TR-2012-43 GRANT FOR FIRE DEPT ■ ____ � �
-1 -�t�.�3 � �s���
�'�
rbve 0�'
TR-2012-43
A RESOLUTION ACCEPTING A GRANT FROM MASSACHUSETTS
DEPARTMENT OF CONSERVATION AND RECREATION
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER 44, SECTION 53AI/2 FOR THE AGAWAM FIRE DEPARTMENT
(Sponsored by Richard A. Cohen)
WHEREAS, Department of Conservation and Recreation administers a
grant program; and
WHEREAS, the Agawam applied for and received a grant in the amount n
of$5,000.00; and S
-Z
WHEREAS, the Agawam Fire Department will use the grant to rep e P,
and purchase equipment to be utilized for wildland firefighting;
WHEREAS, it is in the best interests of the Town of Agawam to accept Me
grant.
NOW THEREFORE, the Agawam City Council hereby resolves pursuarte
to M.G.L. c.44, §53A1/2 to accept the grant of Massachusetts Department of
Conservation and Recreation to the Agawam Fire Department.
DATED THIS 19-� DAY OF S�effgm" 12012.
PER ORDER OF THE AGAWAM CITY COUNCIL
Christopher C. jLihnson, President
0 U 'D
AP OVED TO FORM AND LEGALITY
V"incent F. tiscia�, Szlicitor 0 CC- - TA CA iL—
Treajltrer
CC_ Lrt,K)
COMMONWEALTH OF MASSACHUSETTS � ST DA D CONTRACT FORM
This form ls)ointfy Issued and pubIthed by the Executiye Office for Admin�sqaiion and Finanw-�ANFI,the Office Iler e n
pi-Asion(OSO)as the default contract for all Commonwealth Departments when another form i�a not preesccA b n ch to I
Iangu2gG Of thS Form shall to void.Additional nork-conflicting terms may be added try Atlachment.Conlractt quire addilli r men meni le Contract JSP
forms or other additional terms as pad of this Contrast�vithout prior Department approval. Click on hyperunks for itions,tons on legal qui ants tar rated by
reference into this Contract. An electronic copy of[his Jonn is available al www.mass Qovl=. tinder G i a F victors-F s S. und S
CONTRACTOR LEGA L N6M t T V, t-, F A 6- COMMONWEALTH DEP RTMENT NAME:
(and dWd): :Tj-,L.; ,� MMAIRS Department Cog: Department of Conservation and Recreation
Legal Address:(W-9,W4,T&Q: Business MAnaAddjL%j: OCR G1JVe3U0fF0r4$tFkQC0ntf0t.251 C2U=W2yS11t1Wt-Guihl600:
1 /�, --1 /�6 1 k:�r Boston,Massachusetts 02114
Contract Manage-. - i 01001 Billing Address PI'differeq:DCRBureau offoreslFireContiol;251 CausmoySt/SloGM.Eloston,
c.:11iE j--� A L fiN' S I MAD2114
"-Mall. S I Dj,� rV 4 C-/i Ic Al-7- /rz do Maio Firicano
gjaUjg Manager: David V.CeEno
Lhone. L-Mall: qV glino �h�-rr.-. rnarIefV1;w2@§ta1q.rna us
]Fax,
PLC Phone:61742&4981 IBOSt 5W32&2"cd) 1 rax; 617-626-Ml
Vendor Code Address 10(e.g.-AD001"): A09,el fr',,,p—P�4 0
(Note:The Address Id Must be W up fot EFT payments.)
RFR[ProcurgmentorDi�eriDNurnber: pj/w
NEW CONTRACT CONTRACt AMENDMENT
PROCUREMENT gR EXCEPTIQR TYPE�(Check one Option only) Eider Current Contract End Date Prior to Amendmenl�_20_
Statewide Contrac (OSD or an OSD-designated Department) Enter Amendment Amount: (or'rvo chanDe-)
Collect' Purchm AMEND MENT TYPE.jCheck one option only.Attach details of Amendment changeo.)
