TR-2015-54 GRANT EM i - ��� N(�G. vv
j \ I
TR-2015-64
A RESOLUTION ACCEPTING A GRANT FROM COMMONWEALTH OF
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER d4, SECTION 53A TO AGAWAM EMERGENCY MANAGEMENT
(Sponsored by Richard A. Cohen)
WHEREAS, Agawam Emergency Management applied for and received a
grant from the Massachusetts Emergency Management Agency; and
WHEREAS, Agawam Emergency Management desires to accept said
grant; and
WHEREAS, the grant is in the amount of six thousand four hundred sixty
and 001100 ($6,460.00) dollars;
WHEREAS, the Agawam Emergency Management will use the funds to
purchase new digital radios and accessories to enhance communication and any
other purposes said funds may be used for; 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 lq"/�AY OF `:! , 2016. or _ 'frj('01—
V ItAd I
PER ORDER OF THE AGAWAM CITY COUNCIL CC 1"M
- Y�1'�
P. .
President
A PROVED AS O FORM AND LEGALITY
Virfcent F, Gioscia, Solicitor
MAYORAL ACTION
Received this D day ofJ 2016 from Council Clerk.
Signed by Council President this r q'tyL day of 2016.
APPROVAL OF LEGISLATION
By the powers vested in me pursuant to Article 3, Section 3-6 of the Aga Charter, as
am ded, I hereby approve the passage of the above legislation on this day of
2016.
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, l hereby veto the passage of the above legislation on this day of
2016 for the following reason(s):
Richard A. Cohen,Mayor
RETURN OF LEGISLATION TO COUNCIL CLERK
Returned to Council Clerk this day of 2016.
TR-2015-54
A RESOLUTION ACCEPTING A GRANT FROM COMMONWEALTH OF
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PURSUANT TO MASSACHUSETTS GENERAL LAWS
CHAPTER 44, SECTION 63A TO AGAWAM EMERGENCY MANAGEMENT
(Sponsored by Richard A. Cohen)
WHEREAS, Agawam Emergency Management applied for and received a
grant from the Massachusetts Emergency Management Agency; and
WHEREAS, Agawam Emergency Management desires to accept said
grant; and
WHEREAS, the grant is in the amount of six thousand four hundred sixty
and 001100 ($6,460.00) dollars;
WHEREAS, the Agawam Emergency Management will use the funds to
purchase new digital radios and accessories to enhance communication and any
other purposes said funds may be used for; 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 , 2016.
PER ORDER OF THE AGAWAM CITY COUNCIL
Christopher C. J nson, President
A PROVED AS 0 FORM AND LEGALITY
Vi cent F. Gioscia, Solicitor
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
This form is jointly issued and published by the Executive Office for Administration and Finance ANF,the Office of the Comptroller(CTRI and the Operational Services Division f05D1
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 farm shall be
void. Additional non-conflicting terms may be added by Attachment.Contractors may not require any additional agreements,engagement letters,contract forms or other additional
terms as part of this Contract without prior Department approval. Click on hypedinks for definitions,instructions and legal requirements that are incorporated by reference into this
Contract. An electronic copy of this form is available at M".mass.govlosc under Guidance For Vendors-Forms or www.mass.gov/osd under LSD Forms
CONTRACTOR LEGAL NAME:AGAWAM,Town of COMMONWEALTH DEPARTMENT NAME:
(and dlbla): MMARS Department Code: Massachusetts Emergency Management Agency
Legal Address:(W•9,W4,T&C):36 Main Street Business Mailing Address: 400 Worcester Road,Framingham,MA 01702
Contraot Manager: Chet Nicora Billing Address(if different):
E-Mail: emdirectorr@agawam.ma.us C�Manager: Lord Gifford
Phone: 413.531.54791413.786.6925 Fax: E-Mail: lorri.gifford@state.ma.us
Contractor Vendor Code:VC6000191692 Phone:508.820.1407 Fax: 508.820.2030
Vendor Code Address ID(e.g."AD001"): ADS MMARS Doc IDW:FY16EMPG1500000AGAWA
(Note:The Address ld Must be set up for FAT payments.) RFRfProcurement or Other iD Number:FFY 2015 EMPG
X NEW CONTRACT _ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTION TYPE:(Check one option only) Enter Current Contract End Date Prior to Amendment: .20�
_,Statewide Contract(OSD or an OSD-designated Department) Enter Amendment Amount:3 ,(or'no change')
Collective Purchase(Attach OSD approval,scope,budget) AMENDMENLTYPE:(Check one option only.Attach details of Amendment changes.)
X Department Procurement(includes State or Federal grants 815 CMR 2.001 _Amendment to Scope or BudtreY(Attach updated scope and budget)
(Attach RFR and Response or other procurement supporting documentation)Emergency Contract (Attach justification for emergency,scope,budget) —Interim Contract(Attach justification for interim Contract and updated scope/budget)
_
Contract Employee(Attach Employment Status Form,scope,budget) _Contract Employee(Attach any updates to scope or budget)
_Legisfativell-egal or Other:(Attach authorizing languageljuslifrcation,scope and _LegislativelLegal 9r Other.(Attach authorizing languagefjustification 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.
X Commonwealth Terms and Conditions Commonwealth Terms and Conditions For Human and Social Services
COMPENSATION:(Check ONE option):The Department certifies that payments for authorized performance 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 owed debts under 815 CMR 9.00.
_Rae Conlract(No Maximum Obligation. Attach details of all rates,units,calculations,conditions or terms and any changes if rates or terms are being amended.)
)L Maximum Obligation Contract Enter Total Maximum Obligation for total duration of this Contract(or new Total if Contract is being amended).$6,460.00
PROMPT PAYMENT DISCOUNTS fPPDI: 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. If PPD percentages are felt blank,identify reason:_agree to standard 45 day cycle statutoryflegal or Ready Payments(G.L.c.29.§,23A1;x only initial
payment(subsequent payments scheduled to sqporl standard EFT 45 day payment cycle.See Prom Promot Pay Discounts Pali
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT:(Enter the Contract title,purpose,fiscal 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 is provided via Federal Fiscal Year 2015(FFY15)Emergency Management Performance Grant(EMPG),CFDA#97.042
The Town of Agawam purchase new digital radios with accessories to enhance their communications.This project was reviewed and approved by the Statewide
-Inleroperabilfty Coordinator on 1113/2015.
ANTICIPATED START DATE: (Complete ONE option only)The Department and Contractor certify for this Contract,or Contract Amendment,that Contract obligations:
X 1.may be incurred as of the Effective Date(latest signature date below)and no obligations have been incurred gElLr to the EffeclivQ Date.
_2.may be incurred as of .20_,a date LATER than the)Nective Oate below and no obligations have been incurred prior to the Eftctive Dat
_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 to the Effective Qaleare
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 incorporated into this Contract. Acceptance of payments forever releases the Commonwealth from further claims related to these obligations.
CONTRACT END DATE: Contract performance shall terminate as of June 30,2016,with no new obligations being incurred after this date unless the Contract is property amended,
provided that the terms of this Contract and performance expectations and obligations shall survive its termination for the purpose of resolving any claim or dispute,for completing
any negotiated terms and warranties,to allow any close out or transition performance,reporting,invoicing 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 Contract or
Amendment has been executed by an authorized signatory of the Contractor,the Department,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 Cgitificalin(incorporated by reference 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 Instructions and Contractor Certifications,the Request for Response(RFR)or other solicitation,the Contractor's Response,
and additional negotiated terms,provided that additional negotiated terms will take precedence over the relevant terms in the RFR and the Contractor's Response onty it 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.
AUTHORiliNf2 SIGNATURE FOR THE CONTRACTOR: AUTHORIZING SIGNATURg FOR THE COMMONWEALTH:
X: C Date. /SQCc20l� X:
• Date:
(Signature and Date Must Be Handwritten At Time of Signature) (Signature and Date Must Be Handwritten At Time of Signature)
Print Name: AlartogdK9 4 e oHeAl Print Name: David Mahr
Print Title: 0 49 t __ Print Title: Chief Administrative Officer
(Updated 3/2112014) Page 1 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
INSTRUCTIONS AND CONTRACTOR CERTIFICATIONS Complete this section ONLY if this Contract is brand new. (Complete the
CONTRACT AMENDMENT section for any material changes to an existing or an
The following instructions and berms are incorporated by reference and apply to this
Standard Contract Form.Text that appears underlined indicates a'hyperlink'to an Internet expired Contract,and for exercising options to renew or annual contracts under a
or bovkmarked site and are unofficial versions of these documents and Departments and multi"year procurement or grant program.)
PROCUREMENT OR EXCEPTION TYPE: Check the appropriate type of procurement or
Contractors should consult with their legal counsel to ensure compliance with all legal
requirements. Using the Web Toolbar will make navigation between the form and the exception for this Contract. Only one option can be selected, See Stale fn w
and
hypertinks easier. Please note that not all applicable laws have been cited, General Re uir rents Acquisition Policy and Fund_Asset, the Commodities and
CONTRACTOR LEGAL NAME (AND DlBlA): Enter the Full Legal Name of the Services Policy and the Procurement Information Center tDeoariment OvntrdcLGsridan�
for details.
Contractors business as 4 appears on the Contractor's 4N-9-9 or W-4 Form (Contract
Employees only)and the applicable Commonwealth Terms and Conditions If Contractor Statewide Contract(05D or an OSD designated Department}. Check this option for a
also has a*doing business as'(dlbla)name,BOTH the legal name and the'dAva'name Statewide Contract under OSD,or by an OSD-designated Department.
must appear in this section. Collective Purchase approved by OSD. Check this option for Contracts approved by
Contractor Legal Address: Enter the Legal Address of the Contractor as it appears on OSD for collective purchases through federal,state,local government or other entities.
the Contractor's W-9 or W4 Form (Contract Employees only) and the applicable Department Contract Procurement. Check this option for a Department procurement
Commonwealth Terms and Conditions,which must match the legal address on the 10991 including state grants and federal sub-grants under 815 CMR 2,00 and State Grants and
table in MMARS(or the Legal Address in HRICMS for Contract Employee). Federal Subgrgnts Policy, Departmental Master Agreements (MA). If mufti-Department
Contractor Contract Manager: Enter the authorized Contract Manager who will be user Contract,identify mufti-Department use is allowable in Brief Description.
responsible for managing the Contract, The Contract Manager should be an Authorized Emergency Contract. Check this option when the Department has determined that an
Signatory or, at a minimum, a person designated by the Contractor to represent the unforeseen crisis or incident has arisen which requires or mandates immediate purchases
Contractor, receive legal notices and negotiate ongoing Contract issues. The Contract to avoid substantial harm to the functioning of government or the provision of necessary or
Manager is considered'Key Personnel'and may not be changed without the prior written mandated services or whenever the health,welfare or safety of clients or other persons or
approval of the Department. If the Contract is pasted on COMM$UYS,the name of the serious damage to property is threatened.
