Nondiscrimination Certification
Effective Date: January 13, 2016



Nondiscrimination Certification Forms

Form A: Representation by Individual

Form A: Word format

Form A: pdf format

Form B: Representation by Entity

Form B: Word format

Form B: pdf format

Form C: Affidavit by Entity

Form C: Word format

Form C: pdf format

Form D: New Resolution by Entity

Form D: Word format

Form D: pdf format

Form E: Prior Resolution by Entity

Form E: Word format

Form E: pdf format









The above nondiscrimination certification forms have been approved to assist executive branch agencies in complying with the State's contracting requirements under Connecticut General Statutes §§ 4a-60 and 4a-60a, as amended.

By law, a contractor must provide an awarding State agency with written representation or documentation that certifies the contractor complies with the State's nondiscrimination agreements and warranties prior to the award of any contract with the State.  If after the initial submission there is any change in such representation, the contractor shall provide the updated representation to the State or such political subdivision not later than thirty (30) days after such change or upon the execution of a new contract with the state or political subdivision of the state whichever is earlier.  Such contractor shall also certify no later than fourteen (14) days after the twelve (12) month anniversary of the most recently filed non-discrimination certification that the representation on file is current and accurate.

A nondiscrimination certification is generally required for all State contracts – regardless of type, term, cost, or value.  **See list of exempt entities (below).**


There are five different certification forms, one of which must be submitted in writing or electronically.  Form A is always used for contracts with an individual who is not an entity, regardless of the contract value.  Form B is always used for contracts with an entity when the contract value is less than $50,000.  Form C is recommended for contracts valued at $50,000 or more with an entity.  If Form C is not used, either Form D or E must be used; both require a resolution (new or prior).

For Use By:


Less Than $50,000


$50,000 or More


Form A




Form B


Form C


Form D

New Resolution

Form E

Prior Resolution


  • individual:  a person who is not an entity
  • entity:  corporation, limited liability company, or partnership


Form A. Representation:  For use by an individual when entering into any contract, regardless of contract value.

Form B. Representation:  For use by an entity when entering into any contract valued at less than $50,000 for any year of the contract.

Form C. Affidavit:  (Recommended for contracts at or above $50,000)  For use by an entity when entering into any contract valued at $50,000 or more for any year of the contract and the entity certifies through an affidavit that a complying nondiscrimination policy is currently in place.

Form D. New Resolution:  For use by a entity when entering into any contract valued at $50,000 or more for any year of the contract and the entity has a complying nondiscrimination policy adopted by a new resolution of the board of directors, shareholders, managers, members, or other governing body.

Form E. Prior Resolution:  For use by a entity when entering into any contract valued at $50,000 or more for any year of the contract and the entity has a complying nondiscrimination policy adopted by a prior resolution of the board of directors, shareholders, managers, members, or other governing body.


Pursuant to June Special Session, Public Act No. 15-5, Sections 63 and 64, the entities listed below are exempt and, therefore, not required to submit a nondiscrimination certification form when entering into a contract with the State:

  1. political subdivisions of the State of Connecticut, including, but not limited to municipalities;
  2. quasi-public agencies, as defined in C.G.S. § 1-120, unless the quasi-public agency is a party to contract for a quasi-public agency project with a value greater than $50,000;
  3. other states of the United States, including, but not limited to, the District of Columbia, Puerto Rico, U.S. territories and possessions, and federally recognized Indian tribal governments, as defined in C.G.S. § 1-267;
  4. the federal government;
  5. foreign governments; and
  6. an agency of a subdivision, state or government listed
    in items 1-5.

For Further Information, please direct any questions about the nondiscrimination certification forms to the Commission on Human Rights and Opportunities:

Tel. 860/ 541-3400
Connecticut Toll Free Tel. 1-800/ 477-5737