YL--- (Attach OSD approval.scope.budget)
Department PrZUrieringrit fincludes Stale or Federal grants 815 CMR 2. —Amendmut to Scope oL@kdnL(AnaM updated scope and budget)
(Attach RFR and ReipDrise or other procurement Supporting documentation)
Ememency Contract(Atlach)uslification for emergiency.coDpo,budget) —Interim Contract(Attach juslificalion lor Interim Contract and updated scoperbudget)
CoritractEmploye (AllachEmplooentSlatusil'o swpe,budget) —Contract Employee(Aflach any updates to scope or budgel)
2-
Luisladve/Legal 9 Other:(Attach authortzkog lanquage4ustikatim.scope and _LegislativelLegal or Qft�(Attach authortztrig Wiguage4uslikallon and updated
budget) scope and budget)
The followino COMMONWEALTH TERM5 AND CORQ[IM(T&C)has been executed,Red with CTR and Is Incorporated by reference into title Contract.
XCommowmalth Terma and Conditions —Commonwealth Terms and Conditions Far Human and Social Services
COMPENSATION:(Check ONE optioni)�The Department cedifts that payments for authorized performance accepted in accordance with the terms of this Contract will be supported
in the stale accounting system by sufficieril appropriations or other non-appropriated funds.subed to inlercept for Commonwealth owed debit tinder8l 5 CMR 9,00.
Rate Contme (No Maiinnum Ohliga6on, Attach details of all rates,units,calculations,conditions or terms and any changes if rates or lerms are being amended.)
Maxilrim-ni OblMallon Contract Enter Total Maximum Obligation lar total duration of this Contract(or now ToW if Contract is Wrig amended).$
PROMPT PAYMENT DISCOUNTS fPPDI: Commorrweallh payments are�Ssued through EFT 45 days from Invoice receipt,GonlraCtors requesting accelerated payments must
identify a PPD as follows: Payinenil issued Wthin 10 days__%PPD;Payment Issued vvilhin 15 days—%PPD;Payment issued within 20 days_%PPD;Payment issued Within
3o days L%PPD,.it PPb peMerlitag%are left blank,Identify te=n:_agree to standard 45 day cycle_stalutoryflegal or Ready Payments(�.LL�c2g �23A, only initial
payment(subsequent parents scheduled to support standard EFT 45 day E!Mnt cycfe.See Prompt Pay UscounIs Policy.)
BRIEF DESCRIPTION OF CONIRACI :(Enter the Conlract title,purpose.fiscal ye2qs)aid a detailed description of the scope
of performance or what Is being amended for a Contract Amendment. Attach all supporting documentation and juslilications.)
Tornado(June 1.2011)Recovery Fire Assistance&ant
ANTICIPATED START DATE: (Complete ONE option only)The Department and ContracIO(certly for this Contrad,of COMW Amendment,that Wtlirad obfigalims:
L 1.may be incurred as of the Effadiye Date Oalerl signalum dale Wow)and ngabligations.have been incurred jpdoTto the EW��e Dal .
—2.may be Incurred as of_20_a dWe LATER it=[he EfftOve DalC Wowand no obligabuns have been incurred prior to the Efftclive Ogle.
__a.-,%ere Incurred as of_20—a date PRIOR to the Effective Date below,and the parlias agree that payments for any oblotions incurred prior to the Effective Dal are
authorized to be made either as settlement payments or as authorized reimbursement payments,and that the details and circumstances of all obligations under this Contract are
attached and incorpoialed into this Contract.Acceptance of payments forever releases the Commonwealth tom kirther daims related to these obligations.
CONTRACT END DAT§: Contradt performance Shag terminate as of �,r4WP 204,��,wILh no new ob0gailons being Incurred after this date unless the COAVaCl is property
amended,provided that the terms of this Contract and perfarmance expect5lions and obligations Shall survive its lermirtaijion for the purpose of resolving any claim or dispute,for
competing any negotiated term,%and wurranlies,to allowany close out or transl;lon performance,reporfing,invoicing or final payments.or during any i3psa beween amendments.
