TOWN OF GREENWICH NO.: 7961

PURCHASING DEPARTMENT

101 Field Point Road ISSUE DATE: 06/23/2026

Greenwich, CT 06830

203 622-7881 DEADLINE DATE: 07/14/2026

DEADLINE TIME: 11:00 AM

X REQUEST FOR BID

REQUEST FOR PROPOSAL

PREBID CONFERENCE:

TIME AND DATE:

LOCATION:

RFB/RFP TITLE: GRASS SEED

LOCATION: GREENWICH, CT

PREQUALIFICATION

X STANDARDS/SPECIFICATIONS

INSURANCE REQUIRED

PLEASE NOTE:

1. Sealed Bids/Proposals are due at the Town of Greenwich Purchasing Department on date noted.

NO bids/proposals will be accepted after the date and time specified above. Bidder is responsible for actual delivery of the bid/proposal sent by mail or commercial express service to the PURCHASING

DEPARTMENT before the deadline time. Bids/proposals received after the deadline time will not be considered. PLEASE CLEARLY INDICATE BID/PROPOSAL NUMBER ON LOWER LEFT-HAND

CORNER OF ENVELOPE.

2. BIDS/PROPOSALS ARE NOT ACCEPTED BY FAX OR E-MAIL.

3. COMPANY NAME AND ADDRESS MUST CONFORM ON ALL DOCUMENTS INCLUDING

INSURANCE DOCUMENTS. A POST OFFICE BOX ADDRESS IS NOT ACCEPTABLE.

4. Bid/Proposal number must appear on all bids and related correspondence.

5. The Town of Greenwich is exempt from Federal and State Taxes.

6. The Town will consider an alternate bid only if Bidders have been permitted to provide an alternate bid. An alternate bid must be clearly identified as such in order to be considered by the Town.

7. Stated prices are to be FOB destination inside delivery, unless otherwise specified herein.

8. Terms and Conditions indicated on reverse.

Anthony Guardi, Procurement Specialist

An Affirmative Action/Equal Opportunity Employer, M/F/H

Terms and Conditions

Bidders shall familiarize themselves with all provisions of the specifications and shall not at any time after submitting bid, dispute any of the specifications or assert that there was any misunderstanding in regard to the furnishing and delivering of the items called for in the proposal.

The Town of Greenwich reserves the right to issue addenda as needed on bids/proposals.

The Town of Greenwich reserves the right to reject any and all bids not deemed to be in the best interest of the Town of Greenwich, or to accept that bid which appears to be in the best interest of the Town of Greenwich. The Town of Greenwich reserves the right to waive any informalities in or reject any or all bids, or any part of any bid.

References to a particular trade name or manufacturer's catalog or model number are made for descriptive purposes to guide the Bidder in interpreting the requirements of the Town of Greenwich. They should not be construed as, nor are they intended to exclude proposals on other types of materials, equipment and supplies.

However, the Bidder, if awarded a contract will be required to furnish the particular item referred to in the specification or description unless a departure or substitution is clearly noted and described in the proposal.

Respondents shall provide one proposal and Bidders one bid price for each specified required line item with no more than one total lump sum bid, unless allowed to do otherwise by the solicitation. Respondents shall provide no more than one bid reply unless allowed by the solicitation. Bidders shall not include in their prices any Federal or State taxes from which the Town of Greenwich is exempt.

The successful Bidder/s shall indemnify the Town of Greenwich against all losses, claims, actions and judgments brought or recovered against the contractor or the Town of Greenwich. Any respondent that takes exception to the insurance requirements set forth by the Town of Greenwich Risk Manager shall be deemed unresponsive.

No proposal shall be received from, or contract awarded to, any person, firm or corporation who is in default or in debt to the Town of Greenwich for non-performance of any contract, or who is a defaulter as surety or otherwise from any obligation to the Town of Greenwich.

Bids must be signed in ink by the vendor. No bids shall be made in pencil. Any bids showing any erasures or alterations must be initialed by the Bidder in ink. Failure to sign and give all information requested in the proposal may result in the bid being rejected.

Quantities as listed on the bid sheets are estimated for bidding purposes only. Award of contract shall be for the quantities actually ordered as needed during the contract period. However, the Town of Greenwich reserves the right to increase or decrease the quantities by 10%.

