The Connecticut General Assembly
Joint Committee on Legislative Management
Martin M. Looney
Senate President Pro Tempore
J. Brendan Sharkey
Speaker of the House
Bob Duff, Senate Majority Leader
Leonard Fasano, Senate Minority Leader
Joe Aresimowicz, House Majority Leader
Themis Klarides, House Republican Leader
James P. Tracy
Executive Director
REQUEST FOR PROPOSAL:
BUILDING AUTOMATION EQUIPMENT INSPECTION AND MAINTENANCE
CONTRACT #:
JCLM16REG0007
RFP ISSUANCE DATE:
July 29, 2015
PROPOSAL DUE DATE:
August 28, 2015
Attention 
TIME:
12:00 pm (noon)
A non-mandatory meeting and walk-through meeting will be held on August 11, 2015 in Public Hearing Room
1B at the Legislative Office Building at 10 a.m.
Suite 5100 * Legislative Office Building * Hartford, CT 06106-1591 * (860) 240-0100 * fax (860) 240-0122 * jclm@cga.ct.gov
TABLE OF CONTENTS
PART A CONTRACT INFORMATION ...................................................................................................................................................1
A.1 Executive Summary ................................................................................................................................................................1
A.2 Official Agency Contact Information .................................................................................................................................1
A.3 Term of Contract ....................................................................................................................................................................1
A.4 Terms and Conditions ............................................................................................................................................................1
A.5 Work Schedules ......................................................................................................................................................................1
A.6 Awarded Vendor’s Storage Space ....................................................................................................................................1
A.7 Protection/Safety Measures .................................................................................................................................................1
A.8 Removal and Salvage of Material ......................................................................................................................................2
A.9 Use of Premises........................................................................................................................................................................2
PART B SCOPE OF WORK ....................................................................................................................................................................2
B.1 Project Scope ..........................................................................................................................................................................2
B.2 Prevailing Wage Project ........................................................................................................................................................4
B.3 Procurement Schedule ..........................................................................................................................................................4
PART C PAYMENT TERMS ....................................................................................................................................................................5
C.1 Compensation Amount ........................................................................................................................................................5
C.2 Invoice Guidelines..................................................................................................................................................................5
C.3 Certified Payrolls .....................................................................................................................................................................6
PART D PROPOSAL REQUIREMENTS ...................................................................................................................................................6
D.1 Response Documentation Required ..................................................................................................................................6
D.2 Documentation Required Subsequent to Contract Award ...........................................................................................8
D.3 Documentation Upon Substantial Completion of Project ..............................................................................................9
PART E EVALUATION OF PROPOSALS................................................................................................................................................9
E.1 Mandatory Requirements ......................................................................................................................................................9
E.2 Qualitative Elements ...............................................................................................................................................................9
E.3 Price Comparison Methodology ........................................................................................................................................10
E.4 Presentations ..........................................................................................................................................................................10
E.5 Contract Award ....................................................................................................................................................................10
ATTACHMENTS
Attachment A
Attachment B
Attachment C
Attachment D
Attachment E
Attachment F
Attachment G
Attachment H
Attachment I
Attachment J
Attachment K
Attachment L
Attachment M
Attachment N
Pricing Page
Proof of Authorization Form
Certification Form
Gift and Campaign Contribution Ban Acknowledgement Form
Proposal Checklist
CHRO Notification Bidder / Contract Compliance Monitoring Report
Vendor Profile Form
W-9 Form
Prevailing Wage Rate Schedule
Certified Payrolls Form
Insurance Certificate
Nondiscrimination Certification
CGA Terms and Conditions
Completed Component Checklist and Covered Equipment List
PART A CONTRACT INFORMATION
A.1 Executive Summary
The Connecticut General Assembly (CGA) is the legislative branch of government of the State of Connecticut. Through
statutory enactments, the Joint Committee on Legislative Management is responsible for the coordination and
management of legislative affairs and the supervision and approval of any and all legislative expenditures.
The Joint Committee on Legislative Management (JCLM) is comprised of the top legislative leaders from each political
party and works through a subcommittee system. The Personnel Policies Subcommittee is comprised of the President Pro
Tempore of the Senate, the Speaker of the House of Representatives, and the Majority and Minority Leaders of each
chamber. The Subcommittee is responsible for establishing legislative personnel policies, guidelines, regulations, and salary
schedules, and also approves legislative expenditures exceeding $50,000.
The JCLM on behalf of the CGA is seeking an experienced and certified contractor capable of furnishing all labor,
materials, and equipment to perform inspection of the Andover BMS (building management system) at the State Capitol
and the Legislative Office Building located at 210 and 300 Capitol Avenue, Hartford, Connecticut, respectively, and the
Johnson Controls INET7 BMS located at the Old State House at 800 Main Street, Hartford, Connecticut for a five year period.
The CGA reserves the right to make a split award of the contract between the Andover and the Johnson Controls BMS.
A.2 Official Agency Contact Information
Mail:
Attention: Liz Ferruggiaro
CGA Contracting Group
Office of Legislative Management
Legislative Office Building; Room 5100
300 Capitol Avenue
Hartford, CT 06106
Email:
CGAContracting@cga.ct.gov
Telephone:
(860) 240 – 0100
Fax: (860) 240 – 0122
A.3 Term of Contract
The term of the Contract resulting from this RFP shall commence upon contract execution and end upon September 30,
2020, with the option to extend this Contract up to an additional one year upon mutual agreement of both parties.
A.4 Terms and Conditions
The terms and conditions that apply to this RFP and resulting Contract are included in Attachment M.
A.5 Work Schedules
The work schedule shall be cleared with the State Capitol Police and the CGA in advance of work in any given location.
Public business hours of the State Capitol are from 8:00 a.m. to 5:00 p.m., Monday through Friday, holidays excluded.
Overtime will not be billed during public business hours.
A.6 Awarded Vendor’s Storage Space
(a)
A limited area will be designated in the Capitol where the awarded Respondent may store items for reuse, stage
materials, etc.
(b)
Due to limited on-site storage availability, the awarded Respondent shall confine his on-site storage to the area
designated by the CGA.
(c)
The awarded Respondent is responsible for restoring the designated on-site storage area to its original condition.
A.7 Protection/Safety Measures
(a)
Caution shall be exercised by the awarded Respondent at all times for the protection of persons and property, and
all safety regulations and other provisions of applicable Federal, State and local laws must be observed. Building
and construction codes, including the requirements of the Occupational Safety and Health Administration, shall be
observed.
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(b)
The awarded Respondent shall be responsible for the adequacy and safety of all construction methods and the
safe prosecution of the work. The awarded Respondent shall assume full and complete responsibility for safe
prosecution of the work at all times, and for obtaining satisfactory results.
(c)
If any operation, practice, or condition is deemed by the CGA’s design consultant or the designated
representative of the CGA to be unsafe during the course of the performance of the work, the awarded
Respondent, when notified verbally and later confirmed in writing, shall take such corrective action immediately as
appropriate.
(d)
Any debris or dust that collects on the ground that poses a tripping and /or slipping hazard shall be removed
immediately.
(e)
The awarded Respondent shall pay the cost of repair or replacement resulting from theft or damage to existing
equipment, material or work due to negligence by the awarded Respondent in securing the project site and
adjacent areas affected by the awarded Respondent’s operations.
A.8 Removal and Salvage of Material
The CGA has the right of salvage to any demolished material and equipment. For material or equipment to be removed,
the Contractor is to confirm with the CGA whether or not the CGA desires to keep the respective piece of material or
equipment. Material or equipment desired by the CGA shall be moved by the Contractor to a designated site in building or
on the grounds. Any material or equipment not desired by the CGA shall become the property of the Contractor and
removed/disposed of by the awarded Respondent at his expense.
A.9 Use of Premises
(a)
The premises will be occupied during the performance of work; therefore, it will be necessary to provide CGA with
a schedule in advance when work will take place so that arrangements may be made for safe ingress and egress
by building personnel, parking of vehicles, directing of traffic, delivery of goods, mail, etc. The work shall not
interfere with normal, continuous, and safe operation of the building and site.
(b)
Nothing contained in the specifications shall be interpreted as giving the Contractor exclusive use of the premises.
PART B SCOPE OF WORK
B.1 Project Scope
The awarded Respondent shall conduct annual building automation equipment inspections on the Andover BMS located
at the State Capitol and the Legislative Office Building and the Johnson Controls and INET7 BMS located at the Old State
House between July 1 and September 30 of each contract year for all equipment listed in Attachment N.
B.1.1 Annual Inspection
The awarded Respondent shall perform the following tasks during each inspection, including but not limited to:
(a) Perform inspections during normal working hours from 8:00 a.m. to 5:00 p.m., Monday through Friday
between July 1 and September 30 of each year, excluding Connecticut State Holidays;
(b) Provide a minimum of two technicians on site for the annual inspections. Assign one programmer to control
each piece of equipment being inspected at the BMS front end computer and one technician in the field
to verify the operation of all equipment listed in attachment N;
(c) Submit “Completed Component Checklist” after each annual inspection reflecting all required repairs and
replacements under this Contract and the corresponding warranty information. This completed checklist
shall be submitted within 10 business days of the completed annual inspection. The awarded Respondent
may utilize the form provided in Attachment N or a similar document that includes, at a minimum, the
same information contained in Attachment N. This document shall also be maintained on an on-going
basis to reflect all changes made to the BMS systems;
(d) Maintain a Vendor Log at the CGA’s building maintenance contractor’s office. This Vendor Log shall
include sign-in sheets logging when the vendor is on site as well as work tickets for every site visit and
warranty information for all equipment included in the BMS;
(e) Prepare back-up copies of the system database on a monthly basis and as major revisions are made;
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(f) Check and correct software operating instructions in all components of the system, update the operating
software to the current version (software upgrading costs must be included in the annual inspection fee),
correct all faults and alarms in the system, incorporate instructions for newly added HVAC components or
for changed operating parameters and routines;
(g) Conduct a complete diagnosis of any component suspected to have failed operation through the front
end in the field at no additional cost. Proposals to correct any major deficiencies found after diagnostics
are completed must be submitted within 15 calendar days following the inspection of that component to
the designated representative of the Office of Legislative Management;
(h) Inspect each air handling unit, including all connected VAV's, to allow an overview of the integrated
operation of each system, rather than separate components. A complete list of VAVs are shown in
Attachment N;
(i)
Test and calibrate, as part of the annual inspection, the following sensors and actuators including, but not
limited to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Outside air temperature
Mixed air temperature
Return air temperature
Discharge or supply air temperature
Coil face discharge air temperatures
Chilled water supply temperature
Condenser entering water temperature
Heating water supply temperature
Wet bulb temperature or relative humidity (RH) sensors
Space temperature sensors
Economizer and related dampers
Cooling and heating coil valves
Static pressure transmitters
Air and water flow rates
Terminal unit dampers and flows
B.1.2 Establish and Maintain Technician Training
The awarded Respondent shall:
(a) Provide trained technicians directly employed or supervised by awarded Respondent to perform all work
under this Contract;
(b) Provide proof of current training certificate(s) from an applicable equipment manufacturer’s certified
training course(s) for all technician(s)/programmer(s). This shall be documented in writing and submitted to
the CGA on an annual basis;
(c) Provision of proof that technicians possess all hardware and software tools and licenses/certificates
needed to access, maintain and repair the BMS components. This shall be documented in writing and
submitted to the CGA on an annual basis;
B.1.3 Technical and Programming Services
The awarded Respondent shall:
(a) Submit quotations for technical and programming services to correct any deficiencies found as part of the
annual inspection. Quotations shall be broken down to detail the work on a not-to-exceed hourly time and
material basis. This work can only be performed by the awarded Respondent if so authorized by the Office
of Legislative Management with a signed purchase order.
(b) Provide the name and cell phone number of a contact who can be reached 24 hours a day for
emergencies.
(c) Provide owner-authorized emergency repair or reprogramming response. The awarded Respondent shall
provide response by phone within 30 minutes of being called in case of emergency repair, and shall
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respond on site within 4 hours of being called in case of emergency repair. The CGA reserves the sole right
to determine if a repair or reprogramming request is an emergency. Mileage and travel time are not
billable.
The CGA reserves the right to have the on-site mechanics employed by the CGA’s building maintenance
contractor perform the installation of replacement controllers, sensors, etc. The awarded Respondent would
perform the required programming changes.
B.1.4 Billable off-site telephone support, minor programming changes and reloading the system database.
The awarded Respondent shall submit Quotations for all billable off-site telephone support, minor programming
changes and reloading of the system database. Quotations must be broken down to detail the work on a not-toexceed hourly time and material basis. This work can only be performed by the awarded Respondent if so
authorized by the Office of Legislative Management with a signed purchase order.
B.1.5 Andover Continuum Computer Hardware Upgrade, Software Upgrades and Training
The awarded Respondent shall provide ongoing upgrades and maintain functionality to the Andover and web
access software for the duration of the Contract. Software upgrades shall be performed annually (or as required)
prior to performance of the annual inspections. Software upgrades shall be performed no less than 60 days after
the upgrade has been released by Andover.
B.1.6 Johnson Controls and INET7 BMS Software Upgrades and Training
The awarded Respondent shall provide ongoing upgrades to the Johnson Controls and INET7 BMS software for the
duration of the Contract. Software upgrades must be performed annually (or as required) prior to performance of
the annual inspections. Software upgrades must be performed no less than 60 days after the upgrade has been
released by Johnson Controls.
B.1.7 Replacement Parts
(a) The CGA will provide the awarded Respondent with a list of “shelf stock” items to be maintained on site
with minimum and maximum quantities. The initial order for some items will exceed the maximum quantities
based on known defective devices.
(b) All quotations submitted for replacement items must include the costs for new and reconditioned devices.
(c) All outside of warrantee defective devices replaced remain the property of the CGA and must be returned
to a designated representative of the Office of Legislative Management.
(d) At the request of the CGA or its designated representative, defective devices must be returned to the
manufacturer for diagnosis and refurbishment. Upon request the awarded Respondent shall provide a
quotation for the diagnosis costs. The manufacturer shall provide a report on the condition and
refurbishment cost of each device. Devices are only to be refurbished upon written approval of the CGA
and receipt of a signed purchase order.
B.2 Prevailing Wage Project
This is considered a Prevailing wage project. All Proposals shall incorporate the Prevailing wage rates as indicated on the
attached wage schedule. (Attachment I)
B.3 Procurement Schedule
This Request for Proposal (RFP) is posted on the portal website which can be found at the following address:
http://www.biznet.ct.gov/scp_search/BidResults.aspx?groupid=128.
B.3.1 Issue the RFP
The RFP will be issued by July 29, 2015.
B.3.2 Meeting and Walk-Through
A non-mandatory meeting and walk-through for Respondents will be held on August 11, 2015 in Public Hearing Room
1B at the Legislative Office Building at 10 a.m.
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B.3.3 Deadline for Questions
All questions must be submitted in writing by August 13, 2015 at 5 p.m. These submissions must be sent via email to
CGAContracting@cga.ct.gov or addressed to the attention of CGA Contracting Group at the Office of Legislative
Management; Legislative Office Building; 300 Capitol Avenue; Room 5100, Hartford, CT 06106-1591;
B.3.4 Amendments to Request for Proposal
All amendments to the RFP and response to written questions will be published no later than 5:00 pm on August 18,
2015.
B.3.5 Proposal Delivery
All sealed Proposals must be delivered by 12 p.m. on August 28, 2015 to the CGA Contracting Group at the Office of
Legislative Management; Legislative Office Building; 300 Capitol Avenue; Room 5100, Hartford, CT 06106-1591;
Prior to submitting a Proposal, each Respondent shall examine the RFP and may visit the site of the work. Each
Respondent shall fully inform himself prior to submitting the Proposal as to the existing conditions and limitations under
which the work is to be performed, and shall included in his Proposal a sum to cover the cost of items necessary to
perform the work as set forth in this RFP. No allowance will be made to a Respondent because of lack of such
examination or knowledge. The submission of a Proposal will be considered conclusive evidence that the Respondent
has made such an examination.
B.3.6 Presentations
Respondents submitting Proposals may be contacted for a time to make a presentation, provide an overview of their
written Proposal, answer questions and/or provide clarifications.
B.3.7 Contract Award and Process
All Respondents will be notified of the Contract award once approved by Legislative Leaders.
PART C PAYMENT TERMS
C.1 Compensation Amount
Proposals shall reflect all costs and any payment discounts on the Pricing Page included in this RFP. (Attachment A)
Payments shall be made by the CGA in arrears within (45) forty-five days of receipt of a properly prepared invoice. A
properly prepared invoice is defined as a billing that is dated subsequent to the date the good or services have been
received.
The inspection fees and hourly labor rates listed on the Pricing Page on Attachment A, will be adjusted annually on the
contract anniversary date each year in direct proportion to the percent change in the U.S. Consumer Price Index - Urban
Wage Earners and Clerical Workers for the Northeast Region at the time of the adjustment and the previous year. The CPI is
found at www.bls.gov. The following calculation will be used for this annual adjustment. The numbers below are used as an
example
CPI for current period
Less CPI for previous (1 year) period
Equals index point change
Divided by previous period CPI
Equals
Result multiplied by 100
Equals percent change
136.0
129.9
6.1
129.9
0.047
0.047 x 100
4.7
In the event that the CPI percentage change is negative, no adjustment will be made to the inspection fees and hourly
labor rates listed on the Pricing Page on Attachment D. In the event that the CPI percentage change is greater than 5%,
the adjustment made to the inspection fees and hourly labor rates listed on the Pricing Page on Attachment A will be
capped at 5%.
C.2 Invoice Guidelines
(a)
A properly prepared invoice shall include: the purchase order number, an invoice date, invoice number, separate
invoice line for labor and materials, a description of the service provided and the services dates. All invoices shall
reflect the lines on the signed purchase order.
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(b)
The CGA reserves the right to reject invoices for payment if they are not considered properly prepared as defined
above. Any early payment discount will be taken from the date of a receipt of a properly prepared invoice and all
required supporting documentation.
(c)
Charges for annual inspections of the Legislative Office Building, State Capitol and Old State House buildings’
automation systems shall be billed on an annual basis. These charges should be supported as follows:
1) Copies of certified payrolls including Classification of worker, as well as wage and benefit rate;
2) Copies of work tickets (the number of hours and days worked should match those on the certified payrolls and
the invoice) approved and signed by the CGA’s building maintenance contractor;
3) “Completed Component Checklist” submitted after each annual inspection for all equipment;
4) No reimbursements shall be made for travel unless specifically stated in your Contract;
(d)
Charges for hourly labor shall be billed on a monthly basis. These charges shall be supported as follows:
1) Copies of certified payrolls including Classification of worker, as well as wage and benefit rate;
2) Copies of work tickets (the number of hours and days worked should match those on the certified payrolls and
the invoice) approved and signed-off by the CGA’s building maintenance contractor. Work tickets shall
indicate the type of service performed, i.e. “Technical” or “Programming”; and
3) Description of work and service dates.
4) Programming and off-site telephone support, minor programming changes and reloading the system database
shall be billed in 15 minute increments with no minimum charge.
5) Technical services shall be billed at the hourly rate specified in the proposal with no more than a two hour
minimum charge.
6) No reimbursements shall be made for travel.
(e)
All charges on invoices for material charges shall be broken down between list price and percent discount. Support
shall accompany the invoice establishing the list price. All material invoices shall include assigned purchase order
number on the invoice. No work shall be completed without issuance of a signed purchase order.
C.3 Certified Payrolls
All invoices for prevailing wage projects shall be submitted along with the attached completed Certified Payroll Form and
Contractor Wage Certification Forms. (Attachment J) Invoices will not be paid until complete and accurate certified payroll
forms are received. These forms can also be found at the following links:
(a)
Certified payroll Form: http://www.ctdol.state.ct.us/wgwkstnd/forms/payrollcert1.pdf
(b)
Contractor Wage Certification Form: http://www.ctdol.state.ct.us/wgwkstnd/forms/contractwage.pdf
PART D PROPOSAL REQUIREMENTS
D.1 Response Documentation Required
Respondents shall submit the following documentation. The CGA reserves the right to disqualify any Proposal which does
not include the following documentation. Please note only written Proposals will be accepted.
D.1.1 Administrative Documentation
(a)
Copies: Submit 4 copies of the Proposal;
(b)
Mailing Address: Proposals shall be mailed in a sealed envelope to the following address:
Contracting Group
Office of Legislative Management
Legislative Office Building, Room 5100
300 Capitol Avenue
Hartford, Connecticut 06106
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(c)
Labeled Proposals: The Proposals shall be mailed to the address above in a sealed envelope with the
following label attached to the outside of the envelope;
SEALED PROPOSAL TITLE - REQUEST FOR
PROPOSAL
BUILDING AUTOMATION EQUIPMENT INSPECTION AND
MAINTENANCE
CONTRACT ID:
JCLM16REG0007
DEADLINE FOR RECEIPT:
August 28, 2015 at 12 p.m. (noon)
CONTACT NAME:
Liz Ferruggiaro
(d)
Respondent Experience and Knowledge: Proposal shall include:
1. Description of the Respondent including: Size of firm (number of employees); Resources; Years in
business; Location; Current arrangements with Subcontractors;
2. Reference Projects including the following: Name, title, address and telephone number of
reference; Overview of the project; Length of the project; Total fees associated with the project;
(e)
Individual Experience and Knowledge: Proposal shall include the following in regards to the personnel
assigned to complete the work described in this RFP:
i. A list of specific personnel assigned to the project;
ii. Evidence of five years of experience with projects similar to that described in this RFP;
iii. Similar reference projects for each such individual including: Name, title, address and telephone
number of reference; Overview of the project; Length of the project; Total fees associated with the
project.
iv. A listing of training, for each technician assigned to the account, including courses completed
(name and completion date). The training listed must document the competency of each
technician to inspect, operate and service the BMS;
v. Certification of completion of training on Andover BMS and equipment for the Legislative Office
Building and State Capitol;
vi. Certification of completion of training on Johnson Control BMS and equipment for the Old State
House
(f)
Subcontractor Experience and Knowledge: Subcontractors must be acceptable to the CGA and be
approved in writing by representatives of the JCLM prior to the Subcontractor starting any work on this
project. The Respondent is required to assume responsibility for all services offered in its Proposal. The
Respondent shall be the sole point of contact with regards to all matters, including Subcontractor
performance. The Proposal must include:
i. A complete list of Subcontractors to be used, including a brief description of the services to be
provided by each Subcontractor;
ii. The Subcontractor’s experience with projects similar to that described in this RFP;
iii. Subcontractor references including the following: Name, title, address and telephone number of
reference; Overview of the project; Length of the project; Total fees associated with the project;
iv. Description of the Subcontracting company, including: Size of firm (number of employees);
Resources; Years in business; Location; Current arrangements with Subcontractors;
(g)
Pricing Page: This completed form shall be included in all Proposals; (Attachment A)
(h)
Proof of Authorization: Proposals shall include a completed proof of authorization form; (Attachment B).
(i)
Certification Form: This completed form shall be included in all Proposals; (Attachment C)
(j)
Gift and Campaign Contribution Ban Acknowledgement Form (CCBA): Proposals shall include this
completed from in their Proposal pursuant to Public Act 07-1 and Conn. Gen. Stat. Sec. 4-252. (Attachment
D). Please refer to the Terms and Conditions for more information;
(k)
Proposal Checklist: This completed form shall be included in all Proposals; (Attachment E)
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(l)
CHRO Notification to Bidders/Contract Compliance Monitoring Report: This completed form shall be
included in all Proposals (Attachment F);
(m)
Vendor profile: This completed form shall be included in all Proposals; (Attachment G)
(n)
W-9 form: This completed form shall be included in all Proposals; (Attachment H)
D.1.2 Technical Documentation
(a)
Tentative “Inspection Schedule”: Proposals shall include a tentative inspection for the entire Contract term,
between October 1, 2015 and September 30, 2020. The final inspection schedule will be mutually agreed
upon by the awarded Respondent and the CGA representative. This plan must not hinder the normal
operation and use of the Capitol;
(b)
Draft “Completed Component Checklist”: The proposed “Completed Component Checklist” shall be
submitted as part of the Respondent’s proposal. This draft can either take the form of Attachment N, or
include at a minimum the information in Attachment N. The final “Completed Component Checklist” will
be mutually agreed upon by the awarded Respondent and the CGA representative.
D.2 Documentation Required Subsequent to Contract Award
The following shall be provided subsequent to the Contract award.
(a)
Final “Inspection Schedule”: The final “Inspection Schedule” shall be submitted one month after contract award
and the issuance of a signed purchase order. The final “Inspection Schedule” shall be mutually agreed upon by
awarded responder and the CGA representative;
(b)
Final “Completed Component Checklist”: The final “Completed Component Checklist” shall be submitted one
month after contract award and the issuance of a signed purchase order. The final “Completed Component
Checklist” shall be mutually agreed upon by the awarded Respondent and the CGA representative;
(c)
Insurance Certificate: Please see minimum required levels listed in this RFP. The awarded Respondent must name
the State of CT/CT General Assembly as an additional insured; (Attachment K)
(d)
Performance Bond: A performance bond in the amount of $150,000. The awarded Respondent shall furnish a
performance bond for the protection of the CGA in accordance with Section 49-41(b) of the Connecticut General
Statutes in the amount of $150,000 within fifteen (15) days of notification of award and prior to the execution of the
Contract;
(e)
Labor and Materials Bond: The chosen Contractor shall furnish a labor and materials bond for the protection of the
CGA in accordance with Section 49-41(a) of the Connecticut General Statutes in the amount of $150,000 within
fifteen (15) days of notification of award and prior to the execution of the Contract;
(f)
Certified Payrolls: Wage rate schedules applicable to this project are included with this document. Upon Contract
award, the chosen Contractor will be required to complete and submit a “Contractor’s Wage Certification Form”
to the Department of Labor as well as submit copies of certified payrolls with their invoices to the CGA during the
term of this project;
(g)
Nondiscrimination Certification: Public Act 11-55 and Public Act 11-229 have amended the nondiscrimination
provisions of the Connecticut General Statutes to add gender identity or expression to the existing protected
classes and to require State contractors to adopt policies in support of the new statutes by means of an affidavit or
resolution. Accordingly, this form is a certification that the successful Contractor must deliver executed at the time
that it executes the Contract. The execution and submittal of this certificate is a condition precedent to the CGA’s
executing the Contract, unless the Contractor is exempt from this statutory requirement, in which case the
Contractor must obtain a written waiver from the State’s Commission on Human Rights and Opportunities;
(Attachment L)
Please refer to the following guidelines when completing the Nondiscrimination Certification:
•
Form A. Representation: For use by an individual when entering into any Contract, regardless of Contract
value.
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•
•
•
•
Form B. Representation: For use by an entity when entering into any Contract valued at less than $50,000 for
any year of the Contract.
Form C. Affidavit: For use by an entity when entering into any Contract valued at $50,000 or more for any year
of the Contract and the entity certifies through an affidavit that a complying nondiscrimination policy
is currently in place.
Form D. New Resolution: For use by a entity when entering into any Contract valued at $50,000 or more for any
year of the Contract and the entity has a complying nondiscrimination policy adopted by a new resolution of
the board of directors, shareholders, managers, members, or other governing body.
Form E. Prior Resolution: For use by a entity when entering into any Contract valued at $50,000 or more for any
year of the Contract and the entity has a complying nondiscrimination policy adopted by a prior resolution of
the board of directors, shareholders, managers, members, or other governing body.
D.3 Documentation Upon Substantial Completion of Project
Upon project completion and prior to payment of retainage, the Contractor shall provide the following:
(a)
Substantial Completion Letter: Letter stating the substantial completion date of the work outlined in this RFP.
(b)
Materials and workmanship warranty documentation: Respondent shall guarantee all materials and workmanship
under the specifications and the Contract for a period of one (1) year from the date of final acceptance by owner.
During this guarantee period, all defects developing through faulty equipment, materials or workmanship shall be
corrected or replaced immediately by Respondent without expense to the CGA. Such repairs or replacements
shall be made to the CGA representative’s satisfaction.
(c)
Manufacturer’s warranty documentation: Respondent shall provide a manufacturer which shall guarantee the
product for one year, or the length of the manufacturer’s warranty, whichever is greater, against ordinary wear and
tear, or deficiencies in any or all of the component materials of the product, or workmanship deficiencies in the
installation of the product. This warranty shall include serial number and date of installation and shall be kept in the
warranty log provided by the awarded vendor in the CGA’s building maintenance contractor’s office at the
Capitol and another log solely for the Old State House shall be kept at a designated office at the Old State House.
