Bid Vendor Form Package.pdf

STATE OF CONNECTICUT

DEPARTMENT OF CORRECTION

PURCHASING DEPARTMENT

24 Wolcott Hill Road

Wethersfield, CT 06109

BID PROPOSAL

Bid No:

Bid Opening Date:

Bid Opening Time:

2:00 PM

Note: Bidder means Individual/Sole Proprietor, Partnership or Corporation name.

IMPORTANT: Both pages of this form, Sections 1 through 3 must be completed, signed and returned by the bidder as part of the bid package. Failure to submit both pages constitutes grounds for rejection of your bid.

Section 1 of 3 - BIDDER INFORMATION

COMPLETE BIDDER NAME (TRADE NAME, DOING BUSINESS AS) SSN OR FEIN NUMBER

BIDDER ADDRESS STREET CITY STATE ZIP CODE

CONTACT NAME (TYPED OR PRINTED) PHONE NUMBER (INCLUDE TOLL-FREE NUMBERS) FAX NUMBER

SIGNATURE OF PERSON AUTHORIZED TO SIGN BIDS ON BEHALF OF THE ABOVE NAMED BIDDER DATE

TYPE OR PRINT NAME OF AUTHORIZED PERSON TITLE OF AUTHORIZED PERSON

BIDDER E-MAIL ADDRESS BIDDER WEB SITE

IS YOUR BUSINESS A: ____PROPRIETORSHIP (INDIVIDUAL) ____PARTNERSHIP OR ____CORPORATION?

(TYPE OF CORPORATION - ____________)

IS YOUR BUSINESS CURRENTLY A DAS CERTIFIED SMALL BUSINESS ENTERPRISE? ____ YES (ATTACH CERTIFICATE COPY TO BID)

____ NO

IF YOUR BUSINESS IS A PARTNERSHIP, YOU MUST ATTACH THE NAMES AND TITLES OF ALL PARTNERS TO THIS BID WHEN

RETURNED.

IF YOUR BUSINESS IS A CORPORATION, IN WHICH STATE ARE YOU INCORPORATED?

IS YOU ARE A STATE EMPLOYEE, INDICATE YOUR POSITION, AGENCY NAME & ADDRESS:

IS YOUR BUSINESS REPORTABLE TO THE IRS? ____ YES ____NO IF YES, A 1099/W2 WILL BE MAILED TO YOU AT YEAR-END.

REMITTANCE INFORMATION: IN THIS BOX, INDICATE THE REMITTANCE ADDRESS OF YOUR BUSINESS IF DEFFERENT FROM ABOVE.

BID PROPOSAL

Bid No:

Section 2 of 3 - IMPORTANT INFORMATION FOR BIDDERS

AFFIRMATION OF BIDDER: The undersigned bidder affirms and declares:

1. That this proposal is executed and signed by said bidder with full knowledge and acceptance of the provisions of the STANDARD BID AND CONTRACT TERMS AND CONDITIONS (3 pages) of current issue and in effect on the date of bid issue. The form Standard Bid and Contract Terms and Conditions are made a part of the contract.

2. That should any part of this proposal be accepted in writing by the Department of Correction within thirty (30) calendar days from the date of bid opening unless an earlier date for acceptance is specified by bidder in proposal schedule, said bidder will furnish and deliver the commodities and/or service for which this proposal is made, in the quantities and at the prices bid, and in compliance with the provisions of the STANDARD BID AND CONTRACT TERMS AND CONDITIONS, SECURITY REGULATIONS AND PROPOSAL SCHEDULE. Should award of any part of this proposal be delayed beyond the period of thirty (30) days of an earlier date specified by the bidder in proposal schedule, such award shall be conditioned upon bidder's acceptance.

3. Acceptance of the conditions set forth herein, agreement in strict accordance therewith, and will furnish and deliver the commodities and/or services to the Department of Correction named in the PROPOSAL SCHEDULE at the prices bid therein.

4. Should the Department of Correction determine that bidder has not completed Section 3 - Bidder Debarment and/or Suspension included as part of this document, then such determination may be just cause for disqualification from the evaluation of this bid.

Section 3 of 3 - BIDDER DEBARMENT AND/OR SUSPENSION

The undersigned bidder further affirms and declares that neither the bidder and/or any company official nor any subcontractor to the bidder and/or any company official has received any notices of debarment and/or suspension from contracting with the State of Connecticut or the Federal Government.

____ Yes ____ No

The undersigned bidder further affirms and declares that neither the bidder and/or any company official nor any subcontractor to the bidder and/or any company official has received any notices of debarment and/or suspension from contracting with other states within the United States.

____ Yes ____ No

If the undersigned bidder and/or company official or any subcontractor to the bidder and/or any company official has received notices of debarment and/or suspension with the State of Connecticut, other states within the United States or Federal Government, said notices must be attached to this document when submitting this proposal.

Number of notices attached ______________.

SIGNATURE OF AUTHORIZED PERSON IN SECTION 1, CONSTITUTES AGREEMENT WITH ALL

PROCEDURES INDICATED ABOVE.

