RFP UCHC 1-211857482 AI-enabled Benefits Navigation Solution Bid Documents.pdf.crdownload

REQUEST FOR PROPOSAL

UCONN HEALTH OVERVIEW

UCHC RFP-00 Form Rev. 10/15

UNIVERSITY OF CONNECTICUT HEALTH CENTER

Procurement Operations & Contracts 263 Farmington Avenue, MC4036

Farmington, CT 06032-4036

Buyer

Telephone Number

E-mail Address

Fax Number

RFP NUMBER: PROPOSAL DUE DATE: PROPOSAL DUE TIME: RFP SURETY:

EST

RFP TITLE:

UConn Health Overview

UConn Health is a vibrant, integrated academic medical center based in Farmington, Connecticut – a popular suburb of the state’s capitol of Hartford. It is home to the School of Medicine, School of Dental Medicine, John Dempsey Hospital, UConn Medical Group, UConn Health Partners, University Dentists and a thriving research enterprise.

UConn Health is at the center of Bioscience Connecticut, which will strengthen Connecticut’s position as a national and global leader for bioscience innovation and improve access to quality health care for Connecticut citizens for generations to come.

With approximately 5,000 employees, UConn Health is a major economic driver in the region. It is closely linked with the University of Connecticut’s main campus in Storrs through multiple, cross-campus projects.

The goods and/or services that UConn Health is seeking to obtain through this bid will support UConn Health’s mission of helping people achieve and maintain healthy lives and restoring wellness/health to maximum attainable levels.

Additional information about UConn Health’s health care services, educational programs, research, community outreach, campus, Board of Directors, executive and administrative leadership, and mission, vision, values and goals are available on the UConn Health website, at http://www.uchc.edu/about/index.html.

http://www.uchc.edu/about/index.html

RFP SCHEDULE, EVALUATION CRITERIA & INSTRUCTIONS

UCHC RFP-01 Form Rev. 11/24

263 Farmington Avenue, MC4036 Farmington, CT 06032-4036

Buyer

Telephone Number

RFP TITLE:

I. RFP Schedule

This schedule is tentative and subject to change. Any changes to the schedule up to and including the date when proposals are due, will be made via an official Addendum to this RFP. The remaining dates are estimates only and can be changed by UConn Health at any time without notice.

Milestone Deadline/Target Date

1. RFP posting/release

2. Mandatory pre-bid meeting

3. Written questions due at 2:00 p.m. EST

4. UConn Health’s responses to written questions via Addendum

5. Proposals due – must be received by UConn Health Procurement

Department by due date and time at 2:00 p.m. EST

6. Meetings with proposers end, if any (estimated)

7. Selection committee identifies preferred contractor; contract negotiations begin (estimated)

8. Contract negotiations end (estimated)

9. Contract start date (estimated)

II. Evaluation Criteria

A selection committee that includes UConn Health staff (and/or other designees as deemed appropriate) will evaluate the responsive proposals. The selection committee may ask one or more proposers for clarification of responses and/or to meet with the selection committee.

The selection committee will numerically score and rank the proposals, based on the criteria specified below, to make a recommendation for award that best serves the interests of UConn Health.

Only those proposals found to be responsive to this RFP will be evaluated. To be responsive, a proposal must comply with all instructions contained in this RFP and include all requested information.

UCHC RFP-01 Form

Requirement Criteria Weight

1. Organizational Capability and Structure

Ability to provide the goods/services described in this RFP, as demonstrated through background, qualifications, relevant experience, organizational structure, and financial condition

2. References Confirmation of relevant experience and capabilities, as provided by proposer’s references

3. Staffing Plan Availability, relevant experience and competence of proposer’s staff

4. Scope of Work Understanding of and ability to meet UConn Health’s needs as stated in this RFP, as evidenced by proposer’s responses to the Scope of Work Requirements/Questions

5. Cost Competitiveness of proposed cost

6. Contract Language Did Supplier accept all of UConn Health’s contract language; if not, how burdensome will it be for UConn Health to finalize a contract with this supplier?

100%

III. RFP Instructions

A. Contact Information. UConn Health’s official contact person (buyer) for this RFP is:

Buyer: ___________________ Title: Buyer___________________ Telephone: ___________________ Fax: ___________________ Email: ___________________

NOTE: Bidders are required to submit their bid responses electronically via email to the Buyer named in the bid on or before the due date and time specified in the bid. Do NOT upload your bid response to the Connecticut bid portal. UConn Health only accepts bid responses that are emailed directly to the Buyer per their instructions. Responses must be received by the Buyer via email prior to the deadline.

