountability, the form culminates with a compliance certification section where firms affirm the accuracy of their reporting and adherence to approved utilization plans, underlined by a warning against the submission of false information which could lead to severe contractual and legal penalties. This steadfast process underscores the state's dedication to fostering transparency, fairness, and diversity in its contracting practices.
| Question | Answer |
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| Form Name | Dasny Compliance Report Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | dasny compliance report form, dasny exhibit e payment requisition and dual certification form, example of annual compliance report, dasny payment requisition form and dual certification |
COMPLIANCE REPORT
PRIME CONTRACTOR / CONSULTANT / VENDOR INFORMATION
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MBE/WBE/SDVOB - PAYMENTS
MBE PAYMENT INFORMATION
Instructions: In the appropriate section, please list each NYS Certified MBE/WBE/SDVOB subcontractor or supplier being utilized. All subcontractors and suppliers utilized must be listed regardless of the award amount or the payment being made. Compliance Report Instructions click HERE
Check if no MBE subcontractors or suppliers are being utilized in this section
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MBE SUBTOTAL:
WBE PAYMENT INFORMATION
Check if no WBE subcontractors or suppliers are being utilized in this section
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WBE SUBTOTAL:
SDVOB PAYMENT INFORMATION Check if no SDVOB subcontractors or suppliers are being utilized in this section
DASNY Compliance Report Form (05/26/16) |
Page 1 of 3 |
COMPLIANCE REPORT
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SDVOB Company Information |
Federal ID Number |
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Federal ID Number |
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REPORT TOTAL: |
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DASNY Compliance Report Form (05/26/16) |
Page 2 of 3 |
COMPLIANCE CERTIFICATION*
hereby certifies that for the current payment period: (i) the information in this report regarding MBE/WBE/SDVOB participation on the contract is true and accurate; (ii) the MBE/WBE/SDVOB subcontractors and vendors listed in this report have performed a commercially useful function on the project and have not, other than as allowed in the approved Utilization Plan, subcontracted their assigned scope of work to a
Principal or Officer (print name and title) |
Signature |
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Subscribed and sworn to before me in the State of _________________________ |
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County of ___________________ this _____ day of ________________ , 20____ |
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__________________________________________________________________ |
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Notary Public: |
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ID No.: ______________________________ |
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My Commission Expires: ________________ |
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*False statements, information or data submitted on or with Application for Payment, may result in one or more of the following actions: Termination of Contract for cause; disapproval of future bids, contracts, or subcontracts; withholding of final payments on the contract; and civil and/or criminal prosecution.
DASNY's review of this report does not relieve the Contractor of its obligation to provide a true and accurate report and strictly comply with its approved Utilization Plan and Contract General Conditions requirements.
Reviewed by Design/Const. Phase Manager (print name and title) |
Signature |
Date |
DASNY Compliance Report Form (05/26/16) |
Page 3 of 3 |