TR-2013-2 GRANT FOR EMERG. MNGMT ■-���
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TR-2013-2
A RESOLUTION ACCEPTING A GRANT FROM COMMONWEALTH OF
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER ", SECTION 53A TO AGAWAM EMERGENCY MANAGEMENT
(Sponsored by Richard A. Cohen)
WHEREAS, the Town of Agawam applied for and received a grant from
the Massachusetts Emergency Management Agency; and
WHEREAS, the Agawam Emergency Management desires to accept said
grant; and
WHEREAS, the grant is in the amount of Seven thousand five hundred
and 00/100 ($7,500.00) dollars;
WHEREAS, Agawam Emergency Management will use the funds to
purchase a weather station and portable radios; and
WHEREAS, it is in the best interests of the Town of Agawam to accept the
grant from the Massachusetts Emergency Management Agency.
NOW THEREFORE, the Agawam City Council hereby resolves pursuant
to M.G.L. c.44, §53A to accept this grant from Massachusetts Emergency
Management Agency.
DATED THIS z'`d DAY OF _c1 ;�N` 2012.
PER ORDER OF THE AGAWAM CITY COUNCIL
04� A S"Y � ? 7�
CO -`Tr� CAI --
Christopher C. I hnson, President
A P OVED A O FORM AND LEGALITY
tA
\/Fcent\P. GirAcia, Solicitor
LYE
UMUL U11111 Page 1 of 1
Chet Grant
Vince Gioscia
Sent: Monday, December 17, 2012 5:57 PM
To: Chet Nicora
Cc: Mayor Richard Cohen
Attachments: Chet Grant.pdf(14 KB)
Attached is a draft of the grant resolution. The contract was vague as to the use of the funds, can you elaborate
further?
Vincent F. Gioscia, Esq.
City Solicitor, Town of Agawam
36 Main Street
Agawam, MA 01001
413-786-0400 Ext. 8281
Sol icitor(n)agawam.ma.us
https:l/webmail.agawam.ma.us/owa/?ae=Item&t=IPM.Note&id=RgAAAAAAVac5nLL9... 12/17/2012
TR-2012-
A RESOLUTION ACCEPTING A GRANT FROM COMMONWEALTH OF
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER 44, SECTION 53A TO AGAWAM EMERGENCY MANAGEMENT
(Sponsored by Richard A. Cohen)
WHEREAS, the Town of Agawam applied for and received a grant from
the Massachusetts Emergency Management Agency; and
WHEREAS, the Agawam Emergency Management desires to accept said
grant; and
WHEREAS, the grant is in the amount of Seven thousand five hundred
and 001100 ($7,500.00) dollars;
WHEREAS, Agawam Emergency Management will use the funds to
purchase a weather station and portable radios; and
WHEREAS, it is in the best interests of the Town of Agawam to accept the
grant from the Massachusetts Emergency Management Agency.
NOW THEREFORE, the Agawam City Council hereby resolves pursuant
to M.G.L. c.44, §53A to accept this grant from Massachusetts Emergency
Management Agency.
DATED THIS DAY OF , 2012.
PER ORDER OF THE AGAWAM CITY COUNCIL
Christopher C. Johnson, President
APPROVED AS TO FORM AND LEGALITY
Vincent F. Gioscia, Solicitor
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM 06J
This form is jo:ngy issued and published by the Executive Office for Administrallon and Finance fANJ,the Office of the Comptrofier(CTR)and the Operational Services
Division(OSD)as the default contract for all Commonwealth Departments when another form is not prescribed by regulation or policy. Any changes to the official printed
language of this form shall be void. Additional non-conflicting terms may be added by Attachment.Contractors may not require any additional agreements,engagement letters,contract
fomns or other additional terms as pan of this Contract without prior Department approval. Click on hyperllnks for definitions,Instructions and legal requirements that are incorporated by
reference into this Contract. An electronic copy of this form is available at www.mass.goy/os under Guidance For Vendors-Forms or wwa,mass.00ylosd under OSD Fomrs.
CONTRAMR190L NAME:TOWN OF AGAWAM COMMONWEALTH DEPARTMENT NAME: Mass.Emergency Management Agency
MMARS Department Code: CDA,Emergency Management Agency
Legal Addres}:(W-9,Wa,7116C):36 MAIN ST AGAWAM MA 01001.1$01 Business Milling Address: 400 Worcester Road,Framingham,MA 01702
Contract Manager: DIm iior Chester Nlcora Billing Address(it diffetent):
E.Mell: emdireNcin@Agawamma.us ContraMl4la�r. JefTimped
one: Fax:NIA E-Mall. ]aif.Umperi@state.ma.us
Contra der Vendor Code:VCM00191692 Phone:508.M-2019 Fax: 5094120.2030
Vendor Code Address ID(94.'AD001"): AD_,,, MMARS Doc IDfs):CT-CDA-FY13EMPG1100000AGAWA
(Note:The Address Id Must be set up for fH payments.) RFF2rocuremerht or Other ID Number:FFY2011 EMPG Grant
NEW CONTRACT _ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPIQNlYPE:(Check one option only) Enter Current Contract End Data Er�gr to Amendment: ,20.
