Article Structure
The Connecticut Capital Improvement form serves as a critical tool for requesting enhancements to existing community living arrangements. This form is designed for private residential providers to detail the necessary improvements aimed at ensuring the health and safety of residents. Key sections of the form include the property address, a description of the improvement requested, and an explanation of the need for such enhancements. Additionally, it outlines the scope of work involved and estimates the total project cost. Providers must indicate who incurred the expenses and provide a summary of bids received from contractors. If there are exceptions to the bidding process, reasons must be clearly stated. The form also requires signatures from various stakeholders, including the provider, regional director, and the commissioner of the Department of Developmental Services. This comprehensive approach helps streamline the approval process while ensuring that all necessary considerations are addressed.
Documents used along the form
When submitting a request for capital improvement in Connecticut, several other forms and documents may also be required to ensure a comprehensive application. Each of these documents serves a specific purpose in the process and contributes to the overall approval and funding of the project. Below is a list of commonly used forms alongside the Connecticut Capital Improvement form.
- Bid Summary Form: This document collects details about the bids received for the proposed improvement project. It includes information such as the provider's name, project location, descriptions of work, and the reasons for selecting or not selecting specific bids.
- Scope of Work Document: This outlines the specific tasks and responsibilities involved in the capital improvement project. It provides clarity on what will be done, how it will be done, and who will be responsible for each aspect of the work.
- Cost Estimate Worksheet: This form details the estimated costs associated with the capital improvement project. It breaks down expenses into categories, helping to provide a clear financial picture for both the provider and the approving agency.
- Project Timeline: A timeline is essential for outlining the expected duration of the project. It includes key milestones and deadlines, ensuring that all parties are aware of the schedule and can plan accordingly.
- Quitclaim Deed Form: For property transfers, the Texas Documents provide a necessary template following Texas law, enabling seamless transitions between parties without title warranties.
- Contractor Qualification Form: This document assesses the qualifications and experience of the contractors involved in the project. It may require details about previous work, licenses, and certifications to ensure that qualified professionals are handling the improvement.
- Insurance Certificate: Proof of insurance is often required to protect against potential liabilities during the project. This document verifies that the contractor has the necessary coverage in place before any work begins.
- Environmental Impact Assessment: Depending on the nature of the improvement, an assessment may be necessary to evaluate any potential environmental effects. This ensures that the project complies with local regulations and protects the surrounding environment.
Gathering these forms and documents can facilitate a smoother application process for capital improvements. Each document plays a vital role in demonstrating the project's feasibility, compliance, and financial responsibility, ultimately leading to a successful approval outcome.
Preview - Connecticut Capital Improvement Form
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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: |
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Region |
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Property Address:
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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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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) |
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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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Common Questions
What is the purpose of the Connecticut Capital Improvement form?
The Connecticut Capital Improvement form is used to request funding for improvements to existing community living arrangements. These improvements are necessary to enhance the health and safety of residents. The form collects essential details about the proposed project, including the property address, the type of improvement needed, and an estimated project cost.
Who needs to fill out this form?
This form should be completed by private residential providers or property developers who are seeking state funding for capital improvements. It is essential for those responsible for managing community living arrangements to ensure that the living conditions meet safety and health standards.
What information is required on the form?
The form requires several key pieces of information. You will need to provide the property address, a description of the improvement requested, the reason for the improvement, the scope of work involved, and an estimated total project cost. Additionally, you must indicate who incurred the expenses and provide a detailed explanation of the cost estimate.
How do I estimate the total project cost?
Estimating the total project cost involves gathering quotes from contractors, assessing the materials needed, and considering any additional expenses that may arise during the project. It's important to provide a thorough explanation of your cost estimate on the form to ensure clarity and transparency.
What happens after I submit the form?
Once the form is submitted, it will be reviewed by the Department of Developmental Services. They will evaluate the request based on the information provided and the necessity of the improvements for the residents' health and safety. Approval or denial will be communicated to the provider following this review process.
Can I request an exception to the bidding process?
Yes, if there are valid reasons for not soliciting three bids, you can request an exception. Common reasons include urgency in completing the work or challenges in obtaining bids. Be sure to clearly state your justification on the form.
Is this form a contract for development?
No, the Connecticut Capital Improvement form does not serve as a contract for the development of property. It is merely a request for funding and acknowledges that payments will only be made in accordance with state statutes and regulations.
How can I contact the Department of Developmental Services if I have questions?
You can reach the Department of Developmental Services by phone at 860-418-6000. For TDD services, call 860-418-6079. You can also send a fax to 860-418-6001 or email them at ddsct.co@ct.gov for any inquiries regarding the form or the approval process.
What should I do if my project is approved?
If your project receives approval, you will need to follow the outlined procedures for implementing the improvements. Ensure that all work complies with the specifications provided in your request. Keep detailed records of expenses and progress, as these may be required for reimbursement or future evaluations.
Common PDF Forms
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For those looking to navigate legal responsibilities, the important role of a Power of Attorney document cannot be understated. This form empowers individuals to designate a trusted person who can act in their stead, whether for financial or healthcare decisions, thus ensuring that one's wishes are upheld even when they are unable to make their own choices.
Connecticut Withholding Employer Login - All forms should be mailed to the specified address to ensure receipt and processing.
Connecticut 7B - The applicant must include their Federal Employer ID number if applicable, for identification purposes.
Guide to Filling Out Connecticut Capital Improvement
Completing the Connecticut Capital Improvement form is a straightforward process that requires careful attention to detail. This form is crucial for requesting approval for capital improvements at community living arrangements. Following the steps outlined below will help ensure that all necessary information is accurately provided.
- Date: Fill in the date when the request is being made.
- Property Address: Enter the full address of the property where the improvement is requested.
- Improvement Requested: Clearly state the specific improvement you are seeking.
- Description of Need: Provide a detailed explanation of why this improvement is necessary.
- Scope of Work: Outline the work that will be involved in completing the improvement.
- Estimated Total Project Cost: Indicate the total estimated cost for the project, including all expenses.
- Expense Incurred by: Check the appropriate box to indicate who will incur the expenses.
- Explanation of Cost Estimate: Offer a brief explanation of how the cost estimate was determined.
- Provider Information: Fill in the provider's name and contact information, including phone number.
- Bid Summary Form: Complete the bid summary section, including provider name, project location, and bid details.
- Justification for Bid Selection: If the lowest bid is not selected, provide a justification for the choice made.
- Signatures: Ensure that all required signatures are obtained, including those of the provider, regional director, and commissioner.
Once the form is completed, it should be submitted to the appropriate department for review. Be sure to keep a copy for your records. The review process will determine whether the requested capital improvement can proceed based on the outlined needs and justifications.
Dos and Don'ts
When filling out the Connecticut Capital Improvement form, it is essential to follow specific guidelines to ensure a smooth process. Below is a list of things you should and shouldn't do:
- Do provide accurate property address details.
- Do clearly describe the improvement requested.
- Do outline the scope of work in detail.
- Do include an estimated total project cost.
- Do check the appropriate box for expenses incurred.
- Don't leave any sections blank; complete all required fields.
- Don't use vague language when describing the need for improvement.
- Don't forget to justify your choice if the lowest bid is not selected.
- Don't overlook the signature requirement from all necessary parties.
- Don't submit the form without reviewing it for errors.