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Thank you for contributing to the Suffield Democratic Town Committee. Please complete the form below. Once you submit the required information below, you will be directed to our PayPal page to make your donation with a PayPal account or credit card. If you have any questions, please contact us at donate@suffielddemocrats.com or call our Treasurer, Jack Henrie at (860) 680-2361.

IS CONTRIBUTION BEING MADE FROM THE ACCOUNT OF A SOLE PROPRIETORSHIP?*
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- No
NAME OF SOLE PROPRIETORSHIP*

If "YES" above, and name is different than individual contributor.
RESIDENTAL ADDRESS*
Street Address Address Line 2 City State ZIP Code
EMAIL*
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EMPLOYER INFORMATION*
Employer Principal Occupation

To comply with State law, contributors are required to provide their employment information. If you are retired, please enter N/A under Employer and Retired under Occupation; if a homemaker, please enter N/A - Homemaker; if self-employed, please enter "Self-Employed" under Employer and describe your line of work under Occupation.
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If you are under 18, please contact us at (860) 668-5444 to discuss donation options.
LEGAL COMPLIANCE*
- I confirm the following statements are true:
Legal Compliance: Please click here to review the following definitions before you confirm the following statements. Add notes below if necessary.

• I am not a communicator lobbyist
• I am not a spouse of a communicator lobbyist
• I am not an elected public official
• I am not a principal of a state contractor or prospective state contractor
• I am not a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?
• This contribution is made on a personal credit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person. I hereby certify and state that all of the information disclosed by me and set forth above is true and accurate to the best of my knowledge and belief and that I am NOT a principal of a state contractor, prospective state contractor, and that I am NOT a communicator lobbyist or member of the immediate family of a communicator lobbyist.
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DISCLAIMER*

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 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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Legal Compliance

State Contractor Contribution Bans

Connecticut General Statutes § 9‐612 (g) (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 aholder, 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), as amended by P.A. 10-1, 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 (g) (4), as amended by P.A. 08-2. 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), as amended by P.A. 10-1.

Definition of Terms

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

“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 (g) (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 (g) (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 (g) (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 (g) (1) (F).

“Communicator Lobbyist”: an individual or entity that is or should be registered with the Office of State Ethics as a communicator lobbyist. A “communicator lobbyist” is an individual or entity who receives or agrees to receive $2,000 or more in a calendar year for lobbying. See General Statutes

§ 1-91 (l) & (v).

“Immediate family” means: The spouse or a dependent child of an individual. See General Statutes § 9-601 (24). Please note, “spouse” as used above includes partners to a civil union pursuant to General Statutes § 46b-38aa, et al.

“Dependent Child” means: 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 (g) (1) (G).

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