_Statewide Contrad(OSD or an OSD-4esignated Department) Enter Amendment Amount:5 .(or`no charge) :
_Collecthre Purchase(Attach OSD approval,scope,budget) AMEND>NENI T_YP__E:(Check one option only.Attach details of Amendment changes.)
X Department Prpcuremenl(Includes State or Federal grants 815_CMR 2,001 Amendment to$=Do or Budget(Attach updated scope and budget)
(Attach RFR and Response or other procurement supporting documentation) Interim Contract(Attach 1wldicatfon for Interim Contract and updated scopelbudget)
_Emergency Contract(Attach)ustNicatlon for emergency,scope,budget)
_ContraM Employee(Attach Employment Status Form,scope,budget) _Contract Employee(Attach any updates to scope or budget)
_LegistatfvefLegal or Other.(Mach authorvJng languagefustification,scope and _Le Istalive e a • r(Attach authoAzing languageljustiffcatIon and updated
budgeQ scope and budget)
The following COMMONWEALTH TERMSAND CONDITIONS(TdC)has teen executed,filed with CTR and is incorporated by reference into this Contract
�( Commonwealth Terms and Conditions _Commonwealth Terris and Conditions For Human and Social Services
COMPENSATION:(Check ONE option):The Department certifies that payments for authorized perfomtanee accepted In accordance with the terms of this Contract will be supported
In the state accounting system by sufficient appropriations or other non-appropriated funds,subject to intercept for Commonwealth oared debts under 815 CMR 9,00,
_Rate Co nth rt(No Maximum Obligation Attach details of all rates,units,calculations,conditions or lemus and any changes If rates or terms are being amended.)
_2L Maximum Obligation Contract Enter Total Maximum Obligation for total duration of this Contract(or nswTotal H Contract is being amended),f7500.00
PROMnPAYMENT DISCOUNTS (PPP. Commonwealth payments.are Issued Mmugh gff 45 days from Invoice receipt Contractors requesting accelerated payments must
identity a PPD as follows: Payment Issued within 10 days_%PPD;Payment issued within 15 days_%PPD;Payment issued WIthtn 20 days_%PPD;Payment Issued wlfftirt 30
days—%PPD. It PPD percentages are left blank,Identify reason:_agree to standard 45 day cycle_statutoryltegal or Ready Payments(G.L.a 29,4 23A);JL only initial
paymient Lsubsgueni a scheduled to s R standard EFT 45 d!Z payment cycle.See PSmlg Egy D' n
IRIEF DESCRIPTION OF CONTRACT FERFORMAKE or REASON FOR AMENDMENT:(Enter Me Contract title,purpose,festal years)and a detalled description of the scope of
performance or what is being amended for a Contract Amendment Attach all supporting documentation and jusVltcations,)Funding for this grant is provided through the FFY2011
Emergency Management Performance Grant,the Catalog of Federal Domesk Assistance(CFDA)number Is 97,042.The oommunly intends to procure weather station and portable
radios.
ANTICIPATED START DATE:(Complete ONE option only)The Deparbnent and Contractor oartity for this Contract or Contract Amendment,that Contract obligations:
X 1.may be incurred as of the Effective Date(lamst signature date below)and n3 obligations have been Incurred prior to the Effective Date.
