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TR-2013-39 GRANT EMERG MNGMT - � �. � / r1L�'"' I n -� �/� 1 1 C470 Dy-e IA---' TR-2013-1 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 six thousand thirty and 001100 ($6,030.00) dollars; WHEREAS, Agawam Emergency Management will use the funds to purchase portable radios, batteries, iPads and chargers; and _ c7 WHEREAS, it is in the best interests of the Town of Agawam to acceptthe grant from the Massachusetts Emergency Management Agency. n� D>r— ro NOW THEREFORE, the Agawam City Council hereby resolves pursban!;n to M.G.L. c.44, §53A to- accept this grant from Massachusetts EmergTcy-, Management Agency. n© N � O C DATED THIS DAY OF , 2013. PER ORDER OF THE AGAWAM CITY COUNCIL bristopher C o son President r CC C�� VED TO FORM AND LEGALITY Vincent " scia, Solicitor cc - _EiY1 s MAYORAL ACTION Received this day of- 1°� , 2013 from Council Clerk. Signed by Council President this day of 2013. &pjAPPROVAL OF LEGISLATION By the powers vested in me pursuant to Article 3, Section 3-6 of the Ag Charter, as 1;ended, l ereby approve the passage of the above legislation on this day of ) 2013. 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 2013 for the following reason(s): Richard A. Cohen, Mayor RETURN OF LEGISLATION TO COUNCIL CLERK Returned to Council Clerk this day o& f_ , 2013. COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM y` This form is join issued and published by the Executive Office for Administration and Finance(ANF),the Office of the Co_mpJollar CT R and the Operational Services Division(OSO 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-cogfildng terms may be added by Attachment.Contractors may not require any additional agreements,engagement lette5,contract forms or other additional lerns as part of[his ConUacl without prior Department approval. CI'mck on hyperiinks for del::rations,instructions and legal requirements that are incorporated by reference into this Contract. An electronic copy of this form is available at www.mass.goylosc under Guidance For Vendors-Foms or von•!mass.goylosd under OSD Farms, CONTRACTOR LEGAL NAME: TOWN OF AGAWAM COMMONWEALTH DEPARTfr,EN T NAME: MASS EMERGENCY MANAGEMENT (and dlbla): AGENCY MMARS Department Code: CDA,EMERGENCY MANAGEMENT AGENCY Legal Address:(W•9,W4,T&C);36 MAIN ST,AGAWAM,MA 01001-1801 Business Malling Addrem .400 WORCESTER RD FRAMINGHAM ILA 01702 Contract Manager: Director Chester Nicora Bitlfng Address(if different): L.-Mall: emdlrector@lgawam,ma.us Contract hlanagec KATHLEEN ESTRIDGE Phone: Fax: E-Mail: KATHLEEN.ESTRI ;EF,�STATE,MA.US CGntraclor Vendor Cade:VC6000191692 Phone:508,820.1447 Fax: 508.820.2030 Vendor Code Address ID(e.g."AD001"): AD 001 NIMARS Doc ID(s):FYI4EMPG1200000AGAWA (Note:The Address ld Must be set up for EFT payments.) RFR1Procuremenl or Other ID Nvinber:FFY2012 EMPG X NEW CONTRACT CONTRACT AMENDMENT PROCUREMENT OR EXCEPTION TYPE:(Check one option only) Enter Current Contract End Dale Prior to Amendment .20� Statewide Contrac (OSD or an OSD-desgnated Department) Enter Amendment Amount:$ (or'no change') ^Collective Purchase(Attach OSD approval,scope,budget) AMENDMENT TYPE:(Check one option only,Attach details of Amendment changes.) X Department Procurement(includes Stale or Federal grants 815 CMR 2.001 _Amendment to Scope or Budget(Attach updated scope and budget) (Attach RFR and Response or other procurement suppoting documentation) interim Contract(Attach justification for Interim Contact and updated scope budget) _Emergency.Contract (Attach justification for emergency,scope,budget) — _Contract Employee(Attach Employment Status Farm,scope,budget) _Contract Employee(Attach any updates tp scope or budget} _LegislafivelLenal or Other:(Attach authorizing languagefjusli6calon,scope and LeuislalrvelLegaf or Other.{Ahach aulf prizing languagelusGficallonond updated budgel) R scope and budget) The follo%-Ang COMMONWEALTH TERMS AND CONDITIONS O&C)has been executed,filed vAth CTR and Is Incorporated by reference into this Contract. x Commonwealth Terms and Conditions Commomrealth Terms and Conditions For Human and Swat Services COIAPENSATION:(Check ONE option):Time Department certifies that payments for authorized perlonnanee accepted in accordance with the terns of ibis Contract will be supported In the stale accounting system by suffiden[appropriations or other non-appropriated funds,subject to intercept for Commonwealth owed debts under 815 CMR 9,00. Rate Contract(No Maximum Obligation, Attach deialls of ail rates,urits,calculations,conditions