Attachment II

	STATE OF CONNECTICUT
NANCY WYMAN COMPTROLLER	OFFICE OF THE STATE COMPTROLLER 55 ELM STREET HARTFORD, CONNECTICUT 06106-1775	MARK OJAKIAN DEPUTY COMPTROLLER

All contracts to be awarded are subject to contract compliance requirements mandated by Section 4-114a of the Connecticut General Statutes and, when the awarding agency is the state, Section 46a-71(d) of the Connecticut General Statutes. The awarding agency must consider the following factors when reviewing the bidder's qualifications under the contract compliance requirements; therefore, we are asking that the following information be provided:

1. Contractor

   Name:
   Address:
   Telephone:
   Principal Place of Business:

2. Subcontractor(s)

   Name:
   Address:
   Telephone:
   Principal Place of Business:
   Contact Person:

3. Section 4-114a-3(10) Criteria

   Does the contractor have an Affirmative Action Plan? Yes ___ No ___

   If no, does the contractor plan to develop an Affirmative Action Plan? Yes ___ No ___

   Total Number of Employees? ________

   What percent of total employees are women? ________

   What percent of total employees are minorities? ________

   Does the contractor promise to set aside a portion of the Contract for minority business enterprises? Yes ___ No ___

   __________________________________________	______________________________
   Signature and Title of Principal Officer	Date

Table of Contents | Index of Comptroller's RFPs | Comptroller's Home Page