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Form II

State University of New York

Omnibus Procurement Act

 

Standard 15 Day Notification Form

For Contracts for Goods and Services of $1 Million or More

To Out-of-State/Foreign Firms

 

 

In compliance with Section 2879 subdivision 5 of the Public Authorities Law and Section 139-i of the State Finance Law, the Commissioner of Economic Development is hereby notified that:

 

CONTRACTING AGENCY:______________________________________________________________

 

ADDRESS: __________________________________________________________________________

 

____________________________________________________________________________________

 

TELEPHONE NUMBER: _______________________________________________________________

 

FAX NUMBER: _______________________________________________________________________

 

CONTACT PERSON AT AGENCY: _______________________________________________________

 

is preparing to enter into a contract, on or about _________________with the following out-of-state/foreign firm:                                                                            (date)     

 

FIRM NAME:_________________________________________________________________________

 

ADDRESS: __________________________________________________________________________

 

____________________________________________________________________________________

 

TELEPHONE NUMBER: ________________________________________________________________

 

FAX NUMBER: _______________________________________________________________________

 

BRIEF DESCRIPTION OF GOODS OR SERVICES:__________________________________________

 

____________________________________________________________________________________

 

AMOUNT OF PROPOSED CONTRACT: ___________________________________________________

 

TERM OF PROPOSED CONTRACT:______________________________________________________

 

CONTACT PERSON AT FIRM:___________________________________________________________

 

DATE OF NOTICE TO DED:_____________________________________________________________

 

For immediate notice to DED, please fax form to:

Department of Economic Development

Division for Small Business

Procurement Unit

30 South Pearl Street

Albany, New York 12245

Telephone (518) 292-5220   FAX (518) 292-5884