Contract Manager must be included in the Contract on COMMBUYS. Contract Employee. Check this option when the Department requires the performance of
Contractor E•Mail AddressfPhonelFax: Enter the electronic mail (e-mail) address, an Individual Contractor,and when the planned Contract performance with an Individual
phone and fax number of the Contractor Contract Manager. This information must be kept has been classified using the Emoloyment-Stat It s Form(prior to the Contractors selection)
current by the Contractor to ensure that the Department can contact the Contractor and as work of a Contract Employee and not that of an Independent Contractor.
provide any required legal notices. Notice received by the Contract Manager (with LegislativefLegal or Other. Check this option when legislation, an existing legal
confirmation of actual receipt)through the fisted address,fax number(s)or electronic mail obligation, prohibition or other circumstance exempts or prohibits a Contract from being
address will meet any written legal notice requirements. competitively procured, or identify any other procurement exception not already fisted.
Contractor Vendor Code: The Department must enter the MMARS Vendor Code Legislative'earmarks'exempt the Contract solely from procurement requirements,and all
assigned by the Commonwealth If a Vendor Code has not yet been assigned,leave this other Contract and state finance laws and policies apply.Supporting documentation must
space blank and the Department will complete this section when a Vendor Code has been be attached to explain and justify the exemption,
assigned. The Department is responsible under the Vendor File and W-9s Policy for CONTRACT AMENDMENT(Right Side of Form)
verifying with authorized signatories of the Contractor,as part of contract execution,that Complete this section for any Contract being renewed,amended or to continue a lapsed
the legal name, address and Federal lax Identification Number (TIN) in the Contract Contract Aft Contracts with available options to renew must be amended referencing the
documents match the state accounting system. original procurement and Contract doc ids, since all continuing contracts must be
Vendor Code Address ID: (e.g., "AD001') The Department must enter the MMARS maintained in the same Contract file(even if the underlying appropriation changes each
Vendor Code Address Id identifying the payment remittance address for Contract fiscal year,)'See Amendments.S ruspgrisions.and Termination Eolicv.)
payments,which MUST be set up for EFT payments PRIOR to the first payment under the Enter Current Contract End Date: Enter the termination date of the Current Contract
Contract in accordance with the Bill Paying and Vendor File and W-9 pdides, being amended,even If this date has already passed. (Note: Current Start Date is not
COMMONWEALTH DEPARTMENT NAME: Enter the full Department name with the requested since this date does not change and is already recorded in MMARS)
authority to obligate funds encumbered for the Contract. Enter Amendment Amount:Enter the amount of the Amendment increase or decrease to
Commonwealth MMARS Alpha Department Code: Enter the three(3) letter MMARS a Maximum Obligation Contract. Enter'no change"for Rate Contracts or if no change.
Code assigned to this Commonwealth Department in the state accounting system, AMENDMENT TYPE: Identify the type of Amendment being done. Documentation
Department Business Mailing Address: Enter the address where all fomlal supporting the updates to performance and budget must be attached. Amendment to
correspondence to the Department must be sent. Unless otherwise specified in the Scope or Budget. Check this option when renewing a Contract or executing any
Contract, legal notice sent or received by the Departments Contract Manager (with Amendment('material change"in Contract terms)even if the Contract has lapsed.The
confirmation of actual receipt)through the listed address,fax number(s)or electronic mail pales may negotiate a change in any element of Contract performance or Cost identified
address for the Contract Manager will meet any requirements for legal notice. in the RFR or the Contractor's response which results in lower costs, or a more cost-
Department Billing Address: Enter the Billing Address or email address if invoices must effective or better value performance than was presented in the original selected response,
be sent to a different location. Billing or confirmation of delivery of performance issues provided the negotiation results in a better value within the scope of the RFR than what
should be resolved through the listed Contrail Managers, was proposed by the Contractor in the original selected response. Any'material,change
Department Contract Manager. Identity the authorized Contract Manager who will be in the Contract terms must be memorialized in a formal Amendment even if a
responsible for managing the Contract, who should be an authorized signatory or an corresponding MMARS transaction is not needed to support the change. Additional
employee designated by the Department to represent the Department to receive legal negotiated terns will take precedence over the relevant terms in the RFR and the
notices and negotiate ongoing Contract issues. Confractor's Response only if made using the process outlined in 801 QMR 21.07,
Department E•Mail Address/Phone/Fax: Enter the electronic mail (e-mail) address, incorporated herein, provided that any amended RFR or Response terms result in best
phone and fax number of the Department Contract Manager.Unless otherwise specified in value,lower costs,or a more cost effective Contract.
the Contract,legal notice sent or received by the Contract Manager(with confirmation of Interim Contracts.Check this option for an Interim Contract to prevent a lapse of Contract
actual receipt)through the listed address, fax number(s)or electronic mail address will performance whenever an existing Contract is being re-procured but the new procurement
meet any requirements for written notice under the Contract has not been completed,to bridge the gap during implementation between an expiring and
MMARS Document ID(s): Enter the MMARS 20 character encumbrance transaction a new procurement,or to contract with an interim Contractor when a current Contractor is
number associated with this Contract which must remain the same for the life of the unable to complete full performance under Contract.
Contract. If multiple numbers exist for this Contract,identify all Doc Ids. Contract Employee.Check this option when the Department requires a renewal or other
RFR/Procurement or Other ID Number or Name: Enter the Request for Response amendment to the performance of a Contract Employee.
(RFR) or other Procurement Reference number, Contract ID Number or other Legislative/Legal or Other. Check this option when legislation, an existing legal
referenceltracking number for this Contract or Amendment and will be entered into the obligation, prohibition or other circumstance exempts or prohibits a Contract from being
Board Award Field in the MMARS encumbrance transaction for this Contract, competitively procured, or identify any other procurement exception not already listed.
NEW CONTRACTS(left side of Form): Legislative'earmarks*exempt the Contract solely from procurement requirements,and all
other Contract and state finance laws and pobdes apply.Attach supporting documentation
to explain and justify the exemption and whether Contractor selection has been publicly
(Updated 3/21/2014) Paige 2 of 5
COMMONWEALTH OF MASSACHUSETTS STANDARD CONTRACT FORM s
posted. _ _ _ CONTRACT END DATE _
COMMONWEALTH TERMS AND CONDITIONS The Department must enter the date that Contract performance will terminate. If the
Identify which Commonwealth Terms and C ndit ns the Contractor has executed and is Contract is being amended and the Contract End Date is not changing,this date
incorporated by reference into this Contract,This Form is signed only once and recorded must be reentered again here. A Contract must be signed for at least the initial duration
on the Vendor Customer File(VCUST).See Vendor File and W9s Policy. but not longer than the period of procurement listed in the RFR, or other solicitation
COMPENSATION document(if applicable). No new performance is allowable beyond the end date without
an amendment,but the Department may allow a Contractor to complete minimal dose out
Identify it the Contract is a Rate Contract (wrth no stated Maximum Obligation) or a performance obligations 0 substantial performance has been made prior to the termination
Maximum Obligation Contract (with a stated Maximum Obligation) and identify the date of the Contract and prior to the end of the fiscal year in which payments are
Maximum Obligation, If the Contract is being amended, enter the new Maximum appropriated, provided that any close out performance is subject to appropriation and
Obligation based upon the increase or decreasing Amendment. The Total Maximum funding limits under state finance law,and CTR may adjust encumbrances and payments
Obligation must reflect the total funding for the dates of service under the contract, in the stale accounting system to enable final close out payments, Performance dates are
including the Amendment amount if the Contract is being amended. The Maximum subject to G.L.C.4
Obligation must match the MMARS encumbrance. Funding and allotments must be CERTIFICATIONS AND EXECUTION
verified as available-and engjmbered prior to incuring obligations. If a Contract includes
both a Maximum Obligation component and Rate Contract component, check off both, See DgortmM Head SA nature Auth n Poky and the Contractor A_ uthoryed
specific Maximum Obligation amounts or amended amounts and Attachments must curdy Sianatory ListinQfor policies on Contractor and Department signatures.
outline the Contract breakdown to match the encumbrance. Authorizing Signature for Contractor/Date:The Authorized Contractor Signatory must
PAYMENTS AND PROMPT PAY DISCOUNTS (in their own handwriting and in ink)sign AND enter the date the Contract is signed. See
77 section above under'Ascipate"C ntract Start Date'. Acceptance of payment by the
Payments are processed within a 45 day payment cycle through EFT in accordance with Contractor shall waive any right of the Contractor to claim the ContracUAmendment is not
the Commonwealth Bdl Paving Policy for investment and cash flow purposes. valid and the Contractor may not void the Contract. Rubber stamps,typed or other
Departments may NOT negotiate accelerated payments and Payees are NOT entitled to images are not acceptable. Proof of Contractor signature authorization on a Contra or
accelerated payments UNLESS a prompt payment discount(PPD)is provided to support Authorized Signajo tsting may be required by the Department if not already on file.
the Commonwealth's loss of investment earnings for this earlier payment, or unless a Contractor Name /Title: The Contractor Authorized Signatory's name and Gfle must
payments is legally mandated to be made in less than 45 days (e,g., construction
contracts,Ready Payments under G.L.c.29,s.23A).See Prompt Pay Discounts-Policy. appear legibly as it appears on the Cantr�ctor Au�orized Signatory Lis�ing,
PPD are idenfified as a percentage discount which will be automatically deducted when an Authorizing Signature For Commonweafth/Date:The Authorized Deoartmgnt Signature
accelerated payment is made.Reduced contracts rates may not be negotiated to replace a must(in their own handwriting and in ink)sign AND enter the date the Contract is signed,
PPD. If PPD fields are left blank please identify that the Contractor agrees to the standard See section above under 'Anticipated Slart Date'. Rubber stamps, typed or other
45 day cycle;a statutoryftegat exemption such as Ready Payments(G.L.c.29,4 23A};or images are not accepted. The Authorized Signatory must be an employee within the
only an initial accelerated payment for reimbursements or start up costs for a grant,with Department legally responsible for the Contract. See DenartmenL-Head_Sinnature
subsequent payments scheduled to support standard EFT 45 day payment cycle.Financial Authorization. The Department must have the legislative funding appropriated for all the
hardship is not a sufficient justification to accelerate cash flow for al/payments under a costs of this Contract or funding allocated under an approved lnterdeparlmectal Service
Contract, initial grant or contract payments may be accelerated for the first invoice or initial Agreement(iSA1. A Department may not contract for performance to be delivered to or by
grant installment, but subsequent periodic instafdments or invoice payments should be another state department without specific legislative authorization(unless this Contract is a
scheduled to support the Payee cash flow needs and the standard 45 day EFT payment Statewide Contract). For Contracts requiring Secretariat signoff,evidence of Secretariat
cycle in accordance with the Bill Paying Policy. Any accelerated payment that does not sgnoff must be included in the Contract file.