PART E EVALUATION OF PROPOSALS
E.1 Mandatory Requirements
CGA will determine if all Proposals are complete submissions. The CGA has the sole discretion to decide if Proposals are
nonresponsive to this RFP.
E.2 Qualitative Elements
Once it is determined that the Proposal(s) are complete submissions, the Proposal will be given to the Evaluation Committee
for review. The following factors will be scored by the Evaluation Committee. Each factor will be scored using a scale of 1
through 5. The individual ratings for each member of the Evaluation Committee will be combined and averaged and then
multiplied by pre-set criteria weights. The CGA reserves the right to make a split award of the contract between the
Andover and the Johnson Controls BMS.
1
Evaluation Criteria
Price
2
Demonstrated ability to accomplish the work described in the Scope of Work section of this RFP.
3
Applicable professional experience and references of business entity (including past performance onsite, if
applicable)
4
Applicable professional experience and references of individuals
TOTAL
9
E.3 Price Comparison Methodology
The following methodology will be utilized for price comparison purposes; the numbers provided below are estimates only.
Actual hours will be determined during the course of this Contract.
For the LOB and Capitol system:
(a) Annual inspections of
LOB and Capitol
(b) Andover BMS Annual Software
Maintenance
(c) Material Cost
(% discount off List Price)
(d) ST Hourly Technical Services
(e) OT Hourly Technical Services
(f) ST Hourly Programming Services
(g) OT Hourly Programming Services
(h) ST Hourly Off-Site telephone,
Minor programming changes,
& reloading of the system
(i) OT Hourly Off-Site telephone,
Minor programming changes,
& reloading of the system
(j) ST Mechanical Helper Labor
(k) OT Mechanical Helper Labor
(l) Off-site Labor
$________/ea X 5 inspections
= $_________
$________/yr X 5 years
= $_________
(1- ______%) X $50,000 material cost
$________/hr X 600 hours
$________/hr X 10 hours
$________/hr X 275 hours
$________/hr X 10 hours
= $_________
= $_________
= $_________
= $_________
= $_________
$_________/hr X 5 hours
= $_________
$_________/hr X 5 hours
$_________/hr X 40 hours
$_________/hr X 5 hours
$_________/hr X 15 hours
= $_________
= $_________
= $_________
= $_________
TOTAL LOB & CAPITOL SYSTEM
= $_________
For the Old State House (OSH) system:
(a) Annual inspections of
Old State House:
(b) Johnson Controls INET7 Annual
Software Maintenance:
(c) Material Cost
(% discount off List Price):
(d) ST Hourly Technical Services
(e) OT Hourly Technical Services
(f) ST Hourly Programming Services
(g) OT Hourly Programming Services
(h) ST Hourly Off-Site telephone,
Minor programming changes,
& reloading of the system
(i) OT Hourly Off-Site telephone,
Minor programming changes,
& reloading of the system
(j) ST Mechanical Helper Labor
(k) OT Mechanical Helper Labor
(l) Off-site Labor
$________/ea X 5 inspections
= $_________
$________/yr x 5 years
= $_________
(1- ______%) X $25,000 material cost
$________/hr X 150 hours
$________/hr X 5 hours
$________/hr X 75 hours
$________/hr X 5 hours
= $_________
= $_________
= $_________
= $_________
= $_________
$_________/hr X 5 hours
= $_________
$_________/hr X 5 hours
$_________/hr X 5 hours
$_________/hr X 5 hours
$_________/hr X 15 hours
= $_________
= $_________
= $_________
= $_________
TOTAL OSH SYSTEM
= $_________
E.4 Presentations
After review of the Proposals by the evaluation committee, the CGA may schedule times for some or all Respondents to
make presentations. During these presentations, the Respondent(s) may be asked to provide an overview of their written
Proposal, answer questions and/or provide clarifications.
E.5 Contract Award
The CGA will send letters indicating the Proposal selected for Contract award.
10
ATTACHMENT A
PRICING PAGE
Building Automation Inspection &
Maintenance Services
JCLM16REG0007
Annual Inspections & Software Maintenance
Annual inspection of the Legislative Office
Building and State Capitol Building full
automation system:
Annual inspection of the Old State House full
automation system:
Andover BMS Annual Software Maintenance:
Johnson Controls and INET7 BMS Annual
Software Maintenance:
Hourly Rates
Hourly Technical Services:
The Connecticut General Assembly
Joint Committee on Legislative Management
Legislative Office Building : Rm 5100
Hartford, CT 06106
(860) 240 – 0100
FAX: (860) 240 – 0122
$__________________/ inspection
$__________________/ inspection
$___________________________/year
$___________________________/year
Straight Time
$_______________ /Hour
Overtime
$_______________ /Hour
Hourly Programming Services:
$_______________ /Hour
$_______________ /Hour
Hourly off-site telephone support, minor
programming changes and reloading the
system database:
Hourly Mechanical Helper Labor
Hourly Off-Site Labor
Materials
Percent Discount off List Price
$_______________ /Hour
$_______________ /Hour
$_______________ /Hour
$_______________ /Hour
$_______________ /Hour
________________%
Standard payment terms are net 45 days. Please indicate any early payment discount terms that would be applicable to
this project: __________________% Discount, _______________ Days.
The undersigned agrees to furnish all services and/or commodities to the CT General Assembly as described in Contract at
the prices listed above.
Company:
Address:
Signature:
Date:
Name (Printed):
Title:
Email:
FEIN#:
Phone #:
Fax #:
1
ATTACHMENT B
PROOF OF AUTHORIZATION
Building Automation Inspection &
Maintenance Services
JCLM16REG0007
The Connecticut General Assembly
Joint Committee on Legislative Management
Legislative Office Building : Rm 5100
Hartford, CT 06106
(860) 240 – 0100
FAX: (860) 240 – 0122
Proposals shall provide a completed Proof of Authorization. If the Contractor is a Corporation the first form
included with this Attachment should be completed and submitted with the Proposal. If the Contractor is a Limited
Liability Corporation (LLC) the second form included with this Attachment should be completed and submitted
with the Proposal.
SECRETARY’S CERTIFICATE
The undersigned, _________________________, Secretary of _________________________, [COMPANY NAME] a ____________________
[STATE] corporation, (the “Corporation”), does hereby certify that the following are true and complete resolutions which were
_________________________________________ [NOTE: CHOOSE EITHER (1) unanimously adopted, or (2) adopted by quorum] at a duly
called and held meeting of the Board of Directors of ______________________ [COMPANY NAME] on the _________ day of
__________________, 20___, and that such resolutions have not been amended or modified and that they continue to be in full
force and effect as of this date:
RESOLVED, that the Corporation may execute and deliver any and all contracts or Statements of Work which
it deems to be necessary or appropriate to carry out its business; and
FURTHER RESOLVED, that _______________________________ [NAME OF OFFICER], as
_____________________________ [TITLE OF OFFICE] of the Corporation, is authorized and directed to execute
and deliver any and all contracts and Statements of Work on behalf of the Corporation
________________________________________________________________
[INSERT HERE LIMITATIONS, IF ANY, ON THE AUTHORITY TO SIGN, SUCH AS A MAXIMUM CONTRACTING DOLLAR
AMOUNT] and to do and perform all acts and things which such officer deems to be necessary or
appropriate to carry out the terms of such contracts and Statements of Work, including, but not limited to,
executing and delivering all agreements and documents contemplated by such contracts and Statements
of Work.
The undersigned further certifies that _____________________________ [NAME OF OFFICER] now holds the office of
___________________________ [TITLE OF OFFICE] and has held that office since ________________________ [DATE APPOINTED].
IN WITNESS WHEREOF, the undersigned has executed this Certificate this ____ day of _________, 20__.
_____________________________
Name
Secretary
Attachment B
_______________, LLC
CONSENT TO ACTION
The undersigned, being all of the ___________________________ [CHOOSE ONE: MEMBERS/MANAGERS] of
_______________________________ [COMPANY NAME], LLC (the “Company”), a ____________ [STATE] limited liability
company, do unanimously agree and consent to the following actions:
RESOLVED, that the Company may execute and deliver any and all contracts and Statements of Work which
it deems to be necessary or appropriate to carry out its business; and
FURTHER RESOLVED, that __________________________ [NAME OF MEMBER/MANAGER], as
________________________________ [TITLE OF OFFICE] of the Company, is authorized and directed to execute
and deliver any and all contracts and Statements of Work on behalf of the Company
_______________________________________________________________
[INSERT HERE LIMITATIONS, IF ANY, ON THE AUTHORITY TO SIGN, SUCH AS A MAXIMUM CONTRACTING DOLLAR
AMOUNT] and to do and perform all acts and things which such officer deems to be necessary or
appropriate to carry out the terms of such contracts and Statements of Work, including, but not limited to,
executing and delivering all agreements and documents contemplated by such contracts and Statements
of Work.
IN WITNESS WHEREOF, the undersigned have executed this consent this ____ day of ___________, 20__.
_______________________
NAME
[TITLE]
_______________________
NAME
[TITLE]
_______________________
NAME
[TITLE]
ATTACHMENT C
CERTIFICATION FORM
Building Automation Inspection &
Maintenance Services
JCLM16REG0007
The Connecticut General Assembly
Joint Committee on Legislative Management
Legislative Office Building : Rm 5100
Hartford, CT 06106
(860) 240 – 0100
FAX: (860) 240 – 0122
IN WITNESS WHEREOF, the undersigned, accepting the conditions set forth herein, hereby agrees in
strict accordance therewith, to furnish these services and/or commodities to the General Assembly
as listed in the Request for Proposal in accordance with the following guidelines:
Independent Price Determinations and Offer of Gratuities:
(a) The costs proposed have been arrived at independently, without consultation,
communication, or agreement for the purpose of restricting competition, as to
any matter relating to such process with any other organization or with any
competitor;
(b) Unless otherwise required by law, the costs quoted have not been knowingly
disclosed by the Contractor on a prior basis directly or indirectly to any other
organization or to any competitor;
(c) No attempt has been made or will be made by the Contractor to induce any
other person or firm to submit or not to submit a Proposal for the purpose of
restricting competition;
(d) The Contractor has no knowledge of the specific Proposal contents prior to
actual receipt of the Proposal;
(e) The Contractor certifies that no elected or appointed official or employee of
the State of Connecticut has or will benefit financially or materially from this
procurement. Any contract arising from this procurement may be terminated
by the State if it is determined that gratuities in excess of those allowed under
Chapter 10 of the Connecticut General Statutes (Code of Ethics for Public
Officials) were either offered to or received by any of the aforementioned
officials or employees from the Contractor's agent or the Contractor's
employee(s).
The Contractor agrees to furnish these services and/or commodities to the Connecticut
General Assembly as described in the Request for Proposal at the prices indicated on the
Pricing Page submitted with the Proposal.
SIGNED AND DATED this
day of
Company:
Address:
Signature:
Date:
Name (Printed):
Title:
Telephone No:
Fax No:
Federal Employer Identification No:
ATTACHMENT D
Gift and Campaign Contribution Ban
Acknowledgement Form
Building Automation Inspection &
Maintenance Services
JCLM16REG0007
The Connecticut General Assembly
Joint Committee on Legislative Management
300 Capitol Avenue
Legislative Office Building – Rm 5100
Hartford, CT 06106
(860) 240 – 0100, FAX: (860) 240 - 0122
Written or electronic certification to accompany a State contract with a value of $50,000 or more in a calendar
or fiscal year, pursuant to C.G.S. §§ 4-250 and 4-252(c); Governor M. Jodi Rell’s Executive Orders No. 1, Para. 8,
and No. 7C, Para. 10; and C.G.S. §9-612(g)(2)
INSTRUCTIONS:
Complete all sections of the form. Attach additional pages, if necessary, to provide full disclosure about any lawful
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 initial contract execution
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. Such person shall also submit an
accurate, updated certification not later than fourteen days after the twelve-month anniversary of the most
recently filed certification or updated certification.
CHECK ONE:  Initial Certification
 12 Month Anniversary Update (Multi-year contracts only.)
Updated Certification because of change of information contained in the most
recently filed certification or twelve-month anniversary update.
GIFT CERTIFICATION:
As used in this certification, the following terms have the meaning set forth below:
1.
2.
3.
4.
5.
6.
“Contract” means that contract between the State of Connecticut (and/or one or more of it agencies or
instrumentalities) and the Contractor, attached hereto, or as otherwise described by the awarding State
agency below;
If this is an Initial Certification, “Execution Date” means the date the Contract is fully executed by, and
becomes effective between, the parties; if this is a twelve-month anniversary update, “Execution Date” means
the date this certification is signed by the Contractor.
“Contractor” means the person, firm or corporation named as the contactor below;
“Applicable Public Official or State Employee” means any public official or state employee described in
C.G.S. §4-252(c)(1)(i) or (ii);
“Gift” has the same meaning given that term in C.G.S. § 4-250(1);
“Principals or Key Personnel” means and refers to those principals and key personnel of the Contractor, and its
or their agents, as described in C.G.S. §§ 4-250(5) and 4-252(c)(1)(B) and (C).
I, the undersigned, am the official authorized to execute the Contract on behalf of the Contractor. I hereby certify
that, no gifts were made by (A) such person, firm, corporation, (B) any principals and key personnel of the person
firm or corporation who participate substantially in preparing bids, proposals or negotiating state contracts or (C)
any agent of such, firm, corporation, or principals or key personnel who participates substantially in preparing bids,
proposals or negotiating state contracts, to (i) any public official or state employee of the state agency or quasipublic agency soliciting bids or proposals for state contracts who participates substantially in the preparation of bid
solicitations or request for proposals for state contracts or the negotiation or award of state contracts or (ii) any
public official or state employee of any other state agency, who has supervisory or appointing authority over such
state agency or quasi-public agency.
I further certify that no Principals or Key Personnel know of any action by the Contractor to circumvent (or which
would result in the circumvention of) the above certification regarding Gifts by providing for any other principals,
key personnel, officials, or employees of the Contractor, or its or their agents, to make a Gift to any Applicable
Public Official or State Employee. I further certify that the Contractor made the bid or proposal for the Contract
without fraud or collusion with any person.
CAMPAIGN CONTRIBUTION CERTIFICATION:
I further certify that, on or after December 31, 2006, neither the Contractor nor any of its principals, as defined in
C.G.S. § 9-612(g)(1), has made any campaign contributions to, or solicited any contributions on behalf of, any
exploratory committee, candidate committee, political committee, or party committee established by, or
supporting or authorized to support, any candidate for statewide public office, in violation of C.G.S. § 9612(g)(2)(A). I further certify that all lawful campaign contributions that have been made on or after December 31,
2006 by the Contractor or any of its principals, as defined in C.G.S. § 9-612(g)(1), to, or solicited on behalf of, any
exploratory committee, candidate committee, political committee, or party committee established by, or
supporting or authorized to support any candidates for statewide public office or the General Assembly, are listed
below:
Lawful Campaign Contributions to Candidates for Statewide Public Office:
Contribution Date
Name of Contributor
Recipient
Value
Description
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Lawful Campaign Contributions to Candidates for the General Assembly:
Contribution Date
Name of Contributor
Recipient
Value
Description
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
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)
ATTACHMENT E
PROPOSAL CHECKLIST
Building Automation Inspection &
Maintenance Services
JCLM16REG0007
ADMINISTRATIVE REQUIREMENTS
The Connecticut General Assembly
Joint Committee on Legislative Management
Legislative Office Building : Rm 5100
Hartford, CT 06106
(860) 240 – 0100
FAX: (860) 240 – 0122
Proposal Page
Respondent Experience and Knowledge
Individual Experience and Knowledge
Subcontractor Experience and Knowledge
Pricing Page (Attachment A)
Proof of Authorization (Attachment B)
Certification Form (Attachment C)
Gift and Campaign Contribution Ban Acknowledgement Form (Attachment D)
Proposal Checklist (Attachment E)
CHRO Contract Compliance Monitoring Report Form (Attachment F)
Vendor Profile Form (Attachment G)
W-9 Form (Attachment H)
TECHNICAL DOCUMENTATION
Tentative “Inspection Schedule”
Draft “Completed Component Checklist”
Please include the page number on which these administrative requirements are listed in your Proposal.
ATTACHMENT F
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 4a60a 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.
ATTACHMENT F
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.
ATTACHMENT F
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.
(Page 3)
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
Identification Number____________________
Or
Social Security Number__________________
Major Business Activity
Bidder Identification
(response optional/definitions on page 1)
(brief description)
-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)
Other Locations in Ct.
(If any)
- Bidder
is certified as above by State of CT
Yes__ No__
- 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?
9. Does your company have a mandatory retirement age for all employees?
Yes__ No__
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__
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__
12. Does your company have a written affirmative action Plan? 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__
If no, please explain.
13. Is there a person in your company who is responsible for equal
employment opportunity?
Yes__ No__
If yes, give name and phone number.
____________________________________________________________
____________________________________________________________
ATTACHMENT F
Part III - Bidder Subcontracting Practices
1. Will the work of this contract include subcontractors or suppliers?
(Page 4)
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?
PART IV - Bidder Employment Information
JOB
CATEGORY *
OVERALL
TOTALS
Date:
WHITE
BLACK
(not of Hispanic
origin)
(not of Hispanic
origin)
Male
Female
Yes__ No__
Male
Female
HISPANIC
Male
Female
ASIAN or PACIFIC
ISLANDER
Male
Female
AMERICAN INDIAN or
ALASKAN NATIVE
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)
ATTACHMENT F
PART V - Bidder Hiring and Recruitment Practices
1. Which of the following recruitment sources are used by you?
(Check yes or no, and report percent used)
2. Check (X) any of the below listed
requirements that you use as
a hiring qualification
(Page 5)
3. Describe below any other practices or actions that you take which
show that you hire, train, and promote employees without
discrimination
(X)
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)
ATTACHMENT G
STATE OF CONNECTICUT - AGENCY VENDOR FORM
Clear Form
IMPORTANT: ALL parts of this form must be completed, signed and returned by the vendor.
READ & COMPLETE CAREFULLY
COMPLETE VENDOR LEGAL BUSINESS NAME
SP-26NB-IPDF Rev. 4/10
Taxpayer ID # (TIN):
SSN
FEIN
WRITE/TYPE SSN/FEIN NUMBER ABOVE
BUSINESS NAME, TRADE NAME, DOING BUSINESS AS (IF DIFFERENT FROM ABOVE)
BUSINESS ENTITY:
CORPORATION
NON-PROFIT
LLC CORPORATION
LLC PARTNERSHIP
LLC SINGLE MEMBER ENTITY
PARTNERSHIP
INDIVIDUAL/SOLE PROPRIETOR
GOVERNMENT
NOTE: IF INDIVIDUAL/SOLE PROPRIETOR, INDIVIDUAL’S NAME (AS OWNER) MUST APPEAR IN THE LEGAL BUSINESS NAME BLOCK ABOVE.
BUSINESS TYPE:
A. SALE OF COMMODITIES
B. MEDICAL SERVICES
C. ATTORNEY FEES
D. RENTAL OF PROPERTY
(REAL ESTATE & EQUIPMENT)
E. OTHER (DESCRIBE IN DETAIL)
UNDER THIS TIN, WHAT IS THE PRIMARY TYPE OF BUSINESS YOU PROVIDE TO THE STATE? (ENTER LETTER FROM ABOVE) ➝
UNDER THIS TIN, WHAT OTHER TYPES OF BUSINESS MIGHT YOU PROVIDE TO THE STATE? (ENTER LETTER FROM ABOVE) ➝
NOTE: IF YOUR BUSINESS IS A PARTNERSHIP, YOU MUST ATTACH THE NAMES AND TITLES OF ALL PARTNERS TO YOUR BID SUBMISSION.
NOTE: IF YOUR BUSINESS IS A CORPORATION, IN WHICH STATE ARE YOU INCORPORATED?
VENDOR ADDRESS
STREET
CITY
STATE ZIP CODE
Add Additional Business Address & Contact information on back of this form.
VENDOR E-MAIL ADDRESS
VENDOR WEB SITE
REMITTANCE INFORMATION: INDICATE BELOW THE REMITTANCE ADDRESS OF YOUR BUSINESS.
REMIT ADDRESS
STREET
CITY
CONTACT INFORMATION: NAME
SAME AS VENDOR ADDRESS ABOVE.
STATE ZIP CODE
(TYPE OR PRINT)
1ST BUSINESS PHONE:
ND
2 BUSINESS PHONE:
Ext. #
HOME PHONE:
Ext. #˜
1ST PAGER:
CELLULAR:
2ND PAGER:
1ST FAX NUMBER:˜
TOLL FREE PHONE:
ND
2 FAX NUMBER:˜
TELEX:
WRITTEN SIGNATURE OF PERSON AUTHORIZED TO SIGN PROPOSALS ON BEHALF OF THE ABOVE NAMED VENDOR
ÍSIGN HERE
TYPE OR PRINT NAME OF AUTHORIZED PERSON
DATE EXECUTED
TITLE OF AUTHORIZED PERSON
IS YOUR BUSINESS CURRENTLY A DAS CERTIFIED SMALL BUSINESS ENTERPRISE?
YES (ATTACH COPY OF CERTIFICATE)
IS YOUR BUSINESS CURRENTLY A CT DOT CERTIFIED DISADVANTAGED BUSINESS ENTERPRISE (DBE)?
YES
NO
NO
IF YOU ARE A STATE EMPLOYEE, INDICATE YOUR POSITION,
AGENCY & AGENCY ADDRESS
PURCHASE ORDER DISTRIBUTION:
(E-MAIL ADDRESS)
NOTE: THE E-MAIL ADDRESS INDICATED IMMEDIATELY ABOVE WILL BE USED TO FORWARD PURCHASE ORDERS TO YOUR BUSINESS.
ADD FURTHER BUSINESS ADDRESS, E-MAIL & CONTACT INFORMATION ON SEPARATE SHEET IF REQUIRED
ATTACHMENT H
W-9
Form
(Rev. December 2011)
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.
Print or type
See Specific Instructions on page 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
Exempt payee
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶
Other (see instructions) ▶
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
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.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
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).
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 4.
Sign
Here
Signature of
U.S. person ▶
Date ▶
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
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, 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.
Note. If 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 on any foreign partners’ share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the 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 withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 12-2011)
Page 2
Form W-9 (Rev. 12-2011)
The person who gives Form W-9 to the partnership for purposes of
establishing its U.S. status and avoiding withholding on its allocable
share of net income from the partnership conducting a trade or business
in the United States is in the following cases:
• The U.S. owner of a disregarded entity and not the entity,
• The U.S. grantor or other owner of a grantor trust and not the trust,
and
• The U.S. trust (other than a grantor trust) and not the beneficiaries of
the trust.
Foreign person. If you are a foreign person, do not use Form W-9.
Instead, use the appropriate Form W-8 (see Publication 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a “saving clause.” Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items:
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity not subject to backup
withholding, give the requester the appropriate completed Form W-8.
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS a percentage
of such payments. This is called “backup withholding.” Payments that
may be subject to backup withholding include interest, tax-exempt
interest, dividends, broker and barter exchange transactions, rents,
royalties, nonemployee pay, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See the instructions below and the separate Instructions for the
Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account, for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name shown on
your income tax return. However, if you have changed your last name,
for instance, due to marriage without informing the Social Security
Administration of the name change, enter your first name, the last name
shown on your social security card, and your new last name.
If the account is in joint names, list first, and then circle, the name of
the person or entity whose number you entered in Part I of the form.
Sole proprietor. Enter your individual name as shown on your income
tax return on the “Name” line. You may enter your business, trade, or
“doing business as (DBA)” name on the “Business name/disregarded
entity name” line.
Partnership, C Corporation, or S Corporation. Enter the entity's name
on the “Name” line and any business, trade, or “doing business as
(DBA) name” on the “Business name/disregarded entity name” line.
Disregarded entity. Enter the owner's name on the “Name” line. The
name of the entity entered on the “Name” line should never be a
disregarded entity. The name on the “Name” line must be the name
shown on the income tax return on which the income will be reported.
For example, if a foreign LLC that is treated as a disregarded entity for
U.S. federal tax purposes has a domestic owner, the domestic owner's
name is required to be provided on the “Name” line. If the direct owner
of the entity is also a disregarded entity, enter the first owner that is not
disregarded for federal tax purposes. Enter the disregarded entity's
name on the “Business name/disregarded entity name” line. If the owner
of the disregarded entity is a foreign person, you must complete an
appropriate Form W-8.
Note. Check the appropriate box for the federal tax classification of the
person whose name is entered on the “Name” line (Individual/sole
proprietor, Partnership, C Corporation, S Corporation, Trust/estate).
Limited Liability Company (LLC). If the person identified on the
“Name” line is an LLC, check the “Limited liability company” box only
and enter the appropriate code for the tax classification in the space
provided. If you are an LLC that is treated as a partnership for federal
tax purposes, enter “P” for partnership. If you are an LLC that has filed a
Form 8832 or a Form 2553 to be taxed as a corporation, enter “C” for
C corporation or “S” for S corporation. If you are an LLC that is
disregarded as an entity separate from its owner under Regulation
section 301.7701-3 (except for employment and excise tax), do not
check the LLC box unless the owner of the LLC (required to be
identified on the “Name” line) is another LLC that is not disregarded for
federal tax purposes. If the LLC is disregarded as an entity separate
from its owner, enter the appropriate tax classification of the owner
identified on the “Name” line.
Page 3
Form W-9 (Rev. 12-2011)
Other entities. Enter your business name as shown on required federal
tax documents on the “Name” line. This name should match the name
shown on the charter or other legal document creating the entity. You
may enter any business, trade, or DBA name on the “Business name/
disregarded entity name” line.
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status, then
check the “Exempt payee” box in the line following the “Business name/
disregarded entity name,” sign and date the form.
Generally, individuals (including sole proprietors) are not exempt from
backup withholding. Corporations are exempt from backup withholding
for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should still
complete this form to avoid possible erroneous backup withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2),
2. The United States or any of its agencies or instrumentalities,
3. A state, the District of Columbia, a possession of the United States,
or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions, agencies,
or instrumentalities, or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt from backup withholding include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a possession of the United
States,
9. A futures commission merchant registered with the Commodity
Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under the
Investment Company Act of 1940,
12. A common trust fund operated by a bank under section 584(a),
13. A financial institution,
14. A middleman known in the investment community as a nominee or
custodian, or
15. A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 15.
IF the payment is for . . .
THEN the payment is exempt
for . . .
Interest and dividend payments
All exempt payees except
for 9
Broker transactions
Exempt payees 1 through 5 and 7
through 13. Also, C corporations.
Barter exchange transactions and
patronage dividends
Exempt payees 1 through 5
Payments over $600 required to be Generally, exempt payees
reported and direct sales over
1 through 7 2
1
$5,000
1
2
See Form 1099-MISC, Miscellaneous Income, and its instructions.
However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
services paid by a federal executive agency.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity
separate from its owner (see Limited Liability Company (LLC) on page 2),
enter the owner’s SSN (or EIN, if the owner has one). Do not enter the
disregarded entity’s EIN. If the LLC is classified as a corporation or
partnership, enter the entity’s EIN.
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local Social Security Administration office or get this
form online at www.ssa.gov. You may also get this form by calling
1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can apply for
an EIN online by accessing the IRS website at www.irs.gov/businesses
and clicking on Employer Identification Number (EIN) under Starting a
Business. You can get Forms W-7 and SS-4 from the IRS by visiting
IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, write
“Applied For” in the space for the TIN, sign and date the form, and give
it to the requester. For interest and dividend payments, and certain
payments made with respect to readily tradable instruments, generally
you will have 60 days to get a TIN and give it to the requester before you
are subject to backup withholding on payments. The 60-day rule does
not apply to other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to the
requester.
Note. Entering “Applied For” means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner must
use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, below, and items 4 and 5 on page 4
indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on the “Name” line must sign. Exempt payees, see
Exempt Payee on page 3.
Signature requirements. Complete the certification as indicated in
items 1 through 3, below, and items 4 and 5 on page 4.
