Professional Documents
Culture Documents
has the financial resources necessary to fulfill the requirements of the proposed contract;
has not altered the content of the questions in the questionnaire in any manner;
has read and understands all of the items contained in the questionnaire and any pages attached by the submitting vendor;
has supplied full and complete responses to each item therein to the best of his/her knowledge, information and belief;
is knowledgeable about the submitting vendor's business and operations;
understands that the NYSTA/CC will rely on the information supplied in this questionnaire when entering into a contract with the
ss:
)
is under a duty to notify the NYSTA/CC of any material changes to the vendor's responses herein prior to the NYSTA's/CC's
execution of the contract.
vendor; and
SUPPLEMENT 4
Certificate of No Change
CERTIFICATE OF NO CHANGE
STATE OF )
: SS.:
COUNTY OF )
The undersigned, being duly sworn, deposes and says:
1. I am ___________________________, the _____________________________ (title) of
________________________________________________________________________
(hereinafter Contractor), which is currently submitting a proposal in response to New York
State Thruway Authority (hereinafter Authority) RFP/IFB # ______.
2. Contractor previously submitted a completed Vendor Responsibility Questionnaire, dated
________________________ to the Authority in connection with Authority RFP/IFB #
______.
3. Attached is an accurate and true copy of Contractors previously submitted Vendor
Responsibility Questionnaire dated __________________.
4. I hereby certify that with the exception of the information specified in Question 13 of the
Vendor Responsibility Questionnaire previously submitted to the Thruway Authority, and as
changed herein, there has been no material change in the information pertaining to the
Contractor specified on such attached Questionnaire.
AUTHORIZED CONTACT FOR THE PROPOSED CONTRACT:
Name: ______________________________________________________________
Title: _______________________________________________________________
Telephone Number: ___________________________________________________
Fax Number: _________________________________________________________
Email: ______________________________________________________________
________________________________________
Signature
________________________________________
Print Name
_________________________________________
Title
Sworn before me this ______day
of ___________________, 20__.
__________________________
Notary Public
Registration No: _____________
State of: ____________________
(Revised 1-14-11)
SUPPLEMENT 5
ST-220-CA New York State Department of Taxation and
Finance Contractor Certification
New York State Department of Taxation and Finance
Contractor Certication to Covered Agency
(Pursuant to Section 5-a of the Tax Law, as amended, effective April 26, 2006)
ST-220-CA
(6/06)
Contractor name
Contractors principal place of business City State ZIP code
Contractors mailing address (if different than above)
Contractors federal employer identication number (EIN) Contractors sales tax ID number (if different from contractors EIN)
Contractors telephone number Covered agency name
Covered agency address
I, , hereby afrm, under penalty of perjury, that I am
(name) (title)
of the above-named contractor, that I am authorized to make this certication on behalf of such contractor, and I further certify
that:
(Mark an X in only one box)
G The contractor has led Form ST-220-TD with the Department of Taxation and Finance in connection with this contract and, to the best of
contractors knowledge, the information provided on the Form ST-220-TD, is correct and complete.
G The contractor has previously led Form ST-220-TD with the Tax Department in connection with
(insert contract number or description)
and, to the best of the contractors knowledge, the information provided on that previously led Form ST-220-TD, is correct and complete
as of the current date, and thus the contractor is not required to le a new Form ST-220-TD at this time.
Sworn to this day of , 20
(sign before a notary public) (title)
For covered agency use only
Contract number or description
Estimated contract value over
the full term of contract (but not
including renewals)
$
Covered agency telephone number
For information, consult Publication 223, Questions and Answers Concerning Tax Law Section 5-a (see Need Help? on back).