provide for a PPD must have a legal justification in Contract file for audit purposes Department Name ffitle:Enter the Authorized Signatory's name and We legibly.
explaining why accelerated payments were allowable without a PPD. CONTRACTOR CERTIFICATIONS AND LEGAL REFERENCES
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE Notwithstanding verbal or other representations by the parties,the"Effective Date"of this
Enter a brief description of the Contract performance,project name and/or other identifying Contract or Amendment shall be the latest date that this Contract or Amendment has been
information for the Contract to specifically identify the Contract performance,match the executed by an authorized signatory of the Contractor,the Department,or a later Contract
Contract with attachments, determine the appropriate expenditure code (as fisted in the or Amendment Start Date specified, subject to any required approvals. The Contractor
Expenditure Classification Handbook or to identify or darify,important information related makes all certifications required under this Contract under the pains and penalties of
to the Contract such as the Fiscal Year(s)of performance(ex."FY2012'or'FY2012.14'). Perjury, and agrees to provide any required documentation upon request to support
Identify settlements or other exceptions and attach more detailed justification and compliance,and agrees that all terms governing performance of this Contract and doing
supporting documents. Enter 'Multi�Department Use' if other Departments can access business in Massachusetts are attached or incorporated by reference herein:
procurement. For Amendments,identify the purpose and what items are being amended. Commonwealth and Contractor Ownership Rights.The Contractor certifies and agrees
Merely stating'see attached'or referencing attachments without a narrative description of that the Commonwealth is entitled to ownership and possession of all 'deliverables'
performance is insufficient. purchased or developed with Contract funds. A Department may not relinquish
ANTICIPATED START DATE Commonwealth rights to deliverables nor may Contractors sell products developed with
Commonwealth resources without just compensation. The Contract should detail all
The Department and Contractor must certify WHEN obligations under this Commonwealth deliverables and ownership rights and any Contractor proprietary rights.
ContracUAmendment may be incurred. Option 1 is the default option when performance Qualifications. The Contractor certifies it is qualified and shall at all times remain qualified
may begin as of the Effective Date(latest signature date and any required approvals). It to perform this Contract; that performance shall be timely and meet or exceed industry
the parties want a new Contract or renewal to begin as of the upcoming fiscal year then list standards for the performance required, including obtaining requisite licenses,
the fiscal year(s) (ex. 'FY2012' or 'FY2012-14') in the Brief Description section. registrations,permits,resources for performance,and sufficient professional,liability;and
Performance starts and encumbrances reflect the default Effective Date(if no FY is listed) other appropriate insurance to cover the performance. If the Contractor is a business,the
or the later FY start date(if a FY is listed). Use Option 2 only when the Contract will be Contractor certifies that it is listed under the Secretary of State's websile as licensed to do
signed well in advance of the start date and identify a specific future start date. Do not use business in Massachusetts,as required by law.
Option 2 for a fiscal year start unless it is certain that the Contract wilt be signed prior to
fiscal year. Option 3 is used in lieu of the Senlern net and Release Form when the Business Ethics and Fraud,Waste and Abuse Preventlon.The Contractor certifies that
Contract/Amendment is signed fate, and obligations have already been incurred by the performance under this Contract,in addition to meeting the terms of the Contract,will be
Contractor prior to the Eifertiv_a Date for which the Department has either requested, made using ethical business standards and good stewardship of taxpayer and other public
accepted or deemed legally eligible for reimbursemenl, and the Contract includes funding and resources to prevent fraud,waste and abuse.
supporting documents justifying the performance or proof of elgibibty, and approximate Collusion. The Contractor certifies that this Contract has been offered in good faith and
costs. Any obligations incurred outside the scope of the Effective Date under any Option without Collusion,fraud or unfair trade practices with any other person,that any actions to
fisted,even if the incorrect Option is selected,shall be automatically deemed a settlement avoid or frustrate fair and open competition are prohibited by law,and shall be grounds for
included under the terns of the Contract and upon payment to the Contractor will release rejection or disqualification of a Response or termination of this Contract.
the Commonwealth from further obligations for the identified performance. All settlement Public.Records and Access The Contractor shall provide full access to records related to
payments require justification and must be under same encumbrance and object codes as performance and compliance to the Department and officials listed under Executive Order
the Contract payments. Performance dates are subject to G.L.c. 9. 1J5 and G.L.c. 11,s.12 seven(7)years beginning on the first day after the final payment
(Updated 3/21/2014) Page 3 of 6
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
under this Contract or such longer period necessary for the resolution of any litigation, services are required to identify any potential conflict with representation of any
claim,negotiation,audit or other inquiry involving this Contract.Access to view Contractor Department client in accordance with Massachusetts Board of Bar Overseers(860)rules•
records related to any breach or allegation of fraud,waste and/or abuse may not be denied Federal Anti-Lobbying and Other Federal Requirements. If receiving federal funds,the
and Contractor can not claim confidentiality or trade secret protections solely for viewing Contractor certifies compliance with federal antHobbying requirements including 31 USC
but not retaining documents. Routine Contract performance compliance reports or 1 52;other federal requirements;Executive Order 11246;Air Pollution Act;Federal Water
documents related to any alleged breach or allegation of non-compliance,fraud,waste, Pollution Co ttrrgl Act and Federal Employment Laws.
abuse or collusion may be provided electronically and shall be provided at Contractors Protection of Personal Data and Information. The Contractor certifies that all steps will
own expense. Reasonable costs for copies of non-routine Contract related records shall be taken to ensure the security and confidentiality of all Commonwealth data for which the
not exceed the rates for public records under 950,C.M.R.32.00. Contractor becomes a holder, either as part of performance or inadvertently during
Debarment, The Contractor certifies that neither it nor any of its subcontractors are performance,with special attention to restricting aooess,use and disbursement of personal
currently debarred or suspended by the federal or state government under any law or data and information under G.L. c; 93H and c. 66A and Executive Order 504. The
regulation including,Executive Order 147;G.L.c.29,s.29F G.L.c.300 4 39R,G.L.049,§ Contractor is required to comply with G.L.c.931 for the proper disposal of all paper and
27C,GL.c.149.§44C, G,L,c.149.4 148B and G.L.a 152,s.25C. electronic media,backups or systems containing personal data and information,provided
Applicable Laws. The Contractor shall comply with all applicable state laws and further that the Contractor is required to ensure that any personal data or information
regulations including but not limited to the applicable Massachusetts General Laws;the transmitted electronically or through a portable device be property encrypted using(at a
Official Code of Massachusetts Regula(ons; Code of Massachusens_Revulations minimum) Information Technology Division flTDI Protection of Sensitive Information,
(unofficial); 801 CMR 21. (Procurement of Commodity and Service Procurements, provided further that any Contractor having access to credit card or banking information of
Including Human and Social Services);815 CMR 2.00(Grants and Subsidies);808 CMR Commonwealth customers certifies that the Contractor is PCI compliant in accordance with
1.00 (Compliance, Reporting and Auditing for Human And Social Services); AICPA the Payment Card indu tyt Council Standards and shall provide confirmation compliance
Standards; confidentiality of Department records under G.L. c. 66A; and the during the Contract, provide further that the Contractor shall immediately notify the
Massachusetts Constitution Article XVIII if applicable. Department in the event of any security breach including the unauthorized access,
Invoices. The Contractor must submit invoices in accordance with the terms of the disbursement, use or disposal of personal data or information, and in the event of a
Contract and the Commonwealth Bill Paying_Policv.Contractors must be able to reconcile security breach,the Contractor shall cooperate fully with the Commonwealth and provide
and property attribute concurrent payments from multiple Departments. Final invoices in access to any information necessary for the Commonwealth to respond to the security
any fiscal year must be submitted no later than August 15P for performance made and breach and shall be fully responsible for any damages associated with the Contractors
received (goods delivered, services completed) prior to June 301�, in order to make breach including but not limited to G.L.c,214.s.3B.
payment for that performance prior to the dose of the fiscal year to prevent reversion of Corporate and Business Filings and Reports. The Contractor certifies compliance with
appropriated funds.Failure to submit timely invoices by August 15u,or other date listed in 'any certification,filing,reporting and service of process requirements of the Secretary of
the Contract shall authorize the Department to issue an estimated payment based upon the Commonwealth,the Office of the Attorney Generat or other Departments as related to
the Department's determination of performance delivered and accepted.The Contractors its conduct of business in the Commonwealth;and with its incorporating state(or foreign
acceptance of this estimated payment releases the Commonwealth from further claims for entity).
these invoices. If budgetary funds revert due to the Contractors failure to submit timely Employer Requirements. Contractors that are employers certify compliance with
final invoices,or for disputing an estimated payment,the Department may deduct a penalty applicable state and federaf-employm-ent laws or regulations,including but not limited to
up to 10%from any final payment in the next fiscal year for failure to submit timely invoices. G.L.c.5,s.1(Prevailing Wages for Printing and Distribution of Public Documents);-Q"
Payments Subject To Appropriation. Pursuant toG G.L. c. 29 § 26, § 27 and § 29, 7 s.22(Prevailing ftles for CoUtracts for Mgt Prociggi andI thin f;
Departments are required to expend funds only for the purposes set forth by the mini um wa nd prevailing wage programsand Payments;uneenloymenlinsurance
Legislature and within the funding limits established through appropriation,allotment and and contributions;workers'Fomoensa)ion and insurance,child labgrJaws,AGO fair labor
subsidiary, including mandated allotment reductions triggered by G.L. c. 29, S 9C. A i s;G.L c.149 (Labor and Industries); .L. 0A(Labor Relations);G.L.c.1§1
Department cannot authorize or accept performance in excess of an existing appropriation and 455 CMR 2.00(Minimum Fair Wagesl:C.�.c.151A(Employment and Training);Q.
and allotment, or sufficient non-appropriated available funds. Any oral or written c. 151B (Unlawful Discrimination); G.L. c. 151E (Business Discrimination); .GL c. 152
representations, commitments, or assurances made by the Department or any other (Workers' Compensation); G.L. 053 (Liability for Injuries); 29 USC c' g (Federal Fair
Commonwealth representative are not binding. The Commonwealth has no legal Labor Standards);29 USC c.28 and the Federal Family and MedicaUeave Act.
