Fill - Free fillable Western Connecticut State University Personal Services Agreement & (Western Connecticut State University) PDF form

1. Complete this form and forward to the Purchasing Office 10 business days prior to the start of the service period.

2. The University and the Service Provider as listed below hereby enter into an agreement subject to the terms

and conditions stated herein and/or attached herto and subject ot the provisions of section 4-98 of the Original

Connecticut General Statues as applicable.

3. Acceptance of this agreemet implies conformance with terms and conditions set forth on Pages 2 and 3 of this Amendment

file, as attached hereto and incorporated by reference.

4. If a service provider will be paid more than $3,000 in any rolling 12-month period, a Personal Service Agreement Amendent #

form C)-802A must be prepared and approved in advance of the start date of this service.

1. SERVICE PROVIDER NAME:

2. SERVICE PROVIDER ADDRESS:

SERVICE PROVIDER PHONE: SERVICE PROVIDER EMAIL:

3. ARE YOU CURRENTLY A STATE EMPLOYEE? YES NO

If you answered Yes to Number 3 above, a dual employment form must be completed and made part of this agreement.

4. DO YOU HAVE AN IMMEDIATE FAMILY MEMBER WHO IS A STATE EMPLOYEE? YES NO

5. HAVE YOU CONTRACTED WITH THIS UNIVERSITY DURING THE PAST 12 MONTHS? YES NO

8. BANNER INDEX: AMOUNT:

BANNER INDEX: AMOUNT:

9. TOTAL VALUE OF THIS SERVICE:

10. SERVICE PERIOD: FROM TO

CONTRACT BID AWARD # IF APPLICABLE:

THIS AGREEMENT SHALL REMAIN IN FULL FORCE AND EFFECT FOR THE ENTIRE TERM OF

SERVICE PERIOD STATED ABOVE UNLESS CANCELLED BY THE UNIVERISTY, BY GIVING THE

SERVICE PROVIDER WRITTEN NOTICE OF SUCH INTENTION. (REQUIRED DAYS NOTICE

SPECIFIED AT LEFT.)

12. THE SERVICE PROVIDER AGREES TO: (DETAILED SERVICES MUST BE PROVIDED ALONG WITH SPECIAL PROVISIONS AS NECESSARY - use separate referenced sheet if necessary.)

13. TOTAL AGREEMENT NOT TO EXCEED: (ORIGINAL AGREEMENT AMOUNT + ALL AMENDMENTS.)

14. PAYMENT TO BE MADE UNDER THE FOLLOWING SCHEDULE UPON RECEIPT OF PROPERLY EXECUTED AND APPROVED DISBURSEMENT FORM.

TE:

SERVICE PROVIDER (OWNER OR AUTHORIZED SIGNATURE)

TITLE:

APPROPRIATE DEAN - WESTERN CONNECTICTUT STATE UNIVERSITY AUTHORIZED SIGNATURE:

TITLE:

APPROPRIATE VICE PRESIDENT - WESTERN CONNECTICUT STATE UNIVERSITY AUTHORIZED SIGNATURE:

TITLE: DATE:

REVISED 5/29/20

DOCUM

ENT NUMBER:

PSA

AUTHORIZED FUNDING SIGNATURE:

6. UNIVERSITY INFORMATION: WESTERN CONNECTICUT STATE UNIVERSITY, 181 WHITE ST, DANBURY, CT 06810

7. PROJECT DIRECTOR'S NAME: TELEPHONE NUMBER:

NOTE: If numbers 3 and/or 4 above were answered "Yes" and the contract value of this Agreement is equal to or greater than $100 and the fee is to be paid

as an independent contractor, this contract must have been awarded through an open and public bidding process.

11. NUMB

ER OF DAYS:

Western Connecticut State University

Personal Services Agreement & Honoraruim Request Form

$3,000 or less

Under no circumstances are any services to be performed under this agreement unless the User Department has received approval.

AUTHORIZED FUNDING SIGNATURE:

STATUTORY AUTHORITY CCGS 10a-151b

ENCUMBERED (DATE & INITIALS)

SERVICE PROVIDER

UNIVERSITY

TERMS AND CONDITIONS

ACCEPTANCES/APPROVALS

AUTHORIZED FUNDING SIGNATURE:

Page 1 of 4

$ 0.00

EXECUTIVE ORDERS Nos. 3, 17, 16, and 7C:

This Contract is subject to the provisions of Executive Order No. 7C of Governor M. Jodi Rell,

promulgated July 13, 2006, concerning contracting reforms, Executive Order No. Sixteen of Governor John G.

Rowland promulgated August 4, 1999, concerning violence in the workplace, Executive Order No. Seventeen of

Governor Thomas J. Meskill, promulgated February 15, 1973, concerning the listing of employment openings and

Executive Order No. Three of Governor Thomas J. Meskill, promulgated June 16, 1971, concerning labor

employment practices, all of which are incorporated into and are made a part of the Contract as if they had been

fully set forth in it. At the Contractor’s request, ECSU shall provide a copy of these orders to the Contractor.