Approved March 2024

GUIDE FOR CONTRACTORS IN THE CORRECTIONAL ENVIRONMENT

Correctional contractors, due to the nature of the correctional environment, are expected to adhere to very specific standards of behavior.

The work rules listed below are of a most basic nature and it is the Contractor's responsibility to become familiar with them. Violations of any of these rules may subject the Contractor to payment reduction, contract termination and/or criminal charges.

I. Entrance In/Out of a Facility

Contractors should always contact the facility prior to arriving in order to ensure that Operational needs will allow for entrance. Contractors should allow 20-30 minutes for entrance into the facility. All contractors and contractor employees shall be made to pass through a metal detector prior to entrance into a facility. Failure to clear the metal detector may require a physical search. To this end, items conveyed into the facility should be limited. Cell phones, video/audio recording devices, firearms, and tobacco products are strictly forbidden. Additionally, the following rules shall apply:

A. Contractors shall not convey any item onto facility premises with the intent of conveyance to an inmate without prior written approval of the Warden or his/her designee.

B. Contractors shall not convey any item received from or by an inmate off of facility premises without prior written approval of the Warden or his/her designee.

C. Contractors shall not convey mail or correspondence to or from an inmate without prior written approval of the Warden or his/her designee.

D. Contractors shall not, at any time, possess a firearm on facility property.

E. Contractors shall not possess any item that may be utilized as a weapon or contraband, such as: knives, files, hacksaw blades, metal cutting tools, cutting torches, drugs, narcotics, poisons, hair tonic, acids, shellac, and any liquids with alcoholic content.

If such items are needed to render the services provided under the contract, they shall be authorized by the Warden or his/her designee and stored in places secured against unauthorized access. Only the proper staff shall distribute such materials; quantities entrusted to inmates shall only be sufficient for the immediate purpose to be served and shall be used under careful supervision.

II. Conduct Within a Facility

It is important for contractors to understand that a correctional facility can be a dangerous environment. To that end, contractors should be cognizant of their surroundings at all times and adhere to the following rules:

A. Dress appropriately. Pocket books and knotted ties are discouraged, and may be disallowed. Clothing should not be provocative or revealing in any way. Excessive jewelry is discouraged. Shoes should be low heeled with closed toes.

B. Refrain from using signs of affection as they may be misinterpreted.

C. Contractors shall not leave their work area, for any reason, without a CTDOC escort.

D. Contractors shall conduct themselves professionally at all times. Profane, indecent or humiliating language will not be tolerated.

E. Contractors shall not affix any signs or posters to facility property without prior written approval of the Warden or his/her designee.

F. Contractors shall not take photographs while on facility premises without prior written approval of the Warden or his/her designee.

G. Contractors shall not report to the facility while under the influence of drugs or alcohol. Medication containing any narcotic or controlled substance shall not be allowed on facility premises without prior written approval of the Warden or his/her designee.

H. Contractors shall remain fully attentive to their surroundings while on facility premises.

I. Contractors shall report sickness, accidents or unusual behavior of inmates to a CTDOC staff member immediately.

J. Contractors shall report sickness or accident of/by themselves to a CTDOC staff member immediately.

K. Contractors shall report loss of keys or personal items to a CTDOC staff member immediately.

III. Inmate Contact

Any individual entering a facility will have contact with inmates. Regardless of how limited the interaction, it is imperative for contractors entering the facility to understand certain rules for interaction with inmates.

A. Do not give or receive any item, gift or loan from an inmate without prior written authorization from the Warden or his/her designee.

B. Do not engage in any form of business venture with an inmate.

C. Do not discuss other contractors, inmates or CTDOC staff with any inmate.

D. Treat inmates in a civil and professional manner at all times. Never show preferential treatment, and remain objective.

E. Keep your word! Do not make promises you are unable to keep.

F. Avoid undue familiarity with inmates.

Do not divulge any personal information about yourself, another inmate, or CTDOC staff. While not all inmates are manipulative, possession of such information will make the contractor vulnerable.

Do not become personally involved with any inmates' private or family matters (except for specific professional reasons).

Do not accommodate any requests for favors.

Whenever possible, use formal titles such as, Mr., Ms, Sir, Captain, etc. Do not accept excessive compliments from inmates.

G. Show discernment, some inmates survive on manipulation. Always check the facts.

H. If an inmate becomes hostile, back off and remain calm. If alone, slowly move to where CTDOC staff can see you.

IV. Miscellaneous Rules

A. Contractors shall not release information relative to services provided to CTDOC without prior written approval of

CTDOC.

B. Contractors shall notify the Warden or his/her designee immediately, in writing, if next of kin, known relative or personal friend of the Contractor or employee of the Contractor becomes incarcerated at the facility the Contractor is providing services to. Such notification shall be held confidential by CTDOC.

C. Contractors shall notify the Warden or his/her designee immediately, in writing, if Contractor or employee of the

Contractor is arrested. Such notification shall be held confidential by CTDOC. At the discretion of CTDOC, the arrested individual may be barred from entering the facility.

