Request For Proposals

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 1 Connecticut Lottery Corporation

777 Brook Street Rocky Hill, CT 06067

860-713-2795

Request For Proposals

RFP Number: CLC201502

RFP Description: Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services

RFP Issue Date: March 10, 2015

Proposal Due Date: April 14, 2015 by 2:00 p.m. Eastern Time

Part I. INTRODUCTION

The Connecticut Lottery Corporation (“CLC” or “Lottery”), a quasi-public agency with the mission of generating revenue for the State of Connecticut’s General Fund, issues this Request For Proposals (“RFP”) for its exclusive use. This RFP is not a contract offer, and no contract will exist unless and until there is either a written contract signed by both the CLC and the successful proposer, or a purchase order is issued by the CLC to the successful proposer (either referred to as the “Contract”).

The purpose of this RFP is to obtain competitive prices from qualified vendors to provide the Lottery with Microsoft Dynamics GP 2015 Software, Implementation and Training Services, as described in greater detail in Part V, Service and Software Requirements, below. Interested parties may submit a proposal in accordance with the requirements and directions of this RFP.

The Lottery reserves the right, in its sole discretion, to accept all or any part of a proposal, to reject all proposals, and to waive any informalities or non-material deficiencies in a proposal, in each instance as the CLC determines to be in its best interest.

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 2 Part II. PROPOSAL SUBMISSION REQUIREMENTS

A. SCHEDULE OF CERTAIN KEY EVENTS AND DEADLINES

Proposer questions due March 24, 2015 by 2:00 PM Eastern Time* CLC posts responses to questions March 31, 2015

Proposals due April 14, 2015 by 2:00 PM Eastern Time*

Anticipated Interviews Scheduled April 30 - May 5, 2015 CLC issues preliminary notice of award May 18, 2015

Contract effective date June 3, 2015

Dates bearing an asterisk (*) are firm dates and times. All other dates are anticipated, not firm.

B. PROPOSER QUESTIONS

All questions concerning the CLC’s procurement process for this RFP must be submitted by e-mail and directed only to:

Janice Beckner (the “Purchasing Officer”) Connecticut Lottery Corporation

777 Brook Street Rocky Hill, CT 06067 Telephone: 860-713-2789

E-mail: [email protected]

Proposers are prohibited from contacting any other Lottery employee or officer, or member of the Lottery Board of Directors, or State official or employee concerning this RFP or the goods/services to be provided under it. A proposer’s failure to comply with this requirement may result in disqualification.

The Purchasing Officer must receive questions no later than the date and time set forth in Part II, Section A, above. The Purchasing Officer will confirm receipt of a proposer’s questions by e-mail. Questions cannot be submitted via telephone or fax, but the Purchasing Officer will accept telephone calls to confirm receipt of a proposer’s questions if the proposer has not received an e-mail confirmation.

By the date and time set forth in Part II, Section A, above, the CLC will answer all relevant written questions by issuing one or more written addenda, which shall be a part of this RFP and any resulting Contract. Addenda will be available on the Lottery’s website (www.ctlottery.org, About Us, Bids) as well as the CT Department of Administrative Service’s website (www.das.state.ct.us, State Contracting Portal,

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 3 Current Solicitations, Organization, drop down to “Connecticut Lottery Corporation”) (together, the “Websites”). As noted above, each proposer is responsible for checking the Websites to determine if the CLC has issued any addenda and, if so, to complete its proposal in accordance with the RFP as modified by the addenda. No oral statement of the CLC or any of its officers or employees, including the Purchasing Officer, shall be effective to waive, change or otherwise modify any of the provisions of this RFP, and no proposer shall rely on any alleged oral statement. C. PROPOSAL DUE DATE

Proposals must be received by the Purchasing Officer on or before the date and time set forth in Part II, Section A, above. The CLC will NOT accept submissions by e-mail or fax. Proposers are solely responsible for ensuring timely delivery. The CLC will reject, and may return unopened, proposals received after the proposal due date and time.

D. WITHDRAWAL OF PROPOSAL/PROPOSAL EFFECTIVENESS

A proposer may withdraw a proposal personally or in writing provided that the CLC’s Purchasing Officer receives the withdrawal prior to the proposal due date and time. Proposals are considered valid, and may not be withdrawn, cancelled or modified, for one hundred twenty (120) calendar days after the proposal due date to allow the CLC to review and evaluate the proposals, investigate a proposer, issue a preliminary notice of award, and enter into a Contract with the successful proposer.

