Contract Documents

All applicable contract documents must be submitted as part of the contracting process. Completed forms can be sent to your designated Grants Coordinator.

Obtaining a Workers’ Compensation or Disability Benefits Certificate of Insurance

If you have questions, please direct them to the New York State Workers’ Compensation Board, Bureau of Compliance (518) 462-8882 or (866) 298-7830 or www.wcb.ny.gov or NYS Insurance Fund (877) 435-7743 or www.nysif.com

Forms:

  • Acceptable forms for Workers’ Compensation: C-105.2, U-26.3, SI-12, or SGI-105.2, or CE-200.
  • Acceptable forms for Disability Benefits: DB-120.1, DB-120.2, DB-155, CE-200
  • Please note – an ACORD form is not acceptable proof of New York State workers’ compensation or disability benefits insurance coverage.
  • The acceptable forms are defined below in the section Proof of Coverage. Employers may obtain a form from either their NYS Workers’ Compensation insurance carrier, or a licensed NYS insurance agent of that carrier. 

Source of the rule regarding insurance requirements for contracts, from the Office of the New York State Comptroller (OSC):

https://www.osc.state.ny.us/state-agencies/gfo/chapter-xi/xi18g-workers-compensation-coverage-and-debarment

The Workers’ Compensation Board has developed several forms to assist State contracting entities in ensuring that businesses have the appropriate workers’ compensation and disability insurance coverage as required by Sections 57 and 220(8) of the WCL.

Proof of Coverage

For each new contract or contract renewal, the contracting entity must obtain ONE of the following forms from their carrier and submit to the State contracting entity issuing the contract to prove the contractor has appropriate workers’ compensation insurance and disability insurance coverage:

Proof of Workers’ Compensation Coverage

  • Form C-105.2 – Certificate of Workers’ Compensation Insurance issued by private insurance carriers; or
  • Form U-26.3 issued by the State Insurance Fund; or
  • Form SI-12 – Certificate of Workers’ Compensation Self-Insurance; or
  • Form GSI-105.2 – Certificate of Participation in Workers’ Compensation Group Self-Insurance; or
  • CE-200 – Certificate of Attestation of Exemption from NYS Workers’ Compensation and/or Disability Benefits Coverage.

Proof of Disability Benefits Coverage

  • Form DB-120.13 - Certificate of Disability Benefits Insurance; or
  • Form DB-120.27 – Certificate of Participation in Disability Benefits Group Self Insurance; or
  • Form DB-1554 - Certificate of Disability Benefits Self-Insurance; or
  • CE-2006 – Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Coverage.

On forms where a certificate holder can be indicated, the State contracting entity should ensure the carrier has entered the name of the State contracting entity in this field, as the insurance carrier will notify the certificate holder if a policy is canceled.

Sexual Harassment Prevention Training Certification Form

As of January 1, 2019, bidders on procurements subject to competitive bidding are required to submit a certification with every bid that states they have a policy addressing sexual harassment prevention and that they provide sexual harassment training (that meets the Department of Labor’s model policy and training standards) to all employees on an annual basis.


Complete this form as an attestation that your organization trains staff in sexual harassment prevention. (Download from document list below).

 

Vendor Responsibility Questionnaire (VRQ)

To access or enroll in the VendRep System or update your existing online questionnaire, click Online Questionnaire. Questionnaires in the VendRep System that have been completed in the last six months in response to contracts or bid announcements do not need to be updated.

 

Business with Russia Prohibition Certification

As of March 17, 2022, New York State agencies are prohibited from contracting with
businesses conducting business in Russia. Bidders on procurements must submit a
certification stating that they do not conduct business operations in Russia, or meet the
federal exemptions regarding vital health and safety services.

Full text of Executive Order No. 16 can be found here.

(Download from document list below).