Bid responses won’t be accepted unless all sections of the bid template are completed in their entirety.

Don’t leave any section blank.

References are required – we review the names of the references as part of the bid evaluation. UConn Health will only contact references for the supplier(s) that the selection committee is interested in.

All forms must be signed and dated.

Don’t add or change language on any of the bid forms or compliance documents. The only place where redlining is allowed is in the standard contract in the bid package, and UConn Health is not obligated to accept any requested changes to contract language.

UConn Health is a State of Connecticut agency – requests to keep bid responses confidential will be rejected.

Proposers who solicit information about this RFP, either directly or indirectly, from sources other than the buyer named above may be disqualified.

UCHC RFP-01 Form

B. Questions and Addenda

Interested proposers may submit questions regarding this RFP by email only to the buyer named above. Questions submitted other than by email to the buyer named above will not be accepted or considered.

Proposers must refer to the specific RFP paragraph number and page and must quote the passage being questioned.

To be considered, questions regarding this RFP must be received via email by the identified buyer by the due date/time specified in the RFP Schedule. The early submission of questions is encouraged. It is solely the proposer’s responsibility to ensure and verify UConn Health’s receipt of questions.

UConn Health will respond only to those questions that are received by the identified buyer by the due date/time specified in the RFP Schedule. Official responses to all questions will be in an Addendum to this RFP posted on the State Contracting portal at https://portal.ct.gov/DAS/CTSource/CTsource-Resources/Registration-Resources. Search Solicitations using Organization “University of Connecticut Health Center”. The expected posting date for the Addendum with UConn Health’s responses is listed in the RFP Schedule.

It is solely the proposer’s responsibility to access the State Contracting portal to obtain all Addenda and official announcements pertaining to this RFP. Proposers must provide a signed acknowledgement of the receipt of all Addenda with their proposal.

C. Communication/Meetings During the Evaluation and Selection Process

In order to ensure a fair and competitive process, all communication regarding this RFP will be restricted until the contract with the selected proposer(s) has been executed, except as needed for the selection committee to complete its evaluation.

UConn Health’s Procurement Department may request that any proposer clarify or supplement any information contained in the proposer’s response. Responses to UConn Health’s requests for clarification or supplements must be submitted in writing within a reasonable time as determined by the Procurement Department. In no event shall this exceed three (3) business days of receipt.

At its discretion, the selection committee may convene meetings with one or more proposers to gain a better understanding of the proposal(s). The meetings may involve demonstrations, interviews, presentations and/or site visits. If the selection committee decides meetings are warranted, a UConn Health contact person will call or email proposers to schedule the meetings. All costs of attending these meetings are the responsibility of the proposer.

Proposers may not contact or communicate with any UConn Health department, board member, selection committee member or employee (except for the buyer named above) regarding this RFP, outside of any official selection committee meetings scheduled as part of this RFP process. Violation of this requirement may result in disqualification of that proposer’s response.

https://portal.ct.gov/DAS/CTSource/CTsource-Resources/Registration-Resources

ACKNOWLEDGEMENT: RECEIPT OF RFP DOCUMENTS

UCHC RFP-02 Form Rev. 1/15

263 Farmington Avenue, MC4036 Farmington, CT 06032-4036

Buyer

Telephone Number

NOTE: Please complete and return this acknowledgement as soon as possible to the email address or fax number indicated above. This document is crucial for proposal follow-up.

Please check one of the following boxes: Submitting a proposal NOT submitting a proposal

Complete the following information:

Firm/Corporation Name:

Street Address:

City, State, Zip Code:

Contact Name/Title:

Phone Number:

Fax Number:

E-mail Address:

PROPOSER’S CHECKLIST

UCHC RFP-03 Form Rev. 7/25

263 Farmington Avenue, MC4036 Farmington, CT 06032-4036

Buyer

Telephone Number

IT IS SUGGESTED THAT YOU REVIEW AND CHECK OFF EACH ACTION ITEM AS YOU COMPLETE IT CHECK

1. Form UCHC RFP-02 (Acknowledgement: Receipt of RFP Documents) was completed and returned at least 48 hours before the proposal due date and time.