CERTIFICATIONS NoWthistanding verbal or other represetilislions by[he parties,the'Efrective Data"Of lh�Contract or Amendment shalt be the latest date that this COnVaCtOt
'Amendment has been executed by an authorized signatory of the Contractor.the Depadmi-il,or a later Contract or Amendment Stan Bale specifed above,subjedloany required
apprevals. The Contractor makes all certifications required under Me attached Contractor Certillcaljon�(amporaled by reference if not allached hereto)under Me pahs and
penalties of perjury,agrees W provide any rOqUIred=UrnenlatiOfii upon reqU8SI to suppon compriance,and agrees Tial all terms governing performance of Ihis Conked and doing
business In Massacnuselm are allached or�nmrperaled by reference terein according to the followring hierarchy of documenj precedence,the applicabla Cornringriwean'ferins and
Condhions.this Standard C4htracl Form including the Instrqctions.and Contraglor-Cenilcations,(he Request for Response(RFRI or other solicilalion,the Contra"s Response,
and additional negotiated terms,provided that additional negotiated terms wig take precedence over the relevant terms in the RFR and the Contradoes Response only if made using
ft pro=oullined in 001-CM Incorporated herein,provided that arty amended RFR or Zs
F m terms rju I.in be alue,lawer costs,or a marecostoffective Contract,
V
AUTHORMY2 SIGKAIURg EQR THI CONTIkACTOR:Town Name-A C r, I
A&H R N Sid THE COM14ONWEALTK
Inblusi* (S�and Data Must Be HarxivfittenAt Ti cfSignaLre)
'Z
X: Data; /f, X:
Date,
Una dvaltl At lips-of Signature)
'ima; guid Dale Mull Ile 111r, ep
IlYnt Name:'' prin 114 1,
IN Ft t if
PrIntTille; PH.,Tlu.:
(Issued612712DII)Page 1.of5.
PAGE 001 EFFECTIVE DATE : Z/18/42
CHECK NUMBER : 1276 4
CHECK AMOUNT : ,000.00
Electronic funds transfer (EFT) is the preferred method of payment for all
�ayees doing business with the Commonwealth . You can sign up through the
epartment you do business with or visit littps://massfinance. state.ma.us.
click on VendorWeb and follow the instructions. This web site is also a
resource you can use for all your payment information.
0 'T. E
P
DUME.N.. AMOUNT'.5:-
711"']
a
OCR WIL.DLAND FIRE GRANT PRC OCR2PRCDCR4101692000997 6`17-626-1289 5.000�00
251 Causeway Street DEPARTMENT CONSERVATION AND RECREATION
Town of Agawam-Tornado Recovery Fire, Grant
$5,000-00
FOLD, CREASE: ANI) TE'E.R AL0,NG P'-FFC.irAT10'1'A
'if,
CHECK NUMBER 53-7524
0004527684 113
VENDOR CUSTOMER ID CH�EK DATE
VC6000191692 , 7 18/12
SOVEREIGN BANK
CHECK AMOUNT
PAYI�*********5,000*DOLLARS*AND*00*CENTS**** $5,000 .00
TO THE TOWN OF AGAWAM
ORGER OF TREASURER
36, MAIN ST
AGAWAM MA 01001-1801
1190 DO 4 5 2 ?68'to 1:0 1 13 7 S 2 1, Sl: 0 0 0 88 13 0 S 0 S 0
RETURN TO
Commonwealth of Massachusetts
Deparhnent ofConservation and Recreation
Division ofState Parks&Recreation-Bureau ofForest Fire Control
251 Causeway Street-Suite 600
Boston,Massachusetts 02114
ATTN: Marie Firicano,BMS
On or before. June 22,2012
APPLICATION FOR DCR VdiRand Fire All Risk/All Hazard
Tomado Recovery Fire Assistance Want
APPLICANT'
ADDRESS. P&D ^-0,1 Y-Acwe-j-
TOWN: ZIP:--j3j-CPCP/ COUNTY:
CONTACT PERSON: CA;e-4 MsA, S"a PHONE# : Wj--726-;LW30
EMAIL:gs;^A,�s dR FAX#: 912- 786-1.%YZ
Cell#: PAGER. 6A
2" CONTACT PERSON: C-bi-P "ex &xZt.42r-d PERSON PHONE:9/3
2ndPersonEmail: Lj"q*-,ftQ
i
2"d Person Cell#:.W 3 -T3
Fire Department FED-TAX ID, VENDOR CODE:
I Town Population 2- c,,v
2. Do you have a current contract with DCR's Federal Excess Personal Property (FEPP)
Program? Yes X No
3. List equipment deficiency in Wildland Fire All Risk/All Hazard response vehicles-
d&,"d%2,j --bara., e) r4oa
;nd;,,,, iLaftk-s 6rk&w% - tgoea�r or- 1A Reed
J-1
11,2gu /40-re In fie-Ed 0,J CrQAjf- epr-
A'sln !ca w ,1 #1 L-e d ave- W&I
44-91"A -0,cAhhLq v6We—lacls L,,,fnc- X
4. Loss-.... List��ment or other lost in tomado effort:
Loss dcscription Estimated value
0-,,VE
2
5. Describe any area or situation in your town which you feet places your community at risk
because of the tornado: Use back of page if need more room.
