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AUTHORIZED AGENCY SIGNATURE:

PRINT OR TYPE NAME OF CONTACT PERSON AT BUDGETED AGENCY;

PRINT OR TYPE NAME OF CONTACT PERSON AT CONTRACTOR

DATE OF CONTRACT:

  DATE

  AREA CODE /TELEPHONE NUMBER

The above information has been reviewed and agrees with the records of this agency.

INSTRUCTIONS FOR OSC AND BUDGETED AGENCY:
UPON RECEIPT AND REVIEW, OSC WILL FORWARD TWO COPIES TO THE BUDGETED AGENCY FOR APPROVAL. UPON APPROVAL THE BUDGETED AGENCY WILL SUBMIT ONE APPROVED COPY TO OSC, BUDGET & FINANCIAL ANALYSIS DIVISION AND RETAIN ONE COPY FOR AGENCY FILE.

State of Connecticut
 Office of the State Comptroller
165 Capitol Avenue
 Hartford, CT 06106
www.osc.ct.gov

APPLICATION FOR SUBSTITUTION OF SECURITIES
FOR RETAINAGES
CO-747 REV. 12/2019

INSTRUCTIONS FOR CONTRACTOR:
PREPARE IN QUADRUPLICATE (4), FORWARD ORIGINAL AND TWO COPIES TO THE OFFICE OF THE STATE COMPTROLLER (OSC), 
BUDGET & FINANCIAL ANALYSIS DIVISION, 165 CAPITOL AVENUE, HARTFORD CT 06106. RETAIN ONE COPY FOR YOUR FILE.

PRINT OR TYPE

BUDGETED AGENCY:

PROJECT NUMBER: 

TOWN:

BRIEF DESCRIPTION:

AMOUNT OF CONTRACT AWARD:

MAXIMUM AMOUNT OF RETAINAGE PER
CONTRACT PROVISION:

SECURITIES PREVIOUSLY DEPOSITED:

AMOUNT OF SECURITIES TO BE DEPOSITED:

NAME AND ADDRESS OF CONTRACTOR:

AREA CODE /TELEPHONE NUMBER

AUTHORIZED SIGNATURE OF CONTRACTOR

DATE

APPROVAL BY BUDGETED AGENCY