2. Form UCHC RFP-04 (Proposer’s Info, Debarment & W-9) is fully completed, signed in the appropriate location by an authorized representative and included with your proposal.

3. Form UCHC RFP-05 (Scope & Response Spreadsheet) is included with your proposal and contains the following:

a. Proposer’s name is located in the upper right corner.

b. Responses have been entered for all information and pricing requested. (For ease of identification, the fields that require data entry are highlighted in green).

c. You have attached copies of any documents required as a result of your responses.

d. The proposal prices indicated were reviewed and verified.

e. The price extensions and totals were reviewed and verified. In case of discrepancy between unit prices and total prices, the unit price will govern the proposal evaluation.

f. Any errors, alterations, corrections or erasures to unit prices or total prices must be initialed by the person who signs the proposal or his/her designee. Such changes made and not initialed may result in rejection of that portion of the proposal.

4. If required, any technical or descriptive literature, drawings, or proposal samples are included with your proposal.

5. Form UCHC RFP-06 (CHRO Contract Compliance) was completed in its entirety, signed and submitted with your proposal, even if the business is family owned or operated, and regardless of the number of employees. Non-compliance may result in proposal rejection.

6. Form UCHC RFP-07 (SEEC Form 10 Compliance) was completed in its entirety, signed and submitted with your proposal. Non-compliance may result in proposal rejection.

7. OPM Form 1 (Campaign Contribution Certification) was completed, signed and submitted with your proposal. Non-compliance may result in proposal rejection.

8. Form UCHC RFP-11 (Addendum) was signed and submitted with your proposal. (if applicable)

PROPOSER’S CHECKLIST

UCHC RFP-03 Form Rev. 7/25

9. Form UCHC RFP-12 (Addendum Q & A) was signed and submitted with your proposal. (if applicable)

10. Form UCHC RFP-05 Scope & Response Spreadsheet was completed in its entirety.

11. A signed copy or “red lined” version of the standard contract was submitted with the proposal.

12. Freight quotes and shipping details were submitted to Triose via email at logistics@triose.com. (if applicable)

NOTE: NOTE: Bidders are required to submit their bid responses electronically via email to the Buyer named in the bid on or before the due date and time specified in the bid. Do NOT upload your bid response to the Connecticut bid portal. UConn Health only accepts bid responses that are emailed directly to the Buyer per their instructions. Responses must be received by the Buyer via email prior to the deadline.

Bid responses won’t be accepted unless all sections of the bid template are completed in their entirety.

Don’t leave any section blank.

References are required – we review the names of the references as part of the bid evaluation. UConn Health will only contact references for the supplier(s) that the selection committee is interested in.

All forms must be signed and dated.

Don’t add or change language on any of the bid forms or compliance documents. The only place where redlining is allowed is in the standard contract in the bid package, and UConn Health is not obligated to accept any requested changes to contract language.

UConn Health is a State of Connecticut agency – requests to keep bid responses confidential will be rejected.

NOTE: All proposals shall become the sole property of the University of Connecticut Health Center and will not be returned. Your submitted proposal may be rejected if the following requirements are not met:

a) The following documents have been completed in their entirety and signed by a duly authorized representative of the company where applicable.

- UCHC RFP-04 Proposer's Info, Debarment & W-9

- UCHC RFP-05 Scope & Response Spreadsheet

- UCHC RFP-06 CHRO Contract Compliance

- UCHC RFP-07 SEEC Form 10 Compliance

- OPM Form 1 Campaign Contribution Certification

- UCHC RFP-11 Addendum (if applicable)

- UCHC RFP-12 Addendum Q & A (if applicable)

The links listed below are provided for your convenience. It is your responsibility to ensure that you are compliant with the most current laws, regulations, rules & policies.

