disclosures: 02e4c1d332e2ab39d43fcfc31080f0a666b82ad803d60a54dfc295dcee0d1d80
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| 02e4c1d332e2ab39d43fcfc31080f0a666b82ad803d60a54dfc295dcee0d1d80 | 2019/Tan,_DavidV._5.21.19_-_7(b).pdf | 2019 | David V Tan | Division of Capital Asset Management and Maintenance (DCAMM) | 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) ETHICS ED COMMISSION STATE EMPLOYEE INFORMATION 2019 21 PA Name of state David V Tan 2:29 employee: Title/ Position Office Support Specialist II 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 Division of Capital Asset Management and Maintenance (DCAMM) Agency Address John W McCormack Building One Ashburton Place 14 Floor Room 1411 Boston MA 02108 Office phone: (857) 204 - 1878 Office e-mail: David.Tan@mass.gov Check one: Elected or Non-elected Starting date as a 04/14/2019 state employee. ELECTED, COMPENSATED STATE EMPLOYEE BOX # 1 I am an elected, compensated state employee, other than a state Senator or a state Representative. Select either STATEMENT #1: I had one of the following financial interests in a contract made by a state STATEMENT #1 or agency before I was elected to my compensated state employee position. I will continue to 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 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. Select either STATEMENT # 1: I had one of the following financial interests in a contract made by a state STATEMENT #1 or agency before I took a position as a non-elected state employee. I will continue to STATEMENT #2. have this financial interest in a state contract. My financial interest in a state contract is: Write an X beside your A state agency has a contract with me, but not an employment contract. financial interest. 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 MassHealth 100 Hancock Street made the contract 6th Floor Quincy, MA 02171 "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 X 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. Nu Dam Tan What is your relationship to the person or entity? Son THIS BOX What is the contract for? I am my mother's CPA and she is living with me in the same household. OR THE BOX I get paid by her benefit provider Senior Whole Health. ABOVE | 2019/Tan,_DavidV._5.21.19_-_7(b).pdf |