Instructions
General information
Tax Law section 5-a was amended, effective April 26, 2006. On or
after that date, in all cases where a contract is subject to Tax Law
section 5-a, a contractor must le (1) Form ST-220-CA, Contractor
Certication to Covered Agency, with a covered agency, and
(2) Form ST-220-TD with the Tax Department before a contract
may take effect. The circumstances when a contract is subject to
section 5-a are listed in Publication 223, Q&A 3. This publication is
available on our Web site, by fax, or by mail. (See Need help? for
more information on how to obtain this publication.) In addition, a
contractor must le a new Form ST-220-CA with a covered agency
before an existing contract with such agency may be renewed.
If you have questions, please call our information center at
1 800 698-2931.
Note: Form ST-220-CA must be signed by a person authorized to make
the certication on behalf of the contractor, and the acknowledgement
on page 2 of this form must be completed before a notary public.
When to complete this form
As set forth in Publication 223, a contract is subject to section 5-a, and
you must make the required certication(s), if:
i. The procuring entity is a covered agency within the meaning of the
statute (see Publication 223, Q&A 5);
ii. The contractor is a contractor within the meaning of the statute (see
Publication 223, Q&A 6); and
iii. The contract is a contract within the meaning of the statute. This is
the case when it (a) has a value in excess of $100,000 and (b) is a
contract for commodities or services, as such terms are dened for
purposes of the statute (see Publication 223, Q&A 8 and 9).
Furthermore, the procuring entity must have begun the solicitation to
purchase on or after January 1, 2005, and the resulting contract must
have been awarded, amended, extended, renewed, or assigned on or
after April 26, 2006 (the effective date of the section 5-a amendments).
Internet access: www.nystax.gov
(for information, forms, and publications)
Fax-on-demand forms: 1 800 748-3676
Telephone assistance is available from
8:00 A.M. to 5:00 P.M. (eastern time),
Monday through Friday. 1 800 698-2931
To order forms and publications: 1 800 462-8100
From areas outside the U.S. and outside Canada: (518) 485-6800
Hearing and speech impaired (telecommunications
device for the deaf (TDD) callers only): 1 800 634-2110
Persons with disabilities: In compliance with the
Americans with Disabilities Act, we will ensure that our lobbies,
ofces, meeting rooms, and other facilities are accessible to
persons with disabilities. If you have questions about special
accommodations for persons with disabilities, please call 1 800 972-1233.
Need help?
Individual, Corporation, Partnership, or LLC Acknowledgment
STATE OF }
: SS.:
COUNTY OF }
On the day of in the year 20 , before me personally appeared ,
known to me to be the person who executed the foregoing instrument, who, being duly sworn by me did depose and say that
he resides at ,
Town of ,
County of ,
State of ; and further that:
[Mark an X in the appropriate box and complete the accompanying statement.]
G (If an individual): _he executed the foregoing instrument in his/her name and on his/her own behalf.
G (If a corporation): _he is the
of , the corporation described in said instrument; that, by authority of the Board
of Directors of said corporation, _he is authorized to execute the foregoing instrument on behalf of the corporation for
purposes set forth therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on
behalf of said corporation as the act and deed of said corporation.
G (If a partnership): _he is a
of , the partnership described in said instrument; that, by the terms of said
partnership, _he is authorized to execute the foregoing instrument on behalf of the partnership for purposes set forth
therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on behalf of said
partnership as the act and deed of said partnership.
G (If a limited liability company): _he is a duly authorized member of ,
LLC, the limited liability company described in said instrument; that _he is authorized to execute the foregoing instrument
on behalf of the limited liability company for purposes set forth therein; and that, pursuant to that authority, _he executed
the foregoing instrument in the name of and on behalf of said limited liability company as the act and deed of said limited
liability company.
Notary Public
Registration No.
Page 2 of 2 ST-220-CA (6/06)
Privacy notication
The Commissioner of Taxation and Finance may collect and maintain personal
information pursuant to the New York State Tax Law, including but not limited to,
sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, 1096, 1142, and 1415
of that Law; and may require disclosure of social security numbers pursuant to
42 USC 405(c)(2)(C)(i).
This information will be used to determine and administer tax liabilities and, when
authorized by law, for certain tax offset and exchange of tax information programs as
well as for any other lawful purpose.