Refer to “Guide to the Code of Ethics For Current or Potential State Contractors” at the following website:

https://portal.ct.gov/-/media/Ethics/Guides/2021/Contractors-Guide-to-the-Code-of-Ethics-Rev-11-2021.pdf

Refer to “State of Connecticut Supplier Diversity Program” at the following website:

http://portal.ct.gov/DAS/Procurement/Supplier-Diversity/Apply-for-Small-Business-Enterprise-or-Minority-Business- Enterprise-Certification-SBE-or-MBE/Eligibility

Refer to “OPM Ethics Forms” at the following website:

http://www.ct.gov/opm/cwp/view.asp?a=2982&q=386038

PROPOSER’S INFO, DEBARMENT & W-9

UCHC RFP-04 Form Rev. 11/15

UNIVERSITY OF CONNECTICUT HEALTH CENTER

Procurement Operations & Contracts

263 Farmington Avenue, MC4036 Farmington, CT 06032-4036

Buyer

Telephone Number

E-mail Address

Fax Number

RFP NUMBER: PROPOSAL DUE DATE: PROPOSAL DUE TIME: RFP SURETY:

EST

RFP TITLE:

REQUEST FOR PROPOSAL: Pursuant to the provisions of Sections 10a-151a, 10a-151b and 4a-57 of the Connecticut General Statutes as amended, sealed proposals will be received by the University of Connecticut Health Center for furnishing the commodities and/or services described in this RFP.

IMPORTANT: ALL pages of this form must be completed, signed and returned by the Proposer as part of the proposal package. Failure to complete and submit all pages may constitute grounds for rejection of your proposal. By completing this form, the Proposer agrees that it complies with all applicable UConn Health policies and procedures, federal, state, and local laws and regulations, including but not limited to Sections 10a-151a and 10a-151b, 4a-60 and 4a-60a of the Connecticut General Statutes as amended.

SECTION 1 of 4: PROPOSER INFORMATION

COMPLETE LEGAL BUSINESS NAME: TAXPAYER ID NUMBER (TIN):

BUSINESS NAME, TRADE NAME, DOING BUSINESS AS (IF DIFFERENT FROM ABOVE): WILL CONTRACT BE WITH DBA? (IF APPLICABLE):

YES NO

PRINCIPAL PLACE OF BUSINESS (CITY & STATE): IS YOUR BUSINESS A HUMAN TISSUE SUPPLIER?

YES NO

LIST TYPES OF PRODUCTS AND OR SERVICES PROVIDED:

NOTE: IF YOUR BUSINESS IS AN INDIVIDUAL/SOLE PROPRIETOR, INDIVIDUAL’S NAME MUST APPEAR IN THE COMPLETE LEGAL BUSINESS NAME BLOCK ABOVE. IF YOUR BUSINESS IS A PARTNERSHIP, YOU MUST ATTACH THE NAMES AND TITLES OF ALL PARTNERS.

IS YOUR BUSINESS CURRENTLY A STATE OF CT CERTIFIED SMALL

BUSINESS ENTERPRISE? IF SO, PLEASE ATTACH A COPY OF THE

CERTIFICATE? (PLEASE CHECK) YES NO NO

IS YOUR BUSINESS CURRENTLY REGISTERED WITH THE STATE OF CT SECRETARY OF THE STATE’S OFFICE TO DO BUSINESS IN THE

STATE OF CT? (PLEASE CHECK) YES NO

IF YOU ARE A CURRENT OR PREVIOUS STATE EMPLOYEE, INDICATE THE POSITION, AGENCY, AND AGENCY ADDRESS:

IS IT POSSIBLE THAT WORK WILL BE PERFORMED

OFFSHORE (OUTSIDE OF THE UNITED STATES OR A U.S.

TERRITORY)? (PLEASE CHECK) YES

http://www.cga.ct.gov/2003/pub/Chap185b.htm%23Sec10a-151b.htm http://www.cga.ct.gov/2003/pub/Chap185b.htm%23Sec10a-151b.htm

UCHC RFP-04 Form Rev. 11/15

CORPORATE ADDRESS: REMITTANCE ADDRESS:

ADDRESS:

ADDRESS:

CITY, STATE, ZIP CODE:

TELEPHONE NUMBER:

PURCHASE ORDER DISTRIBUTION:

PLEASE INDICATE THE BEST METHOD OF PURCHASE ORDER DISTRIBUTION (PLEASE CHECK): FAX E-MAIL

CONTACT NAME:

TELEPHONE NUMBER:

FAX NUMBER:

E-MAIL ADDRESS:

SECTION 2 of 4: AFFIRMATION OF PROPOSER

I _______________________________ BEING A DULY AUTHORIZED REPRESENTATIVE OF ___________________________________

NAME OF AUTHORIZED PERSON COMPLETE LEGAL BUSINESS NAME

(“PROPOSER”) HEREBY CERTIFY UNDER PENALTY OF FALSE STATEMENT AS FOLLOWS, REGARDING RFP NUMBER _________________

1. PROPOSER AGREES TO BE BOUND BY ALL TERMS AND CONDITIONS INCLUDED IN THIS RFP.

2. ALL THE INFORMATION SUPPLIED IN RESPONSE TO THIS RFP IS COMPLETE AND TRUE.

3. DOCUMENTATION OF MY AUTHORITY TO BIND PROPOSER IS APPENDED HERETO.

SIGNATURE OF PERSON AUTHORIZED TO SIGN ON BEHALF OF THE ABOVE NAMED BUSINESS:

SIGN HERE

DATE EXECUTED:

NAME OF AUTHORIZED PERSON: TITLE OF AUTHORIZED PERSON:

UCHC RFP-04 Form Rev. 11/15

SECTION 3 of 4: DEBARMENT CERTIFICATION

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY

EXCLUSION - - LOWER TIER COVERED TRANSACTIONS

INSTRUCTIONS FOR CERTIFICATION

1) By signing and submitting this application, the prospective recipient of Federal assistance funds is providing the certification as set out below.

2) The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into.

If it is later determined that the prospective recipient of Federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, UConn Health may pursue available remedies, including suspension and/or debarment.

3) The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to whom this application is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4) The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "application," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549.

5) The prospective recipient of Federal assistance funds agrees by submitting this application that, should the proposed covered transactions be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by UConn Health.

6) The prospective recipient of Federal assistance funds further agrees by submitting this application that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determined the eligibility of its principals. Each participant may, but is not required, to check the List of Parties Excluded from procurement or Non-Procurement Programs.

8) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9) Except for transactions authorized under Paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is debarred, suspended, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, UConn Health may pursue available remedies including suspension and/or debarment.

Before signing Certification, read all the instructions which are an integral part of the Certification.

1) The prospective recipient of Federal assistance funds certifies, by submission of this application, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

2) Where the prospective recipient of Federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this application.

Complete Legal Business Name

Name of Authorized Representative Title of Authorized Representative

Signature Date

UCHC RFP-04 Form Rev. 11/15

SECTION 4 of 4: W-9

W-9 FOLLOWS ON THE NEXT PAGE

THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK

Form W-9 (Rev. August 2013) Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

P ri nt o r ty p e

S ee

S p ec ifi c In st ru ct io ns o n p ag e

2.

Name (as shown on your income tax return)

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification:

Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Other (see instructions) ▶

Exemptions (see instructions):

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Requester’s name and address (optional)

List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Social security number

Employer identification number

Part II Certification Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. I am a U.S. citizen or other U.S. person (defined below), and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. The IRS has created a page on IRS.gov for information about Form W-9, at www.irs.gov/w9. Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page.

Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct.

Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S.

person if you are:

• An individual who is a U.S. citizen or U.S. resident alien,

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,

• An estate (other than a foreign estate), or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

Cat. No. 10231X Form W-9 (Rev. 8-2013)

STATE OF CONNECTICUT

COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES

NOTICE CONCERNING CONTRACT COMPLIANCE RESPONSIBILITIES

TO ALL LABOR UNIONS, WORKERS REPRESENTATIVES AND VENDORS:

Any contract this contractor has with the State of Connecticut or political subdivisions of the state, other than municipalities, shall be performed in accordance with CONN. GEN.

STAT. Section 4a-60 and Section 4a-60a.

This means that this contractor:

1. Agrees to provide the Commission on Human Rights and Opportunities (CHRO) with any information concerning this contractor's employment practices and procedures which relates to the Commission's responsibilities under CONN.

GEN. STAT. Sections 4a-60 or 46a-56 or Section 4a-60a.; and

2. Agrees to include the provisions of CONN. GEN. STAT. Section 46a-60(a) and Section 4a-60a in each and every subcontract and purchase order and to take whatever action the CHRO deems necessary to enforce these provisions.

WITH REGARD TO RACE, COLOR, RELIGIOUS CREED, AGE, MARITAL STATUS,

NATIONAL ORIGIN, ANCESTRY, SEX, MENTAL RETARDATION OR PHYSICAL

DISABILITY, this means that this contractor:

1. Shall not discriminate or permit discrimination against anyone;

2. Shall take affirmative action so that persons applying for employment are hired on the basis of job-related qualifications and that employees once hired are treated without regard to their race, color, religious creed, age, marital status, national origin, ancestry, sex, mental retardation or physical disability, unless the contractor can show that the disability prevents performance of the work involved;

3. Shall state in all advertisements for employees that it is an affirmative action-equal opportunity employer;

4. Shall comply with CONN. GEN. STAT. Sections 4a-60, 46a-68e and 46a-68f and with each regulation or relevant order issued by the CHRO under CONN.