NON DISCRIMINATION

(a) For purposes of this Section, the following terms are defined as follows:

i. "Commission" means the Commission on Human Rights and Opportunities;

ii. "Contract" and “contract” include any extension or modification of the

Contract or contract;

iii. "Contractor" and “contractor” include any successors or assigns of the

Contractor or contractor;

iv. "Gender identity or expression" means a person's gender-related identity,

appearance or behavior, whether or not that gender-related identity,

appearance or behavior is different from that traditionally associated with the

person's physiology or assigned sex at birth, which gender-related identity can

be shown by providing evidence including, but not limited to, medical history,

care or treatment of the gender-related identity, consistent and uniform

assertion of the gender-related identity or any other evidence that the gender-

related identity is sincerely held, part of a person's core identity or not being

asserted for an improper purpose.

v. “good faith" means that degree of diligence which a reasonable person would

exercise in the performance of legal duties and obligations;

vi. "good faith efforts" shall include, but not be limited to, those reasonable initial

efforts necessary to comply with statutory or regulatory requirements and

additional or substituted efforts when it is determined that such initial efforts

will not be sufficient to comply with such requirements;

vii. "marital status" means being single, married as recognized by the State of

Connecticut, widowed, separated or divorced;

viii. "mental disability" means one or more mental disorders, as defined in the

most recent edition of the American Psychiatric Association's "Diagnostic and

Statistical Manual of Mental Disorders", or a record of or regarding a person

as having one or more such disorders;

ix. "minority business enterprise" means any small contractor or supplier of

materials fifty-one percent or more of the capital stock, if any, or assets of

which is owned by a person or persons: (1) who are active in the daily affairs

of the enterprise, (2) who have the power to direct the management and

policies of the enterprise, and (3) who are members of a minority, as such

term is defined in subsection (a) of Connecticut General Statutes § 32-9n; and

x. "public works contract" means any agreement between any individual, firm or

corporation and the State or any political subdivision of the State other than a

municipality for construction, rehabilitation, conversion, extension,

demolition or repair of a public building, highway or other changes or

improvements in real property, or which is financed in whole or in part by the

State, including, but not limited to, matching expenditures, grants, loans,

insurance or guarantees.

For purposes of this Section, the terms "Contract" and “contract” do not include a contract where each

contractor is (1) a political subdivision of the state, including, but not limited to, a municipality, (2) a quasi-

Page 2 of 4

public agency, as defined in Conn. Gen. Stat. Section 1-120, (3) any other state, including but not limited to

any federally recognized Indian tribal governments, as defined in Conn. Gen. Stat. Section 1-267, (4) the

federal government, (5) a foreign government, or (6) an agency of a subdivision, agency, state or

government described in the immediately preceding enumerated items (1), (2), (3), (4) or (5).

(b) (1) The Contractor agrees and warrants that in the performance of the Contract such Contractor will not

discriminate or permit discrimination against any person or group of persons on the grounds of race, color,

religious creed, age, marital status, national origin, ancestry, sex, gender identity or expression, mental

retardation, mental disability or physical disability, including, but not limited to, blindness, unless it is

shown by such Contractor that such disability prevents performance of the work involved, in any manner

prohibited by the laws of the United States or of the State of Connecticut; and the Contractor further agrees

to take affirmative action to insure that applicants with job-related qualifications are employed and that

employees are treated when employed without regard to their race, color, religious creed, age, marital

status, national origin, ancestry, sex, gender identity or expression, mental retardation, mental disability or

physical disability, including, but not limited to, blindness, unless it is shown by the Contractor that such

disability prevents performance of the work involved; (2) the Contractor agrees, in all solicitations or

advertisements for employees placed by or on behalf of the Contractor, to state that it is an "affirmative

action-equal opportunity employer" in accordance with regulations adopted by the Commission; (3) the

Contractor agrees to provide each labor union or representative of workers with which the Contractor has a

collective bargaining Agreement or other contract or understanding and each vendor with which the

Contractor has a contract or understanding, a notice to be provided by the Commission, advising the labor

union or workers’ representative of the Contractor's commitments under this section and to post copies of

the notice in conspicuous places available to employees and applicants for employment; (4) the Contractor

agrees to comply with each provision of this Section and Connecticut General Statutes §§ 46a-68e and 46a-

68f and with each regulation or relevant order issued by said Commission pursuant to Connecticut General

Statutes §§ 46a-56, 46a-68e and 46a-68f; and (5) the Contractor agrees to provide the Commission on

Human Rights and Opportunities with such information requested by the Commission, and permit access to

pertinent books, records and accounts, concerning the employment practices and procedures of the

Contractor as relate to the provisions of this Section and Connecticut General Statutes § 46a-56. If the

contract is a public works contract, the Contractor agrees and warrants that he will make good faith efforts

to employ minority business enterprises as subcontractors and suppliers of materials on such public works

projects.

following factors: The Contractor's employment and subcontracting policies, patterns and practices;

affirmative advertising, recruitment and training; technical assistance activities and such other reasonable

activities or efforts as the Commission may prescribe that are designed to ensure the participation of

minority business enterprises in public works projects.