obligation to compensate a Contractor for performance that is not requested and is Federal And Stag Laws And Regulations Prohibiting Discrimination including but not
intentionally delivered by a Contractor outside the scope of a Contract.Contractors should limited to the Federal ual Employment Opourtuni 0 the Anm�ricans w' }
verify funding prior to beginning performance. Disci iWe A ;42 U,S.0 Sec.12,1 1 sea.,the Rehabilitation Act,29 USC g.16 s.794;
Intercept. Contractors may be registered as Customers in the Vendor file 6 the Contractor 29 USC c.16.s.701;29 USC c,14,b23:the 42 USC c,45:(Federal Fair Housing Act);a
owes a Commonwealth debt. Unresolved and undisputed debts, and overpayments of L. c. 1510 (Unlawful Discrimination); G.L. c, J51E (Business Discrimination);the Public
Contract payments that are not reimbursed timely shall be subject to intercept pursuant to Accommodations Law G.L. c. 272. s. 92A; G.L. g, 272, and 98A, Massachusetts
G.L.c.7A,s.3 and 815 CMR 9.00. Contract overpayments will be subject to immediate Constitution Article CXIV and G.L. c. 93, s. 103; 47 USC c. 5. sc. II, Pa- Irt 1, s. 255
intercept or payment offset The Contractor may not penalize any state Department or (Telecommunication Act; Chapter 149,Section 105D,G.L.c. 151C,G.L.c.272,5 i r
assess late fees,cancel a Contract or other services if amounts are intercepted or offset 92A,Section and Sedign 9 A, and G.L. c. 111, Section 1996,and ,�h
due to recoupment of an overpayment, outstanding taxes, child support, other overdue Disci ill - ased Non-Discrimination Standards For ExeWive Branch ELrtities,and related
debts or Contract overpayments. Standards and Guidance, authorized under Massachusetts Executive Order or any
Tax Law Compliance. The Contractor certifies under the pains and penafties of perjury disability-based protection arising from state or federal law or precedent.See also MCAD
tax compliance with Federal tax laws;state tax laws including but not limited to G.L.c.62C. and MCAD links and Resources.
G.L. c. 62C, s. 49A; compliance with all state tax laws, reporting of employees and Small Business Purchasing Program(SBPP). A Contractor may be efigibte to
contractors,withholding and remitting of tax withhokfings and child support and is in good participate in the SBPP,created pursuant to Execulive Order 5 ,if qualified through the
standing with respect to all state taxes and returns due; reporting of employees and SBPP COMMBUYS subscription process at:www,commbuys.com and with acceptance of
contractors under G.L. c, 62E, withholding and remitting child support including G.L. c. the terms of the SBPP participation agreement.
119A,s.12;TIR 05.11•No independent Contractor Provisions and applicable TIRs. Limitation of Liability for information Technology Contracts(and other Contracts as
Bankruptcy,Judgments, Potential Structural Changes, Pending Legal Matters and Authorized). The Infornialion Technolggy MangatorySpecifications and the IT Agguisitio
Conflicts. The Contractor certifies it has not been in bankruptcy and/or receivership within AccesSrb4ii_ty Contact Language are incorporated by reference into Information Technology
the last three calendar years,and the Contractor certifies that it will immediately notify the Contracts. The following language will apply to Information Technology contracts in the
Department in writing at least 45 days prior to filing for bankruptcy and/or receivership, U01, UO2, UO3, U04, U05, U06, U07, U08, U09, U10, U75, U98 object codes in the
any potential structural change in its organization,or if there is any risk to the solvency of Expenditure Clagsification Handbooh or other Contracts as approved by CTR or OSD.
the Contractor that may impact the Contractors ability to timely fulfill the terms of this Pursuant to Section 11.Indemnification of the Commonwealth Terms and Conditions,the
Contract or Amendment. The Contractor certifies that at any time during the period of the term'other damages'shall include,but shaft not be limited to,the reasonable costs the
Contract the Contractor is required to affirmatively disclose in writing to the Department Commonwealth incurs to repair, return, replace or seek cover(purchase of comparable
Contract Manager the details of any judgment,criminal conviction,investigation or litigation substitute commodities and services)under a Contract.'Other damages'shall not include
pending against the Contractor or any of its officers. directors, employees, agents, or damages to the Commonwealth as a result of third party claims,provided,however,that
subcontractors, including any potential conflicts of interest of which the Contractor has the foregoing in no way limits the Commonwealth's right of recovery for personal injury or
knowledge,or learns of during the Contract term, Law firms or Attorneys providing legal property damages or patent and copyright infringement under Section 11 nor the
Commonwealth's ability to join the contractor as a third party defendant. Further,the term
(Updated 3/21/2014) Page 4 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM p
"other damages' shall not include, and in no event shall the contractor be liable for, to include a specific prohibition against the hiring at any time during the term of Contract,
damages for the Commonwealth's use of contractor provided products or services,loss of and for any position in the Contractor's company,any state management employee who is.
Commonwealth records,or data(or other intangible property),loss of use of equipment, was, or will be involved in the preparation of the RFP, the negotiations leading to the
lost revenue, lost savings or lost profits of the Commonwealth. In no event shall'other awarding of the Contract,the decision to award the Contract,and/or the supervision or
damages'exceed the greater of$100,000,or two times the value of the product or service oversight of performance under the Contract.
(as defined in the Contract scope of work)that is the subject of the claim.Section 11 sets Executive Order 444. Disclosure of Family Relationships W:th Other State Emplovee�.
forth the contractor's entire liability under a Contract.Nothing in this section shall limit the Each person applying for employment (including Contract work) within the Executive
Commonwealth's ability to negotiate higher limitations of liability in a particular Contract, Branch under the Govemor must disclose in writing the names of all immediate family
provided that any such limitation must specifically reference Section 11 of the related to immediate family by marriage who serve as employees or elected officials of the
Commonwealth Terms and Conditions. in the event the limitation of liability conflicts with Commonwealth. All disclosures made by applicants hired by the Executive Branch under
accounting standards which mandate that there can be no cap of damages,the limitation the Governor shall be made available for public inspection to the extent permissible by law
shall be considered waived for that audit engagement. These terns may be applied to by the official with whom such disclosure has been filed.
other Contracts only with prior written confirmation from the Operational Services Division Exec ive Order 504. Reg_ardino the Security and Confidentiality of Personal InfQimetjon.
or the Office of the Comptroller.The terns in this Clarification may not be modified. For all Contracts involving the Contractor's access to personal information,as defined in
Northern Ireland Certification. Pursuant to G.L. c. 7 s. 22C for state agencies, state G.L. c. 93H, and persorai data, as defined inG G.L. c. 66A, owned or controlled by
authorities,the House of Representatives or the state Senate,by signing this Contract the Executive Department agencies,or access to agency systems containing such information
Contractor oertfies that it does not employ ten or more employees in an office or other or data(herein collectively'personal information'),Contractor certifies under the pains and
facility in Northern Ireland and if the Contractor employs ten or more employees in an office penalties of perjury that the Contractor (1) has read Commonwealth of Massachusetts
or other facility located in Northern Ireland the Contractor certifies that it does not Executive Order 504 and agrees to protect any and all personal information;and(2)has
discriminate in employment, compensation, or the terms, conditions and privileges of reviewed all of the Commonwealth Information Technology Division's Securihr
employment on account of religious or political belief;and it promotes religious tolerance Policies. Nobvfthstanding any contractual provision to the contrary,in connection with the
within the work place, and the eradication of any manifestations of religious and other Contractor's performance under this Contract, for all state agencies in the Executive
illegal discrimination;and the Contractor is not engaged in the manufacture,distribution or Department,including all executive offices,boards,commissions,agencies,departments,
sale of firearms,munitions,including rubber or plastic bullets,tear gas,armored vehicles or divisions, councils, bureaus, and offices, now existing and hereafter established, the
military aircraft for use or deployment in any activity in Norther Ireland. Contractor shall: (1) obtain a copy, review, and comply with the contracting agency's
Pandemic,Disaster or Emergency Performance. In the event of a serious emergency, Information Security Program(ISP)and any pertinent security guidelines,standards,and
pandemic or disaster outside the control of the Department,the Department may negotiate policies; (2) comply with all of the Commonwealth of Massachusetts Information
emergency performance from the Contractor to address the immediate needs of the Technology Division's 'Security P icies') (3) communicate and enforce the contracting
Commonwealth even If not contemplated under the original Contract or procurement. agency's ISP and such Security Policies against all employees(whether such employees
Payments are subject to appropriation and other payment terms. are direct or contracted) and subcontractors; (4) implement and maintain any other
Consultant Contractor Certifications (For Consultant Contracts "HH" and 'NN" and reasonable appropriate security procedures and practices necessary to protect personal
11.1105'object codes subject to G.L.Chaar 2 .29 . Contractors must make required information to which the Contractor is given access by the contracting agency from the
disclosures as part of the RFR Response or using the Consultant Contractor Mandatory unauthorized access,destruction,use,modification,disclosure or loss;(5)be responsible
submission Forth, for the full or partial breach of any of these terms by its employees (whether such
Attorneys. Attorneys or firms providing legal services or representing Commonwealth employees are direct or contracted) or subcontractors during or after the term of this
Departments may be subject to G.L.c.30,s.Q5,and H providing litigation services must be Contract,and any breach of these terms may be regarded as a material breach of this
approved by the Office of the Attomey General to appear on behalf of a Department,and Contract; (6) in the event of any unauthorized access, destruction, use, modification,
shall have a continuing obligation to notify the Commonwealth of any conflicts of interest disclosure or loss of the personal information(collectively referred to as the"unauthorized
arising under the Contract. use'):(a)immediately notify the contracting agency if the Contractor becomes aware of the
Subcontractor Performance. The Contractor certifies full responsibility for Contract unauthorized use;(b)provide full cooperation and access to information necessary for the
performance, including subcontractors, and that comparable Contract terms will be contracting agency to determine the scope of the unauthorized use; and(c)provide full
included in subcontracts, and that the Department will not be required to directly or cooperation and access to information necessary for the contracting agency and the
indirectly manage subcontractors or have any payment obligations to subcontractors.. Contractor to fulfill any notification requirements.Breach of these terms may be regarded
EXECUTIVE ORDERS as a material breach of this Contract,such that the Commonwealth may exercise any and
For covered Executive state Departments, the Contractor certifies compliance with all contractual rights and remedies, including without limitation indemnification under
applicable Executive-Orders(see also Massachuselts Executive Orders/,including but not Section 11 of the Commonwealth's Terms and Condi' , withholding of payments,
limited to the specific orders listed below. A breach during period of a Contract may be Contract suspension, or termination, In addition, the Contractor may be subject to
considered a material breach and subject Contractor to appropriate monetary or Contract applicable statutory or regulatory penalties,including and without limitation,those imposed
sanctions. pursuant to G.L.c.93H and under a..L.c.214,4 38 for violations under M.G.L c.66A.