Information concerning quarterly wages paid to employees is provided to certain
state agencies for purposes of fraud prevention, support enforcement, evaluation of
the effectiveness of certain employment and training programs and other purposes
authorized by law.
Failure to provide the required information may subject you to civil or criminal penalties,
or both, under the Tax Law.
This information is maintained by the Director of Records Management and Data
Entry, NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone
1 800 225-5829. From areas outside the United States and outside Canada, call
(518) 485-6800.
ATTACHMENT 1
Fee Proposal Form
Page 1 of 4
Attachment 1
Custody and Safekeeping Services
RFP No: 12C20
FEE PROPOSAL
Five Year Term
Name of Proposer:
________________________________________________________________________
A. One Time Fee
1. Setup Fees (one time only fee) $___________
2. Other (please describe
1
) $___________
TOTAL ONE TIME FEES
(Total of A1 and A2) $___________
________________________________________________________________________
B. Annual Fees:
1. Annual Maintenance Fee, (paid semi-annually), Lump Sum total only:
$___________ Year 1
$___________ Year 2
$___________ Year 3
$___________ Year 4
$___________ Year 5
$___________ Subtotal B1
2. Per Portfolio Fee (Assume 4 portfolios
2
)
$___________ x 4 = $___________ Year 1
$___________ x 4 = $___________ Year 2
$___________ x 4 = $___________ Year 3
$___________ x 4 = $___________ Year 4
$___________ x 4 = $___________ Year 5
$___________ Subtotal B2
1
Any fee indicated as Other shall be fully described with the services that will be provided and with an
explanation of the cost/multiplier, if any.
2
The assumption of four portfolios is used for evaluation purposes only and is not intended to guarantee an
actual level of activity or volume of transactions for this contract.
Page 2 of 4
3. Reporting Package (if any)
$___________ Year 1
$___________ Year 2
$___________ Year 3
$___________ Year 4
$___________ Year 5
___________ Subtotal B3
4. Other (Please describe, if any)
$___________ Year 1
$___________ Year 2
$___________ Year 3
$___________ Year 4
$___________ Year 5
$___________ Subtotal B4
TOTAL ANNUAL FEES
(Total of Subtotals B1 B4)$___________
______________________________________________________________________
C. Per Item Fees
1. Receipt of Securities (Purchase) - (Assume 500 investment transactions
3
per year,
based on the average number of investments processed over the past 3 years.)
(per transaction)
$___________ x 500 = $___________ Year 1
$___________ x 500 = $___________ Year 2
$___________ x 500 = $___________ Year 3
$___________ x 500 = $___________ Year 4
$___________ x 500 = $___________ Year 5
___________ Subtotal C1
3
The assumption of 500 investment transactions portfolios is used for evaluation purposes only and is not
intended to guarantee an actual level of activity or volume of transactions for this contract.
