Division 10 Prior Disqualification and Contract Termination Prior Disqualification: NOTE: See Agency” definition at the end of Question 10.2. Use additional copies of these pages as necessary. “Public 10.1 Has your Firm ever been formally Disqualified, Not Responsible, or Debarred from performing work for a Agency”? “Public YES If you answered YES, then provide the following information for each such “Disqualification”: NO 1. State Agency Name: 2. State Project No.: 3. Project Name/Location: 4. Date of Disqualification: 5. Duration of Disqualification: 6. Reason for Disqualification: 10.2 Has your Firm ever been formally Disqualified, Found Not Responsible, or Debarred from performing work for a any contracting entity other than Agency”? “Public YES If you answered YES, then provide the following information for each such “Disqualification”: NO 1. Contracting Entity Name: 2. Project No.: 3. Project Name/Location: 4. Date of Disqualification: 5. Duration of Disqualification: 6. Reason for Disqualification: Definition :C.G.S. § 1-200 (1): Agency” or means: (A) Any executive, administrative or “Public “agency” legislative office of the state or any political subdivision of the state and any state or town agency, any department, institution, bureau, board, commission, authority or official of the state or of any city, town, borough, municipal corporation, school district, regional district or other district or other political subdivision of the state, including any committee of, or created by, any such office, subdivision, agency, department, institution, bureau, board, commission, authority or official, and also includes any judicial office, official, or body or committee thereof but only with respect to its or their administrative functions, and for purposes of this subparagraph, office” includes, but is not limited to, the Division of Public Defender Services. “judicial (go to next page) Division 10 Prior Disqualification and Contract Termination (Continued) Contract Termination: NOTE: See Agency” definition at the end of Question 10.4. Use additional copies of these pages as necessary. “Public
Division 10 Prior Disqualification and Contract Termination Prior Disqualification: NOTE: See “Public Agency” definition at the end of Question 10.2. Use additional copies of these pages as necessary. 10.1 Has your Firm ever been formally Disqualified, Not Responsible, or Debarred from performing work for a “Public Agency”? YES If you answered YES, then provide the following information for each such “Disqualification”: NO 1. State Agency Name: 2. State Project No.: 3. Project Name/Location: 4. Date of Disqualification: 5. Duration of Disqualification: 6. Reason for Disqualification: 10.2 Has your Firm ever been formally Disqualified, Found Not Responsible, or Debarred from performing work for any contracting entity other than a “Public Agency”? YES If you answered YES, then provide the following information for each such “Disqualification”: NO 1. Contracting Entity Name: 2. Project No.: 3. Project Name/Location: 4. Date of Disqualification: 5. Duration of Disqualification: 6. Reason for Disqualification: Definition :C.G.S. § 1-200 (1): “Public Agency” or “agency” means: (A) Any executive, administrative or legislative office of the state or any political subdivision of the state and any state or town agency, any department, institution, bureau, board, commission, authority or official of the state or of any city, town, borough, municipal corporation, school district, regional district or other district or other political subdivision of the state, including any committee of, or created by, any such office, subdivision, agency, department, institution, bureau, board, commission, authority or official, and also includes any judicial office, official, or body or committee thereof but only with respect to its or their administrative functions, and for purposes of this subparagraph, “judicial office” includes, but is not limited to, the Division of Public Defender Services. (go to next page) Division 10 Prior Disqualification and Contract Termination (Continued) Contract Termination: NOTE: See “Public Agency” definition at the end of Question 10.4. Use additional copies of these pages as necessary.
2._1862_QBS_Sub_Booklet_CPS-SBE-MBE-ELEC-01.docx