E. PROPOSAL SUBMISSION 1. General Requirements

a) Proposals must be clearly written (preferably typed), legible, and signed by a person duly authorized to sign it on the proposer’s behalf. The CLC may reject an unsigned proposal. The person signing the proposal must initial any errors, alterations or corrections on its submission, including all copies.

b) The CLC may allow a proposer to correct obvious clerical mistakes in its proposal.

c) The sealed proposal must be addressed to the Purchasing Officer, must contain the proposer’s name and address in the upper left-hand corner, and must be clearly labeled with the words “RFP PROPOSAL RESPONSE ENVELOPE 1 of X, 2 of X, etc” and the RFP description, RFP number, and proposal due date.

d) The CLC may reject any proposal submitted in an unmarked package or envelope that the CLC opens in the normal course of its business. The CLC may, but shall not be required to, return such proposal and inform the proposer that the proposal may be resubmitted as described above.

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 4 2. Content

The sealed proposal must contain the original and five (5) copies of the following documents:

a) A cover letter and narrative describing the proposer, its history of providing the product described in this RFP, a brief description of staff qualifications and any other information it wishes the CLC to consider;

b) Reference names and phone numbers of, at least, three customers of similar size and complexity to the CLC who have engaged the proposer's services for software product implementations similar in scope and complexity, preferably Microsoft Dynamics GP 2013 or 2015;

c) Any contracts in the last 36 months which were contested by customer for contract compliance issues.

d) A completed Vendor Information Form/Supplier Diversity Information (Attachment A, two (2) pages);

e) A completed Proposer’s Affidavit (Attachment B, two (2) pages); f) A completed Price Proposal (Attachment C, one (1) page); and g) A completed Consulting Agreement Affidavit – OPM Ethics Form 5

(Attachment D, one (1) page). Part III. GENERAL TERMS AND CONDITIONS

A. RIGHT TO AMEND OR TERMINATE RFP

The CLC may, at any time and in its sole discretion, clarify, modify or terminate this RFP when it is in the CLC’s best interests. Any such action shall occur by posting a notice on the Websites.

Each proposer is responsible for checking the Websites to determine if the Lottery has issued any addenda and, if so, to complete its proposal in accordance with this RFP as modified by the addenda.

B. TAXES

Pursuant to Section 12-816 of the Connecticut General Statutes, the CLC is exempt from all state and certain federal taxation. Such taxes must NOT be included in proposal prices.

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 5 Each proposer’s costs incurred in developing its proposal are its sole responsibility, and the CLC shall have no liability for such costs.

D. OWNERSHIP OF PROPOSALS

All proposals become the CLC’s property and will not be returned to proposers. E. ADDITIONAL INFORMATION

The CLC reserves the right, after the proposal due date, to ask any proposer to clarify its proposal or to submit additional information that the CLC in its sole discretion deems desirable.

F. INSURANCE REQUIREMENT

The successful proposer shall maintain the following insurance coverage:

1. In the minimum amount of $1,000,000 Combined Single Limit per occurrence for bodily injury, personal injury and property damage. Coverage shall include Premises and Operations, Independent Contractors, Products and Completed Operations, Contractual Liability and Broad Form Property Damage coverage. General Liability limits of $1,000,000 per occurrence/ $2,000,000 aggregate. General liability to include the following:

- Additional insured/hold harmless status for Connecticut Lottery Corporation.

- Waiver of subrogation

- Primary and non-contributory wording

2. Motor Vehicle Liability Insurance of $1,000,000 combined single limit shall be maintained against claims for damages resulting from bodily injury, including wrongful death, and property damage that may arise from the operations of any owned, hired or non-owned automobiles used by or for the successful Proposer in any capacity in connection with carrying out the Contract; 3. Workers Compensation/Employer's Liability - minimum limits of $500,000 per

accident bodily injury/$500,000 policy limit by disease/$500,000 per employee for bodily injury by disease.

4. Commercial Umbrella Policy in the amount of $1,000,000.

5. Errors and Omissions Coverage with minimum limits of $1,000,000 per claim. Part IV. CONNECTICUT LOTTERY CORPORATION

A. The following information is provided to potential vendors for planning and proposal purposes. The CLC utilizes Infor/Lawson for its current financial software.

