Affidavits Forms

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					                                                                                                   RFQ Legal Notice

      State of Connecticut
   Department of Public Works
 Bureau of Design & Construction
ADV. No.:                 BI-JD-305-ARC

                                                       State of Connecticut
                                                   Department of Public Works
                                              165 Capitol Avenue, Hartford, CT 06106

                                   REQUEST FOR QUALIFICATIONS (RFQ) – LEGAL NOTICE
             Selection Type:                              On-Call                                          Formal

ADV. NO.:           BI-JD-305-ARC                                                    PUBLIC NOTICE DATE:            see instructions

         General Statement:           In accordance with statutory requirements, the State of Connecticut, Department of Public
                                      Works is publishing this Legal Notice for the following Request for Qualifications (RFQ).

 State Contracting Portal:            Go to www.das.state.ct.us/busopp.asp to link to the DAS State Contracting Portal.

   DPW Contract Number:               BI-JD-305-ARC

      Consultant Services:            Architect and Consultant Design Team with Construction Administration Services
                                      beyond the requirements of the basic contract.

                   Project Title:     Replace Roof & Masonry Repairs

        Project Location(s):          Courthouse G.A. #12
                                      172 Golden Hill Street
                                      Bridgeport, CT

     Web Advertisements:              For details on the requirements of this contract:
                                      1. Go to the DPW Website: www.ct.gov/dpw
                                      2. Under LEGAL NOTICES title, click on the Architecture / Engineering link.
                                      3. Under Design Open Requests for Qualifications (RFQ) title, click on DPW Contract
                                         Number for this contract.

   Qualification Submittal            Deadline for the receipt of the QBS Submittal Booklets is:
   Deadline and Location:             3 p.m., Wednesday, June 21, 2006.

                                      State Office Building
                                      Department of Public Works
                                      Room 261
                                      165 Capitol Avenue
                                      Hartford, Connecticut 06106
                                      Note:
                                      Failure to the submit properly formatted QBS Submittal Booklets with all of the required
                                      contents including the affidavits and Certificate of Authority, by the designated deadline and
                                      location will result in the Firm being deemed Non-Responsive for consideration for this
                                      Contract.




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                                                                                                  RFQ Legal Notice

      State of Connecticut
   Department of Public Works
 Bureau of Design & Construction
ADV. No.:                 BI-JD-305-ARC

       Affidavit Submittals:       Connecticut General Statutes, DPW policy, and Executive Orders issued by Governor Rell
                                   require consultants, general contractors and design/builders to submit various types of
                                   affidavits for selections, bids, and proposals . These affidavits require the disclosure of
                                   certain gifts, campaign contributions and consulting agreements.

                                   “Unofficial” samples of DPW Affidavit forms are included in various DPW publications.

                                   “Official” DPW Affidavit forms and instructions can be accessed from the CT DPW Website as
                                   follows:
                                             Go to the DPW Website Home Page: www.ct.gov/dpw
                                             On the left side of the Home Page click on the Affidavits link.
                                             Under the Affidavits Forms title follow the steps below to obtain information about
                                              affidavits, how to fill out, and to determine which ones are required to be submitted for
                                              this Qualification Based Selection:
                                              > Introduction
                                              > General Advice for Filling out Affidavits and Resolutions / Certificates of
                                                 Authority
                                              > Bid / Proposal Affidavit
                                              > Consulting Affidavit
                                              > Disclosure Affidavit and Certificate of Authority
                                              > Ethics Affidavit and Summary of State Ethics Laws
                                              > Resolutions and Certificate of Authority

                RFQ Contacts:      For general selection requirements:               For this selection and contract:
                                   DPW Selection Unit Manager                  OR    DPW Project Manager
                                   Lee A. Rowley, PE                                 Ward Ponticelli, RA
                                   Room 261                                          Room 460
                                   165, Capitol Avenue                               165 Capitol Avenue
                                   Hartford, Connecticut 06106                       Hartford, Connecticut 06106
                                   Fax:     860 713-7272                             Fax:      860-713-7270
                                   Email: lee.rowley@po.state.ct.us                  Email: ward.ponticelli@po.state.ct.us
                                   Note:
                                   Responses to requests for more specific contract information than is contained in this Legal
                                   Notice shall be limited information that is available to all Firms and that is necessary to
                                   complete this selection process.

                                   All requests for more specific contract information must be sent in writing (email
                                   acceptable).



     (James T. Fleming - Commissioner Department of Public Works)                                              Date




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                                                                                     RFQ Legal Notice

      State of Connecticut
   Department of Public Works
 Bureau of Design & Construction
ADV. No.:                 BI-JD-305-ARC


The information below is for DPW Records only and is not to be included in the Legal Notice (do not remove the
page break).

Make sure that the DPW Contract Number (ADV. No.) is on this pages header.

This original signature page, plus a hard copy of the front page should be put in the project file folder.

Approvals:

             Ward Ponticelli
                 (PM Name)                          (PM Signature)                                (Date)
              Don Ouillette
                (SPM Name)                          (SPM Signature)                               (Date)
            Bruce Bockstael
    (Administrator of Client Teams)                   (Signature)                                 (Date)




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