GEN. STAT. Sections 46a-56, 46a-68e and 46a-68f; and

5. Shall make, if the contract is a public works contract, good faith efforts to employ minority business enterprises as subcontractors and suppliers of materials.

UCHC RFP-06 Form

WITH REGARD TO SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION:

1. The contractor will not discriminate or permit discrimination against anyone, and employees will be treated without regard to their sexual orientation, gender identity or expression once employed; and

2. The contractor agrees to fully comply with Section 4a-60a and each regulation or relevant order issued by the CHRO under CONN. GEN. STAT. Section 46a- 56.

Persons having questions about this notice or their rights under the law are urged to contact the:

COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES

AFFIRMATNE ACTION AND CONTRACT COMPLIANCE UNIT

25 Sigourney Street Hartford, Connecticut 06106

860-541-4709

COPIES OF THIS NOTICE SHALL BE POSTED IN CONSPICUOUS PLACES

AVAILABLE TO ALL EMPLOYEES AND APPLICANTS FOR EMPLOYMENT

UCHC RFP-06 Form

COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES

CONTRACT COMPLIANCE REGULATIONS

NOTIFICATION TO BIDDERS

(Revised 09/17/07)

The contract to be awarded is subject to contract compliance requirements mandated by Sections 4a-60 and 4a- 60a of the Connecticut General Statutes; and, when the awarding agency is the State, Sections 46a-71(d) and 46a-81i(d) of the Connecticut General Statutes. 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 awarding all contracts covered by Sections 4a-60 and 46a-71(d) of the Connecticut General Statutes.

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 Connecticut General Statutes 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 Connecticut General Statutes as “(1) Black Americans . . .

(2) Hispanic Americans . . . (3) persons who have origins in the Iberian Peninsula . . . (4)Women . . . (5) Asian Pacific Americans and Pacific Islanders; (6) American Indians . . .” An individual with a disability is also a minority business enterprise as provided by Section 4a-60g of the Connecticut General Statutes. The above definitions apply to the contract compliance requirements by virtue of Section 46a-68j-21(11) of the Contract Compliance Regulations.

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 of the Administrative Regulations of Connecticut State Agencies, inclusive;

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

(d) the bidder’s submission of employment statistics contained in the “Employment Information

Form”, indicating that the composition of its workforce is at or near parity when compared to the racial and sexual 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 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 bidders 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 4a-60g 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 nonprofit corporation shall be construed to be a small contractor if such nonprofit corporation meets the requirements of subparagraphs (A) and (B) of subdivision 4a-60g CONN. GEN. STAT.

UCHC RFP-06 Form

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

MANAGEMENT: Managers plan, organize, direct, and control the major functions of an organization through subordinates who are at the managerial or supervisory level. They make policy decisions and set objectives for the company or departments. They are not usually directly involved in production or providing services. Examples include top executives, public relations managers, managers of operations specialties (such as financial, human resources, or purchasing managers), and construction and engineering managers.

BUSINESS AND FINANCIAL OPERATIONS: These occupations include managers and professionals who work with the financial aspects of the business. These occupations include accountants and auditors, purchasing agents, management analysts, labor relations specialists, and budget, credit, and financial analysts.

MARKETING AND SALES: Occupations related to the act or process of buying and selling products and/or services such as sales engineer, retail sales workers and sales representatives including wholesale.

LEGAL OCCUPATIONS: In-House Counsel who is charged with providing legal advice and services in regards to legal issues that may arise during the course of standard business practices. This category also includes assistive legal occupations such as paralegals, legal assistants.

COMPUTER SPECIALISTS: Professionals responsible for the computer operations within a company are grouped in this category. Examples of job titles in this category include computer programmers, software engineers, database administrators, computer scientists, systems analysts, and computer support specialists ARCHITECTURE AND ENGINEERING: Occupations related to architecture, surveying, engineering, and drafting are included in this category. Some of the job titles in this category include electrical and electronic engineers, surveyors, architects, drafters, mechanical engineers, materials engineers, mapping technicians, and civil engineers.