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 6 1. General Ledger entries and postings

2. Accounts Payable 3. Cash Ledger

4. Asset Management postings

5. Reports, using "canned" reports as well as utilizing the Lawson Report-Writer System

6. Account analysis using Lawson Ledger Reports and Account Analysis 7. Allocations, utilizing Lawson's Allocation System

8. Budgeting, utilizing Lawson's Budget System

9. Purchasing process which includes Purchase Orders, Purchase Requisitions and the Approval Process.

B. Finance Department is comprised of a staff of fourteen (14) people: CFO

Financial Manager Supervising Accountant

Principal Cost Analyst (G/L, Budgets, Projections) A/R Financial Analysts

A/P Financial Analyst A/R Accountants A/P Accountant

A/R Assistant Accountants A/P Assistant Accountant A/P Processing Tech

Purchasing Department is comprised of a staff of three (3) people: Associate Fiscal Administrative Officer (Purchasing Supervisor) Fiscal Administrative Officer (Purchasing Officer)

Purchasing Assistant

C. Information Technology Department will require support and training for three (3) people to maintain user access rights and maintenance functions of software after implementation. IT Department will provide and setup all the hardware with Windows Server 2012 R2 installed. In addition, IT will preinstall MS-SQL 2014.

D. The following table provides some representative sizing metrics of our current system:

File Type Count

GL Natural Accounts 600

GL Sub-accounts Combinations 70

Budgets Minimum of 1/year

GL History Complete 17 year History

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 7

Vendors / Retailers 4,000

Purchase Orders 1000/year

Open Purchase Orders 30

A/P Data 2.3 million Records; 37 Tables

Invoices Up to 600/month

Cash Receipts Up to 10/day

Fixed Assets 3,000

Part V. SERVICE AND SOFTWARE REQUIREMENTS A. REQUIREDSOFTWARE SPECIFICATIONS:

• Microsoft GP 2015 Starter Pack

• Licenses for twelve (12) additional concurrent users of Microsoft GP 2015 • Microsoft Dynamics GP 2015 Customization Pack

• Mekorma Software (MICR) for check writing/accounts payable

• eOne Solutions Extender software to meet diversity tracking/reporting

requirements

• Microsoft Maintenance and Support for one year

B. REQUIRED SERVICES BY VENDOR:

1. Design and set up of Electronic Banking Suite with CLC's financial institution. 2. Vendor will be responsible for determination of data field mapping and

import definitions required to allow for daily batch processes for sales, prizes, commissions, claims, etc. Our internal Information Technology Department will be responsible for the automating of the data imports from 3rd party. 3. Design and set up and of financial statements including expense allocations

for financial statements by type of game based on percentage of sales and employee time devoted to games (allocation bases will be provided by CLC). 4. Set up and design of budget format.

5. Data conversion:

a) All G/L history in Lawson shall be transferred into the Microsoft GP system.

b) All vendor and retailer master files will be input to the Microsoft GP system.

c) Fixed Asset and Accumulated Depreciation detail conversion from Lawson into the Microsoft GP system.

d) Pertinent data which includes invoice date and amount, vendor name and number, payment date and payment amount to populate Accounts Payable in the Microsoft GP system is required to be imported from the Lawson system to ensure a complete

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 8 chronological history of detailed activity for invoices accrued and paid to vendor.

e) Pertinent data which includes purchase date and amount, vendor name and number as well as description of item(s) purchased to populate Purchase Orders module in the Microsoft GP system is required to be imported from the Lawson system to ensure a complete chronological history of detailed activity for purchase Orders within the Purchasing module of the Microsoft GP system. 6. Training:

Staff Training in use of software in significant operating areas to include: a) General Ledger posting and inquiry process;

b) Creation of journal entries;

c) Purchasing input, generation of requisitions and/or purchase orders (P.O.) and electronic requisition and/or P.O. approval process;

d) Accounts Payable entry and check creation process including input of Electronic Fund Transfer vs. check;

e) Fixed Asset entry and related depreciation;

f) Quarter-end and year-end processes including account reconciliations;

g) Financial statement creation;

h) IT Training on System Security, setup, ongoing maintenance, nightly processing, etc.; and

i) Senior management training for approval of purchase requisitions, purchase orders and invoices.

C. DELIVERY:

The Lottery's "go live" date for utilization of the entire Microsoft Dynamics GP 2015 software is October 1, 2015.