D. Confidentiality of CTDOC and inmates shall be adhered to at all times.

V. Safety and Security

In the event of an emergency situation, it is important for Contractors to adhere to the following guidelines.

A. If there is doubt as to a course of action, consult CTDOC staff.

B. Adhere to the directions of CTDOC staff at all times. In the event of an emergency, the Contractor may be directed to leave the area they are working in. Do so in an orderly and timely fashion.

C. If there is an incident in the Contractor's immediate area, allow CTDOC staff to follow procedures for reporting such. If

CTDOC staff is unable to report the problem, utilize the nearest phone to call the facility control center to report the issue.

The facility will notify you of the appropriate number prior to entrance. If it is impractical to utilize the phone, simply knock the receiver off the hook. This will notify the facility control center that there is a problem in your area, and staff will be dispatched appropriately.

D. If an inmate becomes hostile, back off and remain calm. If alone, slowly move to where CTDOC staff can see you. Do not attempt to be a hero, and do not confront the inmate directly. Doing so may compromise your safety.

It is important to realize that this guide does not address every situation and is not all encompassing. It does represent basic requirements necessary to perform the duties effectively and safely within the correctional setting. Failure to adhere to these standards of performance and personal conduct is unacceptable and will be handled accordingly.

Where conflict between this document and language contained in the body of the contract, the contract language shall apply.

BIDDER QUALIFICATIONS

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STATE OF CONNECTICUT

BIDDER’S STATEMENT OF QUALIFICATIONS

Bid Number:

THIS FORM WILL BE USED IN ASSESSING A BIDDER’S QUALIFICATIONS AND TO DETERMINE IF THE BID SUBMITTED IS FROM A RESPONSIBLE BIDDER. STATE LAW DESIGNATES THAT CONTRACTS BE AWARDED TO THE LOWEST RESPONSIBLE QUALIFIED BIDDER. FACTORS SUCH AS PAST PERFORMANCE, INTEGRITY OF THE BIDDER, CONFORMITY TO THE SPECIFICATIONS, ETC. WILL BE USED IN EVALUATING BIDS. ATTACH

ADDITIONAL SHEETS IF NECESSARY

COMPANY NAME:

ADDRESS:

NUMBER OF YEARS COMPANY HAS BEEN ENGAGED IN BUSINESS UNDER THIS NAME: __________YEARS

LIST ANY CONTRACT AWARDS TO YOUR COMPANY BY THE STATE OF CONNECTICUT WITHIN THE LAST THREE (3) YEARS, THAT YOU ACTUALLY PERFORMED SERVICE AGAINST. INDICATE WHICH STATE AGENCY, AND PROVIDE CONTRACT NAME AND NUMBER, AND THE NAME AND TELEPHONE NUMBER OF THE PURCHASING AGENT ADMINISTERING THE CONTRACT.

CONTRACT NO. CONTRACT NAME STATE AGENCY PURCHASING AGENT TEL. NO.

List any contract awards to your company by the State of Connecticut within the last three (3) years, THAT YOUR COMPANY DID NOT PERFORM SERVICE AGAINST. Indicate which State Agency, and provide contract Name and Number, and the name and telephone number of the purchasing agent administering the contract.

CONTRACT NO. CONTRACT NAME STATE AGENCY PURCHASING AGENT TEL. NO.

LIST OTHER NAMES YOUR COMPANY GOES BY: _____________________________________________________________________

LIST PREVIOUS COMPANY NAME (S) ______________________________________________________________________________

LIST AT LEAST THREE COMPLETED PROJECTS SIMILAR IN NATURE TO THIS INVITATION FOR BIDS WHICH DEMONSTRATES YOUR

COMPANY’S ABILITY TO PERFORM THE REQUIRED SERVICES.

Company Name and Address Telephone No.: Dollar Value:

1. ______________________________________________________ _____________________ ______________________

2. ______________________________________________________ _____________________ ______________________

3. ______________________________________________________ _____________________ ______________________

BIDDER QUALIFICATIONS

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BIDDER’S STATEMENT OF QUALIFICATIONS

COMPANY NAME:

SIZE OF COMPANY

OR CORPORATION:

NUMBER OF EMPLOYEES:

FULL TIME _______________________

PART TIME _______________________

COMPANY VALUE:

EQUIPMENT ASSETS ________________

TOTAL ASSETS ___________________

IS YOUR COMPANY REGISTERED WITH THE OFFICE OF THE CONNECTICUT SECRETARY OF STATE? YES NO

REGISTRATION DATE, IF AVAILABLE: ____________________________

IF REQUESTED, WOULD YOUR COMPANY PROVIDE A “GOOD STANDING” CERTIFICATE

ISSUED BY THE CONNECTICUT SECRETARY OF STATE’S OFFICE? YES NO

LIST OF EQUIPMENT TO BE USED FOR THIS SERVICE (INCLUDE MODEL, YEAR & MANUFACTURER):

MODEL YEAR MANUFACTURER

(Attach additional sheets if necessary)

LIST ANY RELEVANT CERTIFICATIONS, LICENSES, REGISTRATIONS, ETC. WHICH QUALIFY YOUR COMPANY TO MEET THE REQUIREMENTS OF

THIS BID.

