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Office of Mental Health

Document Requirements for
NYS Office of Mental Health
Non-Grant Contracts

Contract Document Amendment “0” Amendments Greater than “0”
Non-Grant Contract Face Page PDF Document X1  
Contract Signature Pages 1 & 2 PDF Document X1  
State of New York Agreement PDF Document X  
Appendix A Standard Clauses PDF Document X  
Appendix A-1 Agency Specific Clauses PDF Document X  
Appendix A-1(a) EEO and MWBE Requirements PDF Document X  
Exhibit 1 – MWBE Utilization Plan PDF Document X2  
Exhibit 2 – MWBE Request for Waiver PDF Document X2  
Exhibit 2a – Certification of Good Faith Efforts PDF Document X2  
Exhibit 3 – Contractor Quarterly Compliance Report PDF Document X2  
Exhibit 4 – EEO Workforce Utilization Report PDF Document X2  
Appendix B Budget PDF Document X X
Appendix C Payment and Reporting Schedule PDF Document X X
Appendix D Work Plan PDF Document X X5
Appendix F Business Associate Agreement PDF Document X  
Appendix I Consultant Disclosure Instructions with Form A and B PDF Document X  
Attachments To Be Returned With The Contract:    
     -   Attachment J1 Affirmation of Understanding PDF Document X  
     -   Attachment J2 Disclosure of Prior Non-Responsibility Determinations PDF Document X  
     -   Attachment J3 Certification of Compliance with State Finance Law PDF Document X  
     -   Attachment J4 Termination for Non-Compliance PDF Document X  
Appendix X Modification Agreement Form PDF Document X3 X3
Rider-Provisions for Contractors Receiving Aid-to-Localities Funding (ATL Rider) PDF Document X  
Vendor Responsibility Questionnaire Leaving OMH site X X
Proof of NYS Workers’ Compensation (or exemption) PDF Document X X
Proof of NYS Disability Benefits Insurance (or (or exemption) PDF Document X X
NY Charities Registration (or exemption) PDF Document X X
Federal Certification Form 1 PDF Document X4 X4
Federal Certification Form 2 PDF Document X4 X4

1 Prefilled by OMH and included with letter.
2 Required if MWBE goals are assigned. Goals are identified in the Appendix A-1(a).
3 Include blank copy with Amendment 0.
4 Original signed Federal certification forms are required if Federal funds are included in the contract.
5 Only required if amendment includes change in scope of work.

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