Executive Order 481. Prohibiting th5 Use of UndocumentedV1�ers on State Contracts. Executive Orders 523, 524 and 526. Executive Order 526 (Order Regarding Nan-
Discrimination, Diversity Equal Opportunity and Affirmative Action which supersedes
For all state agencies in the Executive Branch, including all executive offices, boards, Executivq Order 47 , Executive Order 524 (Establishing the Massachusetts Supplier
commissions, agencies, Departments, divisions, councils, bureaus, and offices, now Diversity Program which supersedes Executive Order 390). Executive Doer 523
existing and hereafter established, by signing this Contract the Contractor certifies under (Establishing the Massachusetts Small Business Purchasing Program.) All programs,
the pains and penalties of perjury that they shall not knowingly use undocumented workers activities, and services provided, performed, licensed, chartered, funded, regulated, or
in connection with the performance of this Contract;that,pursuant to federal requirements, contracted for by the state shall be conducted without unlawful discrimination based on
shall verify the immigration status of workers assigned to a Contract without engaging in race color, age, gender, ethnicity, sexual orientation, gender identity or expression,
unlawful discrimination;and shall not knowingly or recklessly alter,falsify,or accept altered religion,creed,ancestry, national origin,disability,veteran's status(including Vietnam-era
or falsified documents from any such worker veterans), or background. The Contractor and any subcontractors may not engage in
Executive Order 130. co An i-Bo . The Contractor warrants,represents and agrees that discriminatory employment practices; and the Contractor certifies Compliance with
during the time this Contract is in effect,neither it nor any affiliated company,as hereafter applicable federal and state laws, rules, and regulations governing fair labor and
defined,participates in or cooperates with an international boycott(See IRC&999ibif3l- employment practices;and the Contractor commits to purchase supplies and services from
(o,and IRS Audit idelin So or engages in conduct declared to be unlawful by cerfifed minority or women-owned businesses,small businesses,or businesses owned by
G.L,c. 151E.s.2. A breach in the warranty,representation,and agreement contained in socially or economically disadvantaged persons or persons with disabilities These
this paragraph,without limiting such other rights as it may have,the Commonweafth shall provisions shall be enforced through the contracting agency, OSO, and/or the
be entitled to rescind this Contract. As used herein,an aff:frated company shall be any Massachusetts Commission Against Discrimination.Any breach shall be regarded as a
business entry of which at least 51%of the ownership interests are directly or indirectly material breach of the contract that may subject the contractor 10 appropriate sanctions.
owned by the Contractor or by a person or persons or business entity or entities directly or
indirectly owning at least 51%of the ownership interests of the Contractor,or which directly
or indirectly owns at least 51%of the ownership interests of the Contractor.
Executive Order 346._Hiring of Stale Employees By Slate Contractors Contractor certifies
compliance with both the conflict of interest law G.L.c.268A specifically s.5 ffl and this
order; and includes limitations regarding the hiring of state employees by private
companies contracting with the Commonwealth. A privatization contract shall be deemed
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On Completing the Contractor Authorized Signatory List (CASLI_Document:
The person signing the contract must be authorized by the entity receiving the grant to sign
contracts.
The CASL document is the form used for this authorization.
4
This two-page form must be completed by MEMA sub-recipients (the "Contractor") in order to
process your contract; both pages must be completed - the second page must be notarized.
The Contractor (i.e., the entity receiving this grant - Municipality, Tribe, etc) must provide a
listing of individual(s) 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.
The person signing the contract must be listed in the table on page 1 of the CASL. In addition,
this person must provide a notarized specimen of their signature on page 2 of the CASL.
The individual who authorizes the above-referenced individual(s) must be either a Mayor, Town
Manager, President, CEO, CFO, Corporate Clerk, or Legal Counsel for the entity receiving the
contract. This authorizing individual would provide their: signature, date, and requested contact
information on page 1 of the CASL
The authorizing individual — unless they are the Mayor, Town Manager, President CEO CFO
Corporate Clerk, or Legal Counsel - cannot authorize himself/herself to sign the contract.
MEMA must have the completed and original copy of the CASL in order to process contracts.
Fiscal Year 2015: DHS Standard Terms and Conditions
1. Assurances, Administrative Reauir_ements and Cost Principles
Recipients of DHS federal financial assistance must complete OMB Standard
Form 424B Assurances — Non-Construction Programs. Certain assurances in
this document may not be applicable to your program, and the awarding
agency may require applicants to certify additional assurances. Please
contact the program awarding office if you have any questions.
The administrative, cost principles and audit requirements that apply to
DHS award recipients originate from:
2 CFR Part 200, Section 3002, Uniform Administrative Requirement, Cost
Principles, and Audit Requirements for Federal Awards.
.H. Ac nowledgement of Federal Fundin_gjrom DHS
All recipients must acknowledge their use of federal funding when issuing
statements, press releases, requests for proposals, bid invitations, and other
documents describing projects or programs funded in whole or in part with
Federal funds.
III. Activities Qonduc gd Abroad
All recipients must ensure that project activities carried on outside the United
States are coordinated as necessary with appropriate government authorities
and that appropriate licenses, permits, or approvals are obtained.
IV. Aae Discriminafion Act gf 1975
All recipients must comply with the requirements of the Age Discrimination Act of
1975 (42 U.S.C. 6101 et seg.), which prohibits discrimination on the basis of
age in any program or activity receiving Federal financial assistance.
V.
All recipients must comply with the requirements of Titles I, 11, and III of the
Americans with Disabilities Act, which prohibits recipients from discriminating on
the basis of disability in the operation of public entities, public and private
transportation systems, places of public accommodation, and certain testing
entities (42 U.S.C. §,q 12101-12213).
VI. Best Practices for Collection and Use of Personally Identifiable Information
LEM
All recipients who collect PII are required to have a publically-available privacy
policy that describes what Pl I they collect, how they use the Pll, whether they
share PH with third parties, and how individuals may have their PII corrected
where appropriate.
Standard Perms& Conditions: Version 5.0 January 21, 2015
1
Award recipients may also find as a useful resource the DHS Privacy impact
Assessments: Privacy Guidance and Privacy template respectively.
ViL Title VI of the Civil Rights Act of 19§4
All recipients must comply with the requirements of Title VI of the Civil Rights Act
of 1964 (42 U.S.C. §2000d et sea.), codified at 6 CFR Part 21 and 44 CFR Part
7, which provides that no person in the United States will, on the grounds of race,
color, or national origin, be excluded from participation in, be denied the benefits
of, or be subjected to discrimination under any program or activity receiving
Federal financial assistance.
ViII. Civil Rights Act of 1968
All recipients must comply with Title Vill of the Civil Rights Act of 1968, which
prohibits recipients from discriminating in the sale, rental, financing, and
advertising of dwellings, or in the provision of services in connection therewith,
on the basis of race, color, national origin, religion, disability, familial status, and
sex (42 U.S.C. § 3601 et seq.), as implemented by the Department of Housing
and Urban Development at 24 CFR Part 100. The prohibition on disability
discrimination includes the requirement that new multifamily housing with four or
more dwelling units—i.e., the public and common use areas and individual
apartment units (all units in buildings with elevators and ground-floor units in
buildings without elevators)—be designed and constructed with certain
accessible features (see 24 CFR 5 100.201).
IX. Copyright
All recipients must affix the applicable copyright notices of 17 U.S.C. § 401 or
402 and an acknowledgement of Government sponsorship (including award
number) to any work first produced under Federal financial assistance awards,
unless the work includes any information that is otherwise controlled by the
Government (e.g., classified information or other information subject to national
security or export control laws or regulations).
X. Debarment and SusRension
All recipients must comply with Executive Orders 12549 and 12689, which
provide protection against waste, fraud and abuse by debarring or suspending
those persons deemed irresponsible in their dealings with the Federal
government.
XI. Drug-Free Workplace Regulgbons
All recipients must comply with the Drug-Free Workplace Act of 1988 (412
U.S.C. $ 701 et sea.), which requires that all organizations receiving grants from
any Federal agency agree to maintain a drug-free workplace. These regulations
are codified at 2 CFR 3001.
Standard Terms& Conditions: Version 5.0 January 21, 2015
2
XII. Quolication of Benefits
State, Local and Tribal Recipients must comply with 2 CFR Part §225, Appendix
A, paragraph (C)(3)(c), which provides that any cost allocable to a particular
Federal award or cost objective under the principles provided for in this authority
may not be charged to other Federal awards to overcome fund deficiencies.
XIII. Enemy Policv and Conservation Ag
All recipients must comply with the requirements of 42 U.S.C. §6201 which
contain policies relating to energy efficiency that are defined in the state energy
conservation plan issues in compliance with this Act.
XIV. Rej2ortiaa Suba,, gUk and ExeIZUtiye Compensation
A. First-tier Subawards.
All recipients, unless exempt as provided in paragraph D, must report each
action that obligates $25,000 or more in Federal funds that does not include
Recovery funds (as defined in section 1512(a)(2) of the American Recovery
and Reinvestment Act of 2009, Pub. L. 111-5) for a subaward to an entity.
Recipients must report the information about each obligating action in
accordance with the submission instructions posted at http://www.fsrs.gov
specify.
B. Total Compensation of Recipient Executives.
1. All recipients must report total compensation for each of the five most
highly compensated executives for the preceding completed fiscal year,
if,
a. the total Federal funding authorized to date under this award is
$25,000 or more;
b. in the preceding fiscal year, recipients received —
i. Eighty percent or more of the annual gross revenues from
Federal procurement contracts (and subcontracts) and Federal
financial assistance subject to the Transparency Act, as defined
at 2 CFR 170.320 (and subawards); and
ii. $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial
assistance subject to the Transparency Act, as defined at 2
CFR 170.320 (and subawards); and
c. The public does not have access to information about the
compensation of the executives through periodic reports filed the
Securities Exchan a Act of 1934 and Internal Revenue Code of
1986.
2. Where and when to report. Recipients must report executive total
compensation described in paragraph b.1 of this award term:
a. As part-of the registration profile at hftp://www.sam.gov.
b. By the end of the month following the month in which this award
is made, and annually thereafter.
Standard Terms& Conditions: Version 5.0 January 21, 2015
3
C. Total Compensation of Subrecipient Executives.
All recipients unless exempt as provided in paragraph d. of this award
term, for each first-tier subrecipient. Recipients must report the names
and total compensation of each of the subrecipient's five most highly
compensated executives for the subrecipient's preceding completed
fiscal year, if
a. in the subrecipient's preceding fiscal year, the subrecipient
received—
i. 80 percent or more of its annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal
financial assistance subject to the Transparency Act, as
defined at 2 CFR 170.320 (and subawards); and
ii. $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts), and Federal
financial assistance subject to the Transparency Act (and
subawards); and
b. The public does not have access to information about the
compensation of the executives through periodic reports filed
under section 13(a) or 15(d) of the Securities Exchange Act of
1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal
Revenue Code of 1986.