2.may be Incurred as of _ .20_,-,a date LATER than the gfleetive Date belay and um obligations have beers incurred rpm[to the
�3.were incutred as of,.. 20—,a date PRIOR to the EffectW Data below,and the parties agree that payments for any oNligatlons incurred prtor to the Effeggye Date 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 tnoo rated Into this Contract. Acce noe of paaent3 forever releases the Commonwealth from further claims related to these obi ations,
CONTRACLEND QATE: Contract performance shall terminate as of .June 30.2013 wt 4 no new obrxgalions being incurred after this date unless the Contract is prop"amended,
pWded that the terms of 7tfs Contract and parka mance expectations and obligations shall survive Its termination far the purpose of resOMng any daim or dispute,for completing any
negotiated terms and wanantfes,to allow any dose out or transition pert manrn,reporting,Invoicing or final payments,or during any lapse between amendments,
CERTIFICATIONS: NobOfttanding verbal or other representations by fine parties,the'Effecttve Date'of this Contract or Amendment shaft be the latest dale that this Contract or
Amendment has been executed by an authorized signatory of the Contractor,the Department,or a later Contract or Amendment Stan Date specified above,subject to any required
approvals. The Contractor makes all certifications required under the attached Contractor Cgr(incallona(Incorporated by reference It not attached hereto)under the pains and
penalties of perjury,agrees to provide any required documentation upon request to support compliance,and agrees that all terms governing performance of this Contract and doing
business In Massachusetts are attached or Incorporated by reference herein according to the fo0owing hierarchy of document precedence,the applicable Cornmonweafth Terms and
Conditions lists Standard Contract Form hdudi g the Instructions and Contraclor Certifications,the'Request for Response(RFR)or other so6cflation,the Contractor's Response,and
additional negotiated terms,provided that additional negotiated terms will take precedence over the relevant terms In tee RFR and the Contractors Response only tt made using the
process oultlned In 801 CMR 21.07 lncorpo�ded herein,provided that any amended RFR or Response terms result in best value,lower costs,or a more cast effective Contrail.
U HORI2i G T F E RACTOR
X: X.-- Date:
(Sign re and Date Must Be Handwritten At Time of Signatu a) (Signature and Date Must Be Handwritten At Time of Signature)
Print Name: t aH EY Print Name; avid Mahr
•- = Print 7ttle. M A d 2 Print Title: Chief Fiscal Officer
(issued 612712011)Page tof 1.
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR VENDOR/CUSTOMER CODE: UqF
PROOF OF AUTHENTICATION OF SIGNATURE
This page is optional and is available for a department to authenticate contract signatures.
It is recommended that Departments obtain authentication of signature for the signatory
who submits the Contractor Authorized Listing.
This Section MUST be completed by the Contractor Authorized Signatory in presence of notary.
%t�%%Awwbw4' � If'1�4�0� �tC�F�4t2v r9. LOEtf'N
x
' Signature as it will appear on contract or other document(Complete only in presence of notary):
AUTHENTICATED BY NOTARY OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS:
I, (NOTARY)as a notary public certify that I witnessed
the signature of the aforementioned signatory above and I verified the individual's identity on this date: f
20 -
My commission expires on:
AFFIX NOTARY SEAL
i, (CORPORATE CLERK)certify that I witnessed the
signature of the aforementioned signatory above,that I verified the individual's identity and confirm the individual's
authority as an authorized signatory for the Contractor on this date:
,20
AFFIX CORPORATE SEAL
(c) The undersigned shall require that the language of this certification be
included in the award documents for all sub-awards at all tiers
(including sub-grants, contracts under grants and cooperative
agreements, and subcontracts) and that all sub-recipients shall certify
and disclose accordingly.
36. Debarment,Suspension,and Other Responsibilities. As required by Executive Order
12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective
participants in primary covered transactions, as defined at 28 CFR Part 67, Section
67.510—
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarmerit,
declared ineligible, sentenced to a denial of Federal benefits by a State
or Federal court, or voluntarily excluded from covered transactions by
any Federal department or agency;
(b) Have not within a three-year period preceding this application been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public(Federal, State,
or local)transaction or contract under a public transaction;violation of
Federal or State antitrust statutes or commission of embezzlement,
theft,forgery,bribery, falsification or destruction of records,making
false statements,or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity(Federal, State, or local)with
commission of any of the offenses enumerated in paragraph(1)(b)of
this certification; and
(d) Have not within a three-year period preceding this application had one
or more public transactions(Federal, State,or local)terminated for
cause or default; acid
B. Where the applicant is unable to certify to any of the statements in this
certification,he or she shall attach an explanation to this application.
37. Internet Access. Sub-recipients must have Internet access.
38. Email addresses. Sub-recipient project directors of grant programs must have individual
email addresses.
As the duly authorized representative of the sub-recipient,I hereby certify that the sub-
recipient will comply with the above conditions.
Signature of Authorized Signatory Date
Printed Name Title
7
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING lc\
CONTRACTOR LEGAL NAME: "rD kl d Of P G A Qjq M
CONTRACTOR VENDOR/CUSTOMER CODE: up
INSTRUCTIONS: Any Contractor (other than a sole-proprietor or an individual contractor) must provide a
listing of individuals who are authorized as legal representatives of the Contractor who can sign.contracts and
other legally binding documents related to the contract on the Contractor's behalf. In addition to this listing,any .
state department may require additional proof of authority to sign contracts on behalf of the Contractor, or proof
of authenticity of signature (a notarized signature that the Department can use to verify that the signature and
date that appear on the Contract or other legal document was actually made by the Contractor's authorized
signatory, and not by a representative, designee or other individual.)