(Attach additional sheets if necessary)

LIST ANY ADMINISTRATIVE ACTIONS EITHER PENDING REVIEW BY THE STATE OR DETERMINATIONS THAT THE STATE HAS MADE REGARDING YOUR COMPANY OR CORPORATION. THIS WOULD INCLUDE COURT JUDGEMENTS AND SUITS PENDING BY A STATE OR FEDERAL COURT. INCLUDE A LISTING OF OSHA VIOLATIONS AND ANY ACTIONS OR ORDERS PENDING OR RESOLVED WITH ANY STATE AGENCY SUCH AS THE DEPARTMENT OF CONSUMER PROTECTION, THE DEPARTMENT OF ENVIRONMENTAL PROTECTION, ETC. DETAIL THIS INFORMATION ON A SEPARATE SHEET OF PAPER. SUCH INFORMATION SHOULD BE FOR THE LAST THREE (3) YEARS.

I HEREBY CERTIFY THAT ALL THE INFORMATION SUPPLIED IS COMPLETE AND TRUE.

SIGNATURE DATE

TITLE

COLLECT BACKGROUND REPORT Fax to DOC.Collect1@ct.gov 860-920-3081 – OR-

FOR VENDORS/CONTRACTORS Email scanned forms to DOC.Collect1@ct.gov

NAME ________________________________________________________ D.O.B. ______________________

(LAST) (FIRST) (MI) (MM/DD/YYYY)

MAIDEN NAME ____________________________________________ SSN ___________________________

HGT. ________ WGT. __________ RACE ____ SEX ____ EYES ___________HAIR ______________

SCARS TATTOOS ___________________________________ VENDOR:_____________________________

DRIVER’S LICENSE # __________________________________________ STATE __________________

CO. CONTACT EMAIL:________________________________________________PHONE: _____________

OFFICIAL USE ONLY – DO NOT COMPLETE: POSITIVE NO PRIOR

RESPONSE CONVICTIONS

FL02 DRIVER INFO ____________

FLQW CT VEHICLE/WANTED INQ.

SPRC CT MASTER FILE

SPSC CT SUSPENSE FILE

OBTS OFF. BASED TRACKING CHECK

FLQH INTERSTATE III CHECK

RT45SS DOC SS CHECK

RT45NM DOC NAME CHECK

FLIQ OUT OF STATE CHECKS

RI

NY

MA

CHECK COMPLETED BY _______________________________________________DATE ____________

Comments/Findings: OFFICIAL USE ONLY:

Arrest

Date:

Arresting Agency/Docket

Number:

Charge: Level:

Misd. or Fel.

Date

Disposed:

Court Disposition:

*Please note: this form will not be processed if incomplete or illegible*

*Please read and sign below in the presence of a witness*

ACKNOWLEDGEMENT

I, the undersigned, acknowledge and understand that the Connecticut Department of Correction (CTDOC) can deny any individual entry to any correctional facility administered by the CTDOC at any time.

Signature of Applicant _________________________________________ Date Signed ____________________________________

Signature of Witness __________________________________________ Date Signed _____________________________________

Revised 03/28/2023 mailto:DOC.Collect1@ct.gov

OPM Form 1

Effective July 23, 2021

CAMPAIGN CONTRIBUTION CERTIFICATION

Written or electronic certification to accompany a bid or proposal or a non-competitive contract with a value of $50,000 or more, pursuant to C.G.S. § 9-612.

INSTRUCTIONS:

Complete all sections of the form. Attach additional pages, if necessary, to provide full disclosure about any campaign contributions made to campaigns of candidates for statewide public office or the General Assembly, as described herein. Sign and date the form, under oath, in the presence of a Commissioner of the Superior Court or Notary Public.

Submit the completed form to the awarding State agency at the time of submission of your bid or proposal (if no bid or proposal– submit this completed form with the earliest submittal of any document to the state or quasi-public agency prior to the execution of the contract), and if there is a change in the information contained in the most recently filed certification, such person shall submit an updated certification either (i) not later than thirty (30) days after the effective date of such change or (ii) upon the submittal of any new bid or proposal for a contract, whichever is earlier.

Check One:

Initial Certification

Updated Certification because of change of information contained in the most recently filed certification

CAMPAIGN CONTRIBUTION CERTIFICATION:

I certify that neither the contractor or prospective state contractor, nor any of its principals, have made any contributions to, or solicited any contributions on behalf of, any party committee, exploratory committee, candidate for state-wide office or for the General Assembly, or political committee authorized to make contributions to or expenditures to or for, the benefit of such candidates, in the previous four years, that were determined by the State Elections Enforcement Commission to be in violation of subparagraph (A) or (B) of subdivision (2) of subsection (f) of Section 9-612 of the General Statutes, without mitigating circumstances having been found to exist concerning such violation. Each such certification shall be sworn as true to the best knowledge and belief of the person signing the certification, subject to the penalties of false statement.

