When it comes to the improvement of your property, the state of Connecticut offers a Capital Improvement Form to help you with the planning and execution stages. This form helps you identify what work needs to be done and how much it will cost, so that you can budget appropriately. In order for your project to qualify for funding from the state, there are certain criteria that must be met. By using this form, you can make sure your project is eligible and get started on making your property look its best!
| Question | Answer |
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| Form Name | Connecticut Capital Improvement Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | ct capital improvement form, certificate of capital improvement in ct new fairfield connecticut, capital improvement form ct, connecticut capital improvement |
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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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