NOTICE: Acceptance of any payment under a Contract or Grant shall operate as a waiver of any defense by
the Contractor challenging.the existence of a valid Contract due to an alleged lack of actual authority to
execute the document by the signatory.
For privacy purposes DO NOT ATTACH any documentation containing personal information, such as bank
account numbers, social security numbers, driver's licenses, home addresses, social security cards or any other
personally identifiable information that you do not want released as part of a public record. The Commonwealth
reserves the right to publish the names and titles of authorized signatories of contractors.
E IG ATORY AME TITLE
r
W &"4,q, - 444evm��q D
•ACIL ✓
om- t �
I certi Chief p �'fla
for th Contraq %-WCO A1 01
identi :ution b!
sign rel
and
a WAkc m *O
Mass land a
this !ia —___. .o any s +
business whenever the authorized signatories above retire, a Q
employ, have their responsibilities changed resulting in their n _
the Commonwealth or whenever new signatories are designated.
Date: IAII�Vltz
Title: #)410 a— Telephone: G f j3 '7�d—�[if(}Q � .�Zd 6
Fax:113,79t-I nat7 f~ Email: r'�G,+ f/L /�a ff41R/►'1. f11f�_ v S
[Listing can not be accepted without all of this information completed.)
A copy of this listing trust be attached to the "record copy" of a contract fled with the department.
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING -C�x
CONTRACTOR LEGAL NAME :�— d W/v Or 4 Ie 0WQ►"l
CONTRACTOR VENDOR/CUSTOMER CODE: UV
PROOF OF AUTHENTICATION OF SIGNATURE
This page is optional and is available for a department to authenticate contract signatures.
It is recommended that Departments obtain authentication of signature for the signatory
who submits the Contractor Authorized Listing.
This Section MUST be completed by the Contractor Authorized Signatory in presence of notary.
✓ Signatory's full legal name(print or type): Al!Lt7 RA IYL
✓ Title: N'IEI?&544-y A0+NA6F&FAIT 91 gVf h)e-
✓ X CAZC�A�A2 �� I
Signature as it will appetkn contract or other ffumcnt(Complete only in presence of notary):
AUTHENTICATED BY NOTARY OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS:
I, (NOTARY)as a notary public certify that 1 witnessed
the signature of the aforementioned signatory above and I verified the individual's identity on this date:
20
r
My commission expires on:
AFFIX NOTARY SEAL
I, (CORPORATE CLERK)certify that I witnessed the
signature of the aforementioned signatory above,that I verified the individual's identity and confirm the individual's
authority as an authorized signatory for the Contractor on this date:
20
AFFIX CORPORATE SEAL
Massachusetts Emergency Management Agency—Project Management Office (MEMA-PMO)
Grant Close-Out Report for EMPG, CCP, and HMEP
This is a required report. Please complete Sections I, II, and III.
Section I: Budget
Entity that received funds
Contact Name and Telephone Number
Contact Email Address
Grant Program and FFY
Grant Award Amount
Total Funds Expended from Award
Total Reimbursement Amount
Balance
IMPORTANT: If your grant program required a match(e.g.,EMPG)please complete and submit the
MEMA-PMO Match Close-Out Report in addition to this report.
Section II: Program
In the space below, please provide the following:
1. A list of expenditures made via this grant and their programmatic application;
z. A brief summary of how these expenditures positively impacted your program; and
3. If applicable, please share a success story involving use of these funds.As an example:Town X
used EMPG funds to procure a mobile generator. During a recent storm,the generator was used
to provide power for residents who evacuated to the town's emergency.shelter.
Section Ill:Certification
I certify that all information contained within this report is accurate. Further, I certify that there were no
insta c s fraud, w e, oralyuse ass cia d with these grant funds
Ah
Signature and Date of Authorized Officia
documentation for expenditures listed above. Please refer to MEMA's Sub-
Recipient Reimbursement Request Guidance (April 2011) for additional
information.
By signing this reimbursement request form, I certify that all costs are
allowable, accurate, and represent costs associated with the MEMA-
approved scope of services. In addition, I certify that this reimbursement
does not constitute `supplanting' nor `dual compensation'.
Authorized Signature:
V/ W�
2 -
MAYORAL ACTION
Received this CY-<-.,, day of , 2013 from Council Clerk.
Signed by Council President this day of , 2013.
APPROVAL OF LEGISLATION
By the powers vested in me pursuant to Article 3, Section 3-6 of the Ag a Carter, as
ame ded, I here y approve the passage of the above legislation on this day of
32013.