If there is any change in the information contained in the most recently filed certification, such person shall submit an updated certification not later than thirty days after the effective date of any such change or upon the submittal of any new bid or proposal for a state contract, whichever is earlier.

All Campaign Contributions on behalf of any party committee, exploratory committee, candidate for state-wide office or for the General Assembly, or political committee authorized to make contributions to or expenditures to or for, the benefit of such candidate, for a period of four years prior to signing the contract or date of the response to the bid, whichever is longer, include:

Contribution Date

Name of Contributor Recipient Value Description

OPM Form 1

Effective July 23, 2021

Sworn as true to the best of my knowledge and belief, subject to the penalties of false statement.

Printed Contractor Name Printed Name of Authorized Official

Signature of Authorized Official

Subscribed and acknowledged before me this day of , 20 .

Commissioner of the Superior Court (or Notary Public)

_ My Commission Expires

CONTRACT COMPLIANCE

REGULATIONS (CHRO)

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CHRO-4

CONTRACT COMPLIANCE REGULATIONS

NOTIFICATION TO BIDDERS

The contract to be awarded is subject to contract compliance requirements mandated by Sections 4a-60 and 4a-60a of the CONN.

GEN. STAT.; and, when the awarding agency is the State, Sections 46a-71(d) and 46a-81i(d) of the CONN. GEN. STAT. There are Contract Compliance Regulations codified at Section 46a-68j-21 through 43 of the Regulations of Connecticut State Agencies which establish a procedure for the awarding of all contracts covered by Sections 4a-60 and 46a-71(d) of the CONN. GEN. STAT.

According to Section 46a-68j-30(9) of the Contract Compliance Regulations, every agency awarding a contract subject to the Contract Compliance Requirements has an obligation to “aggressively solicit the participation of legitimate minority business enterprises as bidders, contractors, subcontractors, and suppliers of materials.” “Minority business enterprise” is defined in Section 4a-60 of the CONN. GEN. STAT. as a business wherein fifty-one percent or more of the capital stock, or assets belong to a person or persons: “(1) Who are active in daily affairs of the enterprise; (2) who have the power to direct the management and policies of the enterprise; and (3) who are members of a minority, as such term is defined in subsection (a) of section 32-9n.” Minority groups are defined in section 32-9n of the CONN. GEN. STAT. as “(1) Black Americans... (2) Hispanic Americans... (3) persons who have origins in the Iberian Peninsula... (4) Women... (5) Asian Pacific American and Pacific Islanders; (6) American Indians...” A business owned by an individual(s) with a physical disability is also a minority business enterprise as provided by Section 32-9e of the CONN. GEN. STAT. The above definitions apply to the contract compliance requirements by virtue of Section 46a-68j-21(11) of the Contract Compliance

The awarding agency will consider the following factors when reviewing the bidder’s qualifications under the contract compliance requirements:

(A) the bidder’s success in implementing an affirmative action plan;

(B) the bidder’s success in developing an apprenticeship program complying with Sections 46a-68-1 to 46a-68-17 inclusive, of the Regulations of Connecticut State Agencies;

(C) the bidder’s promise to develop and implement a successful affirmative action plan;

(D) the bidder’s submission of EEO-1 data indicating that the composition of its workforce is at or near parity when compared to the racial and gender composition of the workforce in the relevant labor market area; and,

(E) the bidder’s promise to set aside a portion of the contract for legitimate minority business enterprises. See

Section 46a-68j-30(10)(E) of the Contract Compliance Regulations.

INSTRUCTIONS AND OTHER INFORMATION

The following two (2) sided BIDDER CONTRACT COMPLIANCE MONITORING REPORT must be completed in full, signed, and submitted with the bid for this contract.

The contract awarding agency and the Commission on Human Rights and Opportunities will use the information contained thereon to determine the bidder’s compliance to Sections 4a-60 and 4a-60a CONN. GEN. STAT., and Sections 46a-68j-23 of the Regulations of Connecticut State Agencies regarding equal employment opportunity, and the bidder’s “good faith efforts” to include minority business enterprises as subcontractors and suppliers for the work of the contract.

1) Definition of Small Contractor Section 32-9e CONN. GEN. STAT. defines a small contractor as a company that has been doing business under the same management and control and has maintained its principal place of business in Connecticut for a one year period immediately prior to its application for certification under this section, had gross revenues not exceeding ten million dollars in the most recently completed fiscal year, and at least fifty-one percent of the ownership of which is held by a person or persons who are active in the daily affairs of the company, and have the power to direct the management and policies of the company, except that a non-profit corporation shall be construed to be a small contractor if such nonprofit corporation meets the requirements of subparagraphs (A) and (B) of subdivision 32-9e CONN. GEN. STAT.

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2) Description of Job Categories (as used in Part IV Bidder Employment Information)

Officials, Managers and Supervisors - Occupations requiring administrative personnel who set broad policies, exercise over-all responsibility for execution of these policies, and direct individual departments or special phases of a firm’s operations.