TA 6 p c Ly rj&,&c e CAI POIcAr-An
5 -C T
a r-in 'k- et"e, a4re-CT, X-'s- a L'814A ,r, W--I &Z�"d� -Ae
02 siC dead Q// w-A,6 &wj -4
JA is P I-e-vWA Cr, D-P- re-rl ko,ASL-S 4—,,�-v r= a P kl^C A 9 , OQA
vn�" s4iQ& Aaz-&--d- Ve imj-Andp ddcrec�41
10, �k
t%a,,e&c,4d 44e Zaceymrd am,=,. -� 04 dead- LZI za i4e- aerk,
Ic4 "eyk
The A&z.,,J-v aas:ed
-4-4fe - Ae&t' 104d w,Yk.th AA o aark are- -a %,or-mat- 0 C
:hM �Egr.
6. Briefly describe:
(a) The purpose of this proposal?
(b) The justification of this request?
(c) nc benefits to be derived from Us proposal?
A-
401- --cr, 4u !and wgd Iaod
—4-trn Q"IM&'M S
v "J r,
x c* )%Aerm and As-P &,-,e,7
,fF U
n r. d d
are a
Ag zd WIVA "i-C
P f
V. V .1 1000'
3
7. PROJECT : Wildland Fire All Risk/All Hazard—Tornado Recovery Aid Assistance
Can be used for
1. Wildland Fire Management Training
2. Personal Protective Equipment(PPE)
3. Rund Forest Fire Defense
> Generators
> Chain-saws and protective gear
> Portable lighting units
> Pumps
> Equipment replacement
> Equipment
> Dry hydrants& replacement parts
> Water delivery systems
> Forestry/FEPP vehicle unit replacement parts refurbishment
> Signage; fire evacuation routes; wildfire danger risk
> Fuel load reduction projects
> Operational response vehicles ... (for example: fire depamnents may wish to ask town or ofl=
sponsorship to match the DCR grant funding of$5000 to complete an ATV purchase,or purchase
wildfire equipment for it .... etc.)
4. Technology transfer
> Computer software(wildfire) update or purchase
> Communication equipment
> Global Positioning system units
5. Firewise commun�ity work
6. Fire Evacuation Plan work
Excluded from Project Consideration
1, Transport or chief/officer vehicles .... operational response type only
2. Personnel payment
4
7.Type of project requested(check all applicable): Tmn:2012 Tomado M/Fim
Tornado Aid Project/Equipment�Training,Organizing
Equipment X'
Training
2rF
Anizing
Proposed Tornado Aid.Project—List all individual items to be ftmded
Quantity Items &Description Unit Cost TdW
td 1 10,--e-4A 4,�V
, PPELNOM'.1c 3
%J IV
OS F-S !�ge /41C Je.Od 94kf.� 0-zsc,
//.o lVelty
'rev 00 e?0.CINP
r-A I dL
15k 0 OF C-TS7—
MAYORAL ACTION
Received this day of 2012 from Council Clerk
Signed by Council President this day of am Mb�(2012.
APPROVAL OF LEGISLATION
By the powers vested in me pursuant to Article 3, Section 3-6 of the Ag Chaner, as
wended, I hFreby approve the passage of the above legislation on this;��W day of
2012.