N o
Richard A. Cohen, Mayor n�
DISAPPROVAL OF LEGISLATION n
� r'
3M
xi
3�
By the powers vested in me pursuant to Article 3, Section 3-6 of the Agawam Chartws
amended, I hereby veto the passage of the above legislation on this day of ,
2013 for the following reason(s): -0
Richard A. Cohen, Mayor
RETURN OF LEGISLATION TO COMCIL CLERK
Returned to Council Clerk this J4 day of C! ' 2013.
S
TR-2013-2
A RESOLUTION ACCEPTING A GRANT FROM COMMONWEALTH OF
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER 44, SECTION 53A TO AGAWAM EMERGENCY MANAGEMENT
(Sponsored by Richard A. Cohen)
WHEREAS, the Town of Agawam applied for and received a grant from
the Massachusetts Emergency Management Agency; and
WHEREAS, the Agawam Emergency Management desires to accept said
grant; and
WHEREAS, the grant is in the amount of Seven thousand five hundred
and 001100 ($7,500.00) dollars;
WHEREAS, Agawam Emergency Management will use the funds to
purchase a weather station and portable radios; and
WHEREAS, it is in the best interests of the Town of Agawam to accept the
grant from the Massachusetts Emergency Management Agency.
NOW THEREFORE, the Agawam City Council hereby resolves pursuant
to M.G.L. c.44, §53A to accept this grant from Massachusetts Emergency
Management Agency.
DATED THIS DAY OF , 2012.
PER ORDER OF THE AGAWAM CITY COUNCIL
0
a c
c�
Christopher C. hnson, President ter,
r
A PROVED A O FORM AND LEGALITY
1 0 rn
i cent . i cia, Solicitor I:
Chet Grant Page I of 1
Chet Grant
Vince Gioscia
Sent: Monday,December 17,2012 5:57 PM
To: Chet Nicora
Cc: Mayor Richard Cohen
Attachments: Chet Grant.pdf(14 KB)
Chet,
Attached is a draft of the grant resolution. The contract was vague as to the use of the funds, can you elaborate
further?
Vincent F. Gioscia, Esq.
City Solicitor, Town of Agawam
36 Main Street
Agawam, MA 01001
413-786-0400 Ext. 8281
Solicitor@agawam.ma.us
https://webmail.agawam.ma.uslowal?ae=Item&t=IPM.Note&id=RgAAAAAAVac5nLL9... 12/17/2012
TR-2012-
A RESOLUTION ACCEPTING A GRANT FROM COMMONWEALTH OF
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER 44, SECTION 53A TO AGAWAM EMERGENCY MANAGEMENT
(Sponsored by Richard A. Cohen)
WHEREAS, the Town of Agawam applied for and received a grant from
the Massachusetts Emergency Management Agency; and
WHEREAS, the Agawam Emergency Management desires to accept said
grant; and
WHEREAS, the grant is in the amount of Seven thousand five hundred
and 001100 ($7,500.00) dollars;
WHEREAS, Agawam Emergency Management will use the funds to
purchase a weather station and portable radios; and
WHEREAS, it is in the best interests of the Town of Agawam to accept the
grant from the Massachusetts Emergency Management Agency.
NOW THEREFORE, the Agawam City Council hereby resolves pursuant
to M.G.L. c.44, §53A to accept this grant from Massachusetts Emergency
Management Agency.
DATED THIS DAY OF , 2012.