D. LOTTERY’S REMEDIES FOR SUCCESSFUL PROPOSER’S BREACH OF CONTRACT:

Notwithstanding anything to the contrary in this RFP, the CLC reserves all of its rights and remedies in connection with the successful proposer’s breach of the Contract, including but not limited to the failure of the installed software to meet the product specifications, and the successful proposer’s failure to deliver the product and/or services in time to meet the Lottery’s needs.

Such rights and remedies include, but are not limited to: (a) termination of the Contract, in which event the Lottery shall have no further liability whatsoever to the successful proposer under the Contract or under any other legal theory; (b) claims against the successful proposer's insurance; and (c) the Lottery’s purchase of the specified services on the open market, in which event the successful proposer will be liable to the Lottery

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CLC201502Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Page 9 for any additional costs incurred. The Lottery’s termination of the Contract does not excuse the successful proposer from any liabilities, damages or costs the Lottery may have incurred as a result of the successful proposer’s failure to meet its obligations while the Contract was in effect.

Part VI. EVALUATION/AWARD CRITERIA, PROCESS, AND THE CONTRACT

All proposals will be publicly opened at the time that proposals are due as set forth in Part II, Section A, above. The name of each proposer will be read aloud. The public, including proposers, may be present at the opening. No information other than the names of proposers will be released at that time.

The Lottery reserves the rights, in its sole discretion, to accept all or any part of a proposal, to reject all proposals, and to waive any informalities or non-material deficiencies in a proposal, in each instance as the CLC determines to be in its best interests.

The CLC will accept the proposal that, all things considered, the CLC determines to be in its best interests. Although price will be an important factor, it will not be the only basis for award. Due consideration will be given to factors such as, but not limited to: a proposer’s experience, references and capabilities with Microsoft GP implementations, a proposer's resources, staffing levels devoted to our project, staff qualifications, past performance issues related to contract compliance disputes, and whether a proposer qualifies as a diverse supplier by the CT Department of Administrative Services or other accrediting entity. Certain proposers may be selected for interviews and, if so, information gathered at that time may be considered in the CLC's selection process. The CLC will select the proposal that it deems to be in its best interests and issue a preliminary notice of award. The making of a preliminary notice of award does not provide a proposer with any rights and does not impose upon the CLC any obligations. The CLC is free to withdraw a preliminary notice of award at any time and for any reason. A proposer has rights, and the CLC has obligations, only if and when there is a Contract.

Prior to a Contract, the CLC will require the proposer receiving a preliminary notice of award to complete certain other forms and affidavits required by state law, particularly those relating to ethics in public contracting. The CLC will not enter into a Contract with a proposer that fails or refuses to complete and submit each required form.

The CLC’s issuance of a preliminary notice of award may be subject to contract negotiations with the proposer that the CLC, in its sole discretion, deems in its best interests. The CLC also reserves the right to conduct any test it may deem advisable and to further evaluate the proposal.

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Attachment A: Proposer (Vendor) Information Form

" The Connecticut Lottery Corporation is collecting vendor and supplier information in order to compile a list of available vendors and to track its compliance with supplier diversity goals. The CT Lottery considers commercial and financial information disclosed on this form to be confidential but, unless exempted from disclosure by the Connecticut Freedom of Information Act or other applicable law, information supplied to the Connecticut Lottery Corporation may be subject to disclosure under the Connecticut Freedom of Information Act."

Rev. 10/11 Page 1 of 2

BUSINESS INFORMATION Vendor Legal Business Name

Vendor Website address

Vendor Address

City State Zip Code

Business Telephone Number Business Fax Number

Nature of Business (please describe):

Business Entity Type: Corporation LLC Corporation LLC Partnership LLC Single Member Entity Non-Profit Partnership Individual/Sole Proprietor

NOTE: If your business is a Corporation, in which State are you Incorporated?

If individual/sole proprietor, individual’s name (as owner) must appear in the legal business name block above. If your business is a Partnership, you must attach the names and titles of all partners to any bid submission. Are you a current CLC Vendor?

Yes No

Do you hire Subcontractors?