Includes officials, executives, middle management, plant managers, department managers, and superintendents, salaried forepersons who are members of management, purchasing agents and buyers, and kindred workers.

Professionals - Occupations requiring either college graduation or experience of such kind and amount as to provide a comparable background. Includes: accountants and auditors, airplane pilots and navigators, architects, artists, chemists, designers, dietitians, editors, engineers, lawyers, librarians, mathematicians, natural scientists, personnel and labor relations workers, physical scientists, physicians, social scientists, teachers, kindred workers.

Technicians - Occupations requiring a combination of basic scientific knowledge and manual skill which can be obtained through about 2 years of post high school education, such as is offered in technical institutes and junior colleges, or through equivalent on-the-job training. Includes: draftspersons, engineering aides, junior engineers, mathematical aides, nurses, photographers, radio operators, scientific assistants, surveyors, technical illustrators, technicians (medical, dental, electronic, physical sciences), and kindred workers.

Sales Workers - Occupations engaging wholly or primarily in direct selling. Includes: advertising agents and sales persons, insurance agents and brokers, real estate agents and brokers, stock and bond salespersons, demonstrators, sales people and sales clerks, and kindred workers.

Office and Clerical Workers - Includes all clerical type work regardless of level of difficulty, where the activities are predominantly non-manual though some manual work not directly involved with altering or transporting the products is included. Includes: bookkeepers, cashiers, collectors (bills and accounts), messengers and office workers, office machine and computer operators, shipping and receiving clerks, stenographers, typists and secretaries, telegraph and telephone operators, and kindred workers.

Skilled Workers - Manual workers of relatively high skill level having a thorough and comprehensive knowledge of the processes in their work. They exercise considerable independent judgment and usually receive an extensive period of training.

Includes: building trades hourly paid forepersons and leadpersons who are not members of management, mechanics and repair people, skilled machining occupations, compositors and typesetters, electricians, engravers, job setters (metal), motion picture projectionists, pattern and model makers, stationary engineers, tailors, and kindred workers.

Semi-Skilled Workers - Workers who operate machine or processing equipment or perform other factory type duties of intermediate skill level which can be mastered in a few weeks and require only limited training.

Unskilled Workers - Workers in manual occupations which generally require no special training. Perform elementary duties that may be learned in a few days and require application of little or no independent judgment. Includes: garage laborers, car washers and greasers, gardeners (except farm) and grounds keepers, longshore persons and stevedores, wood cutters and choppers, laborers performing lifting, digging, mixing, loading, and pulling operations, and kindred workers.

Service Workers - Workers in both protective and non-protective service occupations. Includes: attendants (hospital and other institution, professional, and personal service), barbers, cleaning workers, cooks (except house-hold), counter and fountain workers, fire fighters, police officers and detectives, security workers and doorkeepers, stewards, janitors, porters, food servers and kindred workers.

Apprentices - Persons employed in a program including work training and related instruction to learn a trade or craft which is traditionally considered an apprenticeship, regardless of whether the program is registered with a state or federal agency.

Trainees - Persons engaged in a formal training for craft worker when not trained under an apprenticeship program. Includes:

operatives, laborer and service occupations. Also includes persons engaged in formal training for official, managerial, professional, technical, sales, office, and clerical occupations.

3) Definition of Racial and Ethnic Terms (as used in Part IV Bidder Employment Information)

White (not of Hispanic Origin) - All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Black (not of Hispanic Origin) - All persons having origins in any of the Black racial groups of Africa.

Hispanic All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Asian or Pacific Islander All persons having origins in any of the original peoples of the Far East, Southeast Asia, Indian subcontinent or Pacific Islands. Includes China, India, Japan, Korea, Philippine Islands, & Samoa.

American Indian or Alaskan Native All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

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BIDDER CONTRACT COMPLIANCE MONITORING REPORT

PART I - Bidder Information

Company Name Street Address City & State Chief Executive

Bidder Federal Employer Identification Number (FEIN) or Social Security Number (SSN)

Major Business Activity (brief description)

Bidder Identification (response optional/definitions on page 1) -Is bidder a small contractor? Yes No

Bidder Parent Company (if any) -Is bidder a minority business enterprise? Yes No If Yes, check ownership category Black Hispanic Asian American

Other Locations in CT (if any)

American Indian/Alaskan Native Iberian Peninsula Individual(s) with a Physical Disability Female -Is bidder certified as above by the State of CT (DAS)? Yes No

PART II - Bidder Non-Discrimination Policies & Procedures

1. Does your company have a written Equal Employment Opportunity statement posted on company bulletin boards? Yes No

7. Do all of your company contracts and purchase orders contain non-discrimination statements as required by Sections 4a-60 & 4a-60a of the Conn. Gen. Stat.? Yes No

2. Does your company have a written sexual harassment in the workplace policy posted on company bulletin boards?

Yes No

8. Do you, upon request, provide reasonable accommodation to employees or applicants for employment who have physical or mental disability? Yes No