PER ORDER OF THE AGAWAM CITY COUNCIL
Christopher C. Johnson, President
APPROVED AS TO FORM AND LEGALITY
Vincent F. Gioscia, Solicitor
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
This form Is Jointly Issued and published by the Facecutive Office for 6dminfstrstic n aa In nce�ANF),the Office of the ComptrollerlC'FR)and the I Ic
Division IOSDI as the default contract for all Commonwealth Departments when another form is not prescribed by regulation or policy. Any changes to the official Printed
language of this form shall be void. Additional non-conflicting terms may be added by Attachment Contractors may not require any additional agreements,engagement lettars,contract
forms or other additional terms as pan of this Contract without prior Department approval. CfTck on hypedInks for derinhiens,Instructions and legal mquiremenls that are Incorporated by
reference into this Contract, An electronic copy of this form is available at www.mass.aovlosc under Guidance For Vendors-_Forms or wwrv.mass.QovLmd under QaQ_LM,
CONTRACTOR hEg&NAME:TOWN OF AGAWAM COMMONWEALTH DEPARTMENT NAME: Maas.Emergancy Management Agency
MMARS Department Code: CDA,Emergency Management Agency
Legal Address:(W-9,W4,Ttl,C):36 MAIN ST AGAWAM MA 01001.1801 Business Mailin Address: 400 Worcester Road,Framingham,MA 01702
Contract Manager: Director Chester Nioora Billing Addtost(if different):
E-Mall: emdirector@Agawam.mams Contract Manag r, JeffTimped
P one: Fax:WA E•Mail: jeff.timperl@state.ma.us
Contractor Vendor Code:VC6000191692 Phone:508.820.2019 Fax: 508-820.2030
Vendor Code Addtess!D(e g.60001"): ADS MMARS Doc ID t;CT-CDA-FYi3EMPG1100000AGAWA
(Note:The Address Id Must be sat up for En payments.) RF re e t or her'ID Number:FFY2011 EMPG Grant
X NEW CONTRACT _ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTIONTYPE:(Check one option only) Enter Current Contract End Date Prior to Amendment .20�
_Statewide Con=(OSO or an OSUesignated Department) Enter Amendment Amount:E .(or'na change)
_Collecth a Purchase(Attach OSD approval,scope,budget) AMENDMENT TYPE:(Check one option only.Attach details of Amendment changes.)
Deoarlment Procurement(Includes State or Federal grants 815 CMR 2.001 _Amendment to Scope or Budget(Attach updated scope and budget)
(Attach RFR and Response or other procurement supporting documentation) _Interim Contract(ACach Justification for Interim Contract an cod updated s ud et
_Emeency Contract (Attach justltication for emergency,scope,budget) - g )
g
Contract Employee(Attach Employment Status Form,scope,budget) _Contract Employee(Attach any updates t0 scope or budget)
�L2*latfu1Leaaf Qr Other.(Attach authorizing languagar'iustrfication,scope and _LSglststIvqXq9aI or 0 - r;(Attach authorizing IanguageljusGflcation and updated
budget} scope and budget)
The following COMMONWEALTH TERMS AND CONDITIONS(T&C)has been executed,filed with CTR and is incorporated by reference into this Contract.
Commonwealth Terms and Conditions Commonwealth Tema and Conditions For Human and Social Services
COMPENSATION:(Check ONE option):The Department certifies that payments for authorized performance accepted In accordance with the terns of this Contract wig be supported
In the state accounting system by sufficient appropriations or other non-appropriated funds,subject to intercept for Commonwealth owed debts under 815 CMR 9,00.
_Rate Contract(No Maximum Obligation.Atlarh details of all rates,units,calculations,conditions or terms and any changes if rates or terns are being amended)
X Maximum Oblluation Contract Enter Total Maximum Obligation for total duration of this Contract(or new Total H Contract is betrrg amended).1750,00
PROMPT PAYMENT DISCOUNTS fPPOY Commonwealth payments are Ensued through EMI 45 days tam Invoice receipt Contractors mquesdng accelarated payments must
Identify a PPD as follows: Payment issued within 10 days_%PPD;Payment issued within 15 days_%PPD;Payment Issued wilhh 20 days_%PPD;Payment Issued wttfttn 30
days_%PPD. If PPD percentages are left blank,identify reason:_agree to standard 45 day cycle_statucory/legal or Ready Payments fG.L.c.29,J 23A1;X only InWal
p=ntLubsequent pgmentzi scheduled to su rt standard EFT 45 da paymentcycle.See P D aG
BRIEF DESCRIPTION OF CONTUCI EERFORMARC R AMNOMENT:(Enterft Contract title,purpose,fiscal years)and a detailed destxiptlon of the scope of
performance or what is being amended for a Contract Amendment Attach all supporting documentation and)ustflkxtions.)Funding for this grant Is provided through the FFY2011
Emergency Management Performance Grant,the Catalog of Federal Domestic Assistance(CFDA)number Is 97,042.The community intends to procure weather station and portable
radios.
ANTICIPATED START DATE: (Complete ONE option only)The Department and Contractor certify for this Contract,or ContraclAmendment,that Contract obligations:
_L 1.may be incurred as of the Etleclive Da (blast signature data below)and g2 obligations have been marred r�r to the Effective Data.
_2.may be incurred as of .20�a date LATER than the Effective Date below and no obligations have been incurred pil9.t m the Effective Date,
3,were inured as of—.20^,a date PRIOR to the Fff .hrigrt a Dale below,and the parties agree that payments for any obligatkxrs incurred prior to the gifedye Date are
authorized to be made either as settlement payments or as authorized reimbursement payments,and that the datatls amd circumstances of all obligations under this Contract are
attached and InoorDorated Into this Contract Aece tans of payments forever releases the Commonwealth from further Claims related to these obligations.