or lemu and any changes tl rates or lemts are being amended,) x Alaximum Obligation Contract Enter Total Maximum Obligation for total durabon of this Contract(or nevi Total 8 Contract is being amended),$6.030.00 PROMPT PAYMENT DISCOUNTS(PPD): Commonweallh payments are Issued through EFT 45 days from invoice receipt.Contractors requesting accederaled payments must identity a PPD as follows: Payment Issued within 10 days_%PPD;Payment issued within 15 days_%PPO;Payment issued within 20 days_%PPO;Payment issued wihn 30 days_%PPO. If PPD percentages are left blank,identify reason:,_agree to standard 45 day cycle_statutory/legal or Ready Payments(G.L.c.29.5 23A1;?L only initial payment subsequent payments scheduled to support standard EFT 45 day payment cycle.See Prompt Pay Discounls Polio BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDf,1ENT:(Enter the Contract Lille,purpose,f=I years(and a detailed description of the scope of performance or what is being amended for a Contract Amendment. Attach all supporting documentation and justifications.)Funding for this grant b provided through the FFY2012 Emergency Management Performance Gran[,the Catalog of Federal Domestic Assistance(CFDA)number is 97.042. The community Intends to purchase podabfe radlos,battery, iPad,chargers. ANTICIPATED START DATE: (Complete ONE option only)The Department and Contractor certify foi this Contract.or Contract Amendmen!,that Contract oblgations: x 1,may be incurred as of the Effective Dale(latest signature date belay)and no obligations have been incurred prior to the Effective Dale. 2.may be Incurred as of�,20_,a date LATER Ilion Ome Elfective Dale below and rio obligations have been inaured prier to the Effective Dale. —3,viers incurred as of a dale PRIOR to the Effective Date belay,and the parties agree that payments for any obligations incurred prier to the Effective Dale are authorized to be made either as settlemeal payments of as authorized reimbursement payments,and that the detals and dreuravances of all obligations under this Contract are attached and incorporaled into leis ContracL Acceptance of payments lorever releases the CommornweaRh from further claims related to these obligations. CONTRACT ENO DATE: Contract performance shall terminate as of May 31,2014 Yrth no nevi oblgations being incurred otter this dale unless the Contract is property amended, provided that the terms of this Cornvact and performance expectations and obligations shall survive its termination for the purpose of resolving any claim or dispute,forrcmpleting any negotiated temu and warranties,to al}ow any dose out or transition performance,reporting,invoicing or final payments,or during any lapse behreen amendments. CERTIFICATIONS: N0-Athslandirg verbal or ocher representations by the parties,the"Effacltve Dale"of Ihs Contract or Amendment shall be the fatesidale that this Contractor Amendment has been executed by an authorized signatory of the Contactor,the Department,or a later Contact or Amendment Start Dale spedfied above.subjecl 10 any required approvals. The Contactor makes all certifications required under the attached Contractor Cedifications(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 a l lemu governing performance of the Contrac and doing business In hlamachusetts are attached or incorporated by reference herein accizird[ng to the following hierarchy of document precedence,the applicable Commonwealth-Temms-and Conditions,this Standard Contract Form including the Instructions and Contractor CerLBcations,the Request for Response(RFR)or other solicitation,the Contractors Response, and additional negotiated terms,provided that additional negotiated temms vrill lake precedence over the relevant terms in the RFR and the Contractors Response only if made using the process outlined in B01 CMR 21.07,incorporated herein,provided that any amended RFR or Response terms result in best value,lamer costs,or a more cost ellectn+e ConUacl AUTHORIZING SIGNAT FORT CONTRACTOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH: X: X: Date: (Signature and Date Must Be Ha��nlldraitten At Time 1 Signature) (Signature and Date oust Be Handvnitten At Time of Signature) Print Name:.RAC H#F-� +r7 C.,#XW Print Name: David hlahr Print Title: qd a Print Title: Chief Financial Officer (Issued 612 712 0 1 1)Page 1 r ' Issued May COMMONWEALTH OF MASSACHUSETTS 2004 CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME : CONTRACTOR VENDOR/CUSTOMER CODE: up 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 or notary. Signatory's full