3. Do you notify all recruitment sources in writing of your company non-discrimination employment policy? Yes No

9. Does your company have a mandatory retirement age for all employees? Yes No

4. Do your company advertisements contain a written statement that you are an Equal Opportunity Employer? Yes No

10. If your company has 50 or more employees, have you provided at least two (2) hours of sexual harassment training to all of your supervisors? Yes No NA

5. Do you notify the CT State Employment Service of all employment openings with your company? Yes No

11. If your company has apprenticeship programs, do they meet the equal opportunity requirements of the apprenticeship standards of the CT Dept. of Labor? Yes No NA

6. Does your company have a collective bargaining agreement with workers? Yes No

12. Does your company have a written affirmative action plan?

Yes No

6a. If yes, do the collective bargaining agreements contain non-discrimination clauses covering all workers Yes No

13. Is there a person in your company who is responsible for Equal Employment Opportunity? Yes No

6b. Have you notified each union, in writing, of your commitments under the non-discrimination requirements of contracts with the State of CT? Yes No

If yes, provide name and phone number.

PART III - Bidder Subcontracting Practices

1. Will the work of this contract include subcontractors or suppliers? Yes No 1a. If yes, list all the subcontractors and suppliers and report if they are a small contractor and/or a minority business enterprise (as defined on page 1). Attach additional sheets if necessary.

1b. Will the work of this contract require additional subcontractors or suppliers other than those identified in 1a. above? Yes No

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COMMISSION ON

HUMAN RIGHTS AND OPPORTUNITIES (CHRO)

PART IV - Bidder Employment Information

JOB CATEGORY OVERALL

TOTALS

WHITE

(NOT OF HISPANIC

ORIGIN)

BLACK

(NOT OF HISPANIC

ORIGIN)

HISPANIC ASIAN / PACIFIC

ISLANDER

AMERICAN INDIAN

OR

ALASKAN NATIVE

Male Female Male Female Male Female Male Female Male Female

Officials/Managers

Professionals

Technicians

Sales Workers

Office/Clerical

Craft Workers (Skilled)

Laborers (Unskilled)

Service Workers

TOTALS ABOVE

Total One Year Ago

FORMAL ON-THE-JOB TRAINEES (ENTER FIGURES FOR THE SAME CATEGORIES AS ARE SHOWN ABOVE)

Apprentices

Trainees According to the above employment report, is the composition of your workforce at or near parity when compared with the racial and gender composition of the workforce in the relevant labor market area? Yes No

PART V - Bidder Hiring and Recruitment Practices

1. Which of the following recruitment sources are used by you? (Check yes or no, and report percentage used)

2. Check () any of the requirements listed below that you use as a hiring qualification.

3. Describe below any other practices or actions that you take which show that you hire, train, and promote employees without discrimination.

SOURCE

YES

NO

% of applicants provided by source

State Employment Service Work Experience Private Employment Agencies

Ability to Speak or Write English

Schools and Colleges Written Tests Newspaper Advertisement High School Diploma Walk Ins College Degree Present Employees Union Membership Minority/Community Organizations

Personal Recommendation

Labor Organizations Height or Weight Others (please identify) Car Ownership Arrest Record Wage Garnishment Certification (Read this form and check your statements on it CAREFULLY before signing). I certify that the statements made by me on this BIDDER CONTRACT COMPLIANCE MONITORING REPORT are complete and true to the best of my knowledge and belief, and are made in good faith. I understand that if I knowingly make any misstatement of facts, I am subject to be declared in non-compliance with Section 4a-60, 4a-60a, and related sections of the CONN. GEN. STAT.

Signature Title Date Signed Telephone

OSHA COMPLIANCE

SP-12 NEW 11/97 STATE OF CONNECTICUT

Certificate of Compliance with

Connecticut General Statute Section 31 - 57b

I hereby certify that all of the statements herein contained below have been examined by me, and to the best of my knowledge and belief are true and correct.

The __________________________________________________________________ HAS / HAS NOT

Company Name (Cross out Non-applicable) been cited for three (3) or more willful or serious or serious violations of any Occupational Safety and Health Act (OSHA) or of any standard, order or regulation promulgated pursuant to such act, during the three year period preceding the bid, provided such violations were cited in accordance with the provisions of any State Occupational Safety and Health Act of 1970, and not abated within the time fixed by the citation and such citation has not been set aside following appeal to the appropriate agency of court having jurisdiction or HAS / HAS NOT (Cross out Non-applicable) received one or more criminal convictions related to the injury or death of any employee in the three-year period preceding the bid.

The list of violations (if applicable) is attached.

(Name of Firm, Organization or Corporation)

Signed: ______________________________________________________ Written Signature:

Name Typed: (Corporation Seal)

Title: ______________________________________________________ (Title of Above Person, typed)

Dated: ________________________

State of )

County of ) ss: A.D., 20_________

Sworn to and personally appeared before me for the above, ________________________________________________, (Name of Firm, Organization, Corporation)

Signer and Sealer of the foregoing instrument of and acknowledged the same to be the free act and deed of

_______________________________________________, and his/her free act and deed as (Name of Person appearing in front of Notary or Clerk)

(Title of Person appearing in front of Notary or Clerk)

My Commission Expires: _______________________________________________ (Notary Public) (Seal)

FOR YOUR INFORMATION

Certificate (of Authority) The Certificate of Authority is a document stating the name and title of the person resolved (through a corporate resolution) and authorized to legally bind the organization to contractual agreements on its behalf.