Richard A. Cohen,Mayor
DISAPPROVAL OF LEGISLATION
By the powers vested in me pursuant to Article 3, Section 3-6 of the Agawam Charter, as
amended, I hereby veto the passage of the above legislation on this day of
2012 for the following reason(s).
Richard A. Cohen, Mayor
RETURN OF LEGISLATION TO 'COUNCIL CLEPLK
-�h —
Returned to Council Clerk this 620' day ofjp-trn LY-(, 2012.
TR-20i 2-43
A RESOLUTION ACCEPTING A GRANT FROM MASSACHUSETTS
DEPARTMENT OF CONSERVATION AND RECREATION
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER 44, SECTION 53AI/2 FOR THE AGAWAM FIRE DEPARTMENT
(Sponsored by Richard A. Cohen)
WHEREAS, Department of Conservation and Recreation administers a
grant program; and
WHEREAS, the Agawam applied for and received a grant in the amount
of$5,000.00; and
WHEREAS, the Agawam Fire Department will use the grant to replace
and purchase equipment to be utilized for wildland firefighting;
WHEREAS, it is in the best interests of the Town of Agawam to accept the
grant.
NOW THEREFORE, the Agawam City Council hereby resolves pursuant
to M.G.L. c.44, §53A1/2 to accept the grant of Massachusetts Department of
Conservation and Recreation to the Agawam Fire Department.
DATED THIS DAY OF 2012.
PER ORDER OF THE AGAWAM CITY COUNCIL
Christopher C. Johnson, President
I I
AP OVED TO FORM AND LEGALITY
Vincent F.'64scia, Solicitor
Coo d
.,4 Wv mv�'q
1.3 llosfloo
30
COMMONWEALTH OF MASSACHUSETTS ft S DA D CONTRACT FORM
This form is I"issued and pubFshed by the Executive Offlice for Administralion and Finance(ANF) the Office e ler e nal S , s
Dhis�Dri(OSOI as ft default contract for an Commonwealth Departments when another fomi is no]prew-cAbed n ch 'to nt
language Of this lorm.shall be void, Additional non-currItting terms may be added by Attachment.Contractors m 11M ddifli r ment eng menl to cunt JSP
forms at other odditlonal terms as pad of this Contract Yvithoul prior Department approval, ClidkonhyperlInkster finitic 'ins n legal clui ants ,tar rat by
relarence Into this Contract. An electronic copy of Ois term is available at www.ma5s-QOvA=under 's-F
CONTRACTOP,LEGM NAME: 6.t T V, � /+6�lj jj,%�/,'I COMMONATALTH DEPARTMENT NAME:
(and dlbfm)� -7j; j�7 �-rl it)j MMARS Departotgnt Code: Department of Conservation and Recrea bon
LegaIAddryss:(W-9,W4,T&C): B.,1nqssMa1Iing6ddMS_S.* DCR 8weau of Forest Fie Contro�.251 Causaway Skeet-suiba Goo:
&Lton,Matsochuseft 02114
Contract Manage 0100 1 ElifflngAddress fit differerg):DCR Bureau of Forest Fie Control;251 CaosewaySl I Ste 6W.Boston,
IJ ,S,� � !,-i s
A u, MA 02114
E-Maill. A(
li.,4- 4 Contract Manage: David V.Celino c/o Mvio Fincano
PhoM: qj.? jFax: Vj�� L-Mall: davidgerinogRa!pt
e.rna. marie.firkM2@
PhDMD:617.6,-6r4cAl(BOS)SM32r�2403(ceg) T-r,.: 6l7.&2a1351
Vendor Code Address ID(e.g.'AD0011"Y. ADae,, MM��_?Ve-""4,0
(Note;The Address Id Must be set up for EFT payments.) RIFRIP[ocurement or Other ID Hymbe: 6J4
A NEW CONTRACT CONTRACfAMENDMENT
PROCUREMENT OR EXCEPTION TYPE:(Check one option only) Enter Current Contract End Date Prior to Amendment:_20�
Statewide Contrac (OSD or an 00-desigoated Department) Enter Amendment Amount:S_(or"no change')
LaIlIctiNre bqhale(Aflach OSD approval,scope,budget) AMLNOMENTTYPE (Check one option only.Attach details of Amendment changes.)
