disclosures: 04b858e035d803456b31679a94af68a2a058493775a689b1a40a99ac580b341a
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| 04b858e035d803456b31679a94af68a2a058493775a689b1a40a99ac580b341a | 2016/Margolin,_Andra_section_7_disclosure_5.2.16.pdf | 2016 | Andra 5. Margotin | Department of Developmental Disabilities south Valley office services | Apr.21.2016 06:47 PM drandy 5086989100 PAGE. 1/ 4 DISCLOSURE BY STATE EMPLOYEE OF FINANCIAL INTEREST IN A STATE CONTRACT AND CERTIFICATION BY HEAD OF CONTRACTING AGENCY ETHICS COMMISSION AS REQUIRED BY G. L. c. 268A, 9 7(b) 2016 MAY AM11:28 STATE EMPLOYEE INFORMATION Name of state employee: Andra 5. Margotin Title/ Position Psychologist If you are a state employee because a state agency has contracted with your company or FIII in this box organization, please provide the name and address of the company or organization. If It applies to you. Agency/ Department Department of Developmental Disabilities south Valley office services Agency Address 1941 west St. #9 Milford, MA 01757 Office phone: (508) 634-3345 Office e-mail: Andrew Margolin Mass Mail. state. MA. us Check one: Elected or Non-elected Starting date as a state employee. 04/04/2016 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. 1 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 have this financial interest in a state contract. STATEMENT #2. Apr.21.2016 06:48 PM drandy 5086989100 PAGE. 2/ 4 Write an X My financial interest In a etate contract is: beside your financial interest. A state agency has a contract with me, but not an employment contract. 1 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-alected, 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 # 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 made the contract "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 la 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 Consulting Services to Department of BELOW counseling at Britol Community collese 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 ABOVE Apr.21.2016 06:48 PM drandy 5086989100 PAGE. 3/ 4 What is your - Please explain the financial Interest and Include the dollar amount If you know it. financial Interest In the state contract? 165 an hour (16 how per weekjas needed) Date when you acquired a financial 2/15/2015 interest | 2016/Margolin,_Andra_section_7_disclosure_5.2.16.pdf |