�ONTRACT EN P PAIVContrect perfortnance shag terminate as of June 30 2033 with no new obligations being inmrrod after this date unless the Contract Is properly amended,
prWded that the terms of this Contract an d performance expectations and oblgatlons shall survive Its termination for the purpose of resolving any daim or dispute,for comp lathng any
negotiated terms and w'arartles,to allow any dose out or transition performance,reporting,Invoking or final payments,or during any lapse between amendments.
CERTIFICATIONS: Notwithstanding verbal or other representations by the parties,the"Effective Date"of this Contract or Amendment shall be the latest date that this Contrail or
Amendment has been executed by an authorized signatory of the Contractor,the Departrmnt or a later Contract or Amendment Start Date specified above,subject to any required
approvals. The Contractor makes all certifications required under the attached Contractor Certifications(incorporated by referenoe if not attached hereto) under the pains and
penalties of perjury,agrees to provide any required documentation upon request to support compliance,and agrees that all terms governing performance of this Contract and doing
business in Massachusetts are attached or incorporated by reference herein according to the following hierarchy of document precedence,the applicable Commonwealth Terms and
Conditions,this Standard Contract Form including the Instmuctions and Contractor Certifl Oens,the Request for Response(RFR)or other solicitation,mho Contrailors Response,and
additional negotiated terms,provided that add600rial negotiated terms will take precedence over the relevant terms In the RFR and the Contractor's Response only If made using the
process outlined In 801 CMR 21.07.Incorporated herein,provided that any amended RFR or Response terms result in best value,lower costs,or a more cost effective Contract
AUTHORIZi GNAT FO TRACTOR:
i X: -ram �<'` C•-�� Date: �a ! (� X: Date:
l "T (Sig re and Date Must Be Handwritten At Time of SI natu
E
m C a g ) (Signature and bats Mast Be Handwritten At Time of Signature)Print Name: l� . Print Name: Mah
F� Print Title:_ A f 0 C2— Print Title: Chief Fiscal Officer
(Issued 812712011)Page 1.of 1.
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
upCONTRACTOR VENDOR/CUSTOMER CODE:
PROOF OF AUTHENTICATION OF SIGNATURE
This page is optional and is available for a department to authenticate contract signatures.
It is recommended that Departments obtain authentication of signature for the signatory
who submits the Contractor Authorized Listing.
This Section MUST be completed by the Contractor Authorized Signatory in presence of notary.
� �nAyD2
X
Signature as it will appear on contract or other document(Complete only in presence of notary):
AUTHENTICATED BY NOTARY OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS:
I, (NOTARY)as a notary public certify that I witnessed
the signature of the aforementioned signatory above and I verified the individual's identity on this date: J
,20
My commission expires on:
AFFIX NOTARY SEAL
I, (CORPORATE CLERK)certify that I witnessed the
signature of the aforementioned signatory above,that I verified the individual's identity and confirm the individual's
authority as an authorized signatory for the Contractor on this date:
,20
AFFIX CORPORATE SEAL
(c) The undersigned shall require that the language of this certification be
included in the award documents for all sub-awards at all tiers
(including sub-grants, contracts under grants and cooperative
agreements, and subcontracts)and that all sub-recipients shall certify
and disclose accordingly.
36. Debarment,Suspension,and Other Responsibilities. As required by Executive Order
12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective
participants in primary covered transactions, as defined at 28 CFR Part 67, Section
67.510---
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, sentenced to a denial of Federal benefits by a State
or Federal court, or voluntarily excluded from covered transactions by
any Federal department or agency;
(b) Have not within a three-year period preceding this application been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain,or performing a public(Federal, State,
or local)transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement,
theft,forgery,bribery, falsification or destruction of records,making
false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity(Federal, State,or local)with
commission of any of the offenses enumerated in paragraph(1)(b)of
this certification; and
(d) Have not within a three-year period preceding this application had one
or more public transactions(Federal, State, or local)terminated for
cause or default; and
B. Where the applicant is unable to certify to any of the statements in this
certification,he or she shall attach an explanation to this application.
37. Internet Access. Sub-recipients must have Internet access.
38. Email addresses. Sub-recipient project directors of grant programs must have individual
email addresses.
As the duly authorized representative of the sub-recipient,I hereby certify that the sub-
k6w, UMrecipient will comply with the above conditions.