OFFICE AND ADMINISTRATIVE SUPPORT: All clerical-type work is included in this category. These jobs involve the preparing, transcribing, and preserving of written communications and records; collecting accounts;

gathering and distributing information; operating office machines and electronic data processing equipment; and distributing mail. Job titles listed in this category include telephone operators, bill and account collectors, customer service representatives, dispatchers, secretaries and administrative assistants, computer operators and clerks (such as payroll, shipping, stock, mail and file).

BUILDING AND GROUNDS CLEANING AND

MAINTENANCE: This category includes occupations involving landscaping, housekeeping, and janitorial services. Job titles found in this category include supervisors of landscaping or housekeeping, janitors, maids, grounds maintenance workers, and pest control workers.

CONSTRUCTION AND EXTRACTION: This category includes construction trades and related occupations. Job titles found in this category include boilermakers, masons (all types), carpenters, construction laborers, electricians, plumbers (and related trades), roofers, sheet metal workers, elevator installers, hazardous materials removal workers, paperhangers, and painters. Paving, surfacing, and tamping equipment operators; drywall and ceiling tile installers; and carpet, floor and tile installers and finishers are also included in this category. First line supervisors, foremen, and helpers in these trades are also grouped in this category..

INSTALLATION, MAINTENANCE AND REPAIR:

Occupations involving the installation, maintenance, and repair of equipment are included in this group. Examples of job titles found here are heating, ac, and refrigeration mechanics and installers; telecommunication line installers and repairers; heavy vehicle and mobile equipment service technicians and mechanics; small engine mechanics; security and fire alarm systems installers; electric/electronic repair, industrial, utility and transportation equipment; millwrights; riggers; and manufactured building and mobile home installers. First line supervisors, foremen, and helpers for these jobs are also included in the category.

MATERIAL MOVING WORKERS: The job titles included in this group are Crane and tower operators;

dredge, excavating, and lading machine operators; hoist and winch operators; industrial truck and tractor operators; cleaners of vehicles and equipment; laborers and freight, stock, and material movers, hand; machine feeders and offbearers; packers and packagers, hand;

pumping station operators; refuse and recyclable material collectors; and miscellaneous material moving workers.

PRODUCTION WORKERS: The job titles included in this category are chemical production machine setters, operators and tenders; crushing/grinding workers; cutting workers; inspectors, testers sorters, samplers, weighers;

precious stone/metal workers; painting workers;

cementing/gluing machine operators and tenders;

etchers/engravers; molders, shapers and casters except for metal and plastic; and production workers.

UCHC RFP-06 Form

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

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, the Indian subcontinent, or the Pacific Islands. This area includes China, India, Japan, Korea, the Philippine Islands, and 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.

BIDDER CONTRACT COMPLIANCE MONITORING REPORT

PART I - Bidder Information Company Name Street Address City & State Chief Executive

Bidder Federal Employer (LAST 4 DIGITS ONLY) Identification Number_XX-XXX___________________

Or ______Social Security Number_XXX-XX-_________

Major Business Activity (brief description)

Bidder Identification (response optional/definitions on page 1)

-Bidder is a small contractor. Yes__ No__ -Bidder is a minority business enterprise Yes__ No__ (If yes, check ownership category) Black___ Hispanic___ Asian American___ American Indian/Alaskan Native___ Iberian Peninsula___ Individual(s) with a Physical Disability___ Female___

Bidder Parent Company (If any) - Bidder is certified as above by State of CT Yes__ No__

Other Locations in Ct.

(If any)

- DAS Certification Number ____________________________

PART II - Bidder Nondiscrimination Policies and Procedures

1. Does your company have a written Affirmative Action/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 Conn. Gen. Stat.?

Yes__ No__

2. Does your company have the state-mandated sexual harassment prevention 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’s Affirmative Action/Equal Employment Opportunity 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 Affirmative Action/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 Affirmative Action/Equal Employment Opportunity requirements of the apprenticeship standards of the Ct. Dept. of Labor? Yes__ No__ NA__

12. Does your company have a written affirmative action Plan? Yes__ No__ If no, please explain.

6. Does your company have a collective bargaining agreement with workers?

Yes__ No__

6a. If yes, do the collective bargaining agreements contain non-discrim ination clauses covering all workers? Yes__ No__

6b. Have you notified each union in writing of your commitments under the nondiscrimination requirements of contracts with the state of Ct?