D. Exemptions
All recipients' gross income, from all sources of the previous tax year,
under $300,000, are exempt from the requirements to report:
a. Subawards, and
b. The total compensation of the five most highly compensated
executives of any subrecipient.
XV. False Claims-Act aad Program Fraud_Civil Remedies
All recipients must comply with the requirements of 31 U.S.C. §3729 which set
forth that no recipient of federal payments shall submit a false claim for payment.
See also 38 U.S.C.§_3801-3812 which details the administrative remedies for
false claims and statements made.
XVI.
All recipients are required to be non-delinquent in their repayment of any
Federal debt. Examples of relevant debt include delinquent payroll and other
taxes, audit disallowances, and benefit overpayments. See OMB Circular A-129
and form SF-42413, item number 17 for additional information and guidance.
XVII. Fly America Act of 1974
All recipients must comply with Preference for U.S. Flag Air Carriers: (air
carriers holding certificates under 49 U.S.C, $ 41102) for international air
transportation of people and property to the extent that such service is available,
in accordance with the International Air Transportation Fair Competitive
Practices Act of 1974 (49 U.S.C. § 40118) and the interpretative guidelines
Standard Terms& Conditions: Version 5.0 January 21, 2015
4
issued by the Comptroller General of the United States in the March 31, 1981,
amendment to Comptroller General Decision B138942.
XVIII. Hotel and Motel Fire Safety Act of 190
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990,
15 U.S.C. §2225a, all recipients must ensure that all conference, meeting,
convention, or training space funded in whole or in part with Federal funds
complies with the fire prevention and control guidelines of the Federal Fire
Prevention and Control Act of 1974, 15 U.S.C. §2225.'
XIX. Limited English Proficiency (Civil Rights Act of 1964, Titles
All recipients must comply with the Title VI of the Civil Rights Act of 1964 (Title
VI) prohibition against discrimination on the basis of national origin, which
requires that recipients of federal financial assistance take reasonable steps to
provide meaningful access to persons with limited English proficiency (LEP) to
their programs and services. Providing meaningful access for persons with LEP
may entail providing language assistance services, including oral interpretation
and written translation. In order to facilitate compliance with Title VI, recipients
are encouraged to consider the need for language services for LEP persons
served or encountered in developing program budgets. Executive Order 13166,
Improving Access to Services for Persons with Limited English Proficiency
(August 11, 2000), requires federal agencies to issue guidance to recipients,
assisting such organizations and entities in understanding their language access
obligations. DHS published the required recipient guidance in April 2011 , DHS
Guidance to Federal Financial Assistance Recipients Regarding Title VI
Prohibition Against National Origin Discrimination Affecting Limited English
Proficient Persons, 76 Fed. Reg. 21755-21768, (April 18, 2011). The Guidance
provides helpful information such as how a recipient can determine the extent of
its obligation to provide language services; selecting language services; and
elements of an effective plan on language assistance for LEP persons. For
additional assistance and information regarding language access obligations,
please refer to the DHS Recipient Guidance hfgs://www.dhs.-gov/guidance-
published-help_department-supported-organizations-provide-meanin fg ul-access-
people-limited and additional resources on hfp://www.lep.gov.
XX. Lobbying Prohibitions
All recipients must comply with 31_U.S.C. §1352, which provides that none of the
funds provided under an award may be expended by the recipient to pay any
person to influence, or attempt to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with any Federal action
concerning the award or renewal.
Standard Terms& Conditions: Version 5.0 January 21, 2015
5
XXI. Non-gu pp ianting Reguiremen#
All recipients who receive awards made under programs that prohibit
supplanting by law must ensure that Federal funds do not replace
(supplant) funds that have been budgeted for the same purpose through
non-Federal sources. Where federal statues for a particular program
prohibits supplanting, applicants or recipients may be required to
demonstrate and document that a reduction in non-Federal resources
occurred for reasons other than the receipt of expected receipt of Federal
funds.
XXII. Patents and Intell2ctuall Prgl2e&j Rights
Unless otherwise provided by law, recipients are subject to the Bavh-Dole Act,
Publ. L. No 96-517, as amended, and codified in 35 U.S.C. section 200 et seq.
All recipients are subject to the specific requirements governing the
development, reporting, and disposition of rights to inventions and patents
resulting from financial assistance awards are in 37 C.F.R. Part 401 and the
standard patent rights clause in 37 C.F.R. section 401.14.
XXIII. P14curement of Recovered, Materials
All recipients must comply with section 6002 of the Solid Waste Disposal
act, as amended by the Resource Conservation and Recovery Act. The
requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 CFR part
247 that contain the highest percentage of recovered materials practicable,
consistent with maintaining a satisfactory level of competition, where the
purchase price of the item exceeds $10,000 or the value of the quantity
acquired by the preceding fiscal year exceeded $10,000; procuring solid
waste management services in a manner that maximizes energy and
resource recovery; and establishing an affirmative procurement program for
procurement of recovered materials identified in the EPA guidelines.
XXIV. Contract Provisions for Non-federal Entity Contracts under Federal Awards
a. Contracts for more than the simplified acquisition threshold set at
150 000.
All recipients who have contracts exceeding the acquisition threshold
currently set at $150,000, which is the inflation adjusted amount
determined by Civilian Agency Acquisition Council and the Defense
Acquisition Regulation Council as authorized by 41 U.S.C. �1908,
must address administrative, contractual, or legal remedies in
instance where contractors violate or breach contract terms and
provide for such sanctions and penalties as appropriate.
b. Contracts in excess of$10,000.
All recipients that have contracts exceeding $10,000 must address
termination for cause and for convenience by the non-Federal entity
Standard Terms& Conditions: Version 5.0 January 21, 2015
6
including the manner by which it will be effected and the basis for
settlement.
XXV. SAFECOM
All recipients who receive awards made under programs that provide
emergency communication equipment and its related activities must comply
with the SAFECOM Guidance for Emergency Communication Grants,
including provisions on technical standards that ensure and enhance
interoperable communications.
XXVI. Terrorist Financinct-E.O. 13224
All recipients must comply with U.S. Executive Order 13224 and U.S. law that
prohibit transactions with, and the provisions of resources and support to,
individuals and organizations associated with terrorism. It is the legal
responsibility of recipients to ensure compliance with the E.O. and laws.
XXVII.
Edugation Act)
All recipients must comply with the requirements of Title IX of the Education
Amendments of 1972 (20 U.S.C. § 1681et seq.), which provides that no person
in the United States will, on the basis of sex, be excluded from participation in, be
denied the benefits of, or be subjected to discrimination under any educational
program or activity receiving Federal financial assistance. These regulations are
codified at 6 CFR Part 17 and 44 CFR Part 19
XXVIII. TrAfficking_VictiMA Protection Act of 2000
All recipients must comply with the requirements of the government-wide award
term which implements Section 106(g) of the Trafficking Victims Protection Act
(TVPA) of 2000, as amended (22 U.S.C. § 7104), located at 2 CFR Part 175.
This is implemented in accordance with OMB Interim Final Guidance, Federal
Register, Volume 72, No. 218, November 13, 2007. Full text of the award term is
provided at 2 CFR § 175,15.
XXIX. Rehabilitation Act of 1973
All recipients of must comply with the requirements of Section 504 of the
Rehabilitation Act of 1973, 29 U.S.C. 4 794, as amended, which provides that no
otherwise qualified handicapped individual in the United States will, solely by
reason of the handicap, be excluded from participation in, be denied the benefits
of, or be subjected to discrimination under any program or activity receiving
Federal financial assistance. These requirements pertain to the provision of
benefits or services as well as to employment.
XXX. USA Patriot Act of 2001
Standard Terms& Conditions: Version 5.0 January 21, 2015
7
All recipients must comply with the requirements of the Uniting and
Strengthening America by Providing Appropriate Tools Required to Intercept
and Obstruct Terrorism Act (USA PATRIOT Act), which amends 18 U.S.C.
175-175c. Among other things, the USA PATRIOT Act prescribes criminal
penalties for possession of any biological agent, toxin, or delivery system of a
type or in a quantity that is not reasonably justified by a prophylactic, protective,
bona fide research, or other peaceful purpose.
XXXI.
All recipients must obtain DHS's approval prior to using the DHS seal(s), logos,
crests or reproductions of flags or likenesses of DHS agency officials, including
use of the United States Coast Guard seal, logo, crests or reproductions of flags
or likenesses of Coast Guard officials.
XXXII.Whistleblower Protection Act
All recipients must comply with the statutory requirements for whistleblower
protections (if applicable) at 10 U.S.0 2409, 41 U.S.C. 4712, and 10 U.S.C. 2324,
41 U.S.C. 4304 and 4310.
XXXIII. DHS Specific Acknowledgements and Assurances
All recipients must acknowledge and agree—and require any sub-recipients,
contractors, successors, transferees, and assignees acknowledge and
agree—to comply with applicable provisions governing DHS access to
records, accounts, documents, information, facilities, and staff.
1. Recipients must cooperate with any compliance review or complaint
investigation conducted by DHS.
2. Recipients must give DHS access to and the right to examine and copy
records, accounts, and other documents and sources of information related to
the grant and permit access to facilities, personnel, and other individuals and
information as may be necessary, as required by DHS regulations and other
applicable laws or program guidance.
3. Recipients must submit timely, complete, and accurate reports to the
appropriate DHS officials and maintain appropriate backup documentation to
support the reports.
4. Recipients must comply with all other special reporting, data
collection, and evaluation requirements, as prescribed by law or
detailed in program guidance.
5. If, during the past three years, the recipient has been accused of
discrimination on the grounds of race, color, national origin (including limited
English proficiency), sex, age, disability, religion, or familial status, the
recipient must provide a list of all such proceedings, pending or completed,
Standard Terms& Conditions: Version 5.0 January 21, 2015
8
including outcome and copies of settlement agreements to the DHS awarding
office and the DHS Office of Civil Rights and Civil Liberties.
6. In the event any court or administrative agency makes a finding of
discrimination on grounds of race, color, national origin (including limited English
proficiency), sex, age, disability, religion, or familial status against the recipient,
or the recipient settles a case or matter alleging such discrimination, recipients
must forward a copy of the complaint and findings to the DHS Component
and/or awarding office.
The United States has the right'to seek judicial enforcement of these obligations.
-z' o lS_
Signature of Authorized Signatory Date
11)4 VOIZ
Printed Name
Standard Terms&Conditions: Version 5.0 January 21, 2015
9
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING -CN—
CONTRACTOR LEGAL NAME:
CONTRACTOR VENDORICUSTOMER CODE: UVP
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
IC li,4R A Ce H0nl a
I certify that I am the President,Chief Executive 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 Iisting 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.