Yes No Business Name, Trade Name, Doing Business As Name (if different from above)

Remittance Address if Different from Business Address Above

Remittance City State Zip Code

CONTACT INFORMATION

Name of Individual Job Title

Business Telephone Number Business Fax Number

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Page 2 of 2

Vendor Legal Business Name

CURRENT CERTIFICATION INFORMATION

Small Business Enterprise (SBE) Yes No HUB Zone Enterprise Yes No

Minority Business Enterprise (MBE) Women Business Enterprise (WBE)

Yes Yes No No Disadvantaged Business

Enterprise (DBE) Yes No

Veteran Owned Business Enterprise Yes No Sheltered Workshop Yes No

NOTE: Include copies of certifications with the submission of this form for all items checked YES.

If YES, indicate which Agency/Organization has certified your business:

Department of Administrative Services (DAS) Greater New England Minority Supplier Diversity Council (GNEMSDC)

Department of Transportation (DOT) Women’s Business Enterprise National Council (WBENC)

Small Business Administration (SBA) Other:

Agency/Organization Name If MBE/WBE certified, indicate Diversity Category:

(check all that apply)

Hispanic American African American Asian / Indian American

Native American / Alaskan Woman Owned Minority Woman Owned

Asian / Pacific American Subcontinent Asian American

FINANCIAL AND ORGANIZATIONAL INFORMATION

Please provide the Gross Annual Receipts for the last three fiscal years:

Year Amount $

Fiscal Year End Date / / Year Amount $

MM/DD/YYYY

Year Amount $

Current number of full-time employees Current number of part-time employees

CERTIFICATION

SIGNATURE OF PERSON AUTHORIZED TO SIGN PROPOSALS ON BEHALF OF THE ABOVE NAMED VENDOR Date Executed

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Attachment B: Proposer’s Affidavit

Proposal for: Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services Proposal Number: CLC201502 (the “RFP”)

Proposer’s Complete Legal Name:

____________________________________________________________________

I, _________________________________________________________________, am over the age of eighteen (18) years, believe in, and understand the obligations of an oath. I am of sound mind, not acting under duress, and make this affidavit freely for the purpose of inducing the Connecticut Lottery Corporation (the “CLC”) to consider our proposal and to make a preliminary notice of award to the proposer.

I am the __________________________________ of the proposer and duly authorized to give this affidavit on its behalf.

I, having fully informed myself regarding the accuracy of the statements made in this affidavit, do hereby state that:

1. The proposal is genuine. It is not a collusive, sham or fraudulent proposal, and it was not made in the interest or on behalf of any person or entity not named or disclosed in this affidavit.

2. The proposer developed the proposal independently and submitted it without collusion with, and without any agreement, understanding, communication or planned common course or action with, any person or other entity designed to fix the proposal price or otherwise limit independent competition.

3. The proposer, its officers, employees, and agents have not offered or received any kickbacks or inducements from any person or entity in connection with the proposal.

4. The proposer, its officers, employees, and agents have not conferred or promised to any State of Connecticut or CLC official, officer, employee or member of the Board of Directors any payment, loan, subscription, advance, deposit of money, gift, service, or present unless consideration of substantially equal or greater value was exchanged and such consideration was not related to and was not intended to influence any decision regarding this RFP.

5. The proposer, its officers, employees, and agents have not communicated with any officer, member of the Board of Directors, or employee of the CLC, other than the Purchasing Officer, or the State of Connecticut concerning this RFP and its proposal.

6. The proposer, its officers, employees, and agents have not communicated the contents of its proposal to any person not an officer, employee or agent of the proposer and, further, the proposer represents that it will not communicate the contents of its proposal to any such person until after the proposal due date and time.

7. To the best of my knowledge, information and belief, no CLC officer, official, employee or member of the Board of Directors has any financial or other interest whatsoever, direct or indirect, in the proposer or its business.

(Print Name)

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8. The proposer has thoroughly examined and understood each and every provision of the RFP, including the technical specifications, and any and all addenda.

9. All information in the proposal is complete, not misleading (including misleading by omission), and accurately and fully portrays all requested aspects of the proposer and its goods.

10. The proposer is not currently debarred or otherwise prohibited from contracting or submitting proposals or proposals for contracts with: the State of Connecticut or any agency or political subdivision thereof; any municipal entity; any other state, Native American body, or other governmental or quasi-governmental entity within the United States; or any lottery within the United States.

11. The proposer is not an agent of any person or entity currently debarred or otherwise prohibited from contracting or submitting proposals or proposals for contracts with: the State of Connecticut or any agency or political subdivision thereof; any municipal entity; any other state, Native American body, or other governmental or quasi-governmental entity within the United States; or any lottery within the United States.