- 4a i*f IA
Signature of Authorized Signatory Date
Printed!Name Title
7
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME : "r® uj d b f)4 G 4W(4 n)
CONTRACTOR VENDOR/CUSTOMER CODE:
INSTRUCTIONS: Any Contractor (other than a sole-proprietor or an individual contractor) must provide a
listing of individuals who are authorized as legal representatives of the Contractor who can sign.contracts and
other legally binding documents related to the contract on the Contractor's behalf. In addition to this listing, any
state department may require additional proof of authority to sign contracts on behalf of the Contractor, or proof
of authenticity of signature (a notarized signature that the Department can use to verify that the signature and
date that appear on the Contract or other legal document was actually made by the Contractor's authorized
signatory, and not by a representative, designee or other individual.)
NOTICE: Acceptance of any payment under a Contract or Grant shall operate as a waiver of any defense by
the Contractor challenging.the existence of a valid Contract due to an alleged lack of actual authority to
execute the document by the signatory.
For privacy purposes DO NOT ATTACH any documentation containing personal information, such as bank
account numbers, social security numbers, driver's licenses, home addresses, social security cards or any other
personally identifiable information that you do not want released as part of a public record. The Commonwealth
reserves the right to publish the names and titles of authorized signatories of contractors.
AMIJ0RXZEDSIG1WAT0RYANAME TITLE
4 W &YA�� w
IBLACk VP
ti►�y o�z t n
I certi O H M S ?Woo. Chief P.
for thi Contaaqh'�A�ID
ident_i :ution bi
signrel
3
Mass and
a WAkt,� N-O ip
Massa land a
this H __ �_ .o any s O
business whenever the authorized signatories above retire, a
employ, have their responsibilities changed resulting in their n
the Commonwealth or whenever new signatories are designated.
Date: All it z
99 Title: #)4/0P_ Telephone: -7tt-Dgoo rrT 6
Fax:113.x yya/r Email: 4WA0). 144. v s
[Listing can not be accepted without all of this information completed.]
A copy of this listing must be attached to the "record copy" of a contract filed with the department.
Issued May
COMMONWEALTH OF MASSACHUSETTS '2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME:�a wAJ 0r q r,-4wA►"
CONTRACTOR VENDOR/CUSTOMER CODE: UIV
PROOF OF AUTHENTICATION OF SIGNATURE
This page is optional and is available for a department to authenticate contract signatures.
It is recommended that Departments obtain authentication of signature for the signatory
who submits the Contractor Authorized Listing.
This Section MUST be completed by the Contractor Authorized Signatory in presence of notary.
✓ Signatory's full legal name(print or type): C fFan5e :T' A!LO" 'J 2
✓ Title: -5M]5j?&5jV Gy lI'f DNA�o /f! 'N� ?j-)! to m
+� X
Signature as it will appetkn contract or other ument(Complete only in presence of notary):
AUTHENTICATED BY NOTARY OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS:
I, (NOTARY)as a notary public certify that I witnessed
the signature of the aforementioned signatory above and I verified the individual's identity on this date:
20
r
My commission expires on:
AFFIX NOTARY SEAL
I, (CORPORATE CLERK)certify that I witnessed the
signature of the aforementioned signatory above,that I verified the individual's identity and confirm the individual's .
authority as an authorized signatory for the Contractor on this date:
2Q
AFFIX CORPORATE SEAL
Massachusetts Emergency Management Agency—Project Management Office (MEMA-PMO)
Grant Close-Out Report for EMPG,CCP, and HMEP
This is a required report. Please complete Sections I, II, and III.
Section I: Budget
Entity that received funds
Contact Name and Telephone Number
Contact Email Address
Grant Program and FFY
Grant Award Amount
Total Funds Expended from Award
Total Reimbursement Amount
Balance
IMPORTANT: If your grant program required a match(e.g.,EMPG) please complete and submit the
MEMA-PMO Match Close-Out Report in addition to this report.
Section II: Program
in the space below, please provide the following:
1. A list of expenditures made via this grant and their programmatic application;
2. A brief summary of how these expenditures positively impacted your program; and
3. If applicable, please share a success story involving use of these funds. As an example:Town X
used EMPG funds to procure a mobile generator. During a recent storm,the generator was used
to provide power for residents who evacuated to the town's emergency.shelter.
Section Ill:Certification
I certify that all information contained within this report is accurate. Further, I certify that there were no
insta c s fraud, w e,or a se ass cia d with these grant funds
4J.Ad
Signature and Date of Authorized Officia
documentation for expenditures listed above. Please refer to MEMA's Sub-
Recipient _Reimbursement Request Guidance (April 2011) for additional
information.
By signing this reimbursement request form, I certify that all costs are
allowable, accurate, and represent costs associated with the MEMA-
approved.scope of services. In addition, I certify that this reimbursement
does not constitute `supplanting' nor `dual compensation'.
V -
Authorized Signature: .
)lr,