disclosures: 00ccb43d526d4f670e7c87d63b2e8725238b0d8156da633e0a2240cb4db2a81f
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| 00ccb43d526d4f670e7c87d63b2e8725238b0d8156da633e0a2240cb4db2a81f | 2023/Madison_Eric_10.20.23_7(b).pdf | 2023 | Eric H. Madison | Department of Fire Services, Mass Firefighting Academy | DISCLOSURE BY STATE EMPLOYEE OF FINANCIAL INTEREST IN A STATE CONTRACT AND CERTIFICATION BY HEAD OF CONTRACTING AGENCY AS REQUIRED BY G. L. c. 268A, ยง 7(b) STATE EMPLOYEE INFORMATION Name of state Eric H. Madison employee: Title/ Position Fire Instructor I If you are a state employee because a state agency has contracted with your company or Fill in this box organization, please provide the name and address of the company or organization. if it applies to you. Agency/ Department Department of Fire Services, Mass Firefighting Academy Agency Address 1 State Road PO Box 1025 Stow, MA 01775 Office phone: 978-567-3100 Office e-mail: N/A Check one: Elected or Non-elected Starting date as a October 24, 2023 state employee. ELECTED, COMPENSATED STATE EMPLOYEE BOX # 1 I am an elected, compensated state employee, other than a state Senator or a state Representative. STATEMENT #1: I had one of the following financial interests in a contract made by a state Select either agency before I was elected to my compensated state employee position. I will continue to STATEMENT #1 or have this financial interest in a state contract. OR STATEMENT #2. STATEMENT #2: I will have a new financial interest in a contract made by a state agency. Write an X My financial interest in a state contract is: beside your financial interest. I have a non-elected, compensated state employee position. A state agency has a contract with me. I have a financial benefit or obligation because of a contract that a state agency has with another person or an entity, such as a company or organization. I work for a company or organization that has a contract with a state agency, and I am a "key employee" because the contract identifies me by name or it is otherwise clear that the state has contracted for my services in particular. NON-ELECTED, COMPENSATED STATE EMPLOYEE BOX # 2 I am a non-elected, compensated state employee. STATEMENT # 1: I had one of the following financial interests in a contract made by a state Select either STATEMENT #1 or agency before I took a position as a non-elected state employee. I will continue to have this financial interest in a state contract. STATEMENT #2. Write an X My financial interest in a state contract is: beside your financial interest. A state agency has a contract with me, but not an employment contract. I have a financial benefit or obligation because of a contract that a state agency has with another person or an entity, such as a company or organization. -- OR -- STATEMENT # 2: I will have a new financial interest in a contract made by a state agency. My financial interest in a state contract is: I have a non-elected, compensated state employee position. A state agency has a contract with me. I have a financial benefit or obligation because of a contract that a state agency has with another person or an entity, such as a company or organization. I work for a company or organization that has a contract with a state agency, and I am a "key employee" because the contract identifies me by name or it is otherwise clear that the state has contracted for my services in particular. FINANCIAL INTEREST IN A STATE CONTRACT Name and address of state agency that Massachusetts Registry of Motor Vehicles PO Box 55889 made the contract Boston, MA 02205 "My State Agency" is the state agency that I serve as a state employee. The "contracting agency" is the state agency that made the contract. Please put in an My State Agency is not the contracting agency. to confirm these facts. My State Agency does not regulate the activities of the contracting agency. In my work for my State Agency, I do not participate in or have official responsibility for any of the activities of the contracting agency. The contract was made after public notice or through competitive bidding. ANSWER THE QUESTION IN THIS BOX IF THE CONTRACT IS BETWEEN THE STATE AND YOU. FILL IN - Please explain what the contract is for. THIS BOX OR THE BOX BELOW ANSWER THE QUESTIONS IN THIS BOX IF THE CONTRACT IS BETWEEN THE STATE AND ANOTHER PERSON OR ENTITY. FILL IN - Please identify the person or entity that has the contract with the state agency. - What is your relationship to the person or entity? THIS BOX - What is the contract for? OR THE BOX The contract is between the Registry of Motor Vehicles and the National Safety Council to ABOVE provide various Defensive Driving training courses to those individuals directed to take such courses either by the Registry of Motor Vehicles or a Court in the Commonwealth. I am a paid | 2023/Madison_Eric_10.20.23_7(b).pdf |