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
Page 4
Form W-9 (Rev. 12-2011)
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. “Other payments” include
payments made in the course of the requester’s trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), IRA, Coverdell ESA, Archer MSA or
HSA contributions or distributions, and pension distributions. You
must give your correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
2. Two or more individuals (joint
account)
The individual
The actual owner of the account or,
if combined funds, the first
1
individual on the account
3. Custodian account of a minor
(Uniform Gift to Minors Act)
The minor
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that is
not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
entity owned by an individual
6. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulation section 1.671-4(b)(2)(i)(A))
For this type of account:
The grantor-trustee
7. Disregarded entity not owned by an
individual
8. A valid trust, estate, or pension trust
The owner
2
The actual owner
The owner
The grantor*
Give name and EIN of:
Legal entity
4
The corporation
13. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulation section 1.671-4(b)(2)(i)(B))
The public entity
2
3
1
3
9. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
10. Association, club, religious,
charitable, educational, or other
tax-exempt organization
11. Partnership or multi-member LLC
12. A broker or registered nominee
1
1
The organization
The partnership
The broker or nominee
Note. If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, social security number (SSN), or other identifying
information, without your permission, to commit fraud or other crimes.
An identity thief may use your SSN to get a job or may file a tax return
using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Publication 4535, Identity Theft Prevention
and Victim Assistance.
Victims of identity theft who are experiencing economic harm or a
system problem, or are seeking help in resolving tax problems that have
not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration at 1-800-366-4484. You can forward
suspicious emails to the Federal Trade Commission at: spam@uce.gov
or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT
(1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce
your risk.
The trust
List first and circle the name of the person whose number you furnish. If only one person on a
joint account has an SSN, that person’s number must be furnished.
Circle the minor’s name and furnish the minor’s SSN.
You must show your individual name and you may also enter your business or “DBA” name on
the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you
have one), but the IRS encourages you to use your SSN.
4
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 1.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with
the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation
of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS,
reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District
of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies
to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to
file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a
TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
Minimum Rates and Classifications
for Building Construction
ID# : B 21044
Connecticut Department of Labor
Wage and Workplace Standards Division
By virtue of the authority vested in the Labor Commissioner under provisions of Section 31-53 of the General
Statutes of Connecticut, as amended, the following are declared to be the prevailing rates and welfare payments
and will apply only where the contract is advertised for bid within 20 days of the date on which the rates are
established. Any contractor or subcontractor not obligated by agreement to pay to the welfare and pension
fund shall pay this amount to each employee as part of his/her hourly wages.
Project Number: JCLM16REG0007
State#:
Project Town: Hartford
FAP#:
Project: Building Automation Equipment Inspection And Maintenance
CLASSIFICATION
1a) Asbestos Worker/Insulator (Includes application of insulating materials,
protective coverings, coatings, & finishes to all types of mechanical
systems; application of firestopping material for wall openings &
penetrations in walls, floors, ceilings
Hourly Rate
Benefits
35.75
28.82
37.15
27.56
1b) Asbestos/Toxic Waste Removal Laborers: Asbestos removal and
encapsulation (except its removal from mechanical systems which are not
to be scrapped), toxic waste removers, blasters.**See Laborers Group 7**
1c) Asbestos Worker/Heat and Frost Insulator
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
2) Boilermaker
35.24
25.01
3a) Bricklayer, Cement Mason, Concrete Finisher (including caulking),
Stone Masons
32.50
28.74 + a
3b) Tile Setter
33.75
24.21
3c) Terrazzo Mechanics and Marble Setters
31.69
22.35
3d) Tile, Marble & Terrazzo Finishers
26.26
20.69
3e) Plasterer
32.50
29.45
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
------LABORERS------
4) Group 1: Laborers (common or general), acetylene burners, carpenter
tenders, concrete specialists, wrecking laborers, fire watchers.
27.85
18.30
4a) Group 2: Mortar mixers, plaster tender, power buggy operators,
powdermen, fireproofer/mixer/nozzleman (Person running mixer and
spraying fireproof only).
28.10
18.30
4b) Group 3: Jackhammer operators/pavement breaker, mason tender
(brick), mason tender (cement/concrete), forklift operators and forklift
operators (masonry).
28.35
18.30
4c) **Group 4: Pipelayers (Installation of water, storm drainage or sewage
lines outside of the building line with P6, P7 license) (the pipelayer rate
shall apply only to one or two employees of the total crew who primary
task is to actually perform the mating of pipe sections) P6 and P7 rate is
$26.80.
28.85
18.30
4d) Group 5: Air track operator, sand blaster and hydraulic drills.
28.60
18.30
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
4e) Group 6: Blasters, nuclear and toxic waste removal.
30.85
18.30
4f) Group 7: Asbestos/lead removal and encapsulation (except it's
removal from mechanical systems which are not to be scrapped).
28.85
18.30
4g) Group 8: Bottom men on open air caisson, cylindrical work and boring
crew.
28.38
18.30
4h) Group 9: Top men on open air caisson, cylindrical work and boring
crew.
27.86
18.30
4i) Group 10: Traffic Control Signalman
16.00
18.30
5) Carpenter, Acoustical Ceiling Installation, Soft Floor/Carpet Laying,
Metal Stud Installation, Form Work and Scaffold Building, Drywall
Hanging, Modular-Furniture Systems Installers, Lathers, Piledrivers,
Resilient Floor Layers.
31.45
23.54
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
5a) Millwrights
31.84
23.99
6) Electrical Worker (including low voltage wiring) (Trade License
required: E1,2 L-5,6 C-5,6 T-1,2 L-1,2 V-1,2,7,8,9)
38.20
24.15 + 3% of
gross wage
7a) Elevator Mechanic (Trade License required: R-1,2,5,6)
47.96
28.385+a+b
Groundman
24.37
6.5%+10.04
Linemen/Cable Splicer
44.30
6.5%+17.70
-----LINE CONSTRUCTION----
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
8) Glazier (Trade License required: FG-1,2)
34.58
18.55 + a
9) Ironworker, Ornamental, Reinforcing, Structural, and Precast Concrete
Erection
34.47
31.09 + a
Group 1: Crane handling or erecting structural steel or stone, hoisting
engineer 2 drums or over, front end loader (7 cubic yards or over); work
boat 26 ft. and over. (Trade License Required)
37.55
23.05 + a
Group 2: Cranes (100 ton rate capacity and over); Excavator over 2 cubic
yards; Piledriver ($3.00 premium when operator controls hammer); Bauer
Drill/Caisson. (Trade License Required)
37.23
23.05 + a
Group 3: Excavator; Backhoe/Excavator under 2 cubic yards; Cranes
(under 100 ton rated capacity), Grader/Blade; Master Mechanic; Hoisting
Engineer (all types of equipment where a drum and cable are used to hoist
or drag material regardless of motive power of operation), Rubber Tire
Excavator (Drott-1085 or similar);Grader Operator; Bulldozer Fine Grade.
(slopes, shaping, laser or GPS, etc.). (Trade License Required)
36.49
23.05 + a
----OPERATORS----
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
Group 4: Trenching Machines; Lighter Derrick; Concrete Finishing
Machine; CMI Machine or Similar; Koehring Loader (Skooper).
36.10
23.05 + a
Group 5: Specialty Railroad Equipment; Asphalt Paver; Asphalt
Reclaiming Machine; Line Grinder; Concrete Pumps; Drills with Self
Contained Power Units; Boring Machine; Post Hole Digger; Auger;
Pounder; Well Digger; Milling Machine (over 24" Mandrell)
35.51
23.05 + a
Group 5 continued: Side Boom; Combination Hoe and Loader; Directional
Driller; Pile Testing Machine.
35.51
23.05 + a
Group 6: Front End Loader (3 up to 7 cubic yards); Bulldozer (rough
grade dozer).
35.20
23.05 + a
Group 7: Asphalt roller, concrete saws and cutters (ride on types),
vermeer concrete cutter, Stump Grinder; Scraper; Snooper; Skidder;
Milling Machine (24" and under Mandrell).
34.86
23.05 + a
Group 8: Mechanic, grease truck operator, hydroblaster; barrier mover;
power stone spreader; welding; work boat under 26 ft.; transfer machine.
34.46
23.05 + a
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
Group 9: Front end loader (under 3 cubic yards), skid steer loader
regardless of attachments, (Bobcat or Similar): forklift, power chipper;
landscape equipment (including Hydroseeder).
34.03
23.05 + a
Group 10: Vibratory hammer; ice machine; diesel and air, hammer, etc.
31.99
23.05 + a
Group 11: Conveyor, earth roller, power pavement breaker (whiphammer),
robot demolition equipment.
31.99
23.05 + a
Group 12: Wellpoint operator.
31.93
23.05 + a
Group 13: Compressor battery operator.
31.35
23.05 + a
Group 14: Elevator operator; tow motor operator (solid tire no rough
terrain).
30.21
23.05 + a
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
Group 15: Generator Operator; Compressor Operator; Pump Operator;
Welding Machine Operator; Heater Operator.
29.80
23.05 + a
Group 16: Maintenance Engineer/Oiler.
29.15
23.05 + a
Group 17: Portable asphalt plant operator; portable crusher plant operator;
portable concrete plant operator.
33.46
23.05 + a
Group 18: Power safety boat; vacuum truck; zim mixer; sweeper;
(Minimum for any job requiring a CDL license).
31.04
23.05 + a
31.02
18.55
------PAINTERS (Including Drywall Finishing)------
10a) Brush and Roller
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
10b) Taping Only/Drywall Finishing
31.77
18.55
10c) Paperhanger and Red Label
31.52
18.55
10e) Blast and Spray
34.02
18.55
11) Plumber (excluding HVAC pipe installation) (Trade License required:
P-1,2,6,7,8,9 J-1,2,3,4 SP-1,2)
40.62
28.91
12) Well Digger, Pile Testing Machine
33.01
19.40 + a
13) Roofer (composition)
33.25
18.05
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
14) Roofer (slate & tile)
33.75
18.05
15) Sheetmetal Worker (Trade License required for HVAC and Ductwork:
SM-1,SM-2,SM-3,SM-4,SM-5,SM-6)
35.74
33.22
16) Pipefitter (Including HVAC work)
(Trade
License required: S-1,2,3,4,5,6,7,8 B-1,2,3,4 D-1,2,3,4, G-1, G-2, G-8 &
G-9)
40.62
28.91
17a) 2 Axle
28.58
20.24 + a
17b) 3 Axle, 2 Axle Ready Mix
28.68
20.24 + a
------TRUCK DRIVERS------
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
17c) 3 Axle Ready Mix
28.73
20.24 + a
17d) 4 Axle, Heavy Duty Trailer up to 40 tons
28.78
20.24 + a
17e) 4 Axle Ready Mix
28.83
20.24 + a
17f) Heavy Duty Trailer (40 Tons and Over)
29.03
20.24 + a
17g) Specialized Earth Moving Equipment (Other Than Conventional Type
on-the-Road Trucks and Semi-Trailers, Including Euclids)
28.83
20.24 + a
18) Sprinkler Fitter (Trade License required: F-1,2,3,4)
41.37
20.37 + a
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
19) Theatrical Stage Journeyman
As of: Tuesday, July 28, 2015
25.76
7.34
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
Welders: Rate for craft to which welding is incidental.
*Note: Hazardous waste removal work receives additional $1.25 per hour for truck drivers.
**Note: Hazardous waste premium $3.00 per hour over classified rate
ALL Cranes: When crane operator is operating equipment that requires a fully licensed crane
operator to operate he receives an extra $2.00 premium in addition to the hourly wage rate and benefit
contributions:
1) Crane handling or erecting structural steel or stone; hoisting engineer (2 drums or over)
2) Cranes (100 ton rate capacity and over) Bauer Drill/Caisson
3) Cranes (under 100 ton rated capacity)
Crane with 150 ft. boom (including jib) - $1.50 extra
Crane with 200 ft. boom (including jib) - $2.50 extra
Crane with 250 ft. boom (including jib) - $5.00 extra
Crane with 300 ft. boom (including jib) - $7.00 extra
Crane with 400 ft. boom (including jib) - $10.00 extra
All classifications that indicate a percentage of the fringe benefits must be calculated at the percentage rate
times the "base hourly rate".
Apprentices duly registered under the Commissioner of Labor's regulations on "Work Training Standards for
Apprenticeship and Training Programs" Section 31-51-d-1 to 12, are allowed to be paid the appropriate
percentage of the prevailing journeymen hourly base and the full fringe benefit rate, providing the work site
ratio shall not be less than one full-time journeyperson instructing and supervising the work of each
apprentice in a specific trade.
The Prevailing wage rates applicable to this project are subject to annual adjustments
each July 1st for the duration of the project.
Each contractor shall pay the annual adjusted prevailing wage rate that is in effect each
July 1st, as posted by the Department of Labor.
It is the contractor's responsibility to obtain the annual adjusted prevailing wage rate
increases directly from the Department of Labor's website.
The annual adjustments will be posted on the Department of Labor's Web page:
www.ct.gov/dol. For those without internet access, please contact the division listed
below.
The Department of Labor will continue to issue the initial prevailing wage rate schedule
to the Contracting Agency for the project.
All subsequent annual adjustments will be posted on our Web Site for contractor
access.
Contracting Agencies are under no obligation pursuant to State labor law to pay any
increase due to the annual adjustment provision.
As of: Tuesday, July 28, 2015
ATTACHMENT I
Project: Building Automation Equipment Inspection And Maintenance
Effective October 1, 2005 - Public Act 05-50: any person performing the work of any mechanic, laborer,
or worker shall be paid prevailing wage
All Person who perform work ON SITE must be paid prevailing wage for the
appropriate mechanic, laborer, or worker classification.
All certified payrolls must list the hours worked and wages paid to All Persons
who perform work ON SITE regardless of their ownership i.e.: (Owners,
Corporate Officers, LLC Members, Independent Contractors, et. al)
Reporting and payment of wages is required regardless of any contractual
relationship alleged to exist between the contractor and such person.
~~Unlisted classifications needed for work not included within the scope of the
classifications listed may be added after award only as provided in the labor
standards contract clause (29 CFR 5.5 (a) (1) (ii)).
Please direct any questions which you may have pertaining to classification of work and payment of
prevailing wages to the Wage and Workplace Standards Division, telephone (860)263-6790.
As of: Tuesday, July 28, 2015
ATTACHMENT
ATTACHMENT JI
CONNECTICUT DEPARTMENT OF LABOR
WAGE AND WORKPLACE STANDARDS DIVISION
CONTRACTORS WAGE CERTIFICATION FORM
Construction Manager at Risk/General Contractor/Prime Contractor
I,
of
Officer, Owner, Authorized Rep.
Company Name
do hereby certify that the
Company Name
Street
City
and all of its subcontractors will pay all workers on the
Project Name and Number
Street and City
the wages as listed in the schedule of prevailing rates required for such project (a copy of which is
attached hereto).
Signed
Subscribed and sworn to before me this
day of
Notary Public
Return to:
Connecticut Department of Labor
Wage & Workplace Standards Division
200 Folly Brook Blvd.
Wethersfield, CT 06109
Rate Schedule Issued (Date):
,
.
[New] In accordance with Section 31-53b(a) of the C.G.S. each contractor shall provide a copy of the OSHA 10 Hour Construction Safety and Health Card for each employee, to be attached to the first
certified payroll on the project.
ATTACHMENT J
PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS
In accordance with Connecticut General Statutes, 31-53
Certified Payrolls with a statement of compliance
shall be submitted monthly to the contracting agency.
Connecticut Department of Labor
Wage and Workplace Standards Division
200 Folly Brook Blvd.
Wethersfield, CT 06109
WEEKLY PAYROLL
CONTRACTOR NAME AND ADDRESS:
SUBCONTRACTOR NAME & ADDRESS
WORKER'S COMPENSATION INSURANCE CARRIER
POLICY #
PAYROLL NUMBER
Week-Ending
Date
PERSON/WORKER,
APPR MALE/
ADDRESS and SECTION RATE FEMALE
% AND
RACE*
PROJECT NAME & ADDRESS
EFFECTIVE DATE:
EXPIRATION DATE:
WORK
CLASSIFICATION
S
M
T
DAY AND DATE
W
TH
Trade License Type
& Number - OSHA
10 Certification Number
HOURS WORKED EACH DAY
TYPE OF
FRINGE
BENEFITS
TOTAL FRINGE
Per Hour
Total
BENEFIT PLAN
1 through 6
O/T Hours
CASH
(see back)
1. $
$
2. $
Base Rate
3. $
4. $
$
5. $
Cash Fringe
6. $
1. $
$
2. $
Base Rate
3. $
4. $
$
5. $
Cash Fringe
6. $
1. $
$
2. $
Base Rate
3. $
4. $
$
5. $
Cash Fringe
6. $
1. $
2. $
$
Base Rate
3. $
4. $
Total ST
F
S
Hours
BASE HOURLY
RATE
$
Cash Fringe
12/9/2013
GROSS PAY
TOTAL DEDUCTIONS
FOR ALL
FEDERAL STATE
WORK
PERFORMED
THIS WEEK FICA
WITHWITH-
GROSS PAY FOR
THIS PREVAILING CHECK # AND
RATE JOB
NET PAY
LIST
OTHER
HOLDING HOLDING
5. $
6. $
*IF REQUIRED
WWS-CP1
OSHA 10 ~ATTACH CARD TO 1ST CERTIFIED PAYROLL
*SEE REVERSE SIDE
PAGE NUMBER
OF
ATTACHMENT J
*FRINGE BENEFITS EXPLANATION (P):
Bona fide benefits paid to approved plans, funds or programs, except those required by Federal or State
Law (unemployment tax, worker’s compensation, income taxes, etc.).
Please specify the type of benefits provided:
1) Medical or hospital care
4) Disability
2) Pension or retirement
5) Vacation, holiday
3) Life Insurance
6) Other (please specify)
CERTIFIED STATEMENT OF COMPLIANCE
For the week ending date of
,
of
I,
, (hereafter known as
Employer) in my capacity as
(title) do hereby certify and state:
Section A:
1. All persons employed on said project have been paid the full weekly wages earned by them during
the week in accordance with Connecticut General Statutes, section 31-53, as amended. Further, I
hereby certify and state the following:
a) The records submitted are true and accurate;
b) The rate of wages paid to each mechanic, laborer or workman and the amount of payment or
contributions paid or payable on behalf of each such person to any employee welfare fund, as
defined in Connecticut General Statutes, section 31-53 (h), are not less than the prevailing rate
of wages and the amount of payment or contributions paid or payable on behalf of each such
person to any employee welfare fund, as determined by the Labor Commissioner pursuant to
subsection Connecticut General Statutes, section 31-53 (d), and said wages and benefits are not
less than those which may also be required by contract;
c) The Employer has complied with all of the provisions in Connecticut General Statutes,
section 31-53 (and Section 31-54 if applicable for state highway construction);
d) Each such person is covered by a worker’s compensation insurance policy for the duration of
his employment which proof of coverage has been provided to the contracting agency;
e) The Employer does not receive kickbacks, which means any money, fee, commission, credit,
gift, gratuity, thing of value, or compensation of any kind which is provided directly or
indirectly, to any prime contractor, prime contractor employee, subcontractor, or subcontractor
employee for the purpose of improperly obtaining or rewarding favorable treatment in
connection with a prime contract or in connection with a prime contractor in connection with a
subcontractor relating to a prime contractor; and
f) The Employer is aware that filing a certified payroll which he knows to be false is a class D
felony for which the employer may be fined up to five thousand dollars, imprisoned for up to
five years or both.
2. OSHA~The employer shall affix a copy of the construction safety course, program or
training completion document to the certified payroll required to be submitted to the contracting
agency for this project on which such persons name first appears.
(Signature)
(Title)
Submitted on (Date)
***THIS IS A PUBLIC DOCUMENT***
***DO NOT INCLUDE SOCIAL SECURITY NUMBERS***
ATTACHMENT J
PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS
Weekly Payroll Certification For
Public Works Projects (Continued)
Week-Ending Date:
Contractor or Subcontractor Business Name:
WEEKLY PAYROLL
PERSON/WORKER,
ADDRESS and SECTION
APPR MALE/
RATE FEMALE
%
AND
RACE*
WORK
CLASSIFICATION S
M
T
DAY AND DATE
W
TH
F
Trade License Type
& Number - OSHA
10 Certification Number
S
Total ST BASE HOURLY
Hours
RATE
TOTAL FRINGE
BENEFIT PLAN
O/T Hours
CASH
Total
HOURS WORKED EACH DAY
TYPE OF
GROSS PAY
TOTAL DEDUCTIONS
GROSS PAY FOR
FRINGE
FOR ALL WORK
FEDERAL STATE
THIS PREVAILING CHECK # AND
BENEFITS
PERFORMED
RATE JOB
NET PAY
LIST
Per Hour
THIS WEEK
1 through 6
FICA WITHWITHOTHER
(see back)
HOLDING HOLDING
1. $
$
Base Rate
2. $
3. $
4. $
$
Cash Fringe
5. $
6. $
1. $
$
Base Rate
2. $
3. $
4. $
$
Cash Fringe
5. $
6. $
1. $
$
Base Rate
2. $
3. $
4. $
$
Cash Fringe
5. $
6. $
1. $
$
Base Rate
2. $
3. $
4. $
$
Cash Fringe
5. $
6. $
1. $
$
Base Rate
2. $
3. $
4. $
$
Cash Fringe
5. $
6. $
*IF REQUIRED
12/9/2013
WWS-CP2
NOTICE: THIS PAGE MUST BE ACCOMPANIED BY A COVER PAGE (FORM # WWS-CP1)
PAGE NUMBER
OF
ATTACHMENT K
INSURANCE REQUIREMENTS
BUILDING AUTOMATION EQUIPMENT
INSPECTION AND MAINTENANCE
JCLM16REG0007
The Connecticut General Assembly
Joint Committee on Legislative
Management
Legislative Office Building : Rm 5100
Hartford, CT 06106
(860) 240 – 0100
FAX: (860) 240 – 0122
1. The awarded Respondent shall carry in force for the duration of this agreement the following insurance:
Insurance Limits
A) Commercial General Liability: $1,000,000 combined single limit per occurrence for bodily injury, personal injury
and property damage. Coverage shall include Premises and Operations, Independent Contractors, Products and
Completed Operations, Contractual Liability and Broad Form Property Damage coverage. If a general aggregate is
used, the general aggregate limit shall apply separately to the project or the general aggregate limit shall be twice
the occurrence limit. The State of Connecticut/CT General Assembly, its officers, officials, employees, agents,
boards and commissions shall be named as Additional Insured
B)
Automobile Liability: $1,000,000 combined single limit per accident for bodily injury. Coverage extends to
owned, hired and non-owned automobiles. If the awarded Respondent does not own an automobile, but one is
used in the execution of the contract, then only hired and non-owned coverage is required. If a vehicle is not used
in the execution of the contract then automobile coverage is not required.
C)
Workers’ Compensation and Employers Liability: Statutory coverage in compliance with the Compensation laws
of the State of Connecticut. Coverage shall include Employer’s Liability with minimum limits of $100,000 each
accident, $500,000 Disease – Policy limit, $100,000 each employee.
D) Professional Liability/ Error & Omissions Insurance in an amount equal to the greater of $1,000,000 or 10% of the
construction contract amount. Depending on project size deductible minimum of $10,000 to a maximum of
$100,000. (If Applicable)
E)
Builder’s Risk Coverage. The awarded Respondent shall purchase and maintain builder’s risk insurance in the
amount of the initial contract amount plus values of subsequent modifications or change orders comprising the
value of the entire project on a replacement cost basis. The builder’s risk coverage shall be written on a Special
Covered Cause of Loss form and shall include theft, vandalism, malicious mischief, temporary buildings, transit,
debris removal, increased cost of construction, architect fees and expenses, soft costs, flood and earthquake.
Insured property shall include portions of the work located away from the site but intended for use at the site and
shall cover portions of the work in transit. Equipment breakdown coverage (boiler and machinery) shall be
included and shall cover insured equipment during installation and testing. Policy shall include a beneficial
occupancy clause to permit occupancy of the building during construction. The State/CT General Assembly shall
be listed as a Loss Payee
Insurance Provisions
A) Awarded Respondent shall assume any and all deductibles in the described insurance policies.
B) The awarded Respondent’s insurer shall have no right of recovery or subrogation against the municipality or the
State/CT General Assembly and the described insurance shall be primary coverage.
C) Each required insurance policy shall not be suspended, voided, cancelled or reduced except after 30 days prior
written notice by certified mail, has been given to the CT General Assembly.
D) "Claims made" coverage is unacceptable, with the exception of Professional Liability.
E) Insurance is to be placed with insurers with a current AM Best Rating of no less than A-, VII.
F) Awarded Respondent shall include all subcontractors as insured under its policies or shall obtain separate
certificate of insurance evidencing insurance requirements herein.
G) Awarded Respondent shall furnish the CT General Assembly with original certificate of insurance prior to
commencement of work.
2. The insurance certificate shall indicate that the awarded Respondent name, the State/CT General Assembly, as an additional insured
and shall defend and save harmless the State/CT General Assembly from actions, suits, or other legal proceedings that may be instituted
on such claims or demands. The insurance certificate shall be accompanied by an endorsement indicating that the State/CT
General Assembly has been in fact added to the insurance policy as an additional insured.
ATTACHMENT L
NONDISCRIMINATION
CERTIFICATION
BUILDING AUTOMATION EQUIPMENT
INSPECTION AND MAINTENANCE
JCLM16REG0007
The Connecticut General Assembly
Joint Committee on Legislative Management
300 Capitol Avenue
Legislative Office Building – Room 5100
Hartford, CT 06106
(860) 240 – 0100 FAX: (860) 240 - 0122
Representation By Individual For All Contract Types Regardless of Value (FORM A)
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
INSTRUCTIONS:
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 §§ 4a60(a)(1)and 4a-60a(a)(1), as amended.
___________________________________________
Signatory
___________________________________________
Printed Name
___________________________________
Date
Representation By Entity For Contracts Valued at Less Than $50,000 (FORM B)
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
INSTRUCTIONS:
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
___________________________________________
Printed Name
___________________________________
Date
Affidavit By Entity For Contracts Valued at $50,000 or More (FORM C)
Documentation in the form of an affidavit signed under penalty of false statement by a chief executive officer,
president, chairperson, member, or other corporate officer duly authorized to adopt corporate, company, or
partnership policy that certifies the contractor complies with the nondiscrimination agreements and warranties
under Connecticut General Statutes §§ 4a-60(a)(1) and 4a-60a(a)(1), as amended
INSTRUCTIONS:
For use by an entity (corporation, limited liability company, or partnership) when entering into any contract type with the
State of Connecticut valued at $50,000 or more for any year of the contract. Complete all sections of the form. Sign form
in the presence of a Commissioner of Superior Court or Notary Public. Submit to the awarding State agency prior to
contract execution.
AFFIDAVIT:
I, the undersigned, am over the age of eighteen (18) and understand and appreciate the obligations of an oath. I am
_________________________ of ________________________________ , an entity
Signatory’s Title
Name of Entity
duly formed and existing under the laws of _____________________________________.
Name of State or Commonwealth
I certify that I am authorized to execute and deliver this affidavit 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
___________________________________________
Printed Name
Sworn and subscribed to before me on this ______ day of ____________, 20____.
___________________________________________
Commissioner of the Superior Court/
Notary Public
___________________________________
Commission Expiration Date
New Resolution By Entity For Contracts Valued at $50,000 or More (FORM D)
Documentation in the form of a corporate, company, or partnership policy adopted by resolution of the board of
directors, shareholders, managers, members or other governing body of a contractor that certifies the contractor
complies with the nondiscrimination agreements and warranties under Connecticut General Statutes §§ 4a60(a)(1) and 4a-60a(a)(1), as amended
INSTRUCTIONS:
For use by an entity (corporation, limited liability company, or partnership) when entering into any contract type with the
State of Connecticut valued at $50,000 or more for any year of the contract. Complete all sections of the form. Submit to
the awarding State agency prior to contract execution.
CERTIFICATION OF RESOLUTION:
I, _________________________ , ___________________ , of ________________________________ ,
Authorized Signatory
Title
Name of Entity
an entity duly formed and existing under the laws of __________________________________________ ,
Name of State or Commonwealth
certify that the following is a true and correct copy of a resolution 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 resolution has not been modified
Name of State or Commonwealth
or revoked, and is in full force and effect.
RESOLVED: That the policies of ________________________________ comply with the
Name of Entity
nondiscrimination agreements and warranties of Connecticut General Statutes §§ 4a-60(a)(1) and 4a-60a(a)(1), as
amended.
The undersigned has executed this certificate this _____ day of ___________ , 20_____ .