700"OfZ,1,6111(�,' Z�L Date: ��
Signature
Title: Mqyorll Telephone: 1113 - 7S4 c We x
Fax: Email:
ct , It S
[Listing can not be accepted without all of this information completed.]
A copy of this fisting 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 VENDORICUSTOMER 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): /?T L
Title: m•19 y6l'2,
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, bkh (NOTARY)as a notary public certify that I witnessed
the signature of the aforemen Toned signatory above and I verified the individual's identity on this da
!9 1S
My commission expires on: t j"y ^X,9,9,
AFFIX NOTARY SEAL
I, (CORPORATE CLERK)certify that 1 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:
,24
AFFIX CORPORATE SEAL
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 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
I certify that I am the President,Chief Executive 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. 1 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.
jo / a, 2
✓ 7'Z—Z,�'( tom/ ✓
Date:
Signature
Title: #74v0e Telephone: 413 - 7e4-0LI-00 x $Z`0
Fax: 03-74A( Email:
[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:
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):
Title:
X
Signature as it will appear oiVontract or other docume J omplete only in presence of notary):
AUTHENTICATED BY NOTARY OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS:
1, 6 a (NOTARY)as a notary public certify that I witnessed
the signature of the afore[meentio ed signatory above and I verified the individual's identity on this date:
My commission expires on: — !
AFFIX NOTARY SEAL
1, (CORPORATE CLERK)certify that 1 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 MANAGNMENT OFFICE
Special Terms, Conditions, and Reporting Requirements for EMPG, CCP, and
HMEP Serb-Recipients
September 2015
Parties
The "Contractor"or"Sub-recipient" is an eligible public or private not-for-profit entity that has
submitted an application for grant funding to the Massachusetts Emergency Management Agency
(MEMA) and has received an approved award. The sub-recipient must be represented by a duly
authorized official(s)of the Contractor whose signature(s), authorization(s), and/or
certification(s) legally represent and bind the Contractor. The Commonwealth of Massachusetts,
acting through the Massachusetts Emergency Management Agency("Department"), is
responsible for administering this grant program.
Agreement
The Sub-recipient and Department will execute a State Standard Grant Contract through
which the subrecipient agrees to perform all activities as described in the attached
application within the budget, dates of service, and other conditions set forth below. The
Department agrees to reimburse the Sub-recipient for all allowable costs incurred and to
provide technical assistance and support required to carry out the purposes of the grant.
Terms and Conditions
I. Emergency Management Performance Grant (EMPG) and Citizen Corps Program
(CCP)sub-recipients agree to adhere to all policies and guidance documents set by the
U.S. Department of Homeland Security-Federal Emergency Management Agency _
(DHS/FEMA)and the Massachusetts Emergency Management Agency(MEMA)
regarding use of the U.S. DHS-FEMA federal homeland security funding.
2. Hazardous Material Emergency Preparedness (f3ffP) sub-recipients agree to
adhere to all policies and guidance documents set by the U.S. Department of
Transportation—Pipeline and Hazardous Materials Safety Administration
(DOT/PHMSA)and MEMA regarding use of the U.S. DOT-PHMSA funding.
3. Any substantive adjustment to a sub-recipient's scope of work or budget must be
reviewed and approved by MEMA prior to expenditure. A contract amendment may be
required prior to performance under an adjusted scope of work. Work or expenditures
made outside an approved scope of work or budget may not be reimbursed.
4. Sub-recipients agree to be compliant with the National Incident Management System
(NIMS).
1
5. Sub-recipients agree to comply with the following:
■ 2 CFR Part 200: Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for Federal Awards
■ 815 CMR 2.00: State Grants,Federal Grant Awards, Federal Subgrants,
and Federal Subsidies
6. Federal Funding Accounting and Transparency Act (FFATA). FEMA federal funds
are subject to the Federal Funding Accounting and Transparency Act(FFATA). Sub-
recipient agrees to abide by FFATA regulations and to submit the attached FFATA form
along with its contract package for all contracts in excess of$25,000.
7. 2 CFR 200 Subpart F Audit Reports, Subpart F Form. (Replaces former A-133
Requirements). Per Office of Management and Budget(OMB)regulations, sub-recipient
may be subject to Subpart F audit requirements. Sub-recipient agrees to submit a copy of
any Subpart F audits reports as required by Subpart F. Sub-recipient further agrees to
notify MEMA of any Subpart F audit findings related to any federally funded activities.
Sub-contractor acknowledges that a Corrective Action Plan may be required by MEMA
for related findings prior to execution of contracts or issuance of payments. Sub-recipient
agrees to abide by OMB regulations and to submit the attached Subpart F
acknowledgement form as part of this contract package.
8. Sub-recipient Risk Assessment and Monitoring. (Replaces former A-]33 Monitoring
Form). Per 2 CFR 200.331, prior to awarding of this contract, the sub-recipient must
provide to the Department the attached Sub-recipient Risk Assessment Questionnaire and
Response form. Sub-recipient further agrees to monitoring by the Department as a result
of its assessment of the sub-recipient's risk for non-compliance.
9. Internal Controls. Per 2 CFR 200.303, sub-recipients must maintain and implement
effective internal controls that provide reasonable assurance that federal funds are
managed in compliance with all statutes, regulations, and terms and conditions.
Per 2 CFR 200.430 (Compensation), internal controls must cover payroll charges to
federal awards such that payroll charges are documented as accurate, allowable, and
a]locable,are reflected in the official records of the sub-recipient, reasonably reflect the
total activity for each employee(federal and non-federal), and comply with all
accounting policies and practices of the sub-recipient.
I0. Procurement. Sub-recipient must conduct all procurements in compliance with 2 CFR
200,318-326. Specific policies, procedures,and/or standards must be in place that meet
or exceed these requirements at the time of procurement. Costs incurred which are
otherwise appropriate and reasonable, but which were procured in violation of federal
procurement requirements may result in disallowed costs or repayments(See Sub-
recipient Non-compliance).
11. Procurement Contract provisions. Contracts utilized by sub-recipients for goods and
services must contain the applicable provisions described in 2 CFR 200 Appendix 11 and
attached hereto.
12. Disclosures. Per 2 CFR 200.1 12, the sub-recipient must disclose in writing any potential
conflicts of interest to the Department.
13. Per 2 CFR 200. 113, the sub-recipient must disclose in writing all violations of federal
criminal law involving fraud, bribery, or gratuity violations potentially effecting the
federal award.
2
14. Sub-recipients understand and agree that it cannot use any federal funds, either directly or
indirectly, in support of the enactment, repeal, modification or adoption of any law,
regulation or policy, at any level of government without the express prior written
approval of U.S. DHS FEMA and/or U.S. DOT PHMSA.
15. Press. Sub-recipient agrees to proactively notify MEMA of any interactions or planned
media outreach regarding activities funded under this grant program.
16. Release of Information. All records,papers and other documents of any kind related to
the funded activity in any manner and kept by sub-recipients of these funds shall be made
promptly available upon request to any person authorized by MEMA for inspection and
copying.
17. Application of Special.Conditions to Sub-Recipient Grantees: If a sub-recipient
proposes to engage in sub-granting activities, it shall ensure its sub-grantees adhere to all
applicable DHS/FEMA, U.S. DOT, and MEMA special conditions.
18. Reporting. Sub-recipients agree to submit timely and accurate Close-Out and Match
Reports as needed and directed. Failure to comply with this condition may result in the
withholding of sub-recipient funds until the delinquent report is received.
19. Contractor/Consultant Rates. Compensation for individual consultant services is to be
reasonable and consistent with the amount paid for similar services in the market place.
Consideration can be given to compensation, including fringe benefits, for those
individuals whose employers do not provide the same. Time and effort reports are
required for consultants.
20. Copy right/Licenses. The sub-recipient acknowledges that MEMA, DHS, and DOT
reserve a royalty-free, non-exclusive, and irrevocable license to reproduce, publish, or
otherwise use, and authorize others to use, for federal or state purposes: (1)the copyright
in any work developed under an award or sub-award; and (2)and rights of copyright to
which a sub-recipient or sub-grantee purchases ownership with Federal support.
21. Acknowledgement in Published Materials. EMPG and CCP sub-recipients agree
that any publication (e.g., written, visual, or sound) it or its contractors issue describing
programs or projects funded in whole or in part with federal funds,contain the following
statement:
"This document was prepared under a grant from FEMA's Grant Programs Directorate,
U.S. Department of Homeland Security. Points of view or opinions expressed in this
document are those of the authors and do not necessarily represent the official position or
policies of FEMA's Grant Programs Directorate or the U.S. Department of Homeland
Security."
22. Acknowledgement in Published Materials. HMEP sub-recipients agree that any
publication (e.g., written, visual,or sound) it or its contractors issue describing programs
or projects funded in whole or in part with federal funds, contain the following statement:
"This document was prepared under a grant from U.S. DOT PHMSA. Points of view or
opinions expressed in this document are those of the authors and do not necessarily
represent the official position or policies of the U.S. DOT PHMSA."
3
23. Disposal and sale of equipment purchased via DHS funds. Any proposed sale and/or
disposal must adhere to current MEMA policy.
24. User Fees. Any proposed `user fees' related to equipment, items, services, etc acquired
via DHS funding must be pre-approved by MEMA.
25. Environmental Planning and Historic Preservation (EHP). EMPG and CCP sub-
recipients shall not undertake any project having the potential to impact Environmental
or Historical Preservation (EHP)resources without the prior approval of FEMA,which is
done through MEMA.
26. Equipment acquired with grant funds.MEMA requires that equipment acquired with
federal grant funds be tracked and tagged per current MEMA policy.
27. Reporting of violations (fraud,waste,and abuse). It is the responsibility of all grant
sub-recipients and their respective agency personnel, grantees, and contractors under
grants,to report to MEMA any alleged violations, serious irregularities, sensitive issues,
or overt or covert acts that would use public funds or perform program or administrative
requirements in a manner not consistent with grantor agency statutes, related laws and
regulations,appropriate guidelines,or purposes or objectives of the grant.
28. Internet Access. Sub-recipients must have Internet access.
29. Email addresses. Sub-recipient project directors of grant programs must have individual
email addresses.
30. Sub-recipient Non-compliance. Contractor, as sub-recipient, is subject to the federal
and state regulations and related requirements set forth herein. Contractor non-
compliance may result in an audit finding and subsequent repayment of funds to the
Federal Government. Approval of a project, project costs,contract or payment by either
FEMA or MEMA does not exempt the Contractor from requirements to repay funds.
