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Contribution to 2019 IWB appeal

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Contribution to 2019 IWB appeal

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Are you a principal of a state contractor or prospective state contractor? more info

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Do you or a business with which you are associated have a contract with the town, city or borough in which the candidate is running that is valued at more than $5,000 ? more info

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Are you a communicator lobbyist, OR the spouse or dependent child of a communicator lobbyist?: more info

Yes No

Are you a lobbyist?: more info

Yes No

Are you the spouse or dependent child of a lobbyist?:

Yes No

Are you of the Age of 18 or Older?

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“State contractor”: a person, business entity or nonprofit organization that enters into a state contract. Such person, business entity or nonprofit organization shall be deemed to be a state contractor until December thirty-first of the year in which such contract terminates. “State contractor” does not include a municipality or any other political subdivision of the state, including any entities or associations duly created by the municipality or political subdivision exclusively amongst themselves to further any purpose authorized by statute or charter, or an employee in the executive or legislative branch of state government or a quasi-public agency, whether in the classified or unclassified service and full or part-time, and only in such person’s capacity as a state or quasi-public agency employee. See General Statutes § 9-612 (f) (1) (D). “Prospective state contractor”: a person, business entity or nonprofit organization that (i) submits a response to a state contract solicitation by the state, a state agency or a quasi-public agency, or a proposal in response to a request for proposals by the state, a state agency or a quasi-public agency, until the contract has been entered into, or (ii) holds a valid prequalification certificate issued by the Commissioner of Administrative Services under section 4a-100. “Prospective state contractor” does not include a municipality or any other political subdivision of the state, including any entities or associations duly created by the municipality or political subdivision exclusively amongst themselves to further any purpose authorized by statute or charter, or an employee in the executive or legislative branch of state government or a quasi-public agency, whether in the classified or unclassified service and full or part-time, and only in such person’s capacity as a state or quasi-public agency employee. See General Statutes § 9-612 (f) (1) (E). “Principal of a state contractor or prospective state contractor”: (i) an individual who is a member of the board of directors of, or has an ownership interest of 5% or more in a state contractor or prospective state contractor, which is a business entity, except for an individual who is a member of the board of directors of a nonprofit organization, (ii) an individual who is employed by a state contractor or prospective state contractor, which is a business entity, as president, treasurer or executive vice president, (iii) an individual who is the chief executive officer of a state contractor or prospective state contractor, which is not a business entity, or if a state contractor or prospective state contractor has no such officer, then the officer who duly possesses comparable powers and duties, (iv) an officer or an employee of any state contractor or prospective state contractor who has managerial or discretionary responsibilities with respect to a state contract, or (v) the spouse or a dependent child who is eighteen years of age or older of an individual described in (i), (ii), (iii), or (iv). See General Statutes § 9-612 (f) (1) (F).

“Communicator lobbyist”: a lobbyist who communicates directly or solicits others to communicate with an official or his staff in the legislative or executive branch of government or in a quasi-public agency for the purpose of influencing legislative or administrative action. A lobbyist, in turn, is generally defined as a person who, in lobbying and in furtherance of lobbying, makes or agrees to make expenditures, or receives or agrees to receive compensation, reimbursement, or both, and such compensation, reimbursement or expenditures are $3,000 or more in any calendar year or the combined amount thereof is $3,000 or more in any such calendar year. See General Statutes § 1-91 (12) & (22) (as amended by Public Act 15-15). “Immediate family”: the spouse or a dependent child of an individual. See General Statutes § 9-601 (24). “Dependent child”: a child residing in an individual’s household who may legally be claimed as a dependent on the federal income tax return of such individual. See General Statutes § 9-612 (f) (1) (G).

A “business with which you are associated” refers to any business in which the contributor is a director, officer, owner, limited or general partner, or stockholder of 5% of more of the total stock of the business.

Contribution to 2019 IWB appeal

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3 Certify & Pay

Personal Information

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Contribution to 2019 IWB appeal

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$
2 Personal Information
3 Certify & Pay

1. CERTIFICATION

I confirm that the below statements are true and accurate

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor form is true and accurate to the best of my knowledge and belief. I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I certify that this contribution is made on my personal debit or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization, or any other entity. I certify that the address used in this contribution is my residential address and is the billing address associated with this card. I certify that the name used in this contribution is the name that appears on the credit card used for this contribution.

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief. I certify that I do NOT have a contract with the town, city or borough in which the candidate is running that is valued at more than $5,000. I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief. I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.

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