___________________________________________
Authorized Signatory
___________________________________________
Printed Name
___________________________________
Date
Prior Resolution By Entity For Contracts Valued at $50,000 or More (FORM E)
Documentation in the form of a corporate, company, or partnership policy adopted by a prior resolution of the
board of directors, shareholders, managers, members or other governing body of a contractor that certifies the
contractor complies with the nondiscrimination agreements and warranties under Connecticut General Statutes
§§ 4a-60(a)(1) and 4a-60a(a)(1), as amended
INSTRUCTIONS:
For use by an entity (corporation, limited liability company, or partnership) when entering into any contract type with the
State of Connecticut valued at $50,000 or more for any year of the contract. Complete all sections of the form. Attach copy
of previously adopted resolution (State of CT, Nondiscrimination Certification, Form D: New Resolution). Submit all
documentation to the awarding State agency prior to contract execution.
CERTIFICATION OF PRIOR RESOLUTION:
I, the undersigned, am a duly authorized corporate officer or member of ___________________________.
Name of Entity
I have reviewed the attached prior resolution. I certify that:
(1) the attached prior resolution complies with the nondiscrimination agreements and warranties of Connecticut General
Statutes §§ 4a-60(a)(1) and 4a-60a(a)(1), as amended; and
(2) the prior resolution remains in full force and effect on the date this documentation is submitted to the awarding State
agency.
___________________________________________
Authorized Signatory
___________________________________
Title
___________________________________________
Printed Name
___________________________________
Date
RESERVED FOR STATE USE
I, the undersigned head of the awarding State agency, or designee, certify that the attached prior resolution complies with the
nondiscrimination agreements and warranties of Connecticut General Statutes
§§ 4a-60(a)(1) and 4a-60a(a)(1), as amended.
___________________________________________
Signature of Agency Head (or designee)
CT General Assembly
Awarding State Agency
___________________________________
Date
CGA TERMS AND CONDITIONS
1. Definitions. Unless otherwise indicated, the
following terms shall have the following
corresponding definitions:
(a) Bid: A Bid submitted in response to a
Solicitation.
(b) Claims: All actions, suits, claims, demands,
investigations and proceedings of any kind,
open, pending or threatened, whether
mature, unmatured, contingent, known or
unknown, at law or in equity, in any forum.
(c) Confidential Information: This shall mean
any name, number or other information
that may be used, alone or in conjunction
with any other information, to identify a
specific individual including, but not limited
to, such individual's name, date of birth,
mother's maiden name, motor vehicle
operator's license number, Social Security
number, employee identification number,
employer or taxpayer identification
number, alien registration number,
government passport number, health
insurance identification number, demand
deposit account number, savings account
number, credit card number, debit card
number or unique biometric data such as
fingerprint, voice print, retina or iris image,
or other unique physical representation.
Without limiting the foregoing, Confidential
Information shall also include any
information that the CGA classifies as
“confidential” or “restricted.” Confidential
Information shall not include information
that may be lawfully obtained from publicly
available sources or from federal, state, or
local government records which are lawfully
made available to the general public.
(d) Confidential Information Breach: This shall
mean, generally, an instance where an
unauthorized person or entity accesses
Confidential Information in any manner,
including but not limited to the following
occurrences:
(1) any Confidential
Information that is not encrypted or
Attachment M
protected is misplaced, lost, stolen or in any
way compromised; (2)one or more third
parties have had access to or taken control
or possession of any Confidential
Information that is not encrypted or
protected
without
prior
written
authorization from the CGA;
(3) the
unauthorized acquisition of encrypted or
protected
Confidential
Information
together with the confidential process or
key that is capable of compromising the
integrity of the Confidential Information; or
(4) if there is a substantial risk of identity
theft or fraud to the CGA, the Contractor, or
the State.
(e) Contract: The agreement, as of its Effective
Date, between the Contractor and the CGA
for any or all Goods or Services at the
Solicitation price.
(f) Contractor: A person or entity who submits
a Solicitation response and who executes a
Contract.
(g) Contractor Parties:
A Contractor’s
members, directors, officers, shareholders,
partners, managers, principal officers,
representatives,
agents,
servants,
consultants, employees or any one of them
or any other person or entity with whom
the Contractor is in privity of oral or written
contract and the Contractor intends for
such other person or entity to Perform
under the Contract in any capacity.
(h) Day: All calendar days other than Saturdays,
Sundays and days designated as national or
State of Connecticut holidays upon which
banks in Connecticut are closed.
(i) Force Majeure: Events that materially
affect the cost of the Goods or Services or
the time schedule within which to Perform
and are outside the control of the party
asserting that such an event has occurred,
including, but not limited to, labor troubles
unrelated to the Contractor, failure of or
inadequate permanent power, unavoidable
casualties, fire not caused by the
Contractor,
extraordinary
weather
Page 1 of 22
CGA TERMS AND CONDITIONS
conditions, disasters, riots, acts of God,
insurrection or war.
(j) Goods: For purposes of the Contract, all
things which are movable at the time that
the Contract is effective and which include,
without limiting this definition, supplies,
materials and equipment, as specified in the
Solicitation.
(k) Goods or Services: Goods, Services or both,
as specified in the Solicitation.
(l) Records: All working papers and such other
information and materials as may have
been accumulated by the Contractor in
performing the Contract, including but not
limited to, documents, data, plans, books,
computations, drawings, specifications,
notes,
reports,
records,
estimates,
summaries and correspondence, kept or
stored in any form.
(m) Services: The performance of labor or work,
as specified in the Solicitation.
(n) Solicitation: A State request, in whatever
form issued, inviting bids, proposals or
quotes for Goods or Services, typified by,
but not limited to, an invitation to bid,
request for proposals, request for
information or request for quotes. The
Solicitation and this Contract shall be
governed by the statutes, regulations and
procedures of the State of Connecticut,
Department of Administrative Services,
even if the CGA has statutes, regulations
and procedures which overlap DAS’s.
However, to the extent that the CGA has
statutes, regulations or procedures which
the CGA determines in its sole discretion to
be inconsistent with DAS’s, the CGA’s shall
control over those of DAS’s. The
Solicitation is incorporated into and made a
part of the Contract as if it had been fully
set forth in it if, but only if, the Solicitation
is in the form of an invitation to bid, request
for information or request for quotes. A
Solicitation in the form of a request for
proposals is not incorporated into the
Contract in its entirety, but, rather, it is
incorporated into the Contract only to the
extent specifically stated in in the Contract.
Attachment M
(o) State: The State of Connecticut, including
the CGA and any office, department, board,
council, commission, institution or other
CGA of the State.
(p) Termination: An end to the Contract prior
to the end of its term whether effected
pursuant to a right which the Contract
creates or for a breach.
(q) Title: all ownership, title, licenses, rights
and interest, including, but not limited to,
perpetual use, of and to the Goods or
Services.
2. Contracting Vehicle. The Solicitation may
involve an invitation to bid, request for
proposals, request for information or
request for quotes, each of which may be
governed by different statutory, regulatory
and administrative procedures. ALTHOUGH
THIS CONTRACT USES THE TERMS
“SOLICITATION” AND “BID” IT’S USE OF
THOSE TERMS IS INTENDED ONLY FOR
PURPOSES OF CONVENIENCE AND SHALL
NOT BE DEEMED TO BE A CONTROLLING
STATEMENT AS TO THE TYPE OF
SOLICITATION USED OR THE RESPECTIVE
RIGHTS AND OBLIGATIONS OF THE PARTIES.
THE IDENTIFICATION IN THE SOLICITATION
OF THE PARTICULAR PROCUREMENT
VEHICLE THE STATE IS USING TO SOLICIT
GOODS OR SERVICES SHALL CONTROL.
Therefore, if the Solicitation identifies the
procurement vehicle as something other
than an Invitation to Bid, the terms
“Solicitation” and “Bid, “as used in this
Contract shall be read to mean “Request for
Proposals,” Proposal” and “Proposer” or to
mean such other terms as are consistent
with the Solicitation in order to preserve
the integrity of the statutory, regulatory
and procedural distinctions among the
various procurement vehicles and their
corresponding principles.
3. Description of Goods or Services and
Additional Terms and Conditions. The
Contractor shall perform as set forth in the
Contract. For purposes of this Contract, to
perform and the performance in
Attachment A of the Contract is referred to
as “Perform” and the “Performance.”
Page 2 of 22
CGA TERMS AND CONDITIONS
4. Price Schedule, Payment Terms and Billing.
(a) Payment Term: Payment terms under this
Contract are set forth in Exhibit B of the
Contract. Payment shall be made only after
the CGA receives and accepts the Goods
and/or Services and after it receives a
properly completed invoice. Unless
otherwise specified in the Contract,
payment for all accepted Goods and/or
Services shall be due within forty-five (45)
days after acceptance of the Goods and/ or
Services, or thirty (30) days if the Contractor
is a certified small contractor or minority
business enterprise as defined in Conn.
Gen. Stat. § 4a-60g. The Contractor shall
submit an invoice to the CGA for the
Performance. The invoice shall include
detailed information for Goods and/or
Services, delivered and Performed, as
applicable, and accepted. Any late payment
charges shall be calculated in accordance
with the Connecticut General Statutes.
(b) Price Adjustments:
Exhibit B of the Contract will be adjusted
to reflect any annual % increase included in
this Contract on the contract anniversary
date. It is the responsibility of the
Contractor to submit invoices in accordance
with this annual increase. Invoices
submitted using an old rate will be returned
by the CGA to the Contractor for revision
and resubmittal.
5. Rejected Items; Abandonment.
(a) The Contractor may deliver, cause to be
delivered, or, in any other way, bring or
cause to be brought, to any CGA premises
or other destination, Goods, as samples or
otherwise, and other supplies, materials,
equipment or other tangible personal
property. The CGA may, by written notice
and in accordance with the terms and
conditions of the Contract, direct the
Contractor to remove any or all such Goods
(“the “Rejected Goods”) and any or all other
supplies, materials, equipment or other
tangible personal property (collectively, the
“Contractor Property”) from and out of the
CGA premises and any other location which
the CGA or State manages, leases or
controls. The Contractor shall remove the
Rejected Goods and the Contractor
Attachment M
Property in accordance with the terms and
conditions of the written notice. Failure to
remove the Rejected Goods or the
Contractor Property in accordance with the
terms and conditions of the written notice
shall mean, for itself and all Contractor
Parties, that:
(1) they have voluntarily,
intentionally, unconditionally,
unequivocally and absolutely
abandoned and left unclaimed
the Rejected Goods and
Contractor Property and
relinquished all ownership, title,
licenses, rights, possession and
interest of, in and to
(collectively, “Title”) the
Rejected Goods and Contractor
Property with the specific and
express intent of (A)
terminating all of their Title to
the Rejected Goods and
Contractor Property, (B) vesting
Title to the Rejected Goods and
Contractor Property in the State
of Connecticut and (C) not ever
reclaiming Title or any future
rights of any type in and to the
Rejected Goods and Contractor
Property;
(2) there is no ignorance,
inadvertence or unawareness
to mitigate against the intent to
abandon the Rejected Goods or
Contractor Property;
(3) they vest authority, without any
further act required on their
part or the CGA’s part, in the
CGA and the State to use or
dispose of the Rejected Goods
and Contractor Property, in the
CGA’s sole discretion, as if the
Rejected Goods and Contractor
Property were the CGA’s or
State’s own property and in
accordance with law, without
incurring any liability or
obligation to the Contractor or
any other party;
(4) if the CGA or State incur any
costs or expenses in connection
with disposing of the Rejected
Goods and Contractor Property,
Page 3 of 22
CGA TERMS AND CONDITIONS
including, but not limited to,
advertising, moving or storing
the Rejected Goods and
Contractor Property, auction
and other activities, the CGA
shall invoice the Contractor for
all such cost and expenses and
the Contractor shall reimburse
the CGA no later than thirty
(30) days after the date of
invoice; and
(5) they do remise, release and
forever discharge the CGA and
all State employees,
departments, commissions,
boards, bureaus, agencies,
instrumentalities or political
subdivisions and their
respective successors, heirs,
executors and assigns
(collectively, the “State and Its
Agents”) of and from all Claims
which they and their respective
successors or assigns, jointly or
severally, ever had, now have
or will have against the CGA
and the State and Its Agents
arising from the use or
disposition of the Rejected
Goods and Contractor Property.
(b) The Contractor shall secure from each
Contractor Party, as appropriate, such
document or instrument as necessary or
appropriate as will vest in the Contractor
plenary authority to bind the Contractor
Parties to the full extent necessary or
appropriate to give full effect to all of the
terms and conditions of this section. The
Contractor shall provide, no later than
fifteen (15) days after receiving a request
from the CGA, such information as the CGA
may require to evidence, in the CGA’s sole
determination, compliance with this
section.
6. Order and Delivery. The Contract shall bind
the Contractor to furnish and deliver the
Goods or Services in accordance with
Exhibit A of the Contract and at the prices
set forth in Exhibit B of the Contract.
Subject to the sections in this Contract
concerning Force Majeure, Termination and
Attachment M
Open Market Purchases, the Contract shall
bind the CGA to order the Goods or Services
from the Contractor, and to pay for the
accepted Goods or Services in accordance
with Exhibit B of the Contract.
7. Contract Amendments. No amendment to
or modification or other alteration of the
Contract shall be valid or binding upon the
CGA unless made in writing, and signed by
both parties.
8. Assignment. The Contractor shall not assign
any of its rights or obligations under the
Contract, voluntarily or otherwise, in any
manner without the prior written consent
of the CGA. The CGA may void any
purported assignment in violation of this
section and declare the Contractor in
breach of Contract. Any Termination by the
CGA for a breach is without prejudice to the
CGA’s or the State’s rights or possible
Claims.
9. Termination.
(a) Notwithstanding any provisions in this
Contract, the CGA, through a duly
authorized employee, may Terminate the
Contract whenever the CGA makes a
written determination that such
Termination is in the best interests of the
CGA. The CGA shall notify the Contractor in
writing of Termination pursuant to this
section, which notice shall specify the
effective date of Termination and the
extent to which the Contractor must
complete its Performance under the
Contract prior to such date.
(b) Notwithstanding any provisions in this
Contract, the CGA, through a duly
authorized employee, may, after making a
written determination that the Contractor
has breached the Contract, Terminate the
Contract in accordance with the provisions
in the Breach section of this Contract.
(c) The CGA shall send the notice of
Termination via certified mail, return
receipt requested, to the Contractor at the
most current address which the Contractor
has furnished to the CGA for purposes of
correspondence, or by hand delivery. Upon
receiving the notice from the CGA, the
Contractor shall immediately discontinue all
Page 4 of 22
CGA TERMS AND CONDITIONS
services affected in accordance with the
notice, undertake all commercially
reasonable efforts to mitigate any losses or
damages, and deliver to the CGA all
Records. The Records are deemed to be the
property of the CGA and the Contractor
shall deliver them to the CGA no later than
thirty (30) days after the Termination of the
Contract or fifteen (15) days after the
Contractor receives a written request from
the CGA for the Records. The Contractor
shall deliver those Records that exist in
electronic, magnetic or other intangible
form in a non-proprietary format, such as,
but not limited to, ASCII or .TXT.
(d) Upon receipt of a written notice of
Termination from the CGA, the Contractor
shall cease operations as the CGA directs in
the notice, and take all actions that are
necessary or appropriate, or that the CGA
may reasonably direct, for the protection,
and preservation of the Goods and any
other property. Except for any work which
the CGA directs the Contractor to Perform
in the notice prior to the effective date of
Termination, and except as otherwise
provided in the notice, the Contractor shall
terminate or conclude all existing
subcontracts and purchase orders and shall
not enter into any further subcontracts,
purchase orders or commitments.
(e) The CGA shall, within forty-five (45) days of
the effective date of Termination,
reimburse the Contractor for its
Performance rendered and accepted by the
CGA in accordance with Exhibit A of the
Contract, in addition to all actual and
reasonable costs incurred after Termination
in completing those portions of the
Performance which the notice required the
Contractor to complete. However, the
Contractor is not entitled to receive and the
CGA is not obligated to tender to the
Contractor any payments for anticipated or
lost profits. Upon request by the CGA, the
Contractor shall assign to the CGA, or any
replacement contractor which the CGA
designates, all subcontracts, purchase
orders and other commitments, deliver to
the CGA all Records and other information
pertaining to its Performance, and remove
from CGA premises, whether leased or
owned, all of Contractor’s property,
equipment, waste material and rubbish
Attachment M
related to its Performance, all as the CGA
may request.
(f) For breach or violation of any of the
provisions in the section concerning
Representations and Warranties, the CGA
may Terminate the Contract in accordance
with its terms and revoke any consents to
assignments given as if the assignments had
never been requested or consented to,
without liability to the Contractor or
Contractor Parties or any third party.
(g) Upon Termination of the Contract, all rights
and obligations shall be null and void, so
that no party shall have any further rights
or obligations to any other party, except
with respect to the sections which survive
Termination. All representations,
warranties, agreements and rights of the
parties under the Contract shall survive
such Termination to the extent not
otherwise limited in the Contract and
without each one of them having to be
specifically mentioned in the Contract.
(h) Termination of the Contract pursuant to
this section shall not be deemed to be a
breach of contract by the CGA.
10. Cost Modifications. The parties may agree
to a reduction in the cost of the Contract at
any time during which the Contract is in
effect. Without intending to impose a
limitation on the nature of the reduction,
the reduction may be to hourly, staffing or
unit costs, the total cost of the Contract or
the reduction may take such other form as
the CGA deems to be necessary or
appropriate.
11. Breach. If either party breaches the
Contract in any respect, the non-breaching
party shall provide written notice of such
breach to the breaching party and afford
the breaching party an opportunity to cure
the breach within ten (10) days from the
date that the breaching party receives such
notice. Any other time provided for in the
notice shall trump such ten (10) days. Such
right to cure period shall be extended if the
non-breaching party is satisfied that the
breaching party is making a good faith
effort to cure but the nature of the breach
is such that it cannot be cured within the
right to cure period. The notice may
include an effective Contract Termination
Page 5 of 22
CGA TERMS AND CONDITIONS
date if the breach is not cured by the stated
date and, unless otherwise modified by the
non-breaching party in writing prior to the
Termination date, no further action shall be
required of any party to effect the
Termination as of the stated date. If the
notice does not set forth an effective
Contract Termination date, then the nonbreaching party may Terminate the
Contract by giving the breaching party no
less than twenty four (24) hours' prior
written notice. If the CGA believes that the
Contractor has not performed according to
the Contract, the CGA may withhold
payment in whole or in part pending
resolution of the Performance issue,
provided that the CGA notifies the
Contractor in writing prior to the date that
the payment would have been due in
accordance with Exhibit B of the Contract.
12. Waiver.
(a) No waiver of any breach of the Contract
shall be interpreted or deemed to be a
waiver of any other or subsequent breach.
All remedies afforded in the Contract shall
be taken and construed as cumulative, that
is, in addition to every other remedy
provided in the Contract or at law or in
equity.
(b) A party’s failure to insist on strict
performance of any provision of the
Contract shall only be deemed to be a
waiver of rights and remedies concerning
that specific instance of Performance and
shall not be deemed to be a waiver of any
subsequent rights, remedies or breach.
13. Open Market Purchases.
Failure of the
Contractor to Perform within the time
specified in the Contract, or failure to
replace rejected or substandard Goods or
fulfill unperformed Services when so
requested and as the Contract provides or
allows, constitutes a breach of the Contract
and as a remedy for such breach, such
failure shall constitute authority for the
CGA, if it deems it to be necessary or
appropriate in its sole discretion, to
Terminate the Contract and/or to purchase
on the open market, Goods or Services to
replace those which have been rejected,
not delivered, or not Performed. The CGA
Attachment M
shall invoice the Contractor for all such
purchases to the extent that they exceed
the costs and expenses in Exhibit B of the
Contract and the Contractor shall pay the
CGA’s invoice immediately after receiving
the invoice. If the CGA does not Terminate
the Contract, the CGA will deduct such open
market purchases from the Contract
quantities. However, if the CGA deems it to
be in the best interest of the CGA, the CGA
may accept and use the Goods and/or
Services delivered which are substandard in
quality, subject to an adjustment in price to
be determined by the CGA.
14. Purchase Orders.
(a) The Contract itself is not an authorization
for the Contractor to ship Goods or begin
Performance in any way. The Contractor
may begin Performance only after it has
received a duly issued purchase order
against the Contract for Performance.
(b) The CGA shall issue a purchase order
against the Contract directly to the
Contractor and to no other party.
(c) All purchase orders shall be in written or
electronic form, bear the Contract number
(if any), be signed and comply with all other
State and CGA requirements, particularly
the CGA’s requirements concerning
procurement. Purchase orders issued in
compliance with these requirements shall
be deemed to be duly issued.
(d) A Contractor making delivery without a
duly issued purchase order in accordance
with this section does so at the Contractor’s
own risk.
(e) The CGA may, in its sole discretion, deliver
to the Contractor any or all duly issued
purchase orders via electronic means only,
such that the CGA shall not have any
additional obligation to deliver to the
Contractor a “hard copy” of the purchase
order.
15. Indemnification.
(a) The Contractor shall indemnify, defend and
hold harmless the CGA and its officers,
representatives,
agents,
servants,
employees, successors and assigns from
and against any and all (1) Claims arising,
directly or indirectly, in connection with the
Contract, including the acts of commission
or omission (collectively, the "Acts") of the
Page 6 of 22
CGA TERMS AND CONDITIONS
Contractor or Contractor Parties; and (2)
liabilities, damages, losses, costs and
expenses, including but not limited to,
attorneys' and other professionals' fees,
arising, directly or indirectly, in connection
with Claims, Acts or the Contract. The
Contractor shall use counsel reasonably
acceptable to the CGA in carrying out its
obligations under this section.
The
Contractor’s obligations under this section
to indemnify, defend and hold harmless
against Claims includes Claims concerning
confidentiality of any part of or all of the
Contractor’s bid, proposal or any Records,
any intellectual property rights, other
proprietary rights of any person or entity,
copyrighted
or
uncopyrighted
compositions, secret processes, patented or
unpatented
inventions,
articles
or
appliances furnished or used in the
Performance.
(b) The Contractor shall not be responsible for
indemnifying or holding the CGA harmless
from any liability arising due to the
negligence of the CGA or any other person
or entity acting under the direct control or
supervision of the CGA.
(c) The Contractor shall reimburse the CGA for
any and all damages to the real or personal
property of the CGA caused by the Acts of
the Contractor or any Contractor Parties.
The CGA shall give the Contractor
reasonable notice of any such Claims.
(d) The Contractor’s duties under this section
shall remain fully in effect and binding in
accordance with the terms and conditions
of the Contract, without being lessened or
compromised in any way, even where the
Contractor is alleged or is found to have
merely contributed in part to the Acts giving
rise to the Claims and/or where the CGA is
alleged or is found to have contributed to
the Acts giving rise to the Claims.
(e) The Contractor shall carry and maintain at
all times during the term of the Contract,
and during the time that any provisions
survive the term of the Contract, sufficient
general liability insurance to satisfy its
obligations under this Contract.
The
Contractor shall cause the CGA to be named
Attachment M
as an additional insured on the policy and
shall provide (1) a certificate of insurance,
(2) the declaration page and (3) the
additional insured endorsement to the
policy to the CGA prior to the Effective Date
of the Contract evidencing that the CGA is
an additional insured. The Contractor shall
not begin Performance until the delivery of
these three documents to the CGA. The
CGA shall be entitled to recover under the
insurance policy even if a body of
competent jurisdiction determines that the
CGA or the CGA is contributorily negligent.
(f) This section shall survive the Termination of
the Contract and shall not be limited by
reason of any insurance coverage.
16. Forum and Choice of Law.
The parties deem the Contract to have been
made in the City of Hartford, State of
Connecticut. Both parties agree that it is
fair and reasonable for the validity and
construction of the Contract to be, and it
shall be, governed by the laws and court
decisions of the State of Connecticut,
without giving effect to its principles of
conflicts of laws. To the extent that any
immunities provided by Federal law or the
laws of the State of Connecticut do not bar
an action against the State, and to the
extent that these courts are courts of
competent jurisdiction, for the purpose of
venue, the complaint shall be made
returnable to the Judicial District of
Hartford only or shall be brought in the
United States District Court for the District
of Connecticut only, and shall not be
transferred to any other court, provided,
however, that nothing here constitutes a
waiver or compromise of the sovereign
immunity of the State of Connecticut. The
Contractor waives any objection which it
may now have or will have to the laying of
venue of any Claims in any forum and
further irrevocably submits to such
jurisdiction in any suit, action or
proceeding.
17. Contractor Guaranties. Contractor shall:
(a) Perform fully under the Contract;
(b) Guarantee the Goods or Services against
defective material or workmanship and to
Page 7 of 22
CGA TERMS AND CONDITIONS
(c)
(d)
(e)
(f)
repair any damage or marring occasioned in
transit or, at the CGA's option, replace
them;
Furnish adequate protection from damage
for all work and to repair damage of any
kind, for which its workers are responsible,
to the premises, Goods, the Contractor’s
work or that of Contractor Parties;
With respect to the provision of Services,
pay for all permits, licenses and fees and
give all required or appropriate notices;
Adhere to all Contractual provisions
ensuring the confidentiality of Records that
the Contractor has access to and are
exempt from disclosure under the State’s
Freedom of Information Act or other
applicable law; and
Neither disclaim, exclude nor modify the
implied warranties of fitness for a particular
purpose or of merchantability.
18. Implied Warranties.
The CGA does not
disclaim, exclude or modify the implied
warranty of fitness for a particular purpose
or the warranty of merchantability.
19. Goods, Standards and Appurtenances. Any
Goods delivered must be standard new
Goods, latest model, except as otherwise
specifically stated in the Contract.
Remanufactured,
refurbished
or
reconditioned equipment may be accepted
but only to the extent allowed under the
Contract. Where the Contract does not
specifically list or describe any parts or
nominal appurtenances of equipment for
the Goods, it shall be understood that the
Contractor shall deliver such equipment
and appurtenances as are usually provided
with the manufacturer's stock model.
20. Delivery.
(a) Delivery shall be made as ordered and in
accordance with the Contract. Unless
otherwise specified in the Contract, delivery
shall be to a loading dock or receiving
platform. The Contractor or Contractor’s
shipping designee shall be responsible for
removal of Goods from the carrier and
placement on the CGA loading dock or
receiving platform. The receiving personnel
of the CGA are not required to assist in this
process. The decision of the CGA as to
reasonable compliance with delivery terms
Attachment M
shall be final and binding. The burden of
proof of proper receipt of the order shall
rest with the Contractor.
(b) In order for the time of delivery to be
extended, the CGA must first approve a
request for extension from the time
specified in the Contract, such extension
applying only to the particular item or
shipment.
(c) Goods shall be securely and properly
packed for shipment, according to accepted
standard commercial practice, without
extra charge for packing cases, baling or
sacks. The containers shall remain the
property of the CGA unless otherwise
stated in the Contract.
(d) All risk of loss and damage to the Goods
transfers to the CGA upon Title vesting in
the CGA.
21. Goods Inspection. The CGA shall determine
the manner and prescribe the inspection of
all Goods and the tests of all samples
submitted to determine whether they
comply with all of the specifications in the
Contract. If any Goods fail in any way to
meet the specifications in the Contract, the
CGA may, in its sole discretion, either reject
it and owe nothing or accept it and pay for
it on an adjusted price basis, depending on
the degree to which the Goods meet the
specifications. Any decision pertaining to
any such failure or rejection shall be final
and binding.
22. Emergency Standby for Goods and/or
Services. If any Federal or State official,
having authority to do so, declares an
emergency or the occurrence of a natural
disaster within the State of Connecticut, the
CGA may request the Goods and Services
on an expedited and prioritized basis. Upon
receipt of such a request the Contractor
shall make all necessary and appropriate
commercially reasonable efforts to
reallocate its staffing and other resources in
order to give primary preference to
Performing this Contract ahead of or prior
to fulfilling, in whole or in part, any other
contractual obligations that the Contractor
may have. The Contractor is not obligated
to make those efforts to Perform on an
expedited and prioritized basis in
Page 8 of 22
CGA TERMS AND CONDITIONS
accordance with this paragraph if doing so
will make the Contractor materially breach
any other contractual obligations that the
Contractor may have. Contractor shall
acknowledge receipt of any request made
pursuant to this paragraph within 2 hours
from the time that the Contractor receives
it via purchase order or through a request
to make an expedited or prioritized
purchase through the State of Connecticut
Purchasing Card (MasterCard) Program (the
“P-Card Program”). If the Contractor fails to
acknowledge receipt within 2 hours,
confirm its obligation to Perform or actually
Perform, as set forth in the purchase order
or through the P-Card Program, then the
CGA may procure the Performance from
another source without further notice to
Contractor and without creating any right of
recourse at law or in equity against the
CGA.