Page 3 of 4
2. Redemption of Securities (Maturity)
(per transaction)
$___________ x 500 = $___________ Year 1
$___________ x 500 = $___________ Year 2
$___________ x 500 = $___________ Year 3
$___________ x 500 = $___________ Year 4
$___________ x 500 = $___________ Year 5
___________ Subtotal C2
3. Receipt of Collateral
(per transaction)
$___________ x 500 = $___________ Year 1
$___________ x 500 = $___________ Year 2
$___________ x 500 = $___________ Year 3
$___________ x 500 = $___________ Year 4
$___________ x 500 = $___________ Year 5
___________ Subtotal C3
4. Return of Collateral
(per transaction)
$___________ x 500 = $___________ Year 1
$___________ x 500 = $___________ Year 2
$___________ x 500 = $___________ Year 3
$___________ x 500 = $___________ Year 4
$___________ x 500 = $___________ Year 5
___________ Subtotal C4
5. Wire Transfer
(per transfer)
$___________ x 500 = $___________ Year 1
$___________ x 500 = $___________ Year 2
$___________ x 500 = $___________ Year 3
$___________ x 500 = $___________ Year 4
$___________ x 500 = $___________ Year 5
___________ Subtotal C5
Page 4 of 4
6. Other (Please describe, if any)
$___________ x _____ = $___________ Year 1
$___________ x _____= $___________ Year 2
$___________ x _____ = $___________ Year 3
$___________ x _____ = $___________ Year 4
$___________ x _____ = $___________ Year 5
___________ Subtotal C6
TOTAL PER ITEM FEES
(Total of Subtotals C1 C6) $____________
TOTAL FEES FOR PROPOSAL (TOTAL
ONE TIME FEES + TOTAL ANNUAL FEES +
TOTAL PER ITEM FEES) $________________
The Signatory to this document must be authorized to bind the proposing firm contractually.
____________
Print name Signature Date
ATTACHMENT 2
Securities held as of September 30, 2012
Page 1 of 5
Fund Security Description / Maturity Date
Yield to
Maturity (%) Cost Par
BP - Construction Series I INGFDG (ING US Funding LLC) 0.00 10/15/12 0.3704 49,951,333.33 $ 50,000,000.00 $
BP - Construction Series I Bank Nova Sco NY CP 0.00 10/01/12 0.1826 49,979,500.00 50,000,000.00
BP - Construction Series I INGFDG (ING US Funding LLC) 0.00 11/02/12 0.2292 24,989,641.75 25,000,000.00
BP - Construction Series I GECC (Gen Elec Cap Corp) CP 0.00 11/20/12 0.1420 8,297,320.94 8,300,000.00
BP - Construction Series I GECC (Gen Elec Cap Corp) CP 0.00 11/20/12 0.1506 12,795,723.14 12,800,000.00
BP - Construction Series I INGFDG (ING US Funding LLC) 0.00 11/09/12 0.1724 9,997,166.67 10,000,000.00
BP - Construction Series I FHLMC Discount Note 0.00 12/03/12 0.1217 4,994,717.69 4,996,000.00
BP - Construction Series I FNMA Discount Note 0.00 12/04/12 0.1116 14,996,425.00 15,000,000.00
BP - Construction Series I FNMA Discount Note 0.00 12/04/12 0.1116 14,996,425.00 15,000,000.00
190,998,253.52 $ 191,096,000.00 $
Reserve Maintenance FHLB Template 4.50 11/15/12 0.1697 3,064,899.00 $ 3,000,000.00 $
Reserve Maintenance INGFDG (ING US Funding LLC) 0.00 10/04/12 0.2445 5,997,148.17 6,000,000.00