legal name(print or type): MLI yOR ';�JeH#ieD dg , 00#6„/ Title: RAID rc— X Z Signature as it will appear on contract or other document (Complele only in presence of notary): AUTHE TICATED BY NOTARY OR CORPORATE CLERK (PICK ONLY ONE) AS FOLLOWS; I, U . (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: 9 �A� 1 1, � My commission expires on: 9�'r-2 1 1 J p1 U f � AFFIX NOTARY SEA:, I, (CORPORATE CLERK) certify that I witnessed the signature of the aforementioned signatory above,that I verified the individual's identity and confirm the 'rndividual's authority as an authorized signatory for the Contractor on this date: , 20 AFFIX CORPORATE SEAL ti (c) The undersigned shall require that the language of this certification be included in the award dOCuinerlt$ for all sub-awards at all tiers (including sub-grants, contracts under grants and cooperative agreements, and subcontracts)and that all stab-recipients shall certify and disclose accordingiy. .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 deharred. suspended. proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntaril) 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 cuntmissiun of an) of Ihe OftCnses enumerated iu paragraph (I )(b) of this certification: and (d) Have not �N ithin 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 duty authorized representative of the sub-recipient, I hereby certify that the sub- recipient wit! cam y with the aboveepriditions. / Signature of Authorized Signatory Date o H,!F1V ,q Aq l Printed Name Title 7 Issued May COMMONWEALTH OF MASSACHUSETTS 2004 CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME : 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. AUTHORIZED SIGNATORY NAME TITLE 1 certify that I am the President, Chief E u ive Officer, Chief Fiscal Officer, Corporate Clerk or Legal Counsel for the Contractor and as an authorized officer of the Contractor I certify that the names of the individuals identified on this listing are current as of the date of execution below and that these individuals are authorized to sign contracts and other legally binding documents related to contracts with the Commonwealth of Massachusetts on behalf of the Contractor. I understand and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state department with which the Contractor does business whenever the authorized signatories above retire, are otherwise terminated from the Contractor's employ, have their responsibilities changed resulting in their no longer being authorized to sign contracts with the Commonwealth or whenever new signatories are designated. ,::�2Z Date: I � Signature Title: f )4y,92 Telephone: 7�3` 7�a y� � EX7 �Z 0 Q Fax: 4(3 - 796- �fo� 7 Email: Cd I rnlo�- U 5 [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 : 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 "ho can sign contracts and other legally binding documents related to the contract on the Contractors 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 oat 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 ant,parment under a Contract or C:ra ni skull operate us a waiver of any derense hl, the Contractor challenrim the existence oJ•a valid Contract due to air olle ed lael; of actaul authority to execute the document 6p the signalorp. For privacy purposes DO NOT ATTACH any doctnnentation 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. /qJ,THORIKQ4IGNAT&Y NAME TITLE I certify that I am the President, Chief E secutiye Officer, Chief Fiscal Officer. Corporate Clerk or Legal Counsel for the Contractor and as an authorized officer of the Contractor I certify that the names of the individuals identified on this listing are current as of the date of execution below and that these individuals are authorized to sign contracts and other legally binding documents related to contracts with the Commonwealth of Massachusetts on behalf of the Contractor. I understand and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state department with which the Contractor does business whenever the authorized signatories above retire, are otherwise terminated from the Contractor's employ, have their responsibilities changed resulting in their no longer being authorized to sign contracts with the Commonwealth or whenever new signatories are designated. zz-, Date: ����//3 Signature // G ? Title: !