Nitiftment er"urement(includes State or Federal grants 815�IVR 2.0 —Amendment to ScoRe or Budget Mach updated scope and budget)
(Attach RIFIR and Response or other procurement suppoirfing documentabon) Interim ConLact(Attach justification for Inlenim Contract and upda5ed soope)budget)
Erntntonry Co*;ct (Allatch justr=lion low emergency,scope,budget,
Cootract Employee(Attach Emoloyment�!�sF tm,scope,budget) —Contract Employee(Attach any updates to scope or budget)
LeRis4dyelLssei Vr WeV(Allach authorizing language4ustificabati,scope aild —Legislative/Legal o[Other:(Attach authorizing la4guage4ustificawn and updated
budget) scope and budget)
The following COMMONWEALT14 T ERM$AND CONDITIONS(T&C)has been executed,filed with CTR and Is Incorporated by reference Into this Cobract.
XCommonweralth Terms and Condilions —Commonwealth Terms and CoAdilions For Human and Social Services
COMPENSATION:(Check ONE option):The Department certifes that paymenis for authorized performance accepted in accordwica vALh the tcrms of 1his Contract will be supported
in Me state accounting system by sufficient appropriations of other non-approprialed funds,suNed to intercept for Commonwealth ovved debts under815 CMR 9DO.
Rate Contrac (No Maximum Obligation.Attach details of an rates,units,c2lculaVons,conditions or terms and any changes if rates of lerms are wing amended.)
MaxImon Qbfl;latlon Contrao Enter Total Maximum Obligation lor total duration of this Contract(or now Total if Contract is being amended).$
PROMPT PAYMENT DISCOUNTS-LPPOI: Commonwealth payments are issued through EFT 45 days from invulce receipt,Contractors requesong accelerated payments must
identily a PPD as bilows: Payment issued ovithin 10 days_%PPD;Payment issued within 15 days_%PPD;Payment issued Within 20 days_%PPD:Payment Issued wi.thin
30 darlrs_%PPD. it PPD percanlages are left blank,identify reason!—agree to standard 45 day cycie_statutoryAegal or Ready Payments&Lc.29_L23A�-K only initial
payment(so
_�equent=ents scheduled to Support standard EFT 45 day payment cycle.See Prompt Pay Dsocrunts Pot
BRIEF DESCRiPTIONOF CONTRACT LRFO :(Enter The Contract title,purpOse,fiscal ysaqs)and a detailed description ol the scope
of�etmanoe or what is being amended for a Contract Amendment. Allach all supporting documentation and jus4licalions.)
Tornado(June 1.2D11 I)Recovery Fire Assistance Grant
ANTICIPATED START VATg (Complete ONE option only)The Department and Contractor CeAfy for this Contract,or Contract Amendment,that Con tract obligations;
t.may be incurred as of the FifecOve 13M (falest signature dAIP below)and Mobliqations have been iricuriad a Lorto the Ekgcllve Dilig.
2.maybe hmned as of_20_a date LATER than The Efleg±�Datt below and nobligalions have been Incurred plLor to the
EflegWe Date
_3.were Incurred as of_,20—a date PRIOR to the Effective Date below,and the parties agree that payments for any obligations incurred prior 10 the EffeLlkDale are
aulftoved to be made either as settlement payments or as authorized renburSeMeril payments,and that the details and circumstances Of 29 Obligations under this Contrad are
attached and Incanted into this Contract. Acceptance of payments forever releases tie Commonwealth kom further claims related to those obfiptions.
CONTRACT END DATE. Contract performance shall terminate a3 of _:fZ.PA,204d=with no now obligations ba�nfi Inwrted after this dale unless the Contract is property
anrwnded,provided that(he terms of this Contract and perfamnance expect5tions and obligallong shag survive its termination for the purpose of resoMng any ciaim or�ispute,tr
completing any negoflaled terms and wairairlies,to allow any close out or IransNon performance,reporting,ifivoicing or final payments,or during any lapse between amendments.