Reserve Maintenance Bank Nova Sco NY CP 0.00 10/04/12 0.1471 3,799,005.14 3,800,000.00
Reserve Maintenance BFPP (Brown-Forman Corp) CP 0.00 10/26/12 0.1572 6,998,312.22 7,000,000.00
Reserve Maintenance Bank Nova Sco NY CP 0.00 11/08/12 0.1349 5,448,731.51 5,450,000.00
25,308,096.04 $ 25,250,000.00 $
Retirement Pension Accrual FHLB 0.20 12/13/12 0.1740 3,958,396.91 $ 3,955,000.00 $
Retirement Pension Accrual FHLMC Discount Note 0.00 12/13/12 0.1421 2,177,076.43 2,179,000.00
Retirement Pension Accrual FHLMC Discount Note 0.00 11/26/12 0.1522 2,303,280.85 2,305,000.00
Retirement Pension Accrual FHLMC 0.515 11/26/12 0.1632 3,907,048.71 3,900,000.00
Retirement Pension Accrual GECC (Gen Elec Cap Corp) CP 0.00 12/13/12 0.3020 2,296,825.84 2,300,000.00
Retirement Pension Accrual GECC (Gen Elec Cap Corp) CP 0.00 12/13/12 0.2310 2,298,036.95 2,300,000.00
Retirement Pension Accrual FHLMC Discount Note 0.00 12/13/12 0.1217 2,299,202.67 2,300,000.00
Retirement Pension Accrual FHLB Discount Note 0.00 12/13/12 0.0710 2,199,674.89 2,200,000.00
21,439,543.25 $ 21,439,000.00 $
Public Liability Claims RABUSA (Rabobank USA Fin) CP 0.00 12/07/12 0.4267 8,382,458.00 $ 8,400,000.00 $
8,382,458.00 $ 8,400,000.00 $
Other Authority Projects Bank Nova Sco NY CP 0.00 10/02/12 0.1470 4,998,771.55 $ 5,000,000.00 $
Other Authority Projects Bank Nova Sco NY CP 0.00 10/09/12 0.1298 6,999,303.11 7,000,000.00
11,998,074.66 $ 12,000,000.00 $
Securities Held by Portfolio
New York State Thruway Authority
As of September 30, 2012
Page 2 of 5
Fund Security Description / Maturity Date
Yield to
Maturity (%) Cost Par
Securities Held by Portfolio
New York State Thruway Authority
As of September 30, 2012
General Reserve INGFDG (ING US Funding LLC) 0.00 10/03/12 0.2029 3,098,570.56 $ 3,100,000.00 $
General Reserve GECC (Gen Elec Cap Corp) CP 0.00 11/06/12 0.1608 9,996,697.90 10,000,000.00
General Reserve Bank Nova Sco NY CP 0.00 10/16/12 0.1450 6,998,999.00 7,000,000.00
General Reserve INGFDG (ING US Funding LLC) 0.00 12/12/12 0.2866 2,998,046.04 3,000,000.00
23,092,313.50 $ 23,100,000.00 $
Revenue Fund FHLMC Discount Note 0.00 11/27/12 0.1268 2,320,290.81 $ 2,321,000.00 $
Revenue Fund FHLMC 1.10 12/27/12 0.1420 4,999,601.85 4,974,000.00
7,319,892.66 $ 7,295,000.00 $
E-ZPass Fund (Revenue) FHLB 0.22 04/23/13 0.2230 8,999,730.00 9,000,000.00
E-ZPass Fund (Revenue) FNMA 4.375 03/15/13 0.2137 10,418,430.53 10,000,000.00
E-ZPass Fund (Revenue) FFCB 1.75 02/21/13 0.2067 10,158,524.44 10,000,000.00
29,576,684.97 $ 29,000,000.00 $
GRAND TOTAL THRUWAY PORTFOLIO 318,115,316.60 $ 317,580,000.00 $
Page 3 of 5
Fund Security Description / Maturity Date
Yield to
Maturity (%) Cost Par
Securities Held by Portfolio
New York State Thruway Authority
As of September 30, 2012
Trust Fund Proceeds Fund Treasury Bill 0.00 10/18/12 0.1471 99,915,416.68 $ 100,000,000.00 $
Trust Fund Proceeds Fund FHLMC Discount Note 0.00 10/25/12 0.1522 49,954,791.65 50,000,000.00