Unit prices quoted shall be net exclusive of all taxes, and must include all transportation, delivery and unloading costs; fully prepaid F.O.B. destination in place inside delivery. Debris, if any, removed.

The Town of Greenwich reserves the right to make awards on an item by item, total or lump sum basis. Where an award is made on an item by item basis, the unit price prevails. The Town reserves the right to make award in best interest of its own operation. All awards are contingent upon certification by the Town Comptroller that funds are available in appropriate accounts.

It is understood that prices shall hold firm and prevail for the actual quantities required or ordered as needed during the life of the contract whether more or less than estimated quantities. Unit prices shall not be subject to any increase during the life of the contract.

All deliveries are to be made within the time period specified in the bid proposal upon receipt of written purchase order or authorized verbal requests except as may be otherwise arranged by Supplier and Purchaser.

Receipt of contract is not authority to ship. Emergency deliveries are to be made within twenty-four (24) hours from receipt of a telephone request from the Town of Greenwich. All deliveries are to be made on business weekdays between the hours of 9:00 A.M. and 4:00 P.M. except as may be otherwise arranged by the Supplier and Purchaser.

In the event deliveries are not made as specified to a Town delivery point, the Town of Greenwich shall reserve the right to purchase any such bid item on the open market and to charge any increase in price paid over the current contract price to the account of the vendor.

All bids will be awarded or rejected within sixty (60) days of bid opening date or for the stated period of validity, if different. Therefore, Bidder agrees that prices will remain firm for acceptance for that period.

Terms of payment to the Contractor shall be net/30 days after receipt of invoice and acceptance and approval of the services by the Town of Greenwich.

The contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex or national origin. The contractor, however, will take affirmative action to insure that minority group members are employed and are not discriminated against during employment. Such actions shall include, but not be limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection of training, including apprenticeship.

The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, religion, color, sex or national origin. The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract of understanding, a notice advising the labor union or worker's representative of the contractors' commitments under this specification and under rules, regulations and orders promulgated by the State.

"Affirmative Action" means procedures which establish hiring and employment goals, timetables, and practices to be implemented, with good faith efforts, for minority group members.

"Minority Group Members" as identified in EEO-4 reports shall mean Black, Hispanic, Asian or Pacific Islanders, American Indian, and Alaskan Natives.

The contractor or subcontractor offers and agrees to assign to the public purchasing body all right, title and interest in and to all causes of action it may have under Section 4 of the Clayton Act, 15 U.S.C. Section 15, or under Chapter 624 of the General Statutes of Connecticut, arising out of the purchase of services, property or intangibles of any kind pursuant to a public purchase contract or subcontract. This assignment shall be made and become effective at the time the public purchasing body awards or accepts such contract, without further acknowledgment by the parties.

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TOWN OF GREENWICH, CT

REQUEST FOR BID #7961 DEADLINE: 07/14/2026 AT 11:00 AM

GRASS SEED

BACKGROUND

The Town of Greenwich Purchasing Department, on behalf of the Department of Parks and

Recreation, is soliciting bids for the Town’s annual supply of Grass Seed.

GENERAL INFORMATION

The Town will order Grass Seed on an as-needed basis. The term of the Award shall be 10/01/2026 to 09/30/2027.

The Town’s estimated annual supply of Grass Seed is provided on the Reply Sheets. The Town makes no guarantees as to the amount of Grass Seed that may be purchased. The Town may purchase more or less than the quantity indicated on the Reply Sheets. The Town reserves the right to award to more than one Vendor.

The Vendor(s) shall hold firm all bid prices for the one (1) year term of the Award. The Grass

Seed will be ordered multiple times throughout the year and shall be delivered by the awarded

Vendor to multiple locations within the Town of Greenwich, CT. The Vendor(s) shall deliver all

Grass Seed within five (5) days of receiving an order. The Vendor(s) shall have the ability to offload Grass Seed at various Town of Greenwich locations.

GRASS SEED SPECIFICATIONS

The Town utilizes the Grass Seed varieties listed below. Refer to Reply Sheet Page 1 of 4 for estimated quantities.