/7gcil2 ftdephone: 71379L^ —Q�0 �)( T 0 G t Fax: i113-- 74— l 5.2 7 Email: WAV L 0jaAOL41A [Existing 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 %vith the department. Issued May COMMONWEALTH OF MASSACHUSETTS 2004 CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME : CONTRACTOR 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. Signatory's full legal name (print or type): CNES �2 Jar /L) 4 j�rJr Title: Signature as it will appe - n contract or ether 641111elit (Complete only in presence of notary): AUTHE '�l[CATEA BY NOT V OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS: I, "� � (NOTARY) as a notary public certify that i witnessed Me signature of the aforementioned signatory above and I verified the individual's identity on this date: qLLI,-.Q_ [I ,20 My commission expires on: AFFIX NOTARY SEAL_ 1, (CORPORATE CLERK) certifj 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: '_0 AFFIX CORPORATE SEAL TR-2013-� 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 six thousand thirty and 00/100 ($6,030.00) dollars; WHEREAS, Agawam Emergency Management will use the funds to purchase portable radios, batteries, iPads and chargers; 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 , 2013. PER ORDER OF THE AGAWAM CITY COUNCIL c� c � x v� hristopher C ohnson, President N �� ED TO FORM AND LEGALITY C VinceneF'15i6scia, Solicitor COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM This form is Jointly issued and published by the Executive Olftce lot Adrnlnislrabon and Finance(ANF4,the Office of the Comptroller f CTRI and the Onralional Services •'r , Division OSD]as the default contracl for all Commonwealth Departments when another form is not prescribed by regutabon of policy. Any ranges to the official printed ianguage of this form shall be void. Additional non-connicting terms may be added by Attachment Contractors may not require any additional agreements,engagement letters,contract forms or other add'nbonal lerrm as pare of this Contract withoul prior Department approval. Click on hyperlinks for definitions,instructions and legal requirements that are Incorporated by reference into this Contract An electronic copy of Vs form is available al+wnw.mass govlosc under Guidance For Vendors-Fonts or vA-nr.mass govlosd under OSO Foms. CONTRACTOR LEGAL NAME: TOWN OF AGAWAhi COMMONWEALTH DEPARTMENT NAME: MASS EMERGENCY MANAGEMENT (and dlbfa): AGENCY MitARS Department Code: CDA,EMERGENCY MANAGEMENT AGENCY Legal Address:(W•9,W4,T86):36 MAIN ST,AGAWAhi,MA 01001•1801 Business f,lalling Address: .400 WORCESTE:R RD FRAI,iINGHAhI IAA 01702 Contract ldanat er: Director Chester Nicora 13(Ning Address(if different): E•f�1alk emd4eclor@Agawam.ma.us Contract Manager: KATHLEEN ESTRIDGE one: Fax: E"Fail: KATHLEEN.ESTRIDGE STATEJAA.US Contractor Vendor Code:VC6000191692 Phone:508.820.1447 Fax: 508.820.2030 Vendor Code Address ID(e.g,"AD001"): AD 001 . AifAARS Doc IDfsl:FY14ElAPGt200000AGAWA (Note:The Address Id Must beset up for EFT payments,) RF&Procuremen t or OtherlD Number:FFY2012 EMPG X NEW CONTRACT _ CONTRACT AMENDMENT PROCUREMENT OR EXCEPTION TYPE:(Check one option only) EnlerCurrent Contract End Dale Pddrto Amendment .20_ Statewide Contract(OSO or an 00-designated Department) Enter Amendment Amount 5 .(or'no change') Collective Purchase(Altach OSO approval,scope,budget) AMENDMENT TYPE:(Check one option only.Attach details of Amendment changes.) X Department Procurement(includes State or Federal grams 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(Attach justification for Interim Contract and updated scopelbudgel) Emergency Contract (Atlach justification foremergenay,scope,budget) — _W Contract Employee(Attach Employment Status Form,scope,budget) _Contract EmQloyee(Attach any updates fc scope or budget) _Legislative/Legal or Other:(Attach authorizing larguagerlustification,scope and _Leuislativell-eaa(or Other:(Attach aulhonzing languagelluslification and updated budget) scope and budget) The follovAng COMMONWEALTH TERMS AND CONDITIONS(&C)has been executed,filed vrith CTR and Is Incorporated by reference into this Contract, x Commonwealth Terms and Conditions Commonwealth Tema and Conditions For Human and Social Services COMPENSATION:(Check ONE option):The Departmenl certifies that payments lot authorized performance accepted in accordance with the fenrns of this Contract vrill be supported In the state accounling system by sufficient appropriations or other non•approprialed funds,subject to intercept for Commonwealth owner debts under 815 CMR 9.00. _Rate Contract(No Maximum Obligation. Attach details of all tales,units,calculations,conditions or lemms and any changes tf tales or terms are being amended.) Y Ahi6ximuni Obligation Contract Enter Total Maximum Obligation for total duration of this Contract(or new Total 6 Contract is being amended).