Instructions for completing the Certificate (of Authority)

The Certificate (Authority) to Accompany the Bid Proposal Form:

1. 1st Paragraph:

a. First, enter the name and title of the individual signing the Certificate (of Authority).

b. Second, enter the name the entity (exactly as it shows on the Secretary of State registry).

c. Third, enter the name of the state or commonwealth the entity is registered in.

d. Fourth, enter the date the resolution was adopted by the governing body. This date is on or before the date the Bid Proposal is signed.

e. Fifth, enter the name of the state or commonwealth the entity is registered in.

2. 2nd Paragraph:

a. Enter the name and title of the individual signing bid documents for the entity.

b. Second, enter the name of the entity (exactly as it shows on the Secretary of State registry).

3. Last Paragraph:

a. Enter the Witness date, this will likely be the date of execution of the Bid Proposal form.

The Date should not be before the date of execution of the bid proposal.

The Certificate (Authority) to Accompany the Contract:

4. 1st Paragraph:

a. First, enter the name and title of the individual signing the Certificate (of Authority).

b. Second, enter the name the entity (exactly as it shows on the Secretary of State registry).

c. Third, enter the name of the state or commonwealth the entity is registered in.

d. Fourth, enter the date the resolution was adopted by the governing body. This date is on or before the date the Contract is signed.

e. Fifth, enter the name of the state or commonwealth the entity is registered in.

5. 2nd Paragraph:

a. First enter the name and title of the individual signing contract documents for the entity.

b. Second, enter the name of the entity (exactly as it shows on the Secretary of State registry).

6. Last Paragraph:

a. Enter the Witness date, this will be the date of execution of the Contract.

The Date should not be before the date of execution of the Contract.

CERTIFICATE

I _____________________________________, ______________________________ (Signer’s name) (Signer’s title) of _____________________________________________, an entity lawfully organized (Name of entity) and existing under the laws of _______________________________, do hereby certify that the (Name or State or Commonwealth) following are true and correct copies of resolutions adopted on the ____ day of ____________, 20__ by the governing body of ___________________________________________________, (Name of entity) in accordance with all of its documents of governance and management and the laws of

_________________________________ and further certify that such resolutions have not been (Name or State or Commonwealth) modified, rescinded or revoked, and are at present in full force and effect.

RESOLVED: That ___________________________, ___________________________ (Name and title of signer of contract documents) of ____________________________ is empowered and authorized, on behalf of the entity, (Name of entity) to execute and deliver contracts and amendments thereto, and all documents required by the

Governor, the Connecticut Department of Correction, and the Office of the Attorney General associated with such contracts and amendments.

IN WITNESS WHEREOF, the undersigned has executed this certificate this ______ day of __________, 20__.

Sign name: Title:

Print name:

FORM A

NONDISCRIMINATION CERTIFICATION — Representation By Individual For All Contract Types Regardless of Value

Written representation that complies with the nondiscrimination agreements and warranties under Connecticut General Statutes §§ 4a-60(a)(1) and 4a-60a(a)(1), as amended

For use by an individual who is not an entity (corporation, limited liability company, or partnership) when entering into any contract type with the State of Connecticut, regardless of contract value. Submit to the awarding State agency prior to contract execution.

REPRESENTATION OF AN INDIVIDUAL:

I, _____________________________ , of _________________________________________________ , Signatory Business Address represent that I will comply with the nondiscrimination agreements and warranties of Connecticut General

Statutes §§ 4a-60(a)(1)and 4a-60a(a)(1), as amended.

Signatory Date

Printed Name

FORM B

NONDISCRIMINATION CERTIFICATION — Representation By Entity For Contracts Valued at Less Than $50,000

Written representation that complies with the nondiscrimination agreements and warranties under Connecticut General Statutes §§ 4a-60(a)(1) and 4a-60a(a)(1), as amended

For use by an entity (corporation, limited liability company, or partnership) when entering into any contract type with the State of Connecticut valued at less than $50,000 for each year of the contract. Complete all sections of the form. Submit to the awarding State agency prior to contract execution.

REPRESENTATION OF AN ENTITY:

I, _________________________ , ___________________ , of _______________________________ , Authorized Signatory Title Name of Entity an entity duly formed and existing under the laws of __________________________________ , Name of State or Commonwealth represent that I am authorized to execute and deliver this representation on behalf of

________________________________ and that ________________________________

Name of Entity Name of Entity has a policy in place that complies with the nondiscrimination agreements and warranties of Connecticut

General Statutes §§ 4a-60(a)(1) and 4a-60a(a)(1), as amended.

Authorized Signatory Date

Printed Name

12 Non-Discrimination Form B