1) 60% Improved Variety Kentucky Bluegrass / 40% Turf Type Perennial Ryegrass in 50 lb. bags

2) 50% Improved Variety Kentucky Bluegrass / 50% Turf Type Perennial Ryegrass in 50 lb. bags

3) Three-way Triplex Perennial Ryegrass in 50 lb. bags

4) Turf Annual Ryegrass in 50 lb. bags

5) Regenerating Perennial Ryegrass in 50 lb. bags

6) Rhizomatous Tall Fescue in 50 lb. bags

BIDDER REPLY

Bidders shall respond to this Request for Bid (RFB) by completing the attached Reply Sheets.

Bidders shall indicate their pricing and all other required information on the Reply Sheets. The pricing on the Reply Sheets shall be complete and shall include the costs of all shipping, delivery, installation, labor, insurance, certificates, permits, and/or other prices pertaining to this procurement.

Bidders shall indicate their pricing and lead times (in days) on the Reply Sheets. For products not available from the Bidder, the Bidder may write “no bid” on the corresponding price line(s). For products with Fixed Agency Prices the Bidder shall indicate delivery lead time only. For Agency products not available from the Bidder, the Bidder may write “no bid” on the corresponding lead time line(s).

Page | 4

Bidders shall not alter the Reply Sheets. Bidders that alter the Reply Sheets by changing quantities, sizes, product names, product descriptions, etc. may be disqualified.

The awarded Vendor will be required to furnish the item on the Reply Sheets, unless a substitution is formally approved in an addendum prior to the RFB deadline.

The pricing on the Reply Sheets shall be complete and shall include all shipping and inside delivery costs to Greenwich, CT. Shipping terms are FOB Greenwich, Freight Prepaid, and Allowed. The term of the Award will be one (1) year. All prices shall be held firm for the term of the Award.

ISSUANCE OF ADDENDA

The Town of Greenwich reserves the right to amend this solicitation by addenda. Addenda will be posted to the Town’s website (www.greenwichct.gov/bids) up to 48 hours in advance of the deadline. It is the responsibility of the Bidder to check the Town’s website for addenda, the Town will not provide notification. If in the Town’s opinion revisions are of such a magnitude, the deadline for this solicitation may be extended in an addendum. In addition, addenda can change

Specifications, Reply Sheets, and times/dates for Pre-Bid Conferences, as well as deadlines for questions and submissions.

DELIVERY OF BIDS

Bids shall be delivered via USPS or commercial delivery service (UPS, FedEx etc.) to the Town of Greenwich Purchasing Department, First Floor, Town Hall, 101 Field Point Road, Greenwich, CT 06830 by:

11:00 AM on Tuesday, July 14th, 2026

The Purchasing Department is accepting hand-delivered bids. Bids received after the deadline date and time will not be accepted and will be returned unopened to the Bidder. The Reply Sheets must be completed and returned with the bid in a sealed envelope. Please clearly indicate

RFB #7961 on the lower left-hand corner of the envelope.

PACKAGING

Each bid must be sealed to provide confidentiality of the information prior to the submission date and time. Please note the RFB # on the outside of the package. The Town will not be responsible for premature opening of bids that are not properly labeled.

PRICE GUARANTEE / DURATION OF BID

Bids will remain in effect for a minimum of ninety (90) days from the deadline for submission of the bid.

BID COSTS

The Bidder shall be responsible for all costs incurred in the development and submission of their bid. The Town assumes no contractual obligation as a result of the issuance of this RFB, the preparation or submission of a bid by a Bidder, or the evaluation of an accepted bid.

TAXES

The Town of Greenwich is exempt from the payment of taxes imposed by the Federal Government and/or State of Connecticut, and such taxes shall not be included in the bid prices.

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PAYMENTS

The Town of Greenwich shall make payment net thirty (30) days of receipt of invoice, submittal of documentation, and acceptance of the products and/or services.

RESERVATION OF RIGHTS

The Town of Greenwich reserves the right to reject any and all bids not deemed to be in the best interest of the Town, or to accept that bid which appears to be in the best interest of the Town. The

Town reserves the right to waive any and all informalities, or to reject any or all bids or any part of any bid.