23. Setoff. In addition to all other remedies
available hereunder, the CGA, in its sole
discretion, may setoff (1) any costs or
expenses that the CGA incurs resulting from
the
Contractor's
unexcused
nonperformance under the Contract and
under any other agreement or arrangement
that the Contractor has with the CGA and
(2) any other amounts that are due or may
become due from the CGA to the
Contractor, against amounts otherwise due
or that may become due to the Contractor
under the Contract, or under any other
agreement or arrangement that the
Contractor has with the CGA. The CGA’s
right of setoff shall not be deemed to be the
CGA’s exclusive remedy for the Contractor’s
or Contractor Parties’ breach of the
Contract, all of which shall survive any
setoffs by the CGA.
24. Force Majeure. The CGA and the
Contractor shall not be excused from their
obligation to Perform in accordance with
the Contract except in the case of Force
Majeure events and as otherwise provided
for in the Contract. In the case of any such
exception, the nonperforming party shall
give immediate written notice to the other,
explaining the cause and probable duration
of any such nonperformance.
Attachment M
25. Advertising. The Contractor shall not refer
to sales to the CGA for advertising or
promotional purposes, including, but not
limited to, posting any material or data on
the Internet, without the CGA’s prior
written approval.
26. Americans With Disabilities Act. The
Contractor shall be and remain in
compliance with the Americans with
Disabilities Act of 1990 (“Act”), to the
extent applicable, during the term of the
Contract. The CGA may Terminate the
Contract if the Contractor fails to comply
with the Act.
27. Representations and Warranties.
The
Contractor, represents and warrants to CGA
for itself and Contractor Parties, that:
(a) if they are entities, they are duly and validly
existing under the laws of their respective
states of organization and authorized to
conduct business in the State of
Connecticut in the manner contemplated by
the Contract. Further, as appropriate, they
have taken all necessary action to authorize
the execution, delivery and Performance of
the Contract and have the power and
authority to execute, deliver and Perform
their obligations under the Contract;
(b) they will comply with all applicable State
and Federal laws and municipal ordinances
in satisfying their obligations to the CGA
under and pursuant to the Contract,
including, but not limited to (1) Connecticut
General Statutes Title 1, Chapter 10,
concerning the State’s Codes of Ethics and
(2) Title 4a concerning State purchasing,
including, but not limited to Section 22a194a concerning the use of polystyrene
foam;
(c) the execution, delivery and Performance of
the Contract will not violate, be in conflict
with, result in a breach of or constitute
(with or without due notice and/or lapse of
time) a default under any of the following,
as applicable: (1) any provision of law; (2)
any order of any court or the CGA; or (3)
any indenture, agreement, document or
other instrument to which it is a party or by
which it may be bound;
Page 9 of 22
CGA TERMS AND CONDITIONS
(d) they are not presently debarred,
suspended, proposed for debarment,
declared ineligible, or voluntarily excluded
from covered transactions by any
governmental entity;
(e) as applicable, they have not, within the
three years preceding the Contract, in any
of their current or former jobs, been
convicted of, or had a civil judgment
rendered against them or against any
person who would Perform under the
Contract, for commission of fraud or a
criminal offense in connection with
obtaining, attempting to obtain, or
performing a transaction or contract with
any governmental entity. This includes, but
is not limited to, violation of Federal or
state antitrust statutes or commission of
embezzlement, theft, forgery, bribery,
falsification or destruction of records,
making false statements, or receiving stolen
property;
(f) they are not presently indicted for or
otherwise criminally or civilly charged by
any governmental entity with commission
of any of the offenses listed above;
(g) they have not within the three years
preceding the Contract had one or more
contracts with any governmental entity
Terminated;
(h) they have not employed or retained any
entity or person, other than a bona fide
employee working solely for them, to solicit
or secure the Contract and that they have
not paid or agreed to pay any entity or
person, other than a bona fide employee
working solely for them, any fee,
commission, percentage, brokerage fee,
gifts, or any other consideration contingent
upon or resulting from the award or making
of the Contract or any assignments made in
accordance with the terms of the Contract;
(i) to the best of their knowledge, there are no
Claims involving the Contractor or
Contractor Parties that might reasonably be
expected to materially adversely affect their
businesses, operations, assets, properties,
financial stability, business prospects or
ability to Perform fully under the Contract;
(j) they shall disclose, to the best of their
knowledge, to the CGA in writing any Claims
involving them that might reasonably be
expected to materially adversely affect their
businesses, operations, assets, properties,
Attachment M
financial stability, business prospects or
ability to Perform fully under the Contract,
no later than ten (10) Days after becoming
aware or after they should have become
aware of any such Claims. For purposes of
the Contractor’s obligation to disclose any
Claims to the CGA, the ten (10) Days in the
section of this Contract concerning
Disclosure of Contractor Parties Litigation
shall run consecutively with the ten (10)
Days provided for in this representation and
warranty;
(k) their participation in the Solicitation
process is not a conflict of interest or a
breach of ethics under the provisions of
Title 1, Chapter 10 of the Connecticut
General Statutes concerning the State’s
Code of Ethics;
(l) the Bid was not made in connection or
concert with any other person or entity,
including any affiliate (as defined in the
Tangible Personal Property section of this
Contract) of the Contractor, submitting a
bid for the same Goods or Services, and is in
all respects fair and without collusion or
fraud;
(m) they are able to Perform under the Contract
using their own resources or the resources
of a party who is not a Contractor;
(n) the Contractor shall obtain in a written
contract all of the representations and
warranties in this section from any
Contractor Parties and to require that
provision to be included in any contracts
and purchase orders with Contractor
Parties;
(o) they have paid all applicable workers’
compensation
second
injury
fund
assessments concerning all previous work
done in Connecticut;
(p) they have a record of compliance with
Occupational
Health
and
Safety
Administration regulations without any
unabated, willful or serious violations;
(q) they owe no unemployment compensation
contributions;
(R) they are not delinquent in the payment of
any taxes owed, or, that they have filed a
sales tax security bond, and they have, if
and as applicable, filed for motor carrier
road tax stickers and have paid all
outstanding road taxes;
(S) all of their vehicles have current
registrations and, unless such vehicles are
Page 10 of 22
CGA TERMS AND CONDITIONS
no longer in service, they shall not allow any
such registrations to lapse;
(t) each Contractor Party has vested in the
Contractor plenary authority to bind the
Contractor Parties to the full extent
necessary or appropriate to ensure full
compliance with and Performance in
accordance with all of the terms and
conditions of the Contract and that all
appropriate parties shall also provide, no
later than fifteen (15) days after receiving a
request from the CGA, such information as
the CGA may require to evidence, in the
CGA’s sole determination, compliance with
this section;
(u) except to the extent modified or abrogated
in the Contract, all Title shall pass to the
CGA upon complete installation, testing and
acceptance of the Goods or Services and
payment by the CGA;
(v) if either party Terminates the Contract, for
any reason, they shall relinquish to the CGA
all Title to the Goods delivered, accepted
and paid for (except to the extent any
invoiced amount is disputed) by the CGA;
(w) with regard to third party products
provided with the Goods, they shall transfer
all licenses which they are permitted to
transfer in accordance with the applicable
third party license;
(x) they shall not copyright, register, distribute
or claim any rights in or to the Goods after
the Effective Date of the Contract without
the CGA’s prior written consent;
(y) they either own or have the authority to
use all Title of and to the Goods, and that
such Title is not the subject of any
encumbrances, liens or claims of ownership
by any third party;
(z) the Goods do not infringe or
misappropriate any patent, trade secret or
other intellectual property right of a third
party;
(aa) the CGA's use of any Goods shall not
infringe or misappropriate any patent, trade
secret or other intellectual property right of
a third party;
(bb)
if they procure any Goods, they shall
sub-license such Goods and that the CGA
shall be afforded the full benefits of any
manufacturer or subcontractor licenses for
the use of the Goods; and
(cc) they shall assign or otherwise transfer to
the CGA, or afford the CGA the full benefits
Attachment M
of any manufacturer's warranty for the
Goods, to the extent that such warranties
are assignable or otherwise transferable to
the CGA.
28. Representations and Warranties Concerning
Motor Vehicles.
If in the course of
Performance or in any other way related to
the Contract the Contractor at any time
uses or operates “motor vehicles,” as that
term is defined by Conn. Gen. Stat. §14-1
(including, but not limited to such services
as snow plowing, sanding, hauling or
delivery
of
materials,
freight
or
merchandise, or the transportation of
passengers), the Contractor, represents and
warrants for itself and the Contractor
Parties, that:
(a) It is the owner of record or lessee of record
of each such motor vehicle used in the
Performance of the Contract, and each such
motor vehicle is duly registered with the
Connecticut Department of Motor Vehicles
(“ConnDMV”) in accordance with the
provisions of Chapter 246 of the
Connecticut General Statutes. Each such
registration shall be in valid status, and shall
not be expired, suspended or revoked by
ConnDMV , for any reason or cause. If such
motor vehicle is not registered with
ConnDMV, then it shall be duly registered
with another state or commonwealth in
accordance with such other state’s or
commonwealth’s applicable statutes. Each
such registration shall be in valid status, and
shall not be expired, suspended or revoked
by such other state or commonwealth for
any reason or cause.
(b) Each such motor vehicle shall be fully
insured in accordance with the provisions of
Sections 14-12b, 14-112 and 38a-371 of the
Connecticut General Statutes, as amended,
in the amounts required by the said
sections or in such higher amounts as have
been specified by ConnDMV as a condition
for the award of the Contract, or in
accordance with all substantially similar
provisions imposed by the law of the
jurisdiction where the motor vehicle is
registered.
(c) Each Contractor Party who uses or operates
a motor vehicle at any time in the
Page 11 of 22
CGA TERMS AND CONDITIONS
Performance of the Contract shall have and
maintain a motor vehicle operator’s license
or commercial driver’s license of the
appropriate class for the motor vehicle
being used or operated. Each such license
shall
bear
the
endorsement
or
endorsements required by the provisions of
Section 14-36a of the Connecticut General
Statutes, as amended, to operate such
motor vehicle, or required by substantially
similar provisions imposed by the law of
another jurisdiction in which the operator is
licensed to operate such motor vehicle. The
license shall be in valid status, and shall not
be expired, suspended or revoked by
ConnDMV or such other jurisdiction for any
reason or cause.
(d) Each motor vehicle shall be in full
compliance with all of the terms and
conditions of all provisions of the
Connecticut
General
Statutes
and
regulations, or those of the jurisdiction
where the motor vehicle is registered,
pertaining to the mechanical condition,
equipment, marking and operation of
motor vehicles of such type, class and
weight, including, but not limited to,
requirements for motor vehicles having a
gross vehicle weight rating of 18,000
pounds or more or motor vehicles
otherwise described by the provisions of
Conn. Gen. Stat. § 14-163c(a) and all
applicable provisions of the Federal Motor
Carrier Safety Regulations, as set forth in
Title 49, Parts 382 to 399, inclusive, of the
Code of Federal Regulations.
29. Disclosure of Contractor Parties Litigation.
The Contractor shall require that all
Contractor Parties, as appropriate, disclose
to the Contractor, to the best of their
knowledge, any Claims involving the
Contractor Parties that might reasonably be
expected to materially adversely affect their
businesses, operations, assets, properties,
financial stability, business prospects or
ability to Perform fully under the Contract,
no later than ten (10) Days after becoming
aware or after they should have become
aware of any such Claims. Disclosure shall
be in writing.
Attachment M
30. Entirety of Contract. The Contract is the
entire agreement between the parties with
respect to its subject matter, and
supersedes all prior agreements, proposals,
offers, counteroffers and understandings of
the parties, whether written or oral. The
Contract has been entered into after full
investigation, neither party relying upon
any statement or representation by the
other
unless
such
statement
or
representation is specifically embodied in
the Contract.
31. Exhibits.
All exhibits referred to in and
attached to the Contract are incorporated
in this Contract by such reference and shall
be deemed to be a part of it as if they had
been fully set forth in it.
32. Non-discrimination.
(a) For purposes of this Section, the following
terms are defined as follows:
(1) "Commission"
means
the
Commission on Human Rights and
Opportunities;
(2) "Contract" and “contract” include
any extension or modification of the
Contract or contract;
(3) "Contractor" and “contractor”
include any successors or assigns of the
Contractor or contractor;
(4) "Gender identity or expression"
means a person's gender-related
identity, appearance or behavior,
whether or not that gender-related
identity, appearance or behavior is
different from that traditionally
associated with the person's physiology
or assigned sex at birth, which genderrelated identity can be shown by
providing evidence including, but not
limited to, medical history, care or
treatment of the gender-related
identity, consistent and uniform
assertion of the gender-related identity
or any other evidence that the genderrelated identity is sincerely held, part of
a person's core identity or not being
asserted for an improper purpose.
Page 12 of 22
CGA TERMS AND CONDITIONS
(5) “good faith" means that degree
of diligence which a reasonable person
would exercise in the performance of
legal duties and obligations;
(6) "good faith efforts" shall include,
but not be limited to, those reasonable
initial efforts necessary to comply with
statutory or regulatory requirements
and additional or substituted efforts
when it is determined that such initial
efforts will not be sufficient to comply
with such requirements;
(7) "marital status" means being
single, married as recognized by the
state of Connecticut, widowed,
separated or divorced;
(8) "mental disability" means one or
more mental disorders, as defined in
the most recent edition of the American
Psychiatric Association's "Diagnostic
and Statistical Manual of Mental
Disorders", or a record of or regarding a
person as having one or more such
disorders;
(9) "minority business enterprise"
means any small contractor or supplier
of materials fifty-one percent or more
of the capital stock, if any, or assets of
which is owned by a person or persons:
(1) who are active in the 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 Connecticut
General Statutes § 32-9n; and
(10) "public works contract" means
any agreement between any individual,
firm or corporation and the State or any
political subdivision of the State other
than a municipality for construction,
rehabilitation, conversion, extension,
demolition or repair of a public
building, highway or other changes or
improvements in real property, or
which is financed in whole or in part by
the State, including, but not limited to,
Attachment M
matching expenditures, grants, loans,
insurance or guarantees.
For purposes of this Section, the terms
"Contract" and “contract” do not
include a contract where each
contractor is (1) a political subdivision
of the state, including, but not limited
to, a municipality, (2) a quasi-public
CGA, as defined in Conn. Gen. Stat.
Section 1-120, (3) any other state,
including but not limited to any
federally recognized Indian tribal
governments, as defined in Conn. Gen.
Stat. Section 1-267, (4) the federal
government, (5) a foreign government,
or (6) an CGA of a subdivision, CGA,
state or government described in the
immediately preceding enumerated
items (1), (2), (3), (4) or (5).
(b) (1)The Contractor agrees and warrants that
in the performance of the Contract such
Contractor will not discriminate or permit
discrimination against any person or group
of persons on the grounds of race, color,
religious creed, age, marital status, national
origin, ancestry, sex, gender identity or
expression, mental retardation, mental
disability or physical disability, including,
but not limited to, blindness, unless it is
shown by such Contractor that such
disability prevents performance of the work
involved, in any manner prohibited by the
laws of the United States or of the State of
Connecticut; and the Contractor further
agrees to take affirmative action to insure
that
applicants
with
job-related
qualifications are employed and that
employees are treated when employed
without regard to their race, color, religious
creed, age, marital status, national origin,
ancestry, sex, gender identity or expression,
mental retardation, mental disability or
physical disability, including, but not limited
to, blindness, unless it is shown by the
Contractor that such disability prevents
performance of the work involved; (2) the
Page 13 of 22
CGA TERMS AND CONDITIONS
Contractor agrees, in all solicitations or
advertisements for employees placed by or
on behalf of the Contractor, to state that it
is an "affirmative action-equal opportunity
employer" in accordance with regulations
adopted by the Commission; (3) the
Contractor agrees to provide each labor
union or representative of workers with
which the Contractor has a collective
bargaining agreement or other contract or
understanding and each vendor with which
the Contractor has a contract or
understanding, a notice to be provided by
the Commission, advising the labor union or
workers’ representative of the Contractor's
commitments under this section and to
post copies of the notice in conspicuous
places available to employees and
applicants
for employment;
(4) the
Contractor agrees to comply with each
provision of this Section and Connecticut
General Statutes §§ 46a-68e and 46a-68f
and with each regulation or relevant order
issued by said Commission pursuant to
Connecticut General Statutes §§ 46a-56,
46a-68e and 46a-68f; and (5) the Contractor
agrees to provide the Commission on
Human Rights and Opportunities with such
information requested by the Commission,
and permit access to pertinent books,
records and accounts, concerning the
employment practices and procedures of
the Contractor as relate to the provisions of
this Section and Connecticut General
Statutes § 46a-56. If the contract is a public
works contract, the Contractor agrees and
warrants that he will make good faith
efforts to employ minority business
enterprises as subcontractors and suppliers
of materials on such public works projects.
(c) Determination of the Contractor's good
faith efforts shall include, but shall not be
limited to, the following factors: The
Contractor's
employment
and
subcontracting policies, patterns and
practices;
affirmative
advertising,
recruitment
and training;
technical
Attachment M
(d)
(e)
(f)
(g)
assistance activities and such other
reasonable activities or efforts as the
Commission may prescribe that are
designed to ensure the participation of
minority business enterprises in public
works projects.
The Contractor shall develop and maintain
adequate documentation, in a manner
prescribed by the Commission, of its good
faith efforts.
The Contractor shall include the provisions
of subsection (b) of this Section in every
subcontract or purchase order entered into
in order to fulfill any obligation of a contract
with the State and such provisions shall be
binding on a subcontractor, vendor or
manufacturer
unless
exempted
by
regulations or orders of the Commission.
The Contractor shall take such action with
respect to any such subcontract or purchase
order as the Commission may direct as a
means of enforcing such provisions
including sanctions for noncompliance in
accordance with Connecticut General
Statutes §46a-56; provided if such
Contractor becomes involved in, or is
threatened with, litigation with a
subcontractor or vendor as a result of such
direction by the Commission, the
Contractor may request the State of
Connecticut to enter into any such litigation
or negotiation prior thereto to protect the
interests of the State and the State may so
enter.
The Contractor agrees to comply with the
regulations referred to in this Section as
they exist on the date of this Contract and
as they may be adopted or amended from
time to time during the term of this
Contract and any amendments thereto.
(1) The Contractor agrees and warrants that
in the performance of the Contract such
Contractor will not discriminate or permit
discrimination against any person or group
of persons on the grounds of sexual
orientation, in any manner prohibited by
the laws of the United States or the State of
Connecticut, and that employees are
Page 14 of 22
CGA TERMS AND CONDITIONS
treated when employed without regard to
their sexual orientation; (2) the Contractor
agrees to provide each labor union or
representative of workers with which such
Contractor has a collective bargaining
agreement
or
other
contract
or
understanding and each vendor with which
such Contractor has a contract or
understanding, a notice to be provided by
the Commission on Human Rights and
Opportunities advising the labor union or
workers' representative of the Contractor's
commitments under this section, and to
post copies of the notice in conspicuous
places available to employees and
applicants
for employment;
(3) the
Contractor agrees to comply with each
provision of this section and with each
regulation or relevant order issued by said
Commission pursuant to Connecticut
General Statutes § 46a-56; and (4) the
Contractor agrees to provide the
Commission on Human Rights and
Opportunities with such information
requested by the Commission, and permit
access to pertinent books, records and
accounts, concerning the employment
practices and procedures of the Contractor
which relate to the provisions of this
Section and Connecticut General Statutes
§ 46a-56.
(h) The Contractor shall include the provisions
of the foregoing paragraph in every
subcontract or purchase order entered into
in order to fulfill any obligation of a contract
with the State and such provisions shall be
binding on a subcontractor, vendor or
manufacturer
unless
exempted
by
regulations or orders of the Commission.
The Contractor shall take such action with
respect to any such subcontract or purchase
order as the Commission may direct as a
means of enforcing such provisions
including sanctions for noncompliance in
accordance with Connecticut General
Statutes § 46a-56; provided, if such
Contractor becomes involved in, or is
threatened with, litigation with a
Attachment M
subcontractor or vendor as a result of such
direction by the Commission, the
Contractor may request the State of
Connecticut to enter into any such litigation
or negotiation prior thereto to protect the
interests of the State and the State may so
enter.
33. Tangible Personal Property.
(a) The Contractor on its behalf and on behalf of
its Affiliates, as defined below, shall comply
with the provisions of Conn. Gen. Stat. §12411b, as follows:
(1) For the term of the Contract, the
Contractor and its Affiliates shall collect
and remit to the State of Connecticut,
Department of Revenue Services, any
Connecticut use tax due under the
provisions of Chapter 219 of the
Connecticut General Statutes for items of
tangible personal property sold by the
Contractor or by any of its Affiliates in the
same manner as if the Contractor and
such Affiliates were engaged in the
business of selling tangible personal
property for use in Connecticut and had
sufficient nexus under the provisions of
Chapter 219 to be required to collect
Connecticut use tax;
(2) A customer’s payment of a use tax to the
Contractor or its Affiliates relieves the
customer of liability for the use tax;
(3) The Contractor and its Affiliates shall
remit all use taxes they collect from
customers on or before the due date
specified in the Contract, which may not
be later than the last day of the month
next succeeding the end of a calendar
quarter or other tax collection period
during which the tax was collected;
(4) The Contractor and its Affiliates are not
liable for use tax billed by them but not
paid to them by a customer; and
(5) Any Contractor or Affiliate who fails to
remit use taxes collected on behalf of its
customers by the due date specified in the
Contract shall be subject to the interest
and penalties provided for persons
required to collect sales tax under chapter
219 of the general statutes.
Page 15 of 22
CGA TERMS AND CONDITIONS
(b) For purposes of this section of the Contract,
the word “Affiliate” means any person, as
defined in section 12-1 of the general
statutes, that controls, is controlled by, or is
under common control with another
person. A person controls another person if
the person owns, directly or indirectly,
more than ten per cent of the voting
securities of the other person. The word
“voting security” means a security that
confers upon the holder the right to vote
for the election of members of the board of
directors or similar governing body of the
business, or that is convertible into, or
entitles the holder to receive, upon its
exercise, a security that confers such a right
to vote. “Voting security” includes a
general partnership interest.
(c) The Contractor represents and warrants
that each of its Affiliates has vested in the
Contractor plenary authority to so bind the
Affiliates in any agreement with the State of
Connecticut. The Contractor on its own
behalf and on behalf of its Affiliates shall
also provide, no later than 30 days after
receiving a request by the State’s
contracting authority, such information as
the State may require to ensure, in the
State’s sole determination, compliance with
the provisions of Chapter 219 of the
Connecticut General Statutes, including, but
not limited to, §12-411b.
34. Whistleblowing.
The Contract may be
subject to the provisions of Section 4-61dd
of the Connecticut General Statutes. In
accordance with this statute, if an officer,
employee or appointing authority of the
Contractor takes or threatens to take any
personnel action against any employee of
the Contractor in retaliation for such
employee's disclosure of information to any
employee of the contracting state or quasipublic CGA or the Auditors of Public
Accounts or the Attorney General under the
provisions of subsection (a) of such statute,
the Contractor shall be liable for a civil
penalty of not more than five thousand
dollars for each offense, up to a maximum
of twenty per cent of the value of this
Contract. Each violation shall be a separate
and distinct offense and in the case of a
continuing violation, each calendar day's
continuance of the violation shall be
Attachment M
deemed to be a separate and distinct
offense. The CGA may request that the
Attorney General bring a civil action in the
Superior Court for the Judicial District of
Hartford to seek imposition and recovery of
such civil penalty. In accordance with
subsection (f) of such statute, each large
state contractor, as defined in the statute,
shall post a notice of the provisions of the
statute relating to large state contractors in
a conspicuous place which is readily
available for viewing by the employees of
the Contractor.
35. Notice. All notices, demands, requests,
consents, approvals or other
communications required or permitted to
be given or which are given with respect to
this Contract (for the purpose of this section
collectively called “Notices”) shall be
deemed to have been effected at such time
as the notice is placed in the U.S. mail, first
class and postage pre-paid, return receipt
requested or placed with a recognized,
overnight express delivery service that
provides for a return receipt or sent via
email. All such Notices shall be in writing
and shall be addressed as follows:
If to the CGA
Mailing Address:
CT General Assembly;
Financial Administrator;
Office of Legislative Management;
300 Capitol Avenue; Room 5100
Legislative Office Building;
Hartford CT 06106.
Email:
CGAContracting@cga.ct.gov.
If to the Contractor:
Mailing Address:
[VENDOR MAILING ADDRESS]
Email:
[VENDOR EMAIL]
36. Insurance. Before commencing
Performance, the Contractor shall obtain
and maintain at its own cost and expense
for the duration of the Contract, the
following insurance as described in (a)
through (h) below. Contractor shall assume
any and all deductibles in the described
Page 16 of 22
CGA TERMS AND CONDITIONS
insurance policies. The Contractor’s
insurers shall have no right of recovery or
subrogation against the State and the
described Contractor’s insurance shall be
primary coverage. Any failure to comply
with the claim reporting provisions of the
policy shall not affect coverage provided to
the State.
(a) Commercial General Liability: $1,000,000
combined single limit per occurrence for
bodily injury, personal injury and property
damage. Coverage shall include, Premises
and Operations, Independent Contractors,
Products and Completed Operations,
Contractual Liability and Broad Form
Property Damage coverage. If a general
aggregate is used, the general aggregate
limit shall apply separately to the project or
the general aggregate limit shall be twice
the occurrence limit.
(b) Automobile Liability: $1,000,000 combined
single limit per accident for bodily injury.
Coverage extends to owned, hired and nonowned automobiles. If the
vendor/contractor does not own an
automobile, but one is used in the
execution of the contract, then only hired
and non-owned coverage is required. If a
vehicle is not used in the execution of the
contract then automobile coverage is not
required.
(c) Professional Liability: $1,000,000 limit of
liability.
(d) Workers’ Compensation and Employers
Liability: Statutory coverage in compliance
with the Compensation laws of the State of
Connecticut. Coverage shall include
Employer’s Liability with minimum limits of
$100,000 each accident, $500,000 Disease –
Policy limit, $100,000 each employee.
37. Headings.
The headings given to the
sections in the Contract are inserted only
for convenience and are in no way to be
construed as part of the Contract or as a
limitation of the scope of the particular
section to which the heading refers.
Attachment M
38. Number and Gender.
Whenever the
context so requires, the plural or singular
shall include each other and the use of any
gender shall include all genders.
39. Parties. To the extent that any Contractor
Party is to participate or Perform in any
way, directly or indirectly in connection
with the Contract, any reference in the
Contract to “Contractor” shall also be
deemed to include “Contractor Parties,” as
if such reference had originally specifically
included “Contractor Parties” since it is the
parties’ intent for the terms “Contractor
Parties” to be vested with the same
respective rights and obligations as the
term “Contractor.”
40. Contractor Changes. The Contractor shall
notify the CGA in writing no later than ten
(10) Days from the effective date of any
change in:
(a) its certificate of incorporation or other
organizational document;
(b) more than a controlling interest in the
ownership of the Contractor; or
(c) the
individual(s)
Performance.
in
charge
of
the
This change shall not relieve the Contractor
of any responsibility for the accuracy and
completeness of the Performance. The
CGA, after receiving written notice by the
Contractor of any such change, may require
such agreements, releases and other
instruments evidencing, to the CGA’s
satisfaction, that any individuals retiring or
otherwise separating from the Contractor
have been compensated in full or that
provision has been made for compensation
in full, for all work performed under terms
of the Contract. The Contractor shall
deliver such documents to the CGA in
accordance with the terms of the CGA’s
written request. The CGA may also require,
and the Contractor shall deliver, a financial
statement showing that solvency of the
Contractor is maintained. The death of any
Page 17 of 22
CGA TERMS AND CONDITIONS
Contractor Party, as applicable, shall not
release the Contractor from the obligation
to Perform under the Contract; the
surviving Contractor Parties, as appropriate,
must continue to Perform under the
Contract until Performance is fully
completed.
