Structure
The Connecticut Capital Improvement form serves as a crucial document for requesting enhancements to existing community living arrangements. This form facilitates the process of securing approval for necessary improvements aimed at ensuring the health and safety of residents. Key sections of the form include details such as the property address, a description of the requested improvement, and the rationale behind the need for the upgrade. Additionally, it outlines the scope of work and provides an estimated total project cost, ensuring transparency and accountability in funding. The form also requires information regarding the bidding process, including contractor details and bid amounts, to maintain competitive pricing and quality standards. By completing this form, providers demonstrate their commitment to improving living conditions for individuals with developmental disabilities, while adhering to the regulations set forth by the State of Connecticut. Ultimately, the form plays an essential role in the state's efforts to enhance community living environments, fostering a safer and more supportive atmosphere for all residents involved.
Connecticut Capital Improvement Example
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State of Connecticut |
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Department of Developmental Services |
Dannel P. Malloy |
Jordan A. Scheff |
Governor |
Commissioner |
DEPARTMENT OF DEVELOPMENTAL SERVICES
REQUEST FOR CAPITAL IMPROVEMENT TO EXISTING
COMMUNITY LIVING ARRANGEMENTS
DATE
(A)
APPROVAL IS REQUESTED FOR THE CAPITAL IMPROVEMENT DETAILED BELOW AT:
Property Address (B)
Improvement Requested (C):
Description of Need (D):
Scope of Work (E):
Estimated Total Project Cost (F): $
Expense Incurred by: (check one)
Explanation of Cost Estimate (G):
Provider
CIL
Phone: 860
460 Capitol Avenue Hartford, Connecticut 06106
www.ct.gov/dds
An Affirmative Action/Equal Opportunity Employer
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BID SUMMARY FORM |
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Provider: |
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Date: |
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Address: |
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Project Location: |
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Number: |
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Description of Work: |
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Type of Contractor (General, Trade) |
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Contractors Requests to Submit Bids |
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Date Received |
Bid Amount |
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Contract Award To:
If exception to bidding process is requested, check reason:
Unable to solicit three bids |
Urgency to complete work |
Other: |
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If lowest bid is not selected, write justification for choice: |
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Remarks: |
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Prepared by: |
Approved By: |
Provider |
Region |
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Property Address:
(H)
The undersigned acknowledge that this document does not constitute a contract for development of a property and further acknowledges that any payments by the State of Connecticut related to this property may only be made pursuant to Sections
PROPOSED BY: |
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PROPOSED BY: |
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Private Residential Provider |
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Development Staff/Property Developer |
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(if Applicable) |
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________________________ |
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_____________________ |
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Signature (Name) |
(I) |
(Date) |
Signature (Name) ( J) |
(Date) |
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Print/Type Name |
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Print/Type Name |
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Tel No.: |
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Tel.No. |
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REVIEWED BY: |
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AFTER CONSULTATION WITH: |
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_______________________ |
________________ |
___________________ |
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Signature (Name) (L) |
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(Date) |
(Signature) (Name) |
(M) |
(Date) |
Regional Director for Region |
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Commissioner |
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Department of Developmental Services |
Department of Social Services |
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(Or Authorized Designee) |
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(Or Authorized Designee) |
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Print/Type Name |
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Tel.No: |
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APPROVED BY |
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____________________________________ |
______________ |
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(Signature) (Name) |
(N) |
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(Date) |
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Commissioner |
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Department of Developmental Services |
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(Or Authorized Designee) |
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By signing below, I hereby certify that this capital improvement project is considered by the Department of Developmental Services to be a required project for the health or safety of the residents as detailed in CGS
____________________________________ |
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(Signature) (Name) (O) |
(Date) |
Commissioner |
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Department of Developmental Services |
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(Or Authorized Designee) |
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Document Specifications
| Fact Name | Description |
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| Governing Law | This form is governed by Sections 17b-244 and 17a-228 of the Connecticut General Statutes. |
| Purpose | The form is used to request approval for capital improvements to existing community living arrangements. |
| Contact Information | For inquiries, contact the Department of Developmental Services at 860-418-6000. |
| Approval Process | Approval must be obtained from the Commissioner of the Department of Developmental Services. |
| Cost Estimate | The estimated total project cost must be clearly stated on the form. |
| Bid Summary Requirement | A bid summary form is required, detailing contractor information and bid amounts. |
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