Should a state, federal, or local audit reveal that actions taken by the Contractor as sub-
recipient, or any of its contractors, regardless of previous approval by either FEMA or
MEMA, do not comply with policies, laws, or regulations, the Contractor agrees to repay
the required amounts in the manner and timeframe determined by FEMA and/or MEMA.
Repayments not made as expected will be considered debts and addressed under the
Commonwealth's Debt Collection and Intercept policy(815 CMR 9.00).
31. Monitoring. Sub-recipients agree to cooperate with MEMA monitoring and site visits.
32. Records Retention.The Contractor shall retain all related records for a minimum of six
years from the date of the Close-Out Report Submission. In cases of similar requirements
at two or more levels,the more stringent of the requirements must be followed.
33. FEMA Required assurances. All sub-recipients must review and sign the attached
Summary Sheet for Required Assurances and any associated assurances required.
4
34. Certifications (200.415). To assure that expenditures are proper and in accordance with
the terms and conditions of the Federal award and approved project budgets, the annual
and final fiscal reports or vouchers requesting payment under the agreements must
include a certification, signed by an official who is authorized to legally bind the non-
Federal entity, which reads as follows: "By signing this report, I certify to the best of my
knowledge and belief that the report is true, complete, and accurate, and the expenditures,
disbursements and cash receipts are for the purposes and objectives set forth in the terms
and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent
information, or the omission of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code
Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)."
Non-profit organizations must certify as appropriate that they did not meet the definition
of a major corporation as defined in 2 CFR 200.414 Indirect(F&A) costs, paragraph (a).
35. Prior to acceptance of these terms and conditions, Contractor must evaluate its
policies,procedures, and management systems for risk of non-compliance with any of the
above teens and conditions, inclusive of all requirements of FEMA and 2 CFR 200. Any
identified areas of risk must be brought to the attention of MEMA prior to the execution
of the contract in order to determine and implement the appropriate remedy.
36. By signing below, the Contractor certifies that it understands all obligations and has in
place or will implement policies and procedures that meet or exceed the standards and
requirements above. Acceptance of payment for the activities under this agreement
indicates that all actions taken by the sub recipient for the purposes of this grant program
were done so in compliance with all grant requirements and all applicable laws and
regulations, including the certification statement above.
Signature of Authorized Signatory Date
- R 1c if,4RD A ce r/y T M4 Y6 JV,
Printed Name Title
5
including outcome and copies of settlement agreements to the DHS awarding
office and the DHS Office of Civil Rights and Civil Liberties.
6. In the event any court or administrative agency makes a finding of
discrimination on grounds of race, color, national origin (including limited English
proficiency), sex, age, disability, religion, or familial status against the recipient,
or the recipient settles a case or matter alleging such discrimination, recipients
must forward a copy of the complaint and findings to the DHS Component
and/or awarding office.
The United States has the right to seek judicial enforcement of these obligations.
Z"�
Signature of Authorized Signatory Date
P,4�04 R 1C#4RD e iWjOV
Printed Name
Standard Terms& Conditions: Version 5.0 January 21, 2015
9
MEMA Subrecipient Pre-Award Risk Assessment Questionnaire
Subrecipient Name: ocdly C))r_ 614u"A1"
(Includes all departments,divisions, or units within the Municipality or Not-for-Profit receiving federal grant funds)
Per 2 CFR 200.331 section (b), MEMA is required to "evaluate each subrecipient's risk of non-compliance
with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of
determining the appropriate subrecipient monitoring." Please provide the information requested below
with your signed contract package. MEMA may be required to follow up with you regarding your
responses to discuss monitoring requirements.
200.331(b)(1): Has Subrecipient been the direct recipient or a subrecipient of MEMA-issued federal
funds within the last two fiscal years:
Yes 0 No ❑
(if yes, please complete corresponding section on next page)
200.331(b)(2): Was Subrecipient required (OMB A-133 or 2 CFR 200 Subpart F)to have an audit of
Federal Funds performed in the two most recently closed fiscal years?
Yes ❑ No
Does Subrecipient have any findings or questioned costs related to MEMA federal grants administration
in the last two most recently closed fiscal year Audits?
Yes ❑ No 19
(if yes, please complete corresponding section on next page)
200.331(b)(3): Has Subrecipient employed new personnel or implemented new or substantially
changed systems related to Federal Grant Management in the last calendar year
Yes ❑ No X
(if yes, please complete corresponding section on next page)
200.331(b)(4): Has Subrecipient been monitored by any Federal Agency as a direct recipient of Federal
Funding in the last two fiscal years.
Yes ❑ No
(if yes, please complete corresponding section on next page)
Under pains and penalties of perjury, the authorized signatory for this contracts attests to the
accuracy of the above responses and c/orresp nding information attached:
4 l� —
Signature � Date
Printed Name 1C6i�t�—`/✓ Title .'4 I O/e.
MEMA Sub-recipient Pre-Award Risk Assessment Questionnaire
Response Form
200.331(b)(1): Please list below(or attach)all MEMA federal awards received as a direct recipient or
subrecipient in the last two fiscal years:
Federal Award Name Purpose Amount Start Date End Date
Hay
200.331(b)(2): Please list below(or attach)the results of any A-133 or Subpart F audits for the last two
fiscal years of subrecipient:
Grant Audited Finding Date Finding Description
MEMA will send a letter to subrecipient seeking additional details on the above finding(s), requesting subreciplent
response and Corrective Action Plan,and setting a schedule for MEMA to issue a Management Decision.
Additional monitoring and follow up may take place prior to or after MEMA's decision has been issued. Failure to
implement corrective action plans could result in a loss of funds administered by the Massachusetts Emergency
Management Agency.
200.331(b)(3): Please describe any new systems or staffing that may impact federal grant award
administration:
200.331(b)(4): Please describe (or attach) the results of federal monitoring received within the last two
fiscal years.
�Ji `
J"
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
This form is jointly issued and published by the Executive Office for Administration and Finan ANF,the Office of the Comptroller(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 fron-conflicting terms may be added by Attachment.Contractors may not require any additional agreements,engagement letters.Contract forms or other additional
terms as part of this Contract without prior Department approval. Click on hyperlinks 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.govlosc under Guidance For Vendors-Forms or vvww.mass aovlosd under OSD Forms,
CONTRACTOR LEGAL NAME:AGAWAM,Town of COMMONWEALTH DEPARTMENT NAME:
(and dlbla): MMARS_Deaartment Code: Massachusetts Emergency Management Agency
Lego!Address:(W-9,W-4,7&C):36 Main Street Business Mailina Address: 400 Worcester Road,Framingham,MA 01702
Contract Manaoer: Chet Nicora Billinsr Address(if different):
E-Mail: emdirector@agawam.ma.us Contract ManacLer: Lord Gifford
Phone: 413.531.54791413.786.6925 Fax: E-Mail: torri.gifford@state.ma.us
Contractor Vendor Code:VC6000191692 Phone:508.820.1407 Fax: 508.820.2030
Vendor Code Address ID(e.g."AD001"): AD_ MMARS Doc ID(s):FY16EMPG1500000AGAWA
(Note:The Address Id Must be set up for EFT payments.) RFR1Procurement or Other ID Number:FFY 2015 EMPG
-)L NEW CONTRACT _ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTION TYPE:(Check one option only) Enter Current Contract End Date Prior to Amendment: .20�
_Statewide Contract(OSD or an OSD-designated Department) Enter Amendment Amount:$ .(or'rio change')
Collective Purchase(Attach OSD approval,scope,budget) AMENDMENT TYPE:(Check one option only.Attach details of Amendment changes.)
X Department Procurement(includes State or Federal grants 815 CMR 2,00) _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 scope/budget)
_Ememency Contract_(Attach justification for emergency,scope,budget)
_Contract Employee(Attach Employment Status Form,scope,budget) —Contract Employee(Attach any updates to scope or budget}
LettislativelLegaI or Other.(Attach authorizing fanguage/jus6fication,scope and _LegislativelLeraal or Other:(Attach authorizing languageljustifica5on 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.
X Commonwealth Terms and Conditions Commonwealth Terms and Conditions For Human and Social Services
COMPENSATION:(Check ONE option):The Department certifies that payments for authorized performance 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 owed debts under 815 CMR 9,00.
_Rate Contract(No Maximum Obligation. Attach details of all rates,units,calculations,conditions or terns and any changes it rates or terms are being amended.)
L MaximumOblistatlon Contract Enter Total Maximum Obligation for total duration of this Contract(or new Total if Contract is being amended).$6,460.00
PROMPT PAYMENT_DISCOUNTS(PPD): Commonwealth payments are issued through EFT 45 days from invoice reoeipt.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, If PPD percentages are left blank,identity reason:_agree to standard 45 day cycle—statutoryllegal or Ready Payments(G.L.c.29.,§23A);X only initial
ment(subsequent payments scheduled to support standard EFT 45 day a ment cle.See Prompt Pay-Disgounts Policy.)
BRIEF DESCRIPTION OF PERFORMANCE or REASON FOR AMENDMENT:(Enter the Contract title,purpose,fiscal 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 lorthis grant is provided via Federal Fiscal Year 2615(FFY15)Emergency Management Performance Grant(EMPG),CFDA#97.042
The Town of Agawam purchase new digital radios with accessories to enhance their communications.This project was reviewed and approved by the Statewide
Interoperability Coordinator on 111312015,
ANTICIPAIED START DATE: (Complete ONE option only)The Department and Contractor Certify for this Contract,or Contract Amendment,that Contract obligations:
X 1.may be incurred as of the Effective Da (latest signature date below)and no obligations have been incurred prior to the Effective Date.
_2.may be incurred as of .20T a date LATER than the Effective Date below and no obligations have been incurred prior to the Effective 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 to the Eftive 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 inco rated into this Contract. Acceptance of paXments forever releases the Commonwealth from further claims related to these obligations.
CONTRACT END DATE: Contract performance shall terminate as of June 30,2016,with no new obligations being incurred after this date unless the Contract is properly amended,
provided that the terns of this Contract and performance expectations and obligations shall survive its termination for the purpose of resolving any claim or dispute,for completing
any negotiated terms and warranfies,to allow any close out or transition performance,reporting,invoicing 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 Contract or
Amendment has been executed by an authorized signatory of the Contractor,the Department,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 reference 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 Commonwelfth Terms n
Condition ,this Standard Contract Form including the Instructions nd Contractor Certifications,the Request for Response(RFR)or other solicitation,the Contractor's Response,
and additional negotiated terms,provided that additional negotiated terms will take precedence over the relevant terms in the RFR and the Contractors 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.
AUTHORIZIN9 SIGNATURE FOR THE CONTRACTOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH:
X: Cow Date. /S ACC 2�l� X. t Date:
(Signature and Date Must Be Handwritten At Time of Signature) (Signature and Date Must Be Handwritten At Time of Signature)
Print