41. Further Assurances.
The parties shall
provide such information, execute and
deliver any instruments and documents and
take such other actions as may be necessary
or reasonably requested by the other party
which are not inconsistent with the
provisions of this Contract and which do not
involve the vesting of rights or assumption
of obligations other than those provided for
in the Contract, in order to give full effect to
the Contract and to carry out the intent of
the Contract.
42. Audit and Inspection of Plants, Places of
Business and Records.
(a) The State and its agents, including, but
not limited to, the Connecticut Auditors
of Public Accounts, Attorney General
and State’s Attorney and their
respective agents, may, at reasonable
hours, inspect and examine all of the
parts of the Contractor’s and Contractor
Parties’ plants and places of business
which, in any way, are related to, or
involved in, the performance of this
Contract.
(b) The Contractor shall maintain, and shall
require each of the Contractor Parties
to maintain, accurate and complete
Records. The Contractor shall make all
of it’s and the Contractor Parties’
Records available at all reasonable
hours for audit and inspection by the
CGA, State and its agents.
(c) The CGA or State shall make all requests
for any audit or inspection in writing
and shall provide the Contractor with at
least twenty-four (24) hours’ notice
prior to the requested audit and
inspection date. If the CGA or State
suspects fraud or other abuse, or in the
event of an emergency, the CGA or
State is not obligated to provide any
prior notice.
Attachment M
(d) All audits and inspections shall be at the
CGA/State’s expense.
(e) The Contractor shall keep and preserve
or cause to be kept and preserved all of
its and Contractor Parties’ Records until
three (3) years after the latter of (i) final
payment under this Contract, or (ii) the
expiration or earlier termination of this
Contract, as the same may be modified
for any reason. The CGA or State may
request an audit or inspection at any
time during this period. If any Claim or
audit is started before the expiration of
this period, the Contractor shall retain
or cause to be retained all Records until
all Claims or audit findings have been
resolved.
(f) The Contractor shall cooperate fully
with the CGA or State and its agents in
connection with an audit or inspection.
Following any audit or inspection, the
CGA or State may conduct and the
Contractor shall cooperate with an exit
conference.
(g) The Contractor shall incorporate this
entire Section verbatim into any
contract or other agreement that it
enters into with any Contractor Party.
43. Background Checks. The CGA may require
that the Contractor and Contractor Parties
undergo criminal background checks as
provided for in the CGA procedures for
background checks. The Contractor and
Contractor Parties shall cooperate fully as
necessary or reasonably requested with the
CGA and its agents in connection with such
background checks.
44. Continued Performance.
The Contractor
and Contractor Parties shall continue to
Perform their obligations under the
Contract while any dispute concerning the
Contract is being resolved.
45. Working and Labor Synergies.
The
Contractor shall be responsible for
maintaining a tranquil working relationship
between the Contractor work force, the
Contractor Parties and their work force,
CGA employees, and any other contractors
present at the work site. The Contractor
shall quickly resolve all labor disputes which
Page 18 of 22
CGA TERMS AND CONDITIONS
result from the Contractor's or Contractor
Parties’ presence at the work site, or other
action under their control. Labor disputes
shall not be deemed to be sufficient cause
to allow the Contractor to make any claim
for additional compensation for cost,
expenses or any other loss or damage, nor
shall those disputes be deemed to be
sufficient reason to relieve the Contractor
from any of its obligations under the
Contract.
46. Contractor Responsibility.
(a) The Contractor shall be responsible for the
entire Performance under the Contract
regardless of whether the Contractor itself
performs. The Contractor shall be the sole
point
of
contact
concerning
the
management of the Contract, including
Performance and payment issues. The
Contractor is solely and completely
responsible for adherence by the
Contractor Parties to all applicable
provisions of the Contract.
(b) The Contractor shall exercise all reasonable
care to avoid damage to the CGA property
or to property being made ready for the
CGA's use, and to all property adjacent to
any work site.
The Contractor shall
promptly report any damage, regardless of
cause, to the CGA.
47. Severability. If any term or provision of the
Contract or its application to any person,
entity or circumstance shall, to any extent,
be held to be invalid or unenforceable, the
remainder of the Contract or the
application of such term or provision shall
not be affected as to persons, entities or
circumstances other than those as to whom
or to which it is held to be invalid or
unenforceable. Each remaining term and
provision of the Contract shall be valid and
enforced to the fullest extent possible by
law.
48. Confidential Information. The CGA will
afford due regard to the Contractor’s
request for the protection of proprietary or
confidential information which the CGA
receives. However, all materials associated
with the Solicitation and the Contract are
Attachment M
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 merely state
generally that the materials are proprietary
or confidential in nature and not, therefore,
subject to release to third parties. Those
particular sentences, paragraphs, pages or
sections that the Contractor believes are
exempt from disclosure under the FOIA
must be specifically identified as such.
Convincing explanation and rationale
sufficient to justify each exemption
consistent with the 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 the FOIA.
To the extent that any other provision or
part of the Contract, especially including the
Bid, the Records and the specifications,
conflicts or is in any way inconsistent with
this section, this section controls and shall
apply and the conflicting provision or part
shall not be given effect. If the Contractor
indicates that certain documentation is
submitted in confidence, by specifically and
clearly marking said documentation as
CONFIDENTIAL,” the CGA will endeavor to
keep said information confidential to the
extent permitted by law.
The CGA,
however, has no obligation to initiate,
prosecute or defend any legal proceeding or
to seek a protective order or other similar
relief to prevent disclosure of 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 CGA or the
State have any liability for the disclosure of
any documents or information in its
possession which the CGA believes are
required to be disclosed pursuant to the
FOIA or other requirements of law.
49. References
to Statutes, Public Acts,
Regulations, Codes and Executive Orders.
All references in this Contract to any
statute, public act, regulation, code or
Page 19 of 22
CGA TERMS AND CONDITIONS
executive order shall mean such statute,
public act, regulation, code or executive
order, respectively, as it has been amended,
replaced or superseded at any time.
Notwithstanding any language in this
Contract that relates to such statute, public
act, regulation, code or executive order,
and notwithstanding a lack of a formal
amendment to this Contract, this Contract
shall always be read and interpreted as if it
contained the most current and applicable
wording and requirements of such statute,
public act, regulation, code or executive
order as if their most current language had
been
used
in
and
requirements
incorporated into this Contract at the time
of its execution.
50. Cross-Default.
(a) If the Contractor or Contractor Parties
breach, default or in any way fail to Perform
satisfactorily under the Contract, then the
CGA may, in its sole discretion, without
more and without any action whatsoever
required of the CGA, treat any such event as
a breach, default or failure to perform
under any or all other agreements or
arrangements (“Other Agreements”) that
the Contractor or Contractor Parties have
with the CGA. Accordingly, the CGA may
then exercise at its sole option any and all
of its rights or remedies provided for in the
Contract or Other Agreements, either
selectively or collectively and without such
election being deemed to prejudice any
rights or remedies of the CGA, as if the
Contractor or Contractor Parties had
suffered a breach, default or failure to
perform under the Other Agreements.
(b) If the Contractor or Contractor Parties
breach, default or in any way fail to Perform
satisfactorily under any or all Other
Agreements with the CGA or the State, then
the CGA may, in its sole discretion, without
more and without any action whatsoever
required of the CGA, treat any such event as
a breach, default or failure to Perform
under the Contract. Accordingly, the CGA
may then exercise at its sole option any and
all of its rights or remedies provided for in
the Other Agreements or the Contract,
either selectively or collectively and without
such election being deemed to prejudice
any rights or remedies of the CGA or the
Attachment M
State, as if the Contractor or Contractor
Parties had suffered a breach, default or
failure to Perform under the Contract.
51. Disclosure of Records. This Contract may be
subject to the provisions of section 1-218 of
the Connecticut General Statutes.
In
accordance with this statute, each contract
in excess of two million five hundred
thousand dollars between a public CGA and
a person for the performance of a
governmental function shall (a) provide that
the public CGA is entitled to receive a copy
of records and files related to the
performance of the governmental function,
and (b) indicate that such records and files
are subject to FOIA and may be disclosed by
the public CGA pursuant to FOIA. No
request to inspect or copy such records or
files shall be valid unless the request is
made to the public CGA in accordance with
FOIA. Any complaint by a person who is
denied the right to inspect or copy such
records or files shall be brought to the
Freedom of Information Commission in
accordance with the provisions of sections
1-205 and 1-206 of the Connecticut General
Statutes.
52. Summary of State Ethics Laws. Pursuant to
the requirements of section 1-101qq of the
Connecticut General Statutes, the summary
of State ethics laws developed by the State
Ethics Commission pursuant to section 181b of the Connecticut General Statutes is
incorporated by reference into and made a
part of the Contract as if the summary had
been fully set forth in the Contract.
53. Sovereign Immunity. The parties
acknowledge and agree that nothing in the
Solicitation or the Contract shall be
construed as a modification, compromise or
waiver by the CGA or the State of any rights
or defenses of any immunities provided by
Federal law or the laws of the State of
Connecticut to the State or any of its
officers and employees, which they may
have had, now have or will have with
respect to all matters arising out of the
Contract. To the extent that this section
conflicts with any other section, this section
shall govern.
Page 20 of 22
CGA TERMS AND CONDITIONS
54. Time of the Essence. Time is of the essence
with respect to all provisions of this
Contract that specify a time for
performance; provided, however, that this
provision shall not be construed to limit or
deprive a party of the benefits of any grace
or use period allowed in this Contract.
55. Certification as Small Contractor or Minority
Business Enterprise. The Contractor shall
be in breach of this Contract if the
Contractor is certified as a “small
contractor” or a “minority business
enterprise” under Conn. Gen. Stat. § 4a-60g
and that certification lapses during the term
of this Contract.
56. Campaign Contribution Restriction. For all
State contracts as defined in Conn. Gen.
Stat. § 9-612(g)(1) having a value in a
calendar year of $50,000 or more or a
combination or series of such agreements
or contracts having a value of $100,000 or
more, the authorized signatory to this
Contract expressly acknowledges receipt of
the
State
Elections
Enforcement
Commission's
notice
advising
state
contractors of state campaign contribution
and solicitation prohibitions, and will inform
its principals of the contents of the notice,
as set forth in “Notice to Executive Branch
State Contractors and Prospective State
Contractors of Campaign Contribution and
Solicitation Limitations,” attached as Exhibit
C in the Contract.
57. Protection of Confidential Information.
(a) Contractor and Contractor Parties, at
their own expense, have a duty to and
shall protect from a Confidential
Information Breach any and all
Confidential Information which they
come to possess or control, wherever
and however stored or maintained, in a
commercially reasonable manner in
accordance with current industry
standards.
(b) Each Contractor or Contractor Party
shall develop, implement and maintain
Attachment M
a comprehensive data - security
program for the protection of
Confidential Information. The
safeguards contained in such program
shall be consistent with and comply with
the safeguards for protection of
Confidential Information, and
information of a similar character, as set
forth in all applicable federal and state
law and written policy of the CGA or
State concerning the confidentiality of
Confidential Information. Such datasecurity program shall include, but not
be limited to, the following:
i. A security policy for
employees related to the
storage, access and
transportation of data
containing Confidential
Information;
ii. Reasonable restrictions on
access to records containing
Confidential Information,
including access to any locked
storage where such records
are kept;
iii. A process for reviewing
policies and security
measures at least annually;
iv. Creating secure access
controls to Confidential
Information, including but not
limited to passwords; and
v. Encrypting of Confidential
Information that is stored on
laptops, portable devices or
being transmitted
electronically.
(c) The Contractor and Contractor Parties
shall notify the CGA and the
Connecticut Office of the Attorney
General as soon as practical, but no
later than twenty-four (24) hours, after
they become aware of or suspect that
any Confidential Information which
Page 21 of 22
CGA TERMS AND CONDITIONS
Contractor or Contractor Parties have
come to possess or control has been
subject to a Confidential Information
Breach. If a Confidential Information
Breach has occurred, the Contractor
shall, within three (3) business days
after the notification, present a credit
monitoring and protection plan to the
Commissioner of Administrative
Services, the CGA and the Connecticut
Office of the Attorney General, for
review and approval. Such credit
monitoring or protection plan shall be
made available by the Contractor at its
own cost and expense to all individuals
affected by the Confidential
Information Breach. Such credit
monitoring or protection plan shall
include, but is not limited to
reimbursement for the cost of placing
and lifting one (1) security freeze per
credit file pursuant to Connecticut
General Statutes § 36a-701a. Such
credit monitoring or protection plans
shall be approved by the CGA in
accordance with this Section and shall
cover a length of time commensurate
with the circumstances of the
Confidential Information Breach. The
Contractors’ costs and expenses for the
credit monitoring and protection plan
shall not be recoverable from the CGA,
any State of Connecticut entity or any
affected individuals.
(d) The Contractor shall incorporate the
requirements of this Section in all
subcontracts requiring each Contractor
Party to safeguard Confidential
Information in the same manner as
provided for in this Section.
(e) Nothing in this Section shall supersede
in any manner Contractor’s or
Contractor Party’s obligations pursuant
to HIPAA or the provisions of this
Contract concerning the obligations of
Attachment M
the Contractor as a Business Associate
of Covered Entity.
58. Audit Requirements for Recipients of State
Financial Assistance. For purposes of this
paragraph, the word "contractor" shall be
deemed to mean "nonstate entity," as that
term is defined in Section 4-230 of the
Connecticut General Statutes.
The
contractor shall provide for an annual
financial audit acceptable to the CGA for
any expenditure of state-awarded funds
made by the contractor. Such audit shall
include management letters and audit
recommendations. The State Auditors of
Public Accounts shall have access to all
records and accounts for the fiscal year(s) in
which the award was made. The contractor
will comply with federal and state single
audit standards as applicable.
Page 22 of 22
Attachment 1
SYSTEM
POINT NAME
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1/AHU23
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
CHWR.1
COOL.1
V_EC1POS
FILT.1
FREEZ.1
HEAT.1
HWR.1
EP.WO7
NEG.1
OFF.1
EP.WE9
PURGE.1
MAT.1
ECON.1
V_COAH1
V_RAHUM1
AF.CF1
RAT.1
V_SPST1
AH1.SPT
SAT.1
V_CFMR1
AHU.1
CF.1
AF.AH1
EPD.23
V_EC2POS
FILT.2
FREEZ2
COOL.2
HEAT.2
HWR.2
NEG.2
OFF.2
PURGE.2
MAT.2
ECON.2
EP.SE10A
ES.B2
V_COAH2
V_CFMR2
V_RAHUM2
RAT.2
CF.2
AF.CF2
V_SPST2
AH2.SPT
EP.SO8A
ES.A2
V_CFMS2
SAT.2
AHU.2
AF.AH2
TEMP.RH4
TEMP.RH5
Legislative Office Building
Page: 1 of 29
Completed Component Checklist
POINT DESCRIPTION
CHW Return Temp.
Cooling Control Valve
Damper V/P Feedback
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp
Life Safety Neg. Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety Off Mode
Life Safety Purge
Mixed Air Temperature
OA, RA, EA Dampers
Return Air CO2 Transmitter
Return Air Humidity
Return Air Status
Return Air Temperature
Space Static Pressure
Space Temperature
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Start/Stop
Supply Fan Start/Stop
Supply Fan Status
Com. A.A. Damper Open/Close
Damper V/P Feedback
Filter Status
Freezestat
Cooling Control Valve
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Mixed Air Temperature
OA,RA,EA Dampers
Ret. Smoke Dpr. E.P. Switch
Ret. Smoke Dpr. End Switch
Return Air CO2 Transmitter
Return Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Return Fan Start/Stop
Return Fan Status
Space Static Pressure
Space Temperature
SUP. Smoke Dpr. E.P. Switch
Sup. Smoke Dpr. End Switch
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
Women's Locker Temp.
Women's Toilet Temp.
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment1
SYSTEM
POINT NAME
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
COOL.3
V_EC3POS
EP.SE10B
FILT.3
FREEZ.3
HEAT.3
HWR.3
NEG.3
OFF.3
PURGE.3
MAT.3
EP.SO8B
ECON.3
ES.B3
V_COAH3
V_CFMR3
V_RAHUM3
RAT.3
CF.3
AF.CF3
V_SPST3
AH3.SPT
ES.A3
V_CFMS3
SAT.3
AHU.3
AF.AH3
CHWR.4
COOL.4
EP.NE9A
V_EC4POS
FILT.4
FREEZ.4
HEAT.4
HWR.4
NEG.4
OFF.4
PURGE.4
MAT.4
EP.NO7A
ECON.4
ES.B4
V_COAH4
V_CFMR4
V_RAHUM4
RAT.4
CF.4
AF.CF4
V_SPST4
AH4.SPT
ES.A4
V_CFMS4
SAT.4
AHU.4
AF.AH4
Legislative Office Building
Page: 2 of 29
Completed Component Checklist
POINT DESCRIPTION
Cooling Control Valve
Damper V/P Feedback
E.A./Ret. Smoke Dpr. E.P.Sw.
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Mixed Air Temperature
O.A./Sup. Smoke Dpr. E.P.Sw.
OA,RA,EA Dampers
Ret. Smoke Dpr. End Switch
Return Air CO2 Transmitter
Return Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Return Fan Start/Stop
Return Fan Status
Space Static Pressure
Space Temperature
Sup. Smoke Dpr. End Switch
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
CHW Return Temp.
Cooling Control Valve
E.A./Ret. Smoke Dpr. E.P.Sw.
Econ. Damper Feedback
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Mixed Air Temperature
O.A./Sup. Smoke Dpr. E.P.Sw.
OA,RA,EA Dampers
Ret. Smoke Dpr. End Switch
Return Air CO2 Transmitter
Return Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Return Fan Start/Stop
Return Fan Status
Space Static Pressure
Space Temperature
Sup. Smoke Dpr. End Switch
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment 1
SYSTEM
POINT NAME
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-7
CHWR.5
COOL.5
V_EC5POS
FILT.5
FREEZ.5
HEAT.5
HWR.5
EP.WO6A
NEG.5
OFF.5
EP.WE8A
PURGE.5
MAT.5
ECON.5
V_COAH5
V_RAHUM5
AF.CF5
RAT.5
V_EC5POS
CF.5
V_SPST5
AH5.SPT
SAT.5
V_CFMR5
AHU.5
AF.AH5
CHWR.6
COOL.6
V_EC6POS
AHU.6
CF.6
FILT.6
FREEZ.6
HEAT.6
HWR.6
EP.WO6B
NEG.6
OFF.6
EP.WE8B
PURGE.6
MAT.6
ECON.6
V_COAH6
V_RAHUM6
AF.CF6
RAT.6
V_EC6POS
V_SPST6
AH6.SPT
ES.A6
ES.B6
SAT.6
V_CFMR6
AF.AH6
CHWR.7
Legislative Office Building
Page: 3 of 29
Completed Component Checklist
POINT DESCRIPTION
CHW Return Temp.
Cooling Control Valve
Damper V/P Feedback
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp
Life Safety Neg. Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety Off Mode
Life Safety Purge
Mixed Air Temperature
OA, RA, EA Dampers
Return Air CO2 Transmitter
Return Air Humidity
Return Air Status
Return Air Temperature
Return Airflow Transmitter
Return Fan Start/Stop
Space Static Pressure
Space Temperature
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Start/Stop
Supply Fan Status
CHW Return Temp.
Cooling Control Valve
Damper V/P Feedback
Fan Start/Stop
Fan Start/Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp
Life Safety Neg. Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety Off Mode
Life Safety Purge
Mixed Air Temperature
OA, RA, EA Dampers
Return Air CO2 Transmitter
Return Air Humidity
Return Air Status
Return Air Temperature
Return Airflow Transmitter
Space Static Pressure
Space Temperature
Sup. Smoke Dpr. End Switch
Sup. Smoke Dpr. End Switch
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Status
CHW Return Temp.
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment 1
SYSTEM
POINT NAME
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-7
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
AHU-8
COOL.7
EP.SE9A
V_EC7POS
FILT.7
FREEZ.7
HEAT.7
HWR.7
NEG.7
OFF.7
PURGE.7
MAT.7
EP.SO6A
ECON.7
ES.B7
V_COAH7
V_CFMR7
V_RAHUM7
RAT.7
CF.7
AF.CF7
V_SPST7
AH7.SPT
ES.A7
V_CFMS7
SAT.7
AHU.7
AF.AH7
COOL.8
EP.SE9B
V_EC8POS
FILT.8
FREEZ.8
HEAT.8
HWR.8
NEG.8
OFF.8
PURGE.8
MAT.8
EP.SO6B
ECON.8
ES.B8
V_COAH8
V_CFMR8
V_RAHUM8
RAT.8
CF.8
AF.CF8
CHWR.8
V_SPST8
AH8.SPT
ES.A8
V_CFMS8
SAT.8
AHU.8
AF.AH8
Legislative Office Building
Page: 4 of 29
Completed Component Checklist
POINT DESCRIPTION
Cooling Control Valve
E.A./Ret. Smoke Dpr. E.P.Sw.
Econ. Damper Feedback
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Mixed Air Temperature
O.A./Sup. Smoke Dpr. E.P.Sw.
OA,RA,EA Dampers
Ret. Smoke Dpr. End Switch
Return Air CO2 Transmitter
Return Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Return Fan Start/Stop
Return Fan Status
Space Static Pressure
Space Temperature
Sup. Smoke Dpr. End Switch
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
Cooling Control Valve
E.A./Ret. Smoke Dpr. E.P.Sw.
Econ. Damper Feedback
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Mixed Air Temperature
O.A./Sup. Smoke Dpr. E.P.Sw.
OA,RA,EA Dampers
Ret. Smoke Dpr. End Switch
Return Air CO2 Transmitter
Return Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Return Fan Start/Stop
Return Fan Status
Shield Water Return Temp.
Space Static Pressure
Space Temperature
Sup. Smoke Dpr. End Switch
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment 1
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-9
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
AHU-10
CHWR.9
COOL.9
EP.NE9B
V_EC9POS
FILT.9
FREEZ.9
HEAT.9
HWR.9
NEG.9
OFF.9
PURGE.9
MAT.9
EP.NO7B
ECON.9
ES.B9
V_COAH9
V_CFMR9
V_RAHUM9
RAT.9
CF.9
AF.CF9
V_SPST9
AH9.SPT
ES.A9
V_CFMS9
SAT.9
AHU.9
AF.AH9
CHWR.9
COOL.10
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
CHW Return Temp.
Cooling Control Valve
E.A./Ret. Smoke Dpr. E.P.Sw.
Econ. Damper Feedback
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Mixed Air Temperature
O.A./Sup. Smoke Dpr. E.P.Sw.
OA,RA,EA Dampers
Ret. Smoke Dpr. End Switch
Return Air CO2 Transmitter
Return Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Return Fan Start/Stop
Return Fan Status
Space Static Pressure
Space Temperature
Sup. Smoke Dpr. End Switch
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
CHW Return Temp.
Cooling Control Valve
Damper End Switch
Damper End Switch
EP.NE9C E.A./Ret. Smoke Dpr. E.P.Sw.
V_EC9POS Econ. Damper Feedback
FILT.9
Filter Status
FREEZ.9
Freezestat
HEAT.10
Heating Control Valve
HWR.9
Hot Water Return Temp.
NEG.9
Life Safety Neg. Pressure
OFF.9
Life Safety Off
PURGE.9 Life Safety Purge
MAT.9
Mixed Air Temperature
EP.NO7C O.A./Sup. Smoke Dpr. E.P.Sw.
ECON.10 OA,RA,EA Dampers
ES.B9
Ret. Smoke Dpr. End Switch
V_COAH9 Return Air CO2 Transmitter
V_CFMR9 Return Air Flow Transmitter
V_RAHUM9 Return Air Humidity
RAT.9
Return Air Temperature
CF.9
Return Fan Start/Stop
AF.CF9
Return Fan Status
V_SPST9 Space Static Pressure
AH9.SPT
Space Temperature
ES.A9
Sup. Smoke Dpr. End Switch
V_CFMS9 Supply Air Flow Transmitter
Legislative Office Building
Page: 5 of 29
Completed Component Checklist
DATE INSPECTED PASS
FAIL
REMARKS
Attachment 1
SYSTEM
POINT NAME
AHU-10
AHU-10
AHU-10
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
AHU-11
VAV-11A
VAV-11A
VAV-11A
VAV-11A
VAV-11B
VAV-11B
VAV-11B
VAV-11B
VAV-11C
VAV-11C
VAV-11C
VAV-11C
VAV-11D
VAV-11D
VAV-11D
VAV-11D
VAV-11E
VAV-11E
VAV-11E
VAV-11E
SAT.9
AHU.9
AF.AH9
COOL.11
ES.C1_2
VSTP1.11
VSTP2.11
EP.D
AHU.11
FILT.11
FREEZ.11
HEAT.11
HWR.11
EP.SO7
NEG.11
OFF.11
ES.C1_2
EP.SE8
POS.11
MAX.OA11
VMAXOA11
VMINOA11
MIN.OA11
VCFMOA11
MAT.11
V_RAHUM11
RAT.11
CHWR.11
VSP.SP11
VCFMAH11
SAT.11
AF.AH11
SPEED.11
V.RPM11
VAV11.Z1
DPR Closed
DPR Open
Rm2ACO2
SPT.11A
DPRClosed
DPROpen
SPT.11B
DPRClosed
DPROpen
SPT.11C
DPRClosed
DPROpen
SPT.11D
DPRClosed
DPROpen
SPT.11E
Legislative Office Building
Page: 6 of 29
Completed Component Checklist
POINT DESCRIPTION
Supply Air Temperature
Supply Fan Start/Stop
Supply Fan Status
Cooling Control Valve
Damper End Switch
Duct Static Pressure A
Duct Static Pressure B
E.P.Switch
Fan Start/Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg, Off Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety POS, Neg Off. Mode
Life Safety POS. Mode
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Min.O.A. Air Flow Transmitter
Mixed Air Temperature
Return Air Humidity
Return Air Temperature
Shield Water Return Temp.
Space Static Pressure
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Damper Control Closed
Damper Control Open
Hearing Room 2E Carbon Dioxide Level
Space Temperature
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment 1
SYSTEM
POINT NAME
VAV-11F
VAV-11F
VAV-11F
VAV-11F
VAV-11G
VAV-11G
VAV-11G
VAV-11G
VAV-11H
VAV-11H
VAV-11H
VAV-11H
VAV-11I
VAV-11I
VAV-11I
VAV-11I
VAV-11J
VAV-11J
VAV-11J
VAV-11J
VAV-11K
VAV-11K
VAV-11K
VAV-11K
VAV-11L
VAV-11L
VAV-11L
VAV-11L
VAV-11M
VAV-11M
VAV-11M
VAV-11M
VAV-11N
VAV-11N
VAV-11N
VAV-11N
VAV-11P
VAV-11P
VAV-11P
VAV-11P
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
DPR Closed
DPR Open
Rm2ACO2
SPT.11F
DPRClosed
DPROpen
SPT.11G
POINT DESCRIPTION
Damper Control Closed
Damper Control Open
Hearing Room 2A Carbon Dioxide Level
Space Temperature
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.11H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.11I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.11J
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.11K
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
Rm2DCO2 Hearing Room 2D Carbon Dioxide Level
SPT.11L
Space Temperature
DPRClosed Damper Control Closed
DPROpen Damper Control Open
Rm2CCO2 Hearing Room 2C Carbon Dioxide Level
SPT.11M
Space Temperature
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.11N
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.11P
Space Temperature
SPARE
CHWR.12 CHW Return Temp
COOL.12
Cooling Control Valve
VSTP1.12 Duct Static Pressure A
VSTP2.12 Duct Static Pressure B
EP.D
E.P. Switch
ES.CI_3
Exisiting Point
FILT.12
Filter Status
FREEZ.12 Freezestat
HEAT.12
Heating Control Valve
HWR.12
Hot Water Return Temp.