Trust Fund Proceeds Fund FNMA Discount Note 0.00 01/04/13 0.1929 60,707,584.00 60,800,000.00
Trust Fund Proceeds Fund INGFDG (ING US Funding LLC) 0.00 10/25/12 0.3552 15,792,861.52 15,807,000.00
Trust Fund Proceeds Fund FHLB Discount Note 0.00 10/25/12 0.0710 117,678,304.24 117,687,000.00
TOTAL TRUST FUND PROCEEDS PORTFOLIO 344,048,958.09 $ 344,294,000.00 $
Page 4 of 5
Fund Security Description / Maturity Date
Yield to
Maturity (%) Cost Par
Securities Held by Portfolio
New York State Thruway Authority
As of September 30, 2012
PIT Administrative Fund INGFDG (ING US Funding LLC) 0.00 11/08/12 0.2028 209,926.50 $ 210,000.00 $
209,926.50 $ 210,000.00 $
PIT Bond Proceeds Fund INGFDG (ING US Funding LLC) 0.00 12/28/12 0.4620 19,971,436.11 $ 20,000,000.00 $
PIT Bond Proceeds Fund Bank of Nova Sco NY CP 0.00 12/12/12 0.1369 49,981,812.50 50,000,000.00
PIT Bond Proceeds Fund Bank of Nova Sco NY CP 0.00 12/12/12 0.1369 7,887,130.01 7,890,000.00
PIT Bond Proceeds Fund INGFDG (ING US Funding LLC) 0.00 02/01/13 0.5589 4,988,694.44 5,000,000.00
PIT Bond Proceeds Fund INGFDG (ING US Funding LLC) 0.00 11/08/12 0.2028 14,994,750.00 15,000,000.00
PIT Bond Proceeds Fund RABUSA (Rabobank USA Fin) CP 0.00 12/11/12 0.2435 49,968,000.00 50,000,000.00
PIT Bond Proceeds Fund RABUSA (Rabobank USA Fin) CP 0.00 12/11/12 0.2435 49,968,000.00 50,000,000.00
PIT Bond Proceeds Fund NORDNA (Nordea North Am) CP 0.00 12/14/12 0.2029 49,972,500.00 50,000,000.00
PIT Bond Proceeds Fund NORDNA (Nordea North Am) CP 0.00 12/14/12 0.2029 24,986,250.00 25,000,000.00
PIT Bond Proceeds Fund INGFDG (ING US Funding LLC) 0.00 06/03/13 0.8047 27,070,650.40 27,232,000.00
PIT Bond Proceeds Fund FHLB Discount Note 0.00 12/21/12 0.1014 24,992,638.89 25,000,000.00
PIT Bond Proceeds Fund FHLB Discount Note 0.00 12/12/12 0.0913 2,487,396.66 2,488,000.00
PIT Bond Proceeds Fund INGFDG (ING US Funding LLC) 0.00 11/01/12 0.1775 3,499,285.42 3,500,000.00
PIT Bond Proceeds Fund Bank Nova Sco NY CP 0.00 11/08/12 0.1369 11,497,886.88 11,500,000.00
PIT Bond Proceeds Fund FNMA Discount Note 0.00 11/08/12 0.0760 5,199,469.17 5,200,000.00
PIT Bond Proceeds Fund Treasury Bill 0.00 11/08/12 0.0608 8,524,303.79 8,525,000.00
PIT Bond Proceeds Fund Bank Nova Sco NY CP 0.00 10/11/12 0.1242 39,997,958.33 40,000,000.00
PIT Bond Proceeds Fund MOTIVA (Motiva Enterp) CP 0.00 10/09/12 0.1724 4,999,716.67 5,000,000.00
PIT Bond Proceeds Fund Bank Nova Sco NY CP 0.00 12/21/12 0.1430 5,413,197.26 5,415,000.00
406,401,076.53 $ 406,750,000.00 $
TOTAL PIT PROGRAM PORTFOLIO 406,611,003.03 $ 406,960,000.00 $
Page 5 of 5
Fund Security Description / Maturity Date
Yield to
Maturity (%) Cost Par
Securities Held by Portfolio
New York State Thruway Authority
As of September 30, 2012
CHIPS Administrative Fund (No investments) - $ - $
TOTAL CHIPS PROGRAM PORTFOLIO - $ - $
GRAND TOTAL ALL PORTFOLIOS 1,068,775,277.72 $ 1,068,834,000.00 $
Note: The above list does not include Debt Service Funds which are handled under a separate agreement with the Trustee.