CANCELLATION OF AWARD/CONTRACT

If the Vendor fails to perform or observe any material term or condition of the bid/proposal or

Award/Contract and such failure continues for thirty (30) days after the Vendor’s receipt of written notice, the Town of Greenwich may cancel the Award/Contract without liability for cancellation or termination charges.

MODIFICATION OR WITHDRAWAL OF BID PRIOR TO DEADLINE

A Bidder wishing to withdraw a bid prior to the deadline may do so by preparing a formal written request on company letterhead. The person who signs the letter must be the same person who signed the Reply Sheets. The Town will verify that the signature on the letter matches the signature on the Reply Sheets.

The Town will also verify the request to withdraw the bid by calling the Bidder at the telephone number provided on the Reply Sheets.

After the Town is satisfied that a request to withdraw a bid before the established deadline is valid, the bid will be returned to the Bidder. The Bidder may then withdraw completely from the bidding process or may modify the bid and resubmit before the deadline.

MODIFICATION OR WITHDRAWAL OF BID AFTER DEADLINE

If a bid security is required and a Bidder does not honor their bid for the specified time, the bid check shall become the property of the Town; or, if a Bid Bond was furnished, the Bid Bond shall become payable to the Town.

After the deadline, the submitted bids become the property of the Town and are valid offers to be honored by the Bidder for sixty (60) days or longer, as specified in the Request for Bid.

Bidders who do not honor their bids for the sixty (60) day (or as specified) period, shall be disqualified.

PERMITS

If applicable, the Contractor shall ascertain any permits required to perform the service as described in the Specifications and Scope of Work. All required permits shall be obtained and paid for by the Contractor.

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FEDERAL, STATE, AND LOCAL LAWS

The Bidder shall acknowledge and agree that if awarded the RFB, Bidder shall be solely responsible for strict compliance with all Federal, State, and Local statutes, laws, codes, rules, regulations, and ordinances, and to obtain and maintain all necessary licenses and permits relating to this procurement.

APPLICABLE LAW

The laws of the State of Connecticut shall govern this Award/Contract and any and all litigation related to this Award/Contract. In the event of litigation related to this Award/Contract, the exclusive forum shall be the State of Connecticut and the exclusive venue for such litigation shall be the Judicial District for Stamford/Norwalk at Stamford.

PROHIBITED

Consumption or use of alcohol and/or drugs is prohibited on school property. Any individual with alcohol or drugs will be removed from said property. Smoking in the building, consumption of alcoholic beverages, or any illegal substance is expressly prohibited on all Greenwich Public

Schools property, in all school buildings, and on school grounds. All employees or persons entering the property surrounding the school are restricted to the immediate area of work.

Communication between workers and students will not be tolerated.

CONTRACTOR/VENDOR VERIFICATION

If applicable, the Contractor/Vendor is required to perform employee background checks as imposed by Section 2 of Public Act 16-67; which amended Connecticut General Statutes § 10-

222c. The statute, as amended, applies to Contractors/Vendors as well as to the

Contractor’s/Vendor’s employees. With respect to Contractors/Vendors, the statute requires that the Contractor/Vendor follow the procedures regarding applicant background checks for any employee with such a Contractor/Vendor who would be in a position in the school district involving possible student contact. State of Connecticut Contractor Verification form (in accordance with Public Act 16-67) is attached as Exhibit A.

CONFIDENTIALITY/DISCLOSURE

“Contractor” refers to all Bidders/Respondents submitting a bid/proposal.

The Town will afford due regard to the Contractor’s request for the protection of proprietary or confidential information received. However, all materials associated with the Bid/Proposal and the

Contract are subject to the terms of the Connecticut Freedom of Information Act (“FOIA”) and all corresponding rules, regulations and interpretations. In making such a request, the Contractor may not state generally that the materials are proprietary or confidential in nature and therefore not subject to release to third parties. The specific sentences, paragraphs, pages or sections that the

Contractor believes are exempt from disclosure under FOIA must be specifically identified as such. An explanation and rationale to justify each exemption consistent with FOIA must accompany the request. The rationale and explanation must be stated in terms of the prospective harm to the competitive position of the Contractor that would result if the identified material were to be released and the reasons why the materials are legally exempt from release pursuant to FOIA.