CEB11FICaTIONE: NoNkh5tanding varW or other representations by the parties,the"Effecl.lve Dale"of this Con tracl or Amendment sfiall be the latest date that this Contract or
Amendment has been executed by an authorized sl�lnalory of The Contractor,ft Depariment,or a lafer Contract or Amendment Start Date specified above.subject to any required
approvals. The Contractor makes an cerfiricalicins required under the allachedf Contractor Cenliffcatiogli(incorporated by reference if not allached hereto)under(he pains and
penalties of perfury,agrees to proyloe any required documenlawn u pun request to supporl!compliance,and agrees that all terms governing performance of this Contract and doing
business In lvl2ssachusellsi are attached or incorporated by reference tereln accordIng to the following hierarchy of document precedence,The applicabl�3 COMMpngallh Jerms W
ConiAtOns this Standard CGntracl Form including the fnstruqlion�and Contra=Certificatio ,the Request for RespDnse(UR)Or other solicitation,Ina Contractors Response,
and additional negotiated terms,provided that addil.ional negotiated terms YAU take precedence over the relevant lemns in ll�e AFR and the Cortracws Response onlyilmado u&ing
the process oullin ad In $01 CMR 21,D7 Incorporated herelin,provided that any amend d RFR or arms rOst in bal.value,lower costs,or a more cos!effective Contract.
A&H la THE COMMONWEALTH: j
AUTHOROV SIGIATURE FOR TH5 CONTRACTOR:Town Name 6,X
X. Data: If,.
'�: - oate-. J7
(�ig--lu d Da e
inblu ink (ST12two and 02:a Wmt B*Hwdmb:n At Tkne ofS�natmj $ignalu d Date MuslBe Handwrille AlTi e.ol'Signature)
a L
Print Name" m6Aez Print Name;
P fit
ri Me: Print TiUe:'I
7
(issued 6/2712011)Page i.of 5.
e I
�t J14t I'M ".":12.1%r."(XNF,.�Ai
?
PAGE 001 EFFECTIVE DATE : Z/18/J2
CHECK NUMBER ; 52� 4
CHECK AMOUNT ; $5,00 .00
Electronic funds transfer (EFT) is the preferred method of payment for all
ayees doing business with the Commonwealth . You can sign up through the
epartment you do business with or visit hittps://massfinance.state.ma .us .
Click on VendorWeb and follow the instructions . This web site is also a
resource you can use for all your payment information.
AMOUNT4
1. X-
L
4.
DCR WILDLAND FIRE GRANT PRC DCR2PRCDCR410IG92000997 617-626-1289 13,000.00
251 Causeway Street DEPARTMENT CONSERVATION AND RECREATION
Town of Agawam-Tornado Recovery Fire Grant
$5,000-00
41
Xr
CHECK NUMBER 53-7524
7
0004527684 113
VENDOR CUSTOMER 10 CHE�K DATE
VC6000191692 7/18/12 SOVEREIGN BANK
PAY**********5,000*DOLLARS*AND*00*CENTS**** CflECK AMOUNT
$5,000 .00
TO THE TOWN OF AGAWAM
ORDER OF TREAtURER
36 MAIN ST
AGAWAM MA 01001-1801
irv;
u60004 S 2 76aloo 1:0 4 13 7 S 2Li SI: D0088fiiI30 S05118
RETURN TO
Commonwealth of Massachusetts
D�partment ofConservation and Recreation
Division ofState Parks&Recreation-Bureau offorest Fire Control
251 Causeway Street-Suite 600
Boston, Massachusetts 02114
ATTN: Marie Firicano,BMS
On or before.-June 22,2012
APPLICATTON FOR DCR WiWand Fire All Risk/All Hazard
Tornado Recovery Fire Assistance grant
APPLICANT
ADDRESS: P&D
TOWN: ZIP:_j2LLg2j COUNTY: &S
CONTACT PFRSON'-C—L,-,,,t S"j�c PHONE# :-yt3_!7X 6
EMAIL:otstr-as dR njame^An m... V-s FAX#: 9/2- 786-/2Y/
Cell#: yjj-tj>V-97y,4 PAGER. 6��
Vd CONTACT PERSON: CJ
&,,, &,42nd PERSON PHONF,:q/-?-7.2
J,
2"dPers;onEmail:a4r-Vw6,#%A'Q PAGER:
i 1�9
2'd Person Cell#: qj j -T31- rai j
Fire Department FED.TAX ID Qq to& I VENDOR CODE:
I. Town Population
2. Do you have a current contract with DCR's. Federal Excess Personal Property (FEPP)
Program? Yes X No
3. List equipment deficiency in Wildland Fire All Risk/All Hazard response vehicles:
's-1cleffloal LOA �Wylx dam"'edd Aewa, d rnw!n
W #I &
-;n din- ImAk-s -dAA—red -L-rie-ftj er
Aajt- or 1A tiee-4
—A(And lift" 1411-ce- f1% need &*f Ldpajf- Or
I a
In need air- rA0e/dtCrM&"-/'
W
-PAhh,,,j veW-rk lgtaks W#1!2 e- X
4. Loss.... List equipment or other lost in tomado cffort:
loss description Estimated value
0 IfIE
2
5. Describe any area or situation in your town which you feel places your community at risk
because of the tomado: Use back of page if need more room.
