List all positions currently held with the Town, including: 1) any elected or appointed offices, 2) employment by the Town or any entity owned or controlled by the Town, 3) membership on any Town Board, Commission, Committee or other agency or 4) services as an agent for or consultant to the Town.
Select fiscal year being reported on
Describe the nature of the Town transaction, indicating the department or agency involved and the materials, supplies or services furnished or to be furnished or the real or personal property otherwise involved. A separate form is required foreach transaction. Where the Town enters into an arrangement for a series of sales or engagements for services under a single contract, it should be considered a single transaction.
Enter the date the contract for the transaction was entered into or the date a bid was submitted or offer proposed. (If transaction was initiated prior to June 30, 2020, a default date of 06/30/2020 may be entered.)
Provide the total estimated amount of payments to be made by the Town or other value to be given by or received from the Town. If actual amount varies significantly in the future, you should file an amended disclosure.
If you are providing goods or services to the Town directly as an individual, enter "Self." If you are not the direct contractor with the Town, please provide the legal name used by the person or legal entity entering into the above transaction with the Town and also indicate the names of any persons or entities through which you have an indirect interest in the transaction.
Indicate the nature of your relationship to the party or parties entering into the transaction with the Town. If additional information is appropriate, please use section 8 below.
Describe the nature of your interest in the transaction, such as contracting
party or an owner, general or limited partner, shareholder or employee of the contracting party (or family member thereof).Family members include parents, spouses, siblings, children, nieces and nephews, grandchildren, in-laws and any other person legally entitled or reasonably expected to receive substantial financial support. If your interest in the transaction is as a family member of the contracting party indicate the nature of the relationship (e.g. spouse, child, parent, sibling, aunt, uncle, cousin, in-law, legal guardian, civil partner). Nominal interests having an aggregate value of less than $200 in any Town fiscal year are not considered substantial financial interests and do not need to be reported.
To the best of your ability, estimate the total value expected to be received during the current fiscal year by you or the family member or other contracting party through which you have an interest in the transaction. The value should include increases in the value of tangible or intangible property owned, as well as other amounts received. If your interest is indirect, you are entitled to reasonable reliance on the amount reported or estimated by the contracting party. If the value of the transaction is not currently fixed, provide your best estimate of the value and file an amended report later if the value significantly varies from the estimate.
If you do not expect to benefit from all or any of the value received by contractor, you may enter the portion of value you expect to receive above. You may indicate a percentage, a fraction or a dollar amount, or simply state "none" or "to be determined." If you are a direct contractor or subcontractor, you may estimate the net profit that you expect to receive.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. By checking the "I agree" box below, you also agree to the Terms and Conditions for the Board of Ethics on-line filing system.
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