Forms & Descriptions   Summary Chart   Definitions   Other Notes

FORMS & DESCRIPTIONS   

Rev. 11-29-11      Adobe.pdf      Word.doc            

This certification accompanies a State contract with a value of $50,000 or more in a calendar or fiscal year.  The completed form is submitted by the contractor to the awarding State agency at the time of contract execution.  The form is also used when an updated certification is needed due to a change in the information contained in the most recently filed certification and for updates required at the 12 month anniversary of the most recently filed certification.

Form 2. Rescinded on 01-Aug-07.  Use Form 1.

Form 3. Certification of State Agency Official or Employee Authorized to Execute Contract   
Rev. 10-01-11        Adobe.pdf      Word.doc

This certification accompanies a State contract with a value of $50,000 or more in a calendar or fiscal year.  The completed form is signed at the time of contract execution by the State agency official or employee authorized to execute the contract on behalf of the awarding State agency.

Form 4. Rescinded on 01-Aug-07.  Use Form 1.

Form 5. Consulting Agreement Affidavit   
Rev. 10-01-11       Adobe.pdf      Word.doc

This affidavit accompanies a bid or proposal for the purchase of goods or services with a value of $50,000 or more in a calendar or fiscal year.  Form 5 is normally submitted by the contractor to the awarding State agency with the bid or proposal, however, for a sole source or no bid contract, it is submitted at the time of contract execution.

Rev. 10-01-11        Adobe.pdf      Word.doc

This affirmation accompanies a large State construction contract or a large State procurement contract with a cost of more than $500,000.  Form 6 is normally submitted by the contractor to the awarding State agency with the bid or proposal.  However, for a sole source or no bid contract, Form 6 is submitted at the time of contract execution.
When applicable, Form 6 is also used by a subcontractor or consultant of the contractor.  The subcontractor or consultant submits the form to the contractor, who then submits it to the awarding State agency.

Forms 6A, 6B, 6C.  Rescinded on 01-Aug-07.  Use Form 6.

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 SUMMARY CHART

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The chart belows summarizes who signs which ethics form, and when each form is submitted during the contracting process.

 

 

WHEN TO SUBMIT	ETHICS FORMS
	Signed by AGENCY	Signed by CONTRACTOR
		ALL Contracts cost or value $50 K or more	LARGE Contracts cost $500 K or more
submit form with bid or proposal		Form 5 **	Form 6 ***
submit form at time of contract execution	Form 3	Form 1* Form 5 **	Form 6 ***
submit form after contract execution			Form 6 ***
submit form not later than 14 days after the 12 month anniversary of the most recently filed representation, documentation or updated representation or documentation.		Form 1*

 

* Unless otherwise noted no resubmission is required after the initial submission unless there is a change in the information.  If there is a change in the information an updated certification must be submitted no later than 30 days after (i) the effective date of such change or (ii) the submittal of any new bid or proposal, whichever is earlier.

**   Form 5 is normally submitted by the contractor to the awarding State agency with the bid or proposal.  However, for a sole source or no bid contract, it is submitted at the time of contract execution.

*** Form 6 is normally submitted by the contractor to the awarding State agency with the bid or proposal.  However, for a sole source or no bid contract, Form 6 is submitted at the time of contract execution.  When applicable, Form 6 is also used by a subcontractor or consultant of the contractor.  The subcontractor or consultant submits the form to the contractor, who then submits it to the awarding State agency.  Depending on when the contractor engages the subcontractor or consultant, the contractor either submits the form at the time of contract execution or after contract execution.

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 DEFINITIONS

• Cost of the contract means the dollar amount (or equivalent benefit) expended by the State in accordance with the contract.

Example:

 

OPM entered into a contract with Servus Management Corporation to manage the State office complex located at 410-474 Capitol Avenue in Hartford.  OPM pays the contractor a specified amount of money for this service.  This contract represents a cost expended by the State.

• Value of the contract means the dollar amount (or equivalent benefit) expended or received by the State in accordance with the contract. 

Example:

 

OPM entered into an agreement with Pinpoint Power whereby, in the event of a power shortage, certain State agencies may be asked to use their own emergency generators.  In exchange, the contractor pays the State a specified amount of money to compensate for the service interruption.  This contract represents a value received by the State.

• Large state construction contract or large procurement contract means any contract, having a cost of more than $500,000 for (A) the remodeling, alteration, repair or enlargement of any real asset, (B) the construction, alteration, reconstruction, improvement, relocation, widening or changing of the grade of a section of a state highway or a bridge, (C) the purchase or lease of supplies, materials or equipment, as defined in section 4a-50, or (D) the construction, reconstruction, alteration, remodeling, repair or demolition of any public building.

 OTHER NOTES