EP.NO6
Life Safety Neg. Off. Mode
NEG.12
Life Safety Neg. Pressure
OFF.12
Life Safety Off
EP.C1_3
Life Safety Pos. Neg. Off Mode
EP.NE8
Life Safety Pos.Mode
Legislative Office Building
Page: 7 of 29
Completed Component Checklist
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
AttachmenW1
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
AHU-12
VAV-12A
VAV-12A
VAV-12A
VAV-12A
VAV-12B
VAV-12B
VAV-12B
VAV-12B
VAV-12C
VAV-12C
VAV-12C
VAV-12C
VAV-12D
VAV-12D
VAV-12D
VAV-12D
VAV-12E
VAV-12E
VAV-12E
VAV-12E
VAV-12F
VAV-12F
VAV-12F
VAV-12F
VAV-12G
VAV-12G
VAV-12G
VAV-12G
VAV-12H
VAV-12H
VAV-12H
VAV-12H
VAV-12I
VAV-12I
VAV-12I
VAV-12I
VAV-12J
POS.12
VMAXOA12
MAX.OA12
VCFMOA12
MIN.OA12
VMINOA12
MAT.12
V_RAHUM12
RAT.12
V_SPST12
SAT.12
VCFMAH12
AHU.12
AF.AH12
VAV12.Z1
VAV12.Z2
SPEED.12
V_RPM12
DprClose
DprOpen
Rm2BCO2
SPT.12A
DPRClosed
DPROpen
SPT.12B
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
Life Safety Purge
Max. Damper Position Feedback
Max. OA, RA, EA Dampers
Min OA Airflow Transmitter
Min OA Damper Control
Min. Damper Position Feedback
Mixed Air Temperature
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Start/Stop
Supply Fan Status
VAV Main Air Control 12A-G
VAV Main Air Control 12H-N
VFD Speed Control
VFD Speed Feedback
Damper Control Close
Damper Control Open
Hearing Room 2B Carbon Dioxide Level
Space Temperature
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.12C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.12D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.12E
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.12F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.12G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.12H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.12I
Space Temperature
SPARE
DPRClosed Damper Control Closed
Legislative Office Building
Page: 8 of 29
Completed Component Checklist
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
VAV-12J
VAV-12J
VAV-12J
VAV-12K
VAV-12K
VAV-12K
VAV-12K
VAV-12L
VAV-12L
VAV-12L
VAV-12L
VAV-12M
VAV-12M
VAV-12M
VAV-12M
VAV-12N
VAV-12N
VAV-12N
VAV-12N
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
VAV-13A
VAV-13A
VAV-13A
DPROpen
SPT.12J
DPR Closed
DPR Open
SPT.12K
DPRClosed
DPROpen
SPT.12L
DPRClosed
DPROpen
SPT.12M
DPRClosed
DPROpen
SPT.12N
CHWR.13
COOL.13
ES.C1_4
VSTP1.13
VSTP2.13
EP.D
AHU.13
FILT.13
FREEZ.13
HEAT.13
HWR.13
EP.SO5
NEG.13
OFF.13
ES.C1_4
EP.SE7
POS.13
MAX.OA13
VMAXOA13
VMINOA13
MIN.OA13
MAT.13
VCFMOA13
VRAHUM13
RAT.13
VSP.SP13
VCFMAH13
SAT.13
AF.AH13
SPEED.13
V.RPM13
VAV13.Z1
VAV13.Z2
DPR Closed
DPR Open
SPT.13A
Legislative Office Building
Page: 9 of 29
Completed Component Checklist
POINT DESCRIPTION
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
CHW Return Temp.
Cooling Control Valve
Damper End Switch
Duct Static Pressure A
Duct Static Pressure B
E.P.Switch
Fan Start/Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg, Off Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety POS, Neg Off. Mode
Life Safety POS. Mode
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Mixed Air Temperature
O.A. Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Zone 2 VAV's OCC/UNOCC
Damper Control Closed
Damper Control Open
Space Temperature
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
VAV-13A
VAV-13B
VAV-13B
VAV-13B
VAV-13B
VAV-13C
VAV-13C
VAV-13C
VAV-13C
VAV-13D
VAV-13D
VAV-13D
VAV-13D
VAV-13E
VAV-13E
VAV-13E
VAV-13E
VAV-13F
VAV-13F
VAV-13F
VAV-13F
VAV-13G
VAV-13G
VAV-13G
VAV-13G
VAV-13H
VAV-13H
VAV-13H
VAV-13H
VAV-13I
VAV-13I
VAV-13I
VAV-13I
VAV-13J
VAV-13J
VAV-13J
VAV-13J
VAV-13K
VAV-13K
VAV-13K
VAV-13K
VAV-13L
VAV-13L
VAV-13L
VAV-13L
VAV-13M
VAV-13M
VAV-13M
VAV-13M
VAV-13N
VAV-13N
VAV-13N
VAV-13O
VAV-13O
VAV-13O
POINT NAME
POINT DESCRIPTION
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13B
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13E
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.13F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13J
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.13K
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13L
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13M
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13N
Space Temperature
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.13O
Space Temperature
Legislative Office Building
Page: 10 of 29
Completed Component Checklist
SERIAL NUMBER
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
VAV-13O
VAV-13P
VAV-13P
VAV-13P
VAV-13P
VAV-13Q
VAV-13Q
VAV-13Q
VAV-13Q
VAV-13R
VAV-13R
VAV-13R
VAV-13R
VAV-13S
VAV-13S
VAV-13S
VAV-13S
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
VAV-14A
VAV-14A
VAV-14A
POINT NAME
DPR Closed
DPR Open
SPT.13P
DPRClosed
DPROpen
SPT.13Q
DPRClosed
DPROpen
SPT.13R
DPRClosed
DPROpen
SPT.13S
CHWR.14
COOL.14
ES.C1_3
ES.NE77
ES.NO5
VSTP1.14
VSTP2.14
EP.D
AHU14
FILT.14
FREEZ.14
HEAT.14
HWR.14
EP.NO5
NEG.14
OFF.14
EP.C1_3
EP.NE7
POS.14
MAX.OA14
VMAXOA14
VMINOA14
MIN.OA14
MAT.14
VCFMOA14
VRAHUM14
RAT.14
VSP.SP14
VCFMAH14
SAT.14
AF.AH14
SPEED.14
V_RPM14
VAV14.Z1
VAV14.Z2
DprClose
DprOpen
SPT.14A
Legislative Office Building
Page: 11 of 29
Completed Component Checklist
POINT DESCRIPTION
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
CHW Return Temp.
Cooling Control Valve
Damper End Switch
Damper End Switch
Damper End Switch
Duct Static Pressure A
Duct Static Pressure B
E.P.Switch
Fan Start / Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg, Off Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety POS, Neg Off. Mode
Life Safety POS. Mode
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Mixed Air Temperature
O.A. Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Zone 2 VAV's OCC/UNOCC
Damper Control Close
Damper Control Open
Space Temperature
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
VAV-14A
VAV-14B
VAV-14B
VAV-14B
VAV-14B
VAV-14C
VAV-14C
VAV-14C
VAV-14C
VAV-14D
VAV-14D
VAV-14D
VAV-14D
VAV-14E
VAV-14E
VAV-14E
VAV-14E
VAV-14F
VAV-14F
VAV-14F
VAV-14F
VAV-14G
VAV-14G
VAV-14G
VAV-14G
VAV-14H
VAV-14H
VAV-14H
VAV-14H
VAV-14I
VAV-14I
VAV-14I
VAV-14I
VAV-14J
VAV-14J
VAV-14J
VAV-14J
VAV-14K
VAV-14K
VAV-14K
VAV-14K
VAV-14L
VAV-14L
VAV-14L
VAV-14L
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
POINT NAME
POINT DESCRIPTION
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14B
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14E
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.14F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14J
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.14K
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.14L
Space Temperature
SPARE
CHWR.15 CHW Return Temp.
COOL.15
Cooling Control Valve
ES.C1_3
Damper End Switch
ES.WE7
Damper End Switch
ES.WO5
Damper End Switch
VSTP1.15 Duct Static Pressure A
VSTP2.15 Duct Static Pressure B
EP.D
E.P.Switch
OR-AH15 Exisiting Point
AHU.15
Fan Start/Stop
Legislative Office Building
Page: 12 of 29
Completed Component Checklist
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
AHU-15
VAV-15A
VAV-15A
VAV-15A
VAV-15A
VAV-15B
VAV-15B
VAV-15B
VAV-15C
VAV-15C
VAV-15C
VAV-15C
VAV-15D
VAV-15D
VAV-15D
VAV-15D
VAV-15E
VAV-15E
VAV-15E
VAV-15E
VAV-15F
VAV-15F
VAV-15F
VAV-15F
VAV-15G
VAV-15G
VAV-15G
VAV-15G
VAV-15H
VAV-15H
FILT.15
FREEZ.15
HEAT.15
HWR.15
EP.WO5
NEG.15
OFF.15
EP.C1_3
EP.WE7
POS.15
MAX.OA15
VMAXOA15
VMINOA15
MIN.OA15
MAT.15
VCFMOA15
VRAHUM15
RAT.15
VSP.SP15
VCFMAH15
SAT.15
AF.AH15
SPEED.15
V_RPM15
VAV15.Z1
VAV15.Z2
DprOpen
DprClose
SPT.15A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg, Off Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety POS, Neg Off. Mode
Life Safety POS. Mode
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Mixed Air Temperature
O.A. Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Zone 2 VAV's OCC/UNOCC
Damper Control Open
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.15B
Space Temperature
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.15C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.15D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.15E
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.15F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.15G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
Legislative Office Building
Page: 13 of 29
Completed Component Checklist
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
VAV-15H
VAV-15H
VAV-15I
VAV-15I
VAV-15I
VAV-15I
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
AHU-16
VAV-16A
VAV-16A
VAV-16A
VAV-16A
VAV-16B
VAV-16B
VAV-16B
VAV-16B
VAV-16C
VAV-16C
VAV-16C
VAV-16C
VAV-16D
VAV-16D
SPT.15H
DPRClosed
DPROpen
SPT.15I
CHWR.16
COOL.16
ES.C1_3
ES.SE6
ES.SO4
EP.D
VSTP1.16
VSTP2.16
AHU.16
FILT.16
FREEZ.16
HEAT.16
HWR.16
EP.SO4
NEG.16
OFF.16
ES.C1_3
EP.SE6
POS.16
MAX.OA16
VMAXOA16
VMINOA16
MIN.OA16
MAT.16
VCFMOA16
VRAHUM16
RAT.16
VSP.SP16
VCFMAH16
SAT.16
AF.AH16
SPEED.16
V_RPM16
VAV16.Z1
VAV16.Z2
DPRClosed
DPROpen
SPT.16A
DPRClosed
DPROpen
SPT.16B
DPRClosed
DPROpen
SPT.16C
DPRClosed
DPROpen
Legislative Office Building
Page: 14 of 29
Completed Component Checklist
POINT DESCRIPTION
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
CHW Return Temp.
Cooling Control Valve
Damper End Switch
Damper End Switch
Damper End Switch
Damper Open/Close
Duct Static Pressure A
Duct Static Pressure B
Fan Start/Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg, Off Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety POS, Neg Off. Mode
Life Safety POS. Mode
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Mixed Air Temperature
O.A. Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Zone 2 VAV's OCC/UNOCC
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
VAV-16D
VAV-16D
VAV-16E
VAV-16E
VAV-16E
VAV-16E
VAV-16F
VAV-16F
VAV-16F
VAV-16F
VAV-16G
VAV-16G
VAV-16G
VAV-16G
VAV-16H
VAV-16H
VAV-16H
VAV-16H
VAV-16I
VAV-16I
VAV-16I
VAV-16I
VAV-16J
VAV-16J
VAV-16J
VAV-16J
VAV-16K
VAV-16K
VAV-16K
VAV-16K
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
SPT.16D
POINT DESCRIPTION
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.16E
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.16F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.16G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.16H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.16I
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.16J
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.16K
Space Temperature
SPARE
CHWR.17 CHW Return Temp
COOL.17
Cooling Control Valve
ES.C1_2
Damper End Switch
ES.NE6
Damper End Switch
ES.NO4
Damper End Switch
ESC.TAF9 Damper End Switch
VSTP1.17 Duct Static Pressure
EP.D
E.P.Switch
EPC.TAF9 EP Switch
AHU.17
Fan Start/Stop
AF.CEF2
Fan Status
AF.CEF3
Fan Status
FILT.17
Filter Status
FREEZ.17 Freezestat
HEAT.17
Heating Control Valve
HWR.17
Hot Water Return Temp.
EP.NO4
Life Safety Neg. Off. Mode
NEG.17
Life Safety Neg. Pressure
OFF.17
Life Safety Off
EP.NE6
Life Safety Pos. Mode
EP.C1_2
Life Safety Pos. Neg.Off. Mode
POS.17
Life Safety Purge
MAX.OA17 Max OA, RA, & EA Dampers
VMAXOA17 Max. O.A. V/P Feedback
MIN.OA17 Min O.A. Dampers
Legislative Office Building
Page: 15 of 29
Completed Component Checklist
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
AHU-17
VAV-17A
VAV-17A
VAV-17A
VAV-17A
VAV-17B
VAV-17B
VAV-17B
VAV-17B
VAV-17C
VAV-17C
VAV-17C
VAV-17C
VAV-17D
VAV-17D
VAV-17D
VAV-17D
VAV-17E
VAV-17E
VAV-17E
VAV-17E
VAV-17F
VAV-17F
VAV-17F
VAV-17F
VAV-17G
VAV-17G
VAV-17G
VAV-17G
VAV-17H
VAV-17H
VAV-17H
VAV-17H
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
VMINOA17
MAT.17
VCFMOA17
VRAHUM17
RAT.17
VSP.SP17
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
Min. O.A. V/P Feedback
Mixed Air Temperature
OA Airflow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
SPARE
SAT.17
Supply Air Temperature
VCFMAH17 Supply Airflow Transmitter
AF.AH17
Supply Fan Status
SPEED.17 Supply Fan VFD Speed Signal
V.RPM17 Supply VFD Speed Feedback
VAV17.Z1 Zone 1 VAV's OCC/UNOCC
VAV17.Z2 Zone 2 VAV's OCC/UNOCC
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.17A
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.17B
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.17C
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.17D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20J
Space Temperature
SPARE
CHWR.18 CHW Return Temp.
COOL.18
Cooling Control Valve
ES.C1_3
Damper End Switch
ES.WE6
Damper End Switch
ES.WO4
Damper End Switch
VSTP1.18 Duct Static Pressure A
VSTP2.18 Duct Static Pressure B
EP.D
E.P.Switch
OR-AH18 Exisiting Point
Legislative Office Building
Page: 16 of 29
Completed Component Checklist
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
AHU-18
VAV-18A
VAV-18A
VAV-18A
VAV-18A
VAV-18B
VAV-18B
VAV-18B
VAV-18B
VAV-18C
VAV-18C
VAV-18C
VAV-18C
VAV-18D
VAV-18D
VAV-18D
VAV-18D
VAV-18E
VAV-18E
VAV-18E
VAV-18E
VAV-18F
VAV-18F
VAV-18F
VAV-18F
VAV-18G
VAV-18G
VAV-18G
VAV-18G
AHU18
FILT.18
FREEZ.18
HEAT.18
HWR.18
EP.WO4
NEG.18
OFF.18
EP.C1_3
EP.WE6
POS.18
MAX.OA18
VMAXOA18
VMINOA18
MIN.OA18
MAT.18
VCFMOA18
VRAHUM18
RAT.18
VSP.SP18
VCFMAH18
SAT.18
AF.AH18
SPEED.18
V_RPM18
VAV18.Z1
VAV18.Z2
DPRClosed
DPROpen
SPT.18A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
Fan Start / Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg, Off Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety POS, Neg Off. Mode
Life Safety POS. Mode
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Mixed Air Temperature
O.A. Air Flow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Flow Transmitter
Supply Air Temperature
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Zone 2 VAV's OCC/UNOCC
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.18B
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.18C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.18D
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.18E
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.18A
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.18B
Space Temperature
SPARE
Legislative Office Building
Page: 17 of 29
Completed Component Checklist
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
VAV-18H
VAV-18H
VAV-18H
VAV-18H
VAV-18I
VAV-18I
VAV-18I
VAV-18I
VAV-18J
VAV-18J
VAV-18J
VAV-18J
VAV-18K
VAV-18K
VAV-18K
VAV-18K
VAV-18L
VAV-18L
VAV-18L
VAV-18L
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
AHU-19
VAV-19A
VAV-19A
VAV-19A
VAV-19A
VAV-19B
DPRClosed
DPROpen
SPT.18C
DPRClosed
DPROpen
SPT.18D
DPR Closed
DPR Open
SPT.18E
DPRClosed
DPROpen
SPT.18K
DPRClosed
DPROpen
SPT.18L
CHWR.19
COOL.19
VSTP1.19
EP.SE4
EP.SO3
ES.C1_3
AHU.19
FILT.19
FREEZ.19
HEAT.19
HWR.19
NEG.19
OFF.19
POS.19
MAX.OA19
VMAXOA19
VCFMOA19
VMINOA19
MIN.OA19
MAT.19
VRAHUM19
RAT.19
VSP.SP19
SAT.19
VCFMAH19
AF.AH19
SPEED.19
V.RPM19
VAV19.Z1
VAV19.Z2
DprOpen
DprOpen
SPT.19A
DPRClosed
Legislative Office Building
Page: 18 of 29
Completed Component Checklist
POINT DESCRIPTION
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Chilled Water Return Temp.
Cooling Control Valve
Duct Static Pressure
E.P.Switch
E.P.Switch
E.P.Switch
Fan Start/Stop
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Max OA, RA, & EA Dampers
Max. O.A. V/P Feedback
Min. O.A V/P Feedback
Min. O.A. V/P Feedback
Min. O.A.Dampers
Mixed Air Temperature
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's OCC/UNOCC
Zone 2 VAV's OCC/UNOCC
Damper Control Close
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
VAV-19B
VAV-19B
VAV-19B
VAV-19C
VAV-19C
VAV-19C
VAV-19C
VAV-19D
VAV-19D
VAV-19D
VAV-19D
VAV-19E
VAV-19E
VAV-19E
VAV-19E
VAV-19F
VAV-19F
VAV-19F
VAV-19F
VAV-19G
VAV-19G
VAV-19G
VAV-19G
VAV-19H
VAV-19H
VAV-19H
VAV-19H
VAV-19I
VAV-19I
VAV-19I
VAV-19I
VAV-19J
VAV-19J
VAV-19J
VAV-19J
VAV-19K
VAV-19K
VAV-19K
VAV-19K
VAV-19L
VAV-19L
VAV-19L
VAV-19L
VAV-19M
VAV-19M
VAV-19M
VAV-19M
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
DPROpen
SPT.19B
POINT DESCRIPTION
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19E
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.19F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19J
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.19K
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19L
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.19M
Space Temperature
SPARE
CHWR.20 CHW Return Temp.
COOL.20
Cooling Control Valve
V_BLADE2 Damper Blade Position
ES.C1_2
Damper End Switch
ES.NE4
Damper End Switch
ES.NO3
Damper End Switch
ESB.TAF2 Damper End Switch
VSTIP1.20 Duct Static Pressure A
Legislative Office Building
Page: 19 of 29
Completed Component Checklist
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
AHU-20
VAV-20A
VAV-20A
VAV-20A
VAV-20A
VAV-20B
VAV-20B
VAV-20B
VAV-20B
VAV-20C
VAV-20C
VAV-20C
VAV-20C
VAV-20D
VAV-20D
VAV-20D
VAV-20D
VAV-20E
VAV-20E
VAV-20E
VAV-20E
VAV-20F
VAV-20F
VAV-20F
VAV-20F
VAV-20G
VAV-20G
VSTP2.20
EP.C1_2
EP.D
AF.TAF2
FILT.20
FREEZ20
HEAT.20
HWR.20
EP.NE4
NEG.20
OFF.20
EP.NO3
POS.20
VMAXOA20
MAS.OA20
MIN.OA20
VMINOA20
MAT.20
VCFMOA20
V_RAHUM20
RAT.20
VSP.SP20
SAT.20
VCFMAH20
AF.AH20
SPEED.20
V_RPM20
VAV20.Z1
VAV20.Z2
DPR Closed
DPR Open
SPT.20A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
Duct Static Pressure B
EP Switch
Fan Start/Stop
Fan Status
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp
Life Safety Neg. Off. Mode
Life Safety Neg. Pressure
Life Safety Off
Life Safety Pos. Neg. Off. Mode
Life Safety Purge
Max OA V/P Feedback
Max OA, RA & EA Dampers
Min OA Dampers
Min. OA V/P Feedback
Mixed Air Temperature
OA Airflow transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Status
Supply Fan VFD Speed Signal
Supply VFD Speed Feedback
Zone 1 VAV's Occ/Unocc
Zone 2 VAV's Occ/Unocc
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.20J
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.20K
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
Legislative Office Building
Page: 20 of 29
Completed Component Checklist
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
VAV-20G
VAV-20G
VAV-20H
VAV-20H
VAV-20H
VAV-20H
VAV-20I
VAV-20I
VAV-20I
VAV-20I
VAV-20J
VAV-20J
VAV-20J
VAV-20J
VAV-20K
VAV-20K
VAV-20K
VAV-20K
VAV-20L
VAV-20L
VAV-20L
VAV-20L
AHU21
AHU21
AHU21
AHU21
AHU21
AHU21
AHU21
AHU21
AHU21
AHU21
AHU21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
AHU-21
SPT.20G
DPRClosed
DPROpen
SPT.20H
DPRClosed
DPROpen
SPT.20I
DPRClosed
DPROpen
SPT.20J
DPR Closed
DPR Open
SPT.20K
DPRClosed
DPROpen
SPT.20L
COOL.21
AHU.21
HEAT.21
EP.WO3
EP.WE4
EP.C1_2
MAX.OA21
MIN.OA21
SPEED.21
VAV21.Z1
VAV21.Z2
CHWR.21
ES.C1_2
ES.WE4
ES.WO3
VSTP1.21
VSTP2.21
DSEP.WE3_5
EP.W01_2
EP.D
FILT.21
FREEZ.21
HWR.21
NEG.21
OFF.21
POS.21
VMAXOA21
VMINOA21
MAT.21
VCFMOA21
VRAHUM21
RAT.21
VSP.SP21
Legislative Office Building
Page: 21 of 29
Completed Component Checklist
POINT DESCRIPTION
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Damper Control Closed
Damper Control Open
Space Temperature
SPARE
Cooling Control Valve
Fan Start/stop
Heating Control Valve
Life Safety Neg, Offl. Mode
Life Safety POS. Mode
Life Safety Pos. Neg. Off. Mode
Max. O.A., R.A. & EA Dampers
Min. O.A. Dampers
Supply Fan VFD Speed Signal
Zone 1 VAV's OCC/Unocc
Zone 2 VAV's OCC/Unocc
CHW Return Temp.
Damper End Switch
Damper End Switch
Damper End Switch
Duct Static Pressure A
Duct Static Pressure B
E.P.Switch
E.P.Switch
E.P.Switch
Filter Status
Freezestat
Hot Water Return Temp
Life Safety Neg. Pressure
Life Safety Off
Life Safety Purge
Max. O.A. V/P Feedback
Min. O.A. V/P Feedback
Mixed Air Temperature
OA Airflow Transmitter
Return Air Humidity
Return Air Temperature
Space Static Pressure
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
SERIAL NUMBER
AHU-21
AHU-21
AHU-21
AHU-21
VAV-21A
VAV-21A
VAV-21A
VAV-21A
VAV-21B
VAV-21B
VAV-21B
VAV-21B
VAV-21C
VAV-21C
VAV-21C
VAV-21C
VAV-21D
VAV-21D
VAV-21D
VAV-21D
VAV-21E
VAV-21E
VAV-21E
VAV-21E
VAV-21F
VAV-21F
VAV-21F
VAV-21F
VAV-21G
VAV-21G
VAV-21G
VAV-21G
VAV-21H
VAV-21H
VAV-21H
VAV-21H
VAV-21I
VAV-21I
VAV-21I
VAV-21I
VAV-21J
VAV-21J
VAV-21J
VAV-21K
VAV-21K
VAV-21K
VAV-21K
VAV-21L
VAV-21L
VAV-21L
VAV-21L
VAV-21M
VAV-21M
VAV-21M
VAV-21M
SAT.21
VCFMAH21
AF.AH21
V_RPM21
DprOpen
DprClose
SPT.21A
N/A
N/A
N/A
N/A
POINT DESCRIPTION
Supply Air Temperature
Supply Airflow Transmitter
Supply Fan Status
Supply VFD Speed Feedback
Damper Control Open
Damper Control Open
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21B
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21C
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21D
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21E
Space Temperature
SPARE
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.21F
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21G
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21H
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21I
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21J
Space Temperature
DPR Closed Damper Control Closed
DPR Open Damper Control Open
SPT.21K
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21L
Space Temperature
SPARE
DPRClosed Damper Control Closed
DPROpen Damper Control Open
SPT.21M
Space Temperature
SPARE
Legislative Office Building
Page: 22 of 29
Completed Component Checklist
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU-22
AHU23
AHU23
AHU23
AHU23
AHU23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-23
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
AHU-24
CEF-1
CEF-4
COOL.22
ES.B22
FILT.22
FREEZ.22
HEAT.22
EP.SO8C
OAD.22
SAT.22
V_SPST22
V_SPST22
SPT.22
V_CFMS22
AHU.22
AF.22
HEAT.23
FACE.BYP
COOL.23
ECON.23
AHU.23
CHWR.23
POS.23
FILT.23
FREEZ.23
HWR.23
MAT.23
V_RAHUM23
RAT.23
V_SPST23
SPT.23
V_CFMS23
SAT.23
AF.AH23
HWR.24
COOL.24
ES.A24
VEC24POS
AHU.24
AF.AH24
FILT.24
FREEZ.24
HEAT.24
CHWR.24
NEG.24
POS.24
FS.A24
OFF.24
MAT.24
ECON.24
VSPHUM24
V_SPST24
AH24.SPT
SAT.24
V_CFMS24
AF.CEF1
AF.CEF4
Legislative Office Building
Page: 23 of 29
Completed Component Checklist
POINT DESCRIPTION
Cooling Control Valve
Damper End Switch
Filter Status
Freezestat
Heating Control Valve
O.A./SUP.Smoke Dpr. E.P. S.w.
O.A.Dampers
Return Air Temperature
Space Static Pressure
Space Static Pressure
Space Temperature
Supply Air Flow Transmitter
Supply Fan Start/Stop
Supply Fan Status
Cooling Control Valve
Face & Bypass Dampers
Heating Control Valve
OA, RA, EA Dampers
Supply Fan Start/Stop
CHW Return Temp.
Damper V/P Feedback
Filter Status
Freezestat
Hot Water Return Temp
Mixed Air Temperature
Return Air Humidity
Return Air Temperature
Space Static Pressure
Space Temperature
Supply Aiflow Transmitter
Supply Air Temperature
Supply Fan Status
CHW Return Temp
Cooling Control Valve
Damper End Switch
Economizer Damper Feedback
Fan Start/Stop
Fan Status
Filter Status
Freezestat
Heating Control Valve
Hot Water Return Temp.
Life Safety Neg. Pressure
Life Safety Off
Life Safety Open /Close
Life Safety Purge
Mixed Air Temperature
OA,RA,EA Dampers
Space Relative Humidity
Space Static Pressure
Space Temperature
Supply Air Temperature
Supply Airflow Transmitter
Fan Status
Fan Status
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
CEF-5
CEF-6
CEF-7
CEF-8
CEF-9
CEF-10
CEF-12
CEF-13
CEF-14
CEF-15
CEF-16
CEF-17
CEF-18
CEF-18
CEF-19
CEF-20
CEF-20
CEF-21
CEF-22
CEF-23
CEF-24
CEF-25
CEF-25
CEF-26
CEF-27
CEF-28
CEF-29
CEF-30
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
AF.CEF5
AF.CEF6
AF.CEF7
AF.CEF8
AF.CEF9
ES.SE10
AF.CEF12
AF.CEF13
AF.CEF14
AF.CEF15
AF.CEF16
AF.CEF17
CEF.18
AF.CEF18
AF.CEF19
AF.CEF20
VAV11.Z2
AF.CEF21
AF.CEF22
AF.CEF23
AF.CEF24
CEF.25
AF.CEF25
AF.CEF26
AF.CEF27
AF.CEF28
AF.CEF29
AF.CEF30
FLOW.P9
CHW.FLOW
CHWR
CHWS
CHWS.15
CWRT.1
CWRT.2
CWRT.3
CWRT.4
CWRT.5
CWRT.6
CWRT.7
CWRT.8
CWRT.9
CWRT.10
CWRT.11
CWRT.12
CWRT.13
CWRT.14
CWRT.15
FLOW.P1
FLOW.P2
FLOW.P3
FLOW.P4
FLOW.P5
FLOW.P6
FLOW.P7
Legislative Office Building
Page: 24 of 29
Completed Component Checklist
POINT DESCRIPTION
Fan Status
Fan Status
Fan Status
Fan Status
Fan Status
Damper End Switch
Fan Status
Fan Status
Fan Status
Fan Status
Fan Status
Fan Status
Fan Start/Stop
Fan Status
Fan Status
Fan Status
Zone 2 VAV's OCC/UNOCC
Fan Status
Fan Status
Fan Status
Fan Status
Fan Start/Stop
Fan Status
Fan Status
Fan Status
Fan Status
Fan Status
Fan Status
Pump P9 Status
Chilled Water Flow
CHW Return Temp.