If the Contractor indicates that certain documentation is submitted in confidence, by specifically and clearly marking said documentation as CONFIDENTIAL, the Town will endeavor to keep said information confidential to the extent permitted by law. The Town, however, shall have no

Page | 7 obligation to initiate, prosecute or defend any information that is sought pursuant to a FOIA request. The Contractor shall have the burden of establishing the availability of any FOIA exemption in any proceeding where it is an issue. In no event shall the Town, or any representative of the Town, be liable for the disclosure of any documents or information in its possession which the Town believes are required to be disclosed pursuant to FOIA or other requirements as mandated by policy/law.

Additionally, as per Section 1-210(b) of FOIA – Nothing in the Freedom of Information Act shall be construed to require the disclosure of:

(24) Responses to any request for proposals or bid solicitation issued by a public agency, responses by a public agency to any request for proposals or bid solicitation issued by a private entity, or any record or file made by a public agency in connection with the contract award process, until such contract is executed or negotiations for the award of such contract have ended, whichever occurs earlier, provided the chief executive officer of such public agency certifies that the public interest in the disclosure of such responses, record or file is outweighed by the public interest in the confidentiality of such responses, record or file.

ISSUING AUTHORITY

Mr. Anthony Guardi, Procurement Specialist, is responsible for the conduct of this procurement.

Any inquiries or requests regarding this procurement must be submitted in writing to Mr. Guardi at the address below by 11:00 AM on Tuesday, June 30th, 2026:

Town of Greenwich

Purchasing Department

101 Field Point Road

Anthony.Guardi@GreenwichCT.Gov mailto:Anthony.Guardi@GreenwichCT.Gov

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REQUEST FOR BID #7961 DEADLINE: 07/14/2026 AT 11:00 AM

GRASS SEED

REPLY SHEET (Page 1 of 4)

GRASS SEED PRICING

The Bidder shall provide the Brand Name of the Grass Seed and complete the Unit Pricing below, inclusive of all costs such as shipping and inside delivery to Greenwich, CT. The Town reserves the right to purchase more or less than the estimated annual quantities listed below. Bid pricing shall remain fixed through 9/30/2027.

Grass Seed Estimated Annual

Quantity

Unit Price

Per 50 lb. Bag

60% Improved Variety Kentucky Bluegrass/

40% Turf Type Perennial Ryegrass

Brand Name: ________________________

150 Bags $_________

50 % Improved Variety Kentucky Bluegrass/

50% Turf Type Perennial Ryegrass

Brand Name: ________________________

150 Bags $_________

Three-way Triplex Perennial Ryegrass

Brand Name: ________________________ 150 Bags $_________

Turf Annual Ryegrass

Brand Name: ________________________ 100 Bags $_________

Regenerating Perennial Ryegrass

Brand Name: ________________________ 100 Bags $_________

Rhizomatous Tall Fescue

Brand Name: ________________________ 100 Bags $_________

BIDDER’S COMPANY NAME: _________________________________________________

AUTHORIZED SIGNATURE: __________________________________________________

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REQUEST FOR BID #7961 DEADLINE: 07/14/2026 AT 11:00 AM

GRASS SEED

REPLY SHEET (Page 2 of 4)

REFERENCES

Bidder shall list below the names and telephone numbers of at least three (3) customers/references for whom they provided products/services similar to the ones described in this RFB:

The Bidder may list below the key features that distinguish the Bidder’s products/services from their competitors:

BIDDER’S COMPANY NAME: _______________________________________________________

AUTHORIZED SIGNATURE: ________________________________________________________

REFERENCE CONTACT NAME TELEPHONE #

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REQUEST FOR BID #7961 DEADLINE: 07/14/2026 AT 11:00 AM

GRASS SEED

REPLY SHEET (Page 3 of 4)

STATEMENT OF NON-COLLUSION

In submitting this bid/proposal, the undersigned declares that this is made without any connection with any persons making another bid/proposal on the same contract; that the bid/proposal is in all respects fair and without collusion, fraud, or mental reservation; and that no elected or appointed official of the Town, or any person or entity in the employ of the Town, is directly or indirectly interested in said bid/proposal or in the supplies or work to which it relates, or in any portion of the profits thereof, except as permitted under the Town of Greenwich Code of Ethics.