(d) The Contractor shall develop and maintain adequate documentation, in a manner prescribed by the

Commission, of its good faith efforts.

(e) The Contractor shall include the provisions of subsection (b) of this Section in every subcontract or

purchase order entered into in order to fulfill any obligation of a contract with the State and such provisions

shall be binding on a subcontractor, vendor or manufacturer unless exempted by regulations or orders of the

Commission. The Contractor shall take such action with respect to any such subcontract or purchase order

as the Commission may direct as a means of enforcing such provisions including sanctions for

noncompliance in accordance with Connecticut General Statutes §46a-56; provided if such Contractor

becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such

direction by the Commission, the Contractor may request the State of Connecticut to enter into any such

litigation or negotiation prior thereto to protect the interests of the State and the State may so enter.

(f) The Contractor agrees to comply with the regulations referred to in this Section as they exist on the date

of this Contract and as they may be adopted or amended from time to time during the term of this Contract

and any amendments thereto.

Page 3 of 4

(g) (1) The Contractor agrees and warrants that in the performance of the Contract such Contractor will

not discriminate or permit discrimination against any person or group of persons on the grounds of sexual

orientation, in any manner prohibited by the laws of the United States or the State of Connecticut, and that

employees are treated when employed without regard to their sexual orientation; (2) the Contractor agrees

to provide each labor union or representative of workers with which such Contractor has a collective

bargaining Agreement or other contract or understanding and each vendor with which such Contractor has

a contract or understanding, a notice to be provided by the Commission on Human Rights and

Opportunities advising the labor union or workers' representative of the Contractor's commitments under

this section, and to post copies of the notice in conspicuous places available to employees and applicants

for employment; (3) the Contractor agrees to comply with each provision of this section and with each

regulation or relevant order issued by said Commission pursuant to Connecticut General Statutes § 46a-56;

and (4) the Contractor agrees to provide the Commission on Human Rights and Opportunities with such

information requested by the Commission, and permit access to pertinent books, records and accounts,

concerning the employment practices and procedures of the Contractor which relate to the provisions of

this Section and Connecticut General Statutes § 46a-56.

(h) The Contractor shall include the provisions of the foregoing paragraph in every subcontract or

purchase order entered into in order to fulfill any obligation of a contract with the State and such provisions

shall be binding on a subcontractor, vendor or manufacturer unless exempted by regulations or orders of the

Commission. The Contractor shall take such action with respect to any such subcontract or purchase order

as the Commission may direct as a means of enforcing such provisions including sanctions for

noncompliance in accordance with Connecticut General Statutes § 46a-56; provided, if such Contractor

becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such

direction by the Commission, the Contractor may request the State of Connecticut to enter into any such

litigation or negotiation prior thereto to protect the interests of the State and the State may so enter.

INSURANCE;

The Contractor agrees that while performing services specified in this agreement he/she shall carry sufficient

insurance (liability and/or other) as applicable according to the nature of the service to be performed so as to “save

harmless” the State of Connecticut from any insurable cause whatsoever.

APPLICABLE LAW:

This Agreement shall be governed by the laws of the State of Connecticut, without regard to its principles of

conflicts of laws. The Contractor shall at all times comply with and observe all federal and state laws, local laws,

ordinances, and regulations which are in effect during the period of this contract and which in any manner affect the

work or its conduct.

CONTRACT ASSIGNMENT:

No right or duty, in whole or in part, of the Contractor under this Agreement may be assigned or delegated without

the prior written consent of the Board of Regents.

CLAIMS AGAINST THE STATE:

The Contractor agrees that the sole and exclusive means for the presentation of any claim against the State of

Connecticut arising from this agreement shall be in accordance with Chapter 53 of the Connecticut General Statutes

(Claims Against the State) and the Contractor further agrees not to initiate legal proceedings in any state or federal

court in addition to, or in lieu of, said Chapter 53 proceedings.

ENTIRE AGREEMENT

This Agreement constitutes the entire agreement of the parties and supersedes all prior communications,

understandings and agreements relating to the subject matter hereof, whether oral or written. No specific level of

activity or dollar amount is committed or assigned to the Contractor through this contract. The BOR reserves the right

to sol

ici

t bids for any project and there is no special privilege or right of first refusal conveyed by the execution of

this Agreement.

Page 4 of 4

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