—,TAe onceceocre ap'l PeJear-ma Y4de, Aack 4aei-ILL-, cour-
M�eel OrV_C_*V& ]�r a JzS%JeLr, TAe-
CO,
412
a VA�Lw,- LAP- s,;4A, Aaxa-r-d-
e 4k
I%fne&C, 449-0 A-Cimf"a amm, 4- v-4 Led a// zn 44e xmirk
& 4
Q:S i Ile. hazae-dx - atpred-
ble �06#%4&yq /dirmaivej 4,rv!s ond
z6 Ae Jr'
6. Briefly describe:
(a) The purpose of this proposal?
(b) The justification of this request?
(c) The benefits to be derived fi-om this proposal?
A 4AI-c po-VeAaL-,�� -:& ignt-j-00'"
'Id L
4,md
V
A . The'.* r-e-ptse A
S
V V
�x Are, A-4r-ra And -zaeczAr- qy-,Z-A&IP Anyo- Lee*
kJ
e4294 ar-e WN 4-42-c a
)C=xM lmori&irved
4P
44L*VfeJ -,Ore r
3
7. PROJECT : Wildland Fire All Risk/All Hazard—Tornado Recovery Aid Assistance
Can be used for
1. Wildland Fire Management Training
2. Personal Protective Equipment (PPE)
3. Rural Forest Fire Defense
> Generators
> Chain-saws and protective gear
> Portable lighting units
> Pumps
> Equipment replacement
> Equipment
> Dry hydrants & replacement parts
> Water delivery systems
> Forestry/FEPP vehicle unit replacement parts refurbishment
> Signage; fire evacuation routes; wildfire danger risk
> Fuel load reduction projects
> Operational response vehicles ... (for example: fire departrnents may wish to ask town or other
sponsorship to match the DCR grant funding of$5000 to complete an ATV purchase, or purchase
wildfire equipment for it etc.)
4. Technology transfer
P, Computer software(wildfire) update or purchase
> Communication equipment
> Global Positioning system units
5. Firewise community work
6. Fire Evacuation Plan work
Excluded from Project Consideration
1. Transport or chief/officer vehicles .... operational response type only
2. Personnel payment
4
7.Type of project requested(check all applicable): To":2012 Tomado Aid I Firc
Tornado Aid Project I EguipmeM,-Training,2%�Mizing
Equipment X"
Training
Organizing
Proposed Tomado Aid-Project—List al I individual items to be ftinded
Quantity Items &Description Unit Cost Total
10 plreNA4.�V 6�04"exlivonp t.3S-O-±*. 1.3-00-00
4 PPEC
W \4
5- uSFs Ilicteod J14ke 0 -to- '13ro-.0
/Vedt�Z Ofv 4y 4,e� L&Prft? &—oblart 7-c"I A:�) 7o.00 $,760-001
4a r- 70.4WO ?0. CXP
rEoVO 0 F 6 JS 7-
5