CODE OF ETHICS

In submitting this bid/proposal, the undersigned further declares and certifies that a) it has not, and will not induce or attempt to induce any Town of Greenwich employee or officer to violate the Town of Greenwich Code of Ethics in connection with its offer to provide goods or services under, or otherwise in the performance of, such contract, and b) if an elected or appointed official or any person in the employ of the Town has a direct or indirect interest in

Vendor or any supplier or Subcontractor expected to be involved with the contract, such person or entity is in compliance with the safe harbor procedures established by the Town of Greenwich Board of Ethics or has received an advisory from the Town’s Board of Ethics with respect to such involvement. Bidders are hereby notified that the

Town’s Code of Ethics’ definition of a Town Officer includes outside consultants to and agents of the Town in addition to elected and appointed officials and Town employees. The full Code of Ethics can be found on the Town website https://www.greenwichct.gov/682/Board-of-Ethics.

The undersigned further understands that the above declarations are material representations to the Town of

Greenwich made as a condition to the acceptance of the bid/proposal. If found to be false, the Town of Greenwich retains the right to reject said bid/proposal and rescind any resulting contract and/or purchase order and notify the undersigned accordingly, thereby declaring as void said bid/proposal and contract or purchase order.

Relevant provisions of the Town’s Code of Ethics are:

Section 2. DEFINITIONS. (1) Indirect interest, without limiting its generality, shall mean and include the interest of any subcontractor in any prime contract with the Town and the interest of any person or his immediate family in any corporation, firm, or partnership which has a direct or indirect interest in any transaction with the Town. (2) Substantial financial interest shall mean any financial interest, direct or indirect, which is more than nominal, and which is not common to the interest of other citizens of the Town. (3)

Town officer shall mean and include any official, employee, agent, consultant, or member, elected or appointed, of any board, department, commission, committee, legislative body, or other agency of the

Town. (4) Transaction shall mean and include the offer, sale, or furnishing of any real or personal property, material, supplies, or services by any person, directly or indirectly, as Vendor, prime contractor, subcontractor, or otherwise, for the use and benefit of the Town for a valuable consideration, excepting the services of any person as a Town officer.

Section 3. GIFTS AND FAVORS. No Town officer or his immediate family shall accept any valuable gift, thing, favor, loan, or promise that might influence the performance or nonperformance of his official duties.

Section 4. IMPROPER INFLUENCE. No Town officer having a substantial financial interest in any transaction with the Town or in any action to be taken by the Town shall use his office to exert his influence or to vote on such transaction or action.

By signing below, the undersigned acknowledges reviewing and understanding the Non-Collusion and Code of Ethics statements contained herein and confirms compliance with the contents:

AUTHORIZED SIGNATURE: ________________________________________________________

PRINT NAME: _____________________________________________________________________

BIDDER’S COMPANY NAME: _______________________________________________________

https://www.greenwichct.gov/682/Board-of-Ethics

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REQUEST FOR BID #7961 DEADLINE: 07/14/2026 AT 11:00 AM

GRASS SEED

REPLY SHEET (Page 4 of 4)

BIDDER INFORMATION:

BIDDER’S COMPANY NAME

ADDRESS

TELEPHONE # FAX #

E-MAIL ADDRESS

WEB SITE

AUTHORIZED SIGNATURE

PRINT NAME

TITLE

STATE OF CT TAXPAYER ID #

FEDERAL TAXPAYER ID #

INCORPORATED IN THE STATE OF Corporate Seal Yes No

AWARD/CONTRACT SIGNATURE

The Bidder shall indicate below, the full name, title, email, and the complete mailing address of the authorized person (i.e., officer of the company) who will sign the Contract (if applicable) for this procurement:

STATE OF CONNECTICUT

Contractor Verification

(in accordance with Public Act 16-67)

Directions to Contractor: Connecticut law requires that any contractor applying or bidding for a contract (including individuals who are independent contractors) with a local or regional board of education, a governing council of a state or local charter school, or interdistrict magnet school operator require any employee with the contractor who would be in a position involving direct student contact to supply the contractor with the information provided in this form. Information may be collected either through a written communication or telephonically.