The proposer understands and agrees that any misinformation or misrepresentation in this affidavit may disqualify the proposal and result in termination of any resulting contract.

Signature: _____________________________________________________________________________

Date: ___________________________

Subscribed and sworn to before me this ______ day of _______________, 2015.

_________________________________ Notary Public

My Commission Expires __________________ (Place Seal)

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Attachment C: Price Proposal

Proposal for: Microsoft Dynamics GP 2015 Software Purchase, Implementation and Training Services

Proposal Number: CLC201502 (the “RFP”)

PROPOSER’S FULL LEGAL NAME: _______________________________________________________________

In submitting this Price Proposal, the proposer acknowledges and agrees that each price supplied below includes (and the Connecticut Lottery Corporation shall not be separately charged or liable for) the costs of all labor, materials and services; shipping/delivery to the Connecticut Lottery Corporation’s offices in Connecticut; overhead; insurance; profits; permits and licenses; and all other costs related to the delivery of the items and services described in this RFP. No additional payment of any kind will be made for work performed under the price(s) as proposed.

The undersigned proposer, having thoroughly examined the RFP, including any addenda, hereby offers to provide the

Microsoft Dynamics GP 2015 Software, Implementation, Training Services, Data Conversion, Data Import and Annual Maintenance/Support as described in, and in full compliance with, the RFP, including any addenda, for the following fixed prices that are net of all trade discounts and allowances:

Software/Services

Category Vendor Description of Software/Service Pricing

Microsoft Dynamics GP 2015 Software

(per Part V. Software and Service Requirements) Software Implementation Training Services: -include # of hours -Identify type of training (i.e classroom, web, one-on-one)

Data Conversion & Data

Import

Service/Support/ Maintenance Contract (include terms and conditions)

Signature: ________________________________________________________________________________________________ Print Name and Title: _______________________________________________________________________________________ Date: ___________________________________________________________________________________________________

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Attachment D: Consulting Agreement Affidavit – OPM Ethics Form 5

STATE OF CONNECTICUT

CONSULTING AGREEMENT AFFIDAVIT

Affidavit to accompany a proposal or proposal for the purchase of goods and services with a value of $50,000 or more in a calendar or fiscal year, pursuant to Connecticut General Statutes §§ 4a-81(a) and 4a-81(b). For sole source or no proposal contracts the form is submitted at time of contract execution.

INSTRUCTIONS:

If the proposer or vendor has entered into a consulting agreement, as defined by Connecticut General Statutes § 4a-81(b)(1): Complete all sections of the form. If the proposer or contractor has entered into more than one such consulting agreement, use a separate form for each agreement. Sign and date the form in the presence of a Commissioner of the Superior Court or Notary Public. If the proposer or contractor has not entered into a consulting agreement, as defined by Connecticut General Statutes § 4a-81(b)(1): Complete only the shaded section of the form. Sign and date the form in the presence of a Commissioner of the Superior Court or Notary Public. Submit completed form to the awarding State agency with proposal or proposal. For a sole source award, submit completed form to the awarding State agency at the time of contract execution.

This affidavit must be amended if there is any change in the information contained in the most recently filed affidavit not later than (i) thirty days after the effective date of any such change or (ii) upon the submittal of any new proposal or proposal, whichever is earlier.

AFFIDAVIT: [Number of Affidavits Sworn and Subscribed On This Day: _____]

I, the undersigned, hereby swear that I am a principal or key personnel of the proposer or contractor awarded a contract, as described in Connecticut General Statutes § 4a-81(b), or that I am the individual awarded such a contract who is authorized to execute such contract. I further swear that I have not entered into any consulting agreement in connection with such contract, except for the agreement listed below:

__________________________________________ _______________________________________

Consultant’s Name and Title Name of Firm (if applicable)

__________________ ___________________ ___________________

Start Date End Date Cost

Description of Services Provided: ___________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

Is the consultant a former State employee or former public official?  YES  NO

If YES: ___________________________________ __________________________

Name of Former State Agency Termination Date of Employment

Sworn as true to the best of my knowledge and belief, subject to the penalties of false statement.

___________________________ ___________________________________ __________________

Printed Name of Proposer or Contractor Signature of Principal or Key Personnel Date

___________________________________ _Connecticut Lottery Corporation

Printed Name (of above) Awarding State Agency

Sworn and subscribed before me on this _______ day of ____________, 20___. ___________________________________ Commissioner of the Superior Court