Preparation of the PSA

The following instructions refer to the correspondingly-numbered blocks which appear on Form CO-802A. Refer to the following website for a sample document: https://www.osc.ct.gov/agencies/forms/pdf/CO-802a.pdf

(1) ORIGINAL or AMENDMENT: Mark as appropriate.

(2) IDENTIFICATION NO.: Leave this block blank as the number will be assigned once the PSA has been approved.

(3) CONTRACTOR NAME, ADDRESS and FEIN/SSN.: Enter the vendor's name, address and Federal Employer Identification Number (FEIN) if the contractor is a business. In accordance with the State Comptroller's Memorandum 2000- 08, an IRS form W-9 Tax ID Verification form must be provided by the contractor or on file with CSUS.

(4) ARE YOU PRESENTLY A STATE OF CONNECTICUT EMPLOYEE?: If the vendor is presently an employee of the State of Connecticut, check "yes" and complete a Dual Employment Request form (PER-DE-1). This form must be executed and attached to the PSA to submitting the PSA to the Office of the Attorney General for review and approval. (See, Section II.N.10 above for instructions on completing the Dual Employment Request form.)

(5) AGENCY NAME AND ADDRESS: Enter the main address for the university (excluding names of individuals).

(6) AGENCY NO.: Insert the appropriate agency number. The agency number is as follows: ECSU: 7805 (CORE-CT # CSU85500)

(7) DATE (FROM) THROUGH (TO): List the full contract period. Block (23) also requires the contract period. If services are rendered in one day, repeat the same date in both the FROM and TO on both blocks (7) and (23). When stating the contract period, causes of possible postponements should be considered and the term should include sufficient "grace" days to allow for such unexpected occurrences. Doing so may obviate the need to prepare an amended PSA.

(8) INDICATE MASTER AGREEMENT, CONTRACT AWARD, NEITHER: If the document is the result of competitive negotiation via the bid process, check"Contract Award." Otherwise, check "Neither."

(9) CANCELLATION CLAUSE: Enter the number of days' written notice required for cancellation of the contract.

(10) CONTRACTOR AGREES TO: Provide a complete and specific description of the services that the contractor is to provide. The language must be sufficiently specific that a third party unfamiliar with the nature of the contract can understand the services to be provided. If applicable, the contract must clearly identify who owns the developed product or service after completion of the PSA. If necessary, the description may continue on additional pages but if such additional pages are attached, the following language must appear in box (10): "Continued on pages ________ which are attached hereto and incorporated herein." Neither the RFP and the contractor's proposal, or forms provided by the contractor, should be appended to the PSA. The name and contact information for any project manager assigned to contract be also in inserted in box (10).

(11) PAYMENT TO BE MADE UNDER THE FOLLOWING SCHEDULE UPON RECEIPT OF PROPERLY EXECUTED AND APPROVED INVOICES: Insert the amount to be paid the contractor and the schedule upon which payment is to be made. If possible, payment amounts and scheduling should be tied to the completion of discrete services or the provision of certain deliverables. Payment should not be made unless and until the contractor has satisfactorily performed and a satisfactory invoice has been received. Typically, payment terms are net forty-five (45) days from receipt of a properly executed invoice. However, payments to certified small and minority business enterprises are net thirty (30) days. If the contractor is to be reimbursed for travel expenses, it must clearly be stated in box (11) that any such reimbursement will be made only in accordance with the CSUS Travel Policy.  If applicable, the statement "May be Subject to Athletes and Entertainers Tax Withholding" should be included in block 11. (See, Section III.M.6 above.)

(12)-(22) To be completed, if necessary, by the Procurement Services Department.

(23) CONTRACT PERIOD (FROM/TO): See instructions for box (7) above.

(24)-(30) Leave blank.

(31) Insert the Banner organization and account numbers to be charged.

(32)-(33) Leave blank.

(34) STATUTORY AUTHORITY: Enter C.G.S. 10a-151b.

(35) CONTRACTOR (OWNER OR AUTHORIZED SIGNATURE), TITLE, DATE: The contractor must sign the PSA, indicate the capacity in which he or she is signing, and date the PSA. The title should be entered as follows: Individual: A contractor who is an individual may either leave the"Title" section blank or insert the word "contractor"; Partnership: The signatory should be identified as either a general or limited partner; LLC/LLP: The signatory should be identified as either "Member" or"Manager"; Corporation: The signatory should be identified by the title of the office held at the corporation, such as president, vice president, or treasurer.
(36) AGENCY (AUTHORIZED OFFICIAL), TITLE, DATE: The agency's authorized signatory must sign the PSA and insert his or her title and date upon which he or she executed the PSA.

(37) OFFICE OF POLICY & MGMT. (OPM)/DEPT. OF ADMIN. SERV., TITLE, DATE: Leave blank.

(38) ATTORNEY GENERAL (APPROVED AS TO FORM): If required, an authorized representative of the Office of the Attorney General must review, approve and sign the PSA, and insert the date upon which the PSA was signed.

NOTE: Handwritten notations and/or revisions made to the PSA must be initialed by the authorized signatories of both the contractor and the agency.