In addition, pursuant to Connecticut General Statutes (C.G.S.) § 10-222c, the contractor is required to contact – either telephonically or through written communication – any current or former employer of an employee if such employer was a local or regional board of education, a governing council of a state or local charter school, or interdistrict magnet school operator or if the employment caused the employee to have contact with children, to request any information concerning whether there was a finding of abuse or neglect or sexual misconduct against the employee. If the contractor receives any information indicating such a finding, or otherwise has knowledge of such a condition, the contractor must immediately forward such information to any local or regional board of education with which the contractor is under contract.

Directions to Employee of Contractor: Pursuant to Connecticut state law, employees of a contractor who would be in a position involving direct student contact must supply all of the information provided in Section 2 of this form.

Section 1 – To be completed by Contractor

Name

Street address

City, State, Zip Code

Contact person

Telephone number/email address

Section 2 – To be completed by Employee of Contractor

Part A. On a separate sheet of paper, please list the name, address and telephone number of each current or former employer, if such current or former employer was a local or regional board of education, a governing council of a state or local charter school, or interdistrict magnet school operator, or if such employment otherwise caused you to have contact with children.

Part B. Please complete the questions below in their entirety.

Have you ever:

Y N Been the subject of an abuse or neglect or sexual misconduct investigation by any employer, state agency or municipal police department (answer “no” if the investigation resulted in a finding that all allegations were unsubstantiated)?

Y N Been disciplined or asked to resign from employment or resigned from or otherwise separated from any employment while an allegation of abuse or neglect was pending or under investigation by the Department of Children and

Families (the “department”), or an allegation of sexual misconduct was pending or under investigation or due to an allegation substantiated pursuant to section 17a-101g of abuse or neglect, or of sexual misconduct or a conviction for abuse or neglect or sexual misconduct?

Y N Had a professional or occupational license or certificate suspended or revoked or ever surrendered such a license or certificate while an allegation of abuse or neglect was pending or under investigation by the department or an investigation of sexual misconduct was pending or under investigation, or due to an allegation substantiated by the department of abuse or neglect or of sexual misconduct or a conviction for abuse or neglect or sexual misconduct?

RFB #7961

EXHIBIT A

Part C – Written Consent and Disclosure Authorization. I hereby authorize the entities I have listed in Section 2 of this form to release to the entity listed in Section 1 of this form the information required to be released by my previous employer pursuant to

(C.G.S.) § 10-222c along with any related records. I hereby consent to and authorize disclosure by the State Department of Education of the information requested pursuant to C.G.S. § 10-222c, as amended by Public Act 16-67, and I hereby authorize the release by the

State Department of Education of any related records. I further hereby release the above-named employer(s) and the State Department of Education from any and all liability of any kind that may arise from the disclosure or release of records requested pursuant to

C.G.S. § 10-222c, as amended by Public Act 16-67.

Signature of Applicant Date

NOTES:

The terms provided below are currently defined in state law as follows. Please note that statutes may be amended from time to time.

Sexual Misconduct means – “any verbal, nonverbal, written or electronic communication, or any other act directed toward or with a student that is designed to establish a sexual relationship with the student, including a sexual invitation, dating or soliciting a date, engaging in sexual dialog, making sexually suggestive comments, self-disclosure or physical exposure of a sexual or erotic nature and any other sexual, indecent or erotic contact with a student.” Connecticut General Statutes § 10-222c(k).

Abuse or neglect means – “abuse or neglect as described in Section 46b-120, and includes any violation of Sections 53a-70, 53a-70a, 53a-71, 53a-72a, 53a-72b or 53a-73a.” Connecticut General Statutes § 10-222c(k).

The Connecticut State Department of Education is an affirmative action/equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, gender identity or expression, sexual orientation, marital status, national origin, ancestry, age, criminal record, political beliefs, genetic information, intellectual disability, past or present history of mental disability, learning disability, or physical disability, including, but not limited to, blindness or any other basis prohibited by Connecticut state and/or federal nondiscrimination laws.

RFB #7961

EXHIBIT A