$6,030.00 PROMPT PAYMENT DISCOUNTS fPPD1- Commonwealth payments are Issued through EFT 45 days from Invoice receipt.Contractors requesting accelerated payments must identify a PPD as follows: Payment Issued within 10 days_%PPD;Payment issued within 15 days_%PPD;Payment issued within 20 days_%PPD;Payment issued within 30 days_%PPD. II PPD percentages are left blank,identify reason:_agree to standard 45 day cycle_statuloryRegal of Ready Payments[G.L.c.29,§23A1;7S only Initial payment subsequent payments scheduled Io support standard EFT 45 day payment cycle.See Prompt Pay Discounts Pon.) BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AIAENDMENT:(Enter the Contract titre,purpose,(sr I year(s)and a detailed description of the scope of perfomianr a or what is being amended for a Contract Amendment. Attach all supporting documentation and justifications.)Funding for this grant is provided through the FFY2012 Emergency Aianagement Performance Granl,the Calalog of Federal Domestic Assistance(CFDA)number is 97.042.The community intends to purchase portable radlos,battery, iPad,chargers. ANTICIPATED START DATE: (Complete ONE option only)The Department and Contractor certify for this Contract,or Contract Amendment,(hat Cortracl obligations: x 1.may be incurred as of the Effective Dale(latest signature dale below)and no obigalions have been incurred poor to the E ffecU+•e Date. _2.may W incurred as of-20—a date LATER ER tiian Otte Effective Dale below and Po obligations have been fnsurred for In the ENecLive Date, _3,were incurred as of a dale PRIOR to the Effective Date below,and the parties agree that payments for any obligations incurred prior to the Effective Dale are authorized to be made elther as settlement payments or as authorized reimbursement payments,and that the delails and drcurnalances of al)obligations under Nis Contract are attached and incorporated into(his Contracl. Acceptance of payments forever releases the Commonwealth from further claims related to these obligations. CONTRACT END DATE: Contract performance shall!erminale as of trio 7_y 1 2014 vrlh no new obligations being Insured aher this date unless the Contract is property amended, provided that the terms of this Contract and performance expectations and obligaliorts shall survive its termination for the purpose of resolving any claim or dispule,for oompleting any negotiated lens and warranties,to allow any close out or Vamilion performance,reporting,invoicing or final payments,or during any lapse between amendments. CERTIFICATIONS: Nolwithslandintg verbal or other representations by the parties,the"Effective Date"of this Contract or Amendment shall be the latest date that this Contract of a Amendment has been executed by an authorized sgnalory of the Contractor,the Department,or a later Contract or Amendment Start Dale specified above,subject to any required approvals. The Contractor makes all cerpftrabons required under the attached Contractor Certifications(incorporated by reference 4 not atlached hereto) under the pains ands 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 buslness In Massachusetts are attached or incorporated by reference herein according to the following hierarchy of doaiment precedence,the applicable Commonwealth Terms-and Condi' ns,this Standard Contract Form including the Instructions and Corltraclor Certifications,the Request for Response(RFR)of other sgfiatation,the Contractors Response, and additional negotiated terms,provided that additional negotlaled lems will lake precedence over the relevant tents in the RFR and the Contractor's Response only,if made us•Ing the process ouVned 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 eflective ConUacL AUTHORIZING SIGNATUReFORTa CONTRACTOR: A(iT1i0R1ZING 51GNATURJ_>0R THE COA1ftONWEALTH: x: / X: ' . Date: (Signature and Date Must Be H�an l1dwritten At Time f Signature) (Signature and Date Must Be Handvmilien Al Time of Signature) Print Name: _ILlC H#P-J) r7. 