PayPal CT SEEC Contributor Form

Before you donate, please help us fully comply with Connecticut State Elections Enforcement Commission’s regulations. Kindly provide the information below so I can file your contribution.

All responses are required, but it won’t take long.

Many thanks,

Cynthia Feuer
Treasurer Bridgewater Democratic Town Committee





NAME OF INDIVIDUAL CONTRIBUTOR:
First Name:

 

Middle Initial:

 

Last Name:

 

Your Email Address:

 

Your Phone Number:

 

DONATION AMOUNT:
$  (Min: $5. Max: $2000)

RESIDENTIAL ADDRESS*
STREET:

 

CITY:

 

ST:

 

ZIP CODE:

 

Please check if you are UNDER 18:  Yes
If under 18, please list your age:

 

NAME OF EMPLOYER (If self-employed, provide Name of Business.
Example: Dave’s Painting Other Examples: Retired, Unemployed, Student, Homemaker):

 

PRINCIPAL OCCUPATION (If self-employed, provide Job Description.
Example: Painter Other Examples: Retired, Unemployed, Student, Homemaker):

 


PLEASE SCROLL DOWN TO REVIEW THE DEFINITIONS BELOW, THEN SCROLL BACK HERE TO ANSWER EACH OF THE FOLLOWING:

Are you a communicator lobbyist?**  Yes No

Are you the spouse or dependent child of a communicator lobbyist?  Yes No

      If yes, are you an elected public official?  Yes No

Are you a principal of a state contractor or prospective state contractor?  Yes No
      If yes, please indicate which branch or branches of the government the contract(s) is/are with:
       Legislative Executive
      If you answered yes to the previous question, are you an elected public official?  Yes No

Are you a principal of a holder of a valid prequalification issued by the Commissioner
of Administrative Services?  Yes No


CERTIFICATION:
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.

To sign this form digitally, please type your full name as you entered it above:

 

Thank you for your time.

* You may enter an alternate address in lieu of your residential address only if you are admitted into the Address Confidentiality Program pursuant to General Statutes § 54-240 (a) or if you are one of the individuals with protected address status articulated in General Statutes § 1-217.

** Note that under Public Act 10-1, communicator lobbyists and their immediate family members are permitted to give contributions of up to one hundred dollars in the aggregate to party committees.

DEFINITIONS:

State Contractor Contribution Bans
Connecticut General Statutes § 9‐612 (f) (2) (A) & (B) provide in part that no state contractor, prospective state contractor, principal of a state contractor or principal of a prospective state contractor, with regard to a state contract or state contract solicitation with or from the General Assembly, Executive Branch, or a quasi public agency or a holder, or a principal of a holder of a valid prequalification certificate, shall make a contribution to a party committee.

$100 Lobbyist Contribution Limit

Connecticut General Statutes § 9‐610 (g) provides in part that no communicator lobbyist or member of the immediate family of a communicator lobbyist shall make a contribution or contributions to, or for the benefit of a party committee in excess of one hundred dollars.

“Public Official” Exemption

Please Note: The state contractor contribution bans do not apply to a principal of a state contractor or prospective state contractor who is an elected public official. See General Statutes § 9-612 (f) (4). Likewise, the communicator lobbyist contribution limit does not apply to a spouse or dependent child of a communicator lobbyist who is an elected public official. See General Statutes § 9-610 (j).

Definition of Terms

“Party committee”: a state central committee or a town committee. See General Statutes § 9‐601 (2).

“Individual contributor”: a human being, a sole proprietorship, or a professional service corporation organized under chapter 594a and owned by a single human being. A sole proprietorship is a business in which one human being owns all the assets, owes all the liabilities, and operates in his or her personal capacity. Any other type of business is not permitted to make a contribution, including LLCs. See General Statutes § 9-601 (9).

“State contract”: an agreement or contract with the state or any state agency or any quasi-public agency, let through a procurement process or otherwise, having a value of fifty thousand dollars or more, or a combination or series of such agreements or contracts having a value of one hundred thousand dollars or more in a calendar year, for (i) the rendition of services, (ii) the furnishing of any goods, material, supplies, equipment or any items of any kind,
(iii) the construction, alteration or repair of any public building or public work, (iv) the acquisition, sale or lease of any land or building, (v) a licensing arrangement, or (vi) a grant, loan or loan guarantee. “State contract” does not include any agreement or contract with the state, any state agency or any
quasi-public agency that is exclusively federally funded, an education loan, a loan to an individual for other than commercial purposes or any agreement or contract between the state or any state agency and the United States Department of the Navy or the United States Department of Defense. See General Statutes § 9-612 (f) (1) (C).

“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. ʺProspective state contractorʺ 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 five per cent 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).