Yes__ No__

13. Is there a person in your company who is responsible for equal employment opportunity? Yes__ No__

If yes, give name and phone number.

UCHC RFP-06 Form

Part III - Bidder Subcontracting Practices (Page 4)

1. Will the work of this contract include subcontractors or suppliers? Yes__ No__

1a. If yes, please list all subcontractors and suppliers and report if they are a small contractor and/or a minority business enterprise. (defined on page 1 / use additional sheet if necessary)

1b. Will the work of this contract require additional subcontractors or suppliers other than those identified in 1a. above? Yes__ No__

PART IV - Bidder Employment Information Date:

JOB

CATEGORY *

OVERALL

TOTALS

WHITE

(not of Hispanic origin)

BLACK

(not of Hispanic origin)

HISPANIC

ASIAN or PACIFIC

ISLANDER

AMERICAN INDIAN or

ALASKAN NATIVE

Male Female Male Female Male Female Male Female male female

Management

Business & Financial Ops

Marketing & Sales

Legal Occupations

Computer Specialists

Architecture/Engineering

Office & Admin Support

Bldg/ Grounds Cleaning/Maintenance

Construction & Extraction

Installation , Maintenance & Repair

Material Moving Workers

Production Occupations

TOTALS ABOVE

Total One Year Ago

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

Apprentices

Trainees

*NOTE: JOB CATEGORIES CAN BE CHANGED OR ADDED TO (EX. SALES CAN BE ADDED OR REPLACE A CATEGORY NOT USED IN YOUR COMPANY)

UCHC RFP-06 Form

PART V - Bidder Hiring and Recruitment Practices (Page 5)

1. Which of the following recruitment sources are used by you?

(Check yes or no, and report percent used)

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

(X)

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

Labor Organizations Personal Recommendation

Minority/Community Organizations

Height or Weight

Others (please identify) Car Ownership

Arrest Record

Wage Garnishments

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 misstatements 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)

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Text Box

SEEC FORM 10

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Rev. 1/11

Notice to Executive Branch State Contractors and Prospective State Contractors of Campaign Contribution and Solicitation Limitations

Acknowledgement of Receipt of Explanation of Prohibitions for Incorporation in Contracting and Bidding Documents

This notice is provided under the authority of Connecticut General Statutes §9-612(g)(2), as amended by P.A. 10-1, and is for the purpose of informing state contractors and prospective state contractors of the following law (italicized words are defined on the reverse side of this page).

CAMPAIGN CONTRIBUTION AND SOLICITATION LIMITATIONS

No state contractor, prospective state contractor, principal of a state contractor or principal of a prospective state contractor, with regard to a state contract or state contract solicitation with or from a state agency in the executive branch or a quasi-public agency or a holder, or principal of a holder of a valid prequalification certificate, shall make a contribution to (i) an exploratory committee or candidate committee established by a candidate for nomination or election to the office of Governor, Lieutenant Governor, Attorney General, State Comptroller, Secretary of the State or State Treasurer, (ii) a political committee authorized to make contributions or expenditures to or for the benefit of such candidates, or (iii) a party committee (which includes town committees).

In addition, no holder or principal of a holder of a valid prequalification certificate, shall make a contribution to (i) an exploratory committee or candidate committee established by a candidate for nomination or election to the office of State senator or State representative, (ii) a political committee authorized to make contributions or expenditures to or for the benefit of such candidates, or (iii) a party committee.

On and after January 1, 2011, no state contractor, prospective state contractor, principal of a state contractor or principal of a prospective state contractor, with regard to a state contract or state contract solicitation with or from a state agency in the executive branch or a quasi-public agency or a holder, or principal of a holder of a valid prequalification certificate, shall knowingly solicit contributions from the state contractor's or prospective state contractor's employees or from a subcontractor or principals of the subcontractor on behalf of (i) an exploratory committee or candidate committee established by a candidate for nomination or election to the office of Governor, Lieutenant Governor, Attorney General, State Comptroller, Secretary of the State or State Treasurer, (ii) a political committee authorized to make contributions or expenditures to or for the benefit of such candidates, or (iii) a party committee.

State contractors and prospective state contractors are required to inform their principals of the above prohibitions, as applicable, and the possible penalties and other…