CHW Supply Temp.
CHW Supply Temp. VAV AHU's
CHW Return Temp. AHU-1
CHW Return Temp. AHU-2
CHW Return Temp. AHU-3
CHW Return Temp. AHU-4
CHW Return Temp. AHU-5
CHW Return Temp. AHU-6
CHW Return Temp. AHU-7
CHW Return Temp. AHU-8
CHW Return Temp. AHU-9
CHW Return Temp. AHU-10
CHW Return Temp. CRU-1
CHW Return Temp. FCU-1&3
CHW Return Temp. AHU-23
CHW Return Temp. AHU-24
CHW Return Temp. VAV AHU's
Pump P1 Status
Pump P2 Status
Pump P3 Status
Pump P4 Status
Pump P5 Status
Pump P6 Status
Pump P7 Status
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
Chilled Water
EF-11
EFI-8
FCU-1
FCU-1
FCU-1
FLOW.P8
FLOW.P10
FLOW.P11
FLOW.P12
FLOW.P13
FLOW.P14
FLOW.P15
FLOWP15A
PUMP.1
PUMP.2
PUMP.3
PUMP.4
PUMP.5
PUMP.6
PUMP.7
PUMP.8
PUMP.9
PUMP.10
PUMP.11
PUMP.12
PUMP.13
PUMP.14
PUMP.15
PUMP.15A
RPM.P15
RPM.P15A
V_RPM15
V_RPM15A
SUMPPUMP
VCHWPT1H
VCHWPT1L
VCHWPT2H
VCHWPT2L
VCHWPT3H
VCHWPT3L
VLB.P1
VLB.P2
VLB.P3
VLB.P4
VLB.P5
VLB.P6
VLB.P7
VLB.P8
VLB.P9
VLB.P10
VLB.P11
VLB.P12
VLB.P13
VLB.P14
VLB.P15
EPBIEF11
AF.IEF8
FCU1.CL
FCU.1
AF.FCU1
Legislative Office Building
Page: 25 of 29
Completed Component Checklist
POINT DESCRIPTION
Pump P8 Status
Pump P10 Status
Pump P11 Status
Pump P12 Status
Pump P13 Status
Pump P14 Status
Pump 15 Status
Pump 15A Status
Pump P1 Start/Stop
Pump P2 Start/Stop
Pump P3 Start/Stop
Pump P4 Start/Stop
Pump P5 Start/Stop
Pump P6 Start/Stop
Pump P7 Start/Stop
Pump P8 Start/Stop
Pump P9 Start/Stop
Pump P10 Start/Stop
Pump P11 Start/Stop
Pump P12 Start/Stop
Pump P13 Start/Stop
Pump P14 Start/Stop
Pump P15 Start/Stop
Pump P15A Start/Stop
P15 VFD Speed Signal
P15A VFD Speed Signal
Pump VFD Speed Feedback
Pump VFD Speed Feedback
Sump Pump Hi Limit Switch
Chilled Water<P Transmitter
Chilled Water<P Transmitter
Chilled Water <P Transmitter
Chilled Water <P Transmitter
Chilled Water <P Transmitter
Chilled Water <P Transmitter
Dist. CHW Flow Control AHU-1
Dist. CHW Flow Control AHU-2
Dist. CHW Flow Control AHU-3
Dist. CHW Flow Control AHU-4
Dist. CHW Flow Control AHU-5
Dist. CHW Flow Control AHU-6
Dist. CHW Flow Control AHU-7
Dist. CHW Flow Control AHU-8
Dist. CHW Flow Control AHU-1
Dist. CHW Flow Control AHU-10
Dist. CHW Flow Control CRU-1
Dist. CHW Flow Control FUC-1&3
Dist. CHW Flow Control AHU-23
Dist. CHW Flow Control AHU-24
Dist. CHW Flow Control VAV AHU's
E.P.Switch
Fan Status
Cooling Control Valve
Fan Start/Stop
Fan Status
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment
SYSTEM
POINT NAME
FCU-1
FCU-2
FCU-2
FCU-2
FCU-2
FCU-3
FCU-3
FCU-3
FCU-3
FCU-3
FCU-3
FCU-3
FCU-3
FCU-3
FCU-4
FCU-4
FCU-4
FCU-4
FCU-4
FCU-4
FCU5
FCU5
FCU5
FCU6
FCU6
FCU6
FCU7
FCU7
FCU7
FCU8
FCU8
FCU8
FCU-9
FCU-10
FCU-11
FCU-11
FC-11
FC-11
FCU-12
FCU-12
FCU-12
FCU-12
FCU-14
Garage Heating
Garage Heating
Garage Heating
Garage Heating
Garage Heating
Garage Heating
H.W. Radiation
H.W. Radiation
H.W. Radiation
H.W. Radiation
Hot Water
Hot Water
SPT.FCU1
FCU2.CL
FCU.2
AF.FCU2
SPT.FCU2
FCU3.CL
FCU.3
AF.FCU3
FCU3.RH1
FCU3.RH2
FCU3.RH3
SPT.RH3
SPT.RH2
SPT.RH1
FCU.4
AF.FCU4
FRZ.FCU4
FCU4.HT
FCU4.DPR
SPT.FCU4
AF.FCU5
FCU5.CLG
SPT.FCU5
AF.FCU6
FCU6.CLG
SPT.FCU6
AF.FCU7
FCU7.CLG
SPT.FCU7
AF.FCU8
FCU8.CLG
SPT.FCU8
AF.FCU9
AF.FCU10
FCU11.CL
FCU.11
AF.FC11
SPT.FC11
FCU.12
AF.FC12
FCU12.HT
SPT.FC12
FCU.14
UH1.LT
UH2.LT
UH3.LT
UH4.LT
UH5.LT
UH6.LT
RADV43
RADV44
RADV53
RADV54
HW.FLOW
HWR
Legislative Office Building
Page: 26 of 29
Completed Component Checklist
POINT DESCRIPTION
Space Temperature
Cooling Control Valve
Fan Start/Stop
Fan Status
Space Temperature
Cooling Control Valve
Fan Start/Stop
Fan Status
Heating Control Valve
Heating Control Valve
Heating Control Valve
Space Temperature
Space Temperature
Space Temperature
Fan Start/Stop
Fan Status
Freezestat
Heating Control Valve
O.A. Dampers
Space Temperature
Fan Status
FCU5 Cooling Valve
Space Temperature
Fan Status
FCU6 Cooling Valve
Space Temperature
Fan Status
FCU7 Cooling Valve
Space Temperature
Fan Status
FCU8 Cooling Valve
Space Temperature
Fan Status
Fan Status
Cooling Control Valve
Fan Start/Stop
Fan Status
Space Temperature
Fan Start/Stop
Fan Status
Heating Control Valve
Space Temperature
Fan Start/Stop
Ceiling Space Temperature
Ceiling Space Temperature
Ceiling Space Temperature
Ceiling Space Temperature
Ceiling Space Temperature
Ceiling Space Temperature
Radiation Valve V4-3
Radiation Valve V4-4
Radiation Valve V5-3
Radiation Valve V5-4
Hot Water Flow
Hot water Return Temp.
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water
Hot Water HX-1
Hot Water HX-1
Hot Water HX-1
Hot Water HX-2
Hot Water HX-2
Hot Water HX-2
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HWS
PUMP.16
PUMP.16A
FLOW.P16
FLOWP16A
PUMP.17
FLOW.P17
PUMP.17A
FLOWP17A
PUMP.18
FLOW.P18
HX1.PHWR
HX1.SHWR
HX1.SHWS
HX2.PHWR
HX2.SHWR
HX2.SHWS
ZEF.20
RADV12
RADV23
RADV34
RADV35
RADV36
RADV37
RADV55
RADV56
RADV57
RADV410
RADV411
RADV51
RADV52
RADV11
RADV13
RADV21
RADV22
RAD.V_4
RADV41
RADV42
RAD.V1_5
RAD.V1_6
RAD.V1_7
RAD.V1_8
RAD.1_10
RAD.1_11
RAD.1_12
RAD..1_9
RADV24
RADV25
RADV26
RADV31
RADV32
RADV33
RADV38
RAD.V39
RADV45
Legislative Office Building
Page: 27 of 29
Completed Component Checklist
POINT DESCRIPTION
Hot Water Supply Temp.
Pump 16 Start/Stop
Pump 16A Start/Stop
Pump P16 Status
Pump P16A Status
Pump P17 Start/Stop
Pump P17 Status
Pump P17A Start/Stop
Pump P17A Status
Pump P18 Start/Stop
Pump P18 Status
Primary HW Return Temp.
Secondary HW Return Temp.
Secondary HW Supply Temp.
Primary HW Return Temp.
Secondary HW Return Temp.
Secondary HW Supply Temp.
Fan Start/Stop
Radiation Valve V1-2
Radiation Valve V2-3
Radiation Valve V3-4
Radiation Valve V3-5
Radiation Valve V3-6
Radiation Valve V3-7
Radiation Valve V5-5
Radiation Valve V5-6
Radiation Valve V5-7
Radiation Zone Fvalve 4-10
Radiation Zone Fvalve 4-11
Radiation Zone Fvalve 5-1
Radiation Zone Fvalve 5-2
Radiation Zone Valve 1-1
Radiation Zone Valve 1-3
Radiation Zone Valve 2-1
Radiation Zone Valve 2-2
Radiation Zone Valve -4
Radiation Zone Valve 4-1
Radiation Zone Valve 4-2
Radiation Zone Valve -5
Radiation Zone Valve -6
Radiation Zone Valve -7
Radiation Zone Valve -8
Radiation Zone Valve V1-10
Radiation Zone Valve V1-11
Radiation Zone Valve V1-12
Radiation Zone Valve V1-9
Radiation Zone Valve V2-4
Radiation Zone Valve V2-5
Radiation Zone Valve V2-6
Radiation Zone Valve V3-1
Radiation Zone Valve V3-2
Radiation Zone Valve V3-3
Radiation Zone Valve V3-8
Radiation Zone Valve -V3-9
Radiation Zone Valve V4-5
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
HW Radiation
HW Radiation
HW Radiation
HW Radiation
HX-1
HX-2
IEF-1
IEF-1&2
IEF-2
IEF-3
IEF3&4
IEF-4
IEF-5
IEF-6
IEF-6
IEF-7
IEF-8
IEF-10
IEF-10
IEF-10
IEF-10
IEF-11
IEF-11
Kitchen Exhaust Fan
Kitchen Exhaust Fan
Kitchen Exhaust Fan
Main Electric
Outdoor Air
Outdoor Air
Outdoor Air
Outdoor Air
REF-1
REF-2
REF-3
RH-4
RH-4
RH-5
RH-5
T.C. Air Compressor
TAF-1
TAF-1
TAF-1
TAF-1
TAF-1
TAF-1
TAF-1
TAF-2
TAF-2
TAF-2
TAF-3
TAF-3
TAF-3
TAF-4
TAF-4
TAF-5
RADV46
RADV58
RADV510
RADV59
AHU.HWS
RAD.HWS
AF.IEF1
IEF1.2
AF.IEF2
AF.IEF3
IEF3.4
AF.IEF4
AF.IEF5
ES.SO8
IEF.6
AF.EIF7
IEF.8
ESBIEF10
AHU.20
IEF.10
FSBIEF10
IEF.11
AF.IEF11
AF.REF1
AF.REF2
AF.REF3
KW/PULSE
V_OAH1
OAT.IN1
OAT.IN2
OAT.IN3
REF.1
REF.2
REF.3
AF.IEF6
HEAT.RH4
AF.CEF10
HEAT.RH5
LOW.I_A
BLADE.1
V_BLADE1
ESB.TAF1
EPB.TAF1
TAF.1
AF.TAF1
TAF1.MAN
BLADE.2
TAF.2
EPB.TAF2
ESB.TAF3
TAF.3
AF.IEF3
TAF.4
AF.TAF4
TAF5.MAN
Legislative Office Building
Page: 28 of 29
Completed Component Checklist
POINT DESCRIPTION
Radiation Zone Valve V4-6
Radiation Zone Valve V4-8
Radiation Zone Valve V5-10
Radiation Zone Valve V5-9
HX-1 H.W. Control Valve
HX-2 H.W. Control Valve
Fan Status
Fan Start/Stop
Fan Status
Fan Status
Fan Start/Stop
Fan Status
Fan Status
Damper End Switch
Fan Start/Stop
Fan Status
Fan Start/Stop
Damper End Switch
Fan Start/Stop
Fan Start/Stop
Fire Safety Damper
Fan Start/Stop
Fan Status
Fan Status
Fan Status
Fan Status
Elect. Service KW Pulse
Outdoor Air Humidity
Outdoor Air Temperature
Outdoor Air Temperature
Outdoor Air Temperature
Fan Start/Stop
Fan Start/Stop
Fan Start/Stop
Fan Status
Reheat Coil Control
Fan Status
Reheat Coil Control
Instrument Air Alarm
Blade Pitch Control
Damper Blade Position
Damper End Switch
E.P.Switch
Fan Start/Stop
Fan Status
Manual Override Switch
Blade Pitch Control
Fan Start/Stop
Damper End Switch
Fan Start/Stop
Fan Status
Existing Point
Fan Status
Existing Point
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
POINT NAME
TAF-5
TAF-5
TAF-6
TAF-6
TAF-6
TAF-7
TAF-7
TAF-7
TAF-7
TAF-7
TAF-7
TAF-7
TAF-7
TAF-8
TAF-8
TAF-8
TAF-8
TAF-8
TAF-8
TAF-9
TAF-9
TAF.5
AF.TAF5
TAF.6
AF.TAF6
TAF6.MAN
ESC2TAF7
TAF7.ESD
EPC.TAF7
ES.DTAF7
EPD.TAF7
TAF.7
AF.TAF7
TAF7.MAN
EPD.TAF8
ESC.TAF8
EPC.TAF8
TAF.8
TAF8.MAN
AF.DAF8
EPD.TAF9
AF.TAF9
Legislative Office Building
Page: 29 of 29
Completed Component Checklist
POINT DESCRIPTION
Fan Start/Stop
Fan Status
Fan Start/Stop
Fan Status
Manual Override Switch
Damper End Switch
Damper End Switch
E.P.Switch
End Switch for TAF-7
EP Switch for TAF-7
Fan Start/Stop
Fan Status
Manual Override Switch
Atrium Relief Open/Close
Damper End Switch
E.P.Switch
E.P.Switch
Existing Point
Fan Status
Atrium Relief Open/Close
Fan Status
SERIAL NUMBER
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
Cooling Tower
HP Loop
HP Loop
Rad Loop
Rad Loop
Rad Loop
Rad Loop
Rad Loop
Dom Wtr Htr #1
Dom Wtr Htr #1
Dom Wtr Htr #1
Boiler Room UH
Air temp
HP Loop
HP Loop
Cooling Tower
Cooling Tower
Cooling Tower
Cooling Tower
Cooling Tower
Cooling Tower
HP Loop
HP Loop
Rad Loop
Rad Loop
Rad Loop
Rad Loop
Boilers
Boilers
Boilers
Boilers
Boilers
Boilers
Boilers
Boiler Room UH
Boiler Room UH
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
Phone Rm Liebert
Phone Rm Liebert
IT Area Liebert #1
IT Area Liebert #2
IT Area Liebert #1
POINT NAME
CigTwrTemp
Pump1st
Pump2st
RadTempIn
RadTempOut
RadTempLoop
RadPump1DP
RadPump2DP
DomHtr1HwsTemp
DomHtr2HwsTemp
DomHtr3HwsTemp
BlrRmSpt
OAT
LoopPump1
LoopPump2
TwFan1
TwFan2
SprayPump
TwDamper
SumpHtr1
SumpHtr2
HwVlv1/3
HwVlv1/3
RadVlv1/3
RadVlv1/3
RadPump1
RadPump2
BlrStmPress
Blr1ComAlm
Blr2ComAlm
Blr3ComAlm
Blr1
Blr2
Blr3
BlmRmUH
BlrRmUHVlv
AHU4FanSt
AHU4Dat
AHU4Freeze
AHU4Fan
AHU4OaDpr
AHU4HtgVlv
AHU3FanSt
AHU3Dat
AHU3Freeze
AHU3Fan
AHU3OaDpr
AHU3HtgVlv
PhoneSpt
PhoneComAlm
ITSpt1
ITSpt2
IT1ComAlm
Capitol
Page: 1 of 3
Completed Component Checklist
POINT DESCRIPTION
Cooling Tower Temperature
Heat Pump Loop Pump #1 Status
Heat Pump Loop Pump #2 Status
Radiation HW Temperature In
Radiation HW Temperature Out
Radiation HW Temperature Loop
Radiation Loop Pump #1 Diff. Pressure
Radiation Loop Pump #2 Diff. Pressure
Domestic Water Heater #1 HW Supply Temp
Domestic Water Heater #2 HW Supply Temp
Domestic Water Heater #3 HW Supply Temp
Boiler Rm Space Temperature
Outside Air Temperature
Heat Pump Loop Pump#1 Start/Stop
Heat Pump Loop Pump#2 Start/Stop
Cooling Tower Fan #1 Start/Stop
Cooling Tower Fan #2 Start/Stop
Cooling Tower Spray Pump Start/Stop
Cooling Tower Damper Open/Close
Cooling Tower Sump Heater #1 Start/Stop
Cooling Tower Sump Heater #2 Start/Stop
Heat Pump Loop 1/3 Valve
Heat Pump Loop 2/3 Valve
Radiation 1/3 Valve
Radiation 2/3 Valve
Radiation Loop Pump #1 Start/Stop
Radiation Loop Pump #2 Start/Stop
Boiler Steam Pressure
Boiler #1 Common Alarm
Boiler #2 Common Alarm
Boiler #3 Common Alarm
Boiler #1 Enable
Boiler #2 Enable
Boiler #3 Enable
Boiler Room Unit Start/Stop
Boiler Room Unit Heater Valve Modulate
AHU-4 Fan Airflow Status
AHU-4 Discharge Air temeperature
AHU-4 Temperature Low limit Alarm
AHU-4 Fan Start/Stop
AHU-4 Outside Air Damper Open/Close
AHU-4 Heating Valve Modulate
AHU-3 Fan Airflow Status
AHU-3 Discharge Air temeperature
AHU-3 Temp-erature Low limit Alarm
AHU-3 Fan Start/Stop
AHU-3 Outside Air Damper Open/Close
AHU-3 Heating Valve Modulate
Phone Room Space Temperature
Phone Room Liebert Unit Common Alarm
IT Area Space Temperature #1
IT Area Space Temperature #2
IT Area Liebert Unit #1 Common Alarm
SERIAL NUMBER
DATE INSPECTED
PASS
FAIL
REMARKS
Attachment N
SYSTEM
IT Area Liebert #2
Flag Rm Unit
Flag Rm Unit
Flag Rm Unit
Flag Rm Unit
Flag Rm Unit
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-1
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
AHU-6
UH-3
UH-4
UH-9
UH-10
UH-3
UH-4
UH-9
UH-10
UH-9
UH-10
UH-1
UH-2
UH-5
UH-6
EF-10
UH-1
UH-2
UH-5
UH-6
POINT NAME
IT2ComAlm
FlagFanSt
FlagDat
FlagSpt
FlagFan
FlagCool
AHU1FanSt
AHU1Dat
AHU1Freeze
AHU1Fan
AHU1OaDpr
AHU1HtgVlv1/3
AHU1HtgVlv2/3
AHU2FanSt
AHU2Dat
AHU2Freeze
AHU2Fan
AHU2OaDpr
AHU2HtgVlv1/3
AHU2HtgVlv1/3
AHU5FanSt
AHU5Dat
AHU5Freeze
AHU5Fan
AHU5OaDpr
AHU5HtgVlv1/3
AHU5HtgVlv2/3
AHU6FanSt
AHU6Dat
AHU6Freeze
AHU6Fan
AHU6OaDpr
AHU6HtgVlv1/3
AHU6HtgVlv2/3
UH3Spt
UH4Spt
UH9Spt
UH10Spt
UH3
UH4
UH9
UH10
UH9Vlv
UH10Vlv
UH1Spt
UH2Spt
UH5Spt
UH6Spt
EF10St
UH1
UH2
UH5
UH6
Capitol
Page: 2 of 3
Completed Component Checklist
POINT DESCRIPTION
IT Area Liebert Unit #2 Common Alarm
Flag Rm Unit Fan Airflow Status
Flag Rm Unit Discharge Air Temperature
Flag Rm Space Temperature
Flag Rm Unit Fan Start/Stop
Flag Rm Unit Cooling Start/Stop
AHU-1 Fan Airflow Status
AHU-1 Discharge Air temeperature
AHU-1 Temp-erature Low limit Alarm
AHU-1 Fan Start/Stop
AHU-1 Outside Air Damper Open/Close
AHU-1 1/3 Steam Valve Modulate
AHU-1 2/3 Steam Valve Modulate
AHU-2 Fan Airflow Status
AHU-2 Discharge Air temeperature
AHU-2 Temp-erature Low limit Alarm
AHU-2 Fan Start/Stop
AHU-2 Outside Air Damper Open/Close
AHU-2 1/3 Steam Valve Modulate
AHU-2 2/3 Steam Valve Modulate
AHU-5 Fan Airflow Status
AHU-5 Discharge Air temeperature
AHU-5 Temp-erature Low limit Alarm
AHU-5 Fan Start/Stop
AHU-5 Outside Air Damper Open/Close
AHU-5 1/3 Steam Valve Modulate
AHU-5 2/3 Steam Valve Modulate
AHU-6 Fan Airflow Status
AHU-6 Discharge Air temeperature
AHU-6 Temp-erature Low limit Alarm
AHU-6 Fan Start/Stop
AHU-6 Outside Air Damper Open/Close
AHU-6 1/3 Steam Valve Modulate
AHU-6 2/3 Steam Valve Modulate
UH-3 Unit Heater Space Temperature
UH-4 Unit Heater Space Temperature
UH-9 Unit Heater Space Temperature
UH-10 Unit Heater Space Temperature
UH-3 Unit Heater Start/Stop
UH-4 Unit Heater Start/Stop
UH-9 Unit Heater Start/Stop
UH-10 Unit Heater Start/Stop
UH-9 Heater Valve Modulate
UH-10 Heater Valve Modulate
UH-1 Unit Heater Space Temperature
UH-2 Unit Heater Space Temperature
UH-5 Unit Heater Space Temperature
UH-6 Unit Heater Space Temperature
EF-10 Exhaust Fan Status
UH-1 Unit Heater Start/Stop
UH-2 Unit Heater Start/Stop
UH-5Unit Heater Start/Stop
UH-6 Unit Heater Start/Stop
SERIAL NUMBER
DATE INSPECTED
PASS
FAIL
REMARKS
Attachment N
SYSTEM
EF-10
UH-5
UH-6
UH-7
UH-8
EF-4
UH-7
UH-8
EF-4
UH-7
UH-8
UH-11
REF-14
UH-11
REF-14
UH-11
POINT NAME
EF10
UH5Vlv
UH6Vlv
UH7Spt
UH8Spt
EF4St
UH7
UH8
EF4
UH7Vlv
UH8Vlv
UH11Spt
REF14St
UH11
REF14
UH11Vlv
Capitol
Page: 3 of 3
Completed Component Checklist
POINT DESCRIPTION
EF-10 Exhaust Fan Start/Stop
UH-5 Heater Valve Modulate
UH-6 Heater Valve Modulate
UH-7 Unit Heater Space Temperature
UH-8 Unit Heater Space Temperature
EF-4 Exhaust Fan Status
UH-7Unit Heater Start/Stop
UH-8 Unit Heater Start/Stop
EF-4 Exhaust Fan Start/Stop
UH-7 Heater Valve Modulate
UH-8 Heater Valve Modulate
UH-11 Unit Heater Space Temperature
REF-14 Exhaust Fan Status
UH-7Unit Heater Start/Stop
REF-14 Exhaust Fan Start/Stop
UH-11 Heater Valve Modulate
SERIAL NUMBER
DATE INSPECTED
PASS
FAIL
REMARKS
Attachment N
SYSTEM
AHU-1
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-2
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-3
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-4
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-5
AHU-6
AHU-6
AHU-6
AHU-6
POINT NAME
Old State House
Page: 1 of 2
Completed Component Checklist
POINT DESCRIPTION
AHU-1 AHU Start/Stop
AHU-2 Fan Airflow Status
AHU-2 Discharge Air temeperature
AHU-2 Return Air temeperature
AHU-2 Mixed Air temeperature
AHU-2 Temperature Low limit Alarm
AHU-2 Fan Start/Stop
AHU-2 Outside Air Damper Open/Close
AHU-2 Steam Valve control
AHU-2 Humidifier Valve control
AHU-2 High Humidity alarm
AHU-2 CHW Valve control
AHU-3 Fan Airflow Status
AHU-3 Discharge Air temeperature
AHU-3 Return Air temeperature
AHU-3 Mixed Air temeperature
AHU-3 Temperature Low limit Alarm
AHU-3 Fan Start/Stop
AHU-3 Outside Air Damper Open/Close
AHU-3 Steam Valve control
AHU-3 Humidifier Valve control
AHU-3 High Humidity alarm
AHU-3 CHW Valve control
AHU-4 Fan Airflow Status
AHU-4 Discharge Air temeperature
AHU-4 Return Air temeperature
AHU-4 Mixed Air temeperature
AHU-4 Temperature Low limit Alarm
AHU-4 Fan Start/Stop
AHU-4 Outside Air Damper Open/Close
AHU-4 Steam Valve control
AHU-4 Humidifier Valve control
AHU-4 High Humidity alarm
AHU-4 CHW Valve control
AHU-5 Fan Airflow Status
AHU-5 Discharge Air temeperature
AHU-5 Return Air temeperature
AHU-5 Mixed Air temeperature
AHU-5 Temperature Low limit Alarm
AHU-5 Fan Start/Stop
AHU-5 Outside Air Damper Open/Close
AHU-5 Steam Valve control
AHU-5 Humidifier Valve control
AHU-5 High Humidity alarm
AHU-5 CHW Valve control
AHU-6 Fan Start/Stop
AHU-6 Temperature Low limit Alarm
AHU-6 Fan Airflow Status
AHU-6 Discharge Air temeperature
SERIAL NUMBER
DATE INSPECTED PASS
FAIL
REMARKS
Attachment N
SYSTEM
AHU-6
AHU-6
AHU-7
AHU-7
AHU-8
AHU-8
AHU-9
AHU-9
AHU-10
AHU-10
AHU-11
AHU-11
AHU-12
AHU-12
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-13
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
AHU-14
EF-G01
EF-G01
EF-G01
EF-301
EF-301
EF-301
POINT NAME
Old State House
Page: 2 of 2
Completed Component Checklist
POINT DESCRIPTION
AHU-6 Return Air temeperature
AHU-6 CHW Valve control
AHU-7 AHU Start/Stop
AHU-7 AHU Leak Monitoring
AHU-8 AHU Start/Stop
AHU-8 AHU Leak Monitoring
AHU-9 AHU Start/Stop
AHU-9 AHU Leak Monitoring
AHU-10 AHU Start/Stop
AHU-10 AHU Leak Monitoring
AHU-11 AHU Start/Stop
AHU-11 AHU Leak Monitoring
AHU-12 AHU Start/Stop
AHU-12 AHU Leak Monitoring
AHU-13 Fan Start/Stop
AHU-13 Temperature Low limit Alarm
AHU-13 Fan Airflow Status
AHU-13 Discharge Air temeperature
AHU-13 Return Air temeperature
AHU-13 CHW Valve control
AHU-14 Fan Start/Stop
AHU-14 Temperature Low limit Alarm
AHU-14 Fan Airflow Status
AHU-14 Discharge Air temeperature
AHU-14 Return Air temeperature
AHU-14 CHW Valve control
EF-G01 Fan Start/Stop
EF-G01 Fan Airflow Status
EF-G01 Damper Control
EF-301 Fan Start/Stop
EF-301 Fan Airflow Status
EF-301 Damper Control
SERIAL NUMBER
DATE INSPECTED PASS
FAIL
REMARKS