60AW Print Name: David Mahr Print Title: Print Title: Chief Financial Officer (Issued 6012011)Page 1 " Issued May COMMONWEALTH OF MASSACHUSETTS 2004 CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME : CONTRACTOR VENDOR/CUSTOMER CODE: UIP 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. r' This Section MUST be completed by the Contractor Authorized Signatory in presence of notary. Signatory's full legal name(print or type): 011Y,0R �?JCH19-P_D 10 C-OAL6/t/ Title: 177410 2 • r X Signature as it will appear on contract or other document(Complete only in presence of notary): AUTH7ww", ICATED BY(VOTARY OR CORPORATE CLERK (PICK ONLY ONE) AS FOLLOWS: 1, (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: 120 3 My commission expires on: 1 1 J pl U IS' - . AFFIX fJOTARY 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 ExeCLrlive 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 ineligihle. sentenced to a denial of Federal benefits by a State ' or Federal court, or v'oluntaril) excluded fi•om 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 anN of the offenses enunierated in paragraph (I)(b)of this cerlification: and (d) Have not )A ithin 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 ofthe 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 com y with the above nditions. 1 /43 Signature of Authorized Signatory Date Rrc_UALP _A C aHEiV a Printed Name Title 7 Issued May COMMONWEALTH OF MASSACHUSETTS 2004 CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME : CONTRACTOR VENDORICUSTOMER 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. AUTHORIZED SIGNATORY NAME TITLE .1lC I certify that I am the President,Chief u ive Officer,Chief Fiscal Officer, Corporate Clerk or Legal Counsel for the Contractor and as an authorized officer of the Contractor I certify that the names of the individuals identified on this listing are current as of the date of execution below and that these individuals are authorized to sign contracts and other legally binding documents related to contracts with the Commonwealth of Massachusetts on behalf of the Contractor. I understand and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state department with which the Contractor does business whenever the authorized signatories above retire, are otherwise terminated from the Contractor's employ, have their responsibilities changed resulting in their no longer being authorized to sign contracts with the Commonwealth or whenever new signatories are designated. Date: Signature Title: /V4 02 Telephone: Fax: 4(3 — 791- � / Email: C°� Y1��} V 5 f 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 UqP1 CONTRACTOR LEGAL NAME : 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 actuall\' made by the Contractor's authorized signatory, and not by a representative, designee or other individual.) NOTICE: Acceptance of anti pegnient under a Contruci or Grant shall operale cis a waiver of an - defieirse 6t the Contractor challenging the existence of a valid Conlracl ilue to trrr alleged lack of actual authority to execute the document bt,the sianuturY. 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. ftPjTHOR1nq41GNAT&Y NAME TITLE 1 certify that I am the President, Chien Execuiive Officer. Chief'Fiscal Officer, Corporate Clerk or Legal Counsel for the Contractor and as an authorized officer of the Contractor I certify that the names of the individuals identified on this listing are current as of the date of execution below and that these individuals are authorized to sign contracts and other legally binding documents related to contracts with the Commonwealth of Massachusetts on behalf of the Contractor. I understand and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state department with which the Contractor does business whenever the authorized signatories above retire, are otherwise terminated from the Contractor's employ, have their responsibilities changed resulting in their no longer being authorized to sign contracts with the Commonwealth or whenever new signatories are designated. Date: 7/�/./l 3 Signature 7 Title: MA_XolZ 1'elepluone: rr o " Mg WO i400 e T �Z o o Fax: 0,3-- 70 ` Y Z2 7 I mai I: (r [a-f['r'�"""'�1'I1 : IY1 5 [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 : CONTRACTOR VENDOR/CUSTOVIER 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. ti This Section MUST be completed by the Contractor authorized Signatory in presence of notary. Signatory's fuil legal name (print or type): ���s E2 J 1 1 146 1e4, Tp- Title: 41 'C Signature as it will appe n contract or other ument (Complete only in presence of notary): AUTHE �ICATED BY NOT Y OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS: 1, k Jj "t MI (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: qu-t—Q— ,20JG i My commission expires on: AFFIX NOTARY SEAL. 1, _ (('0RI10R:k1'E ('LE:RK)certify that I witnessed the signature of the aforementioned signatory above, that I verified the individuals identity and confirm the individual's authority as an authorized signatory for the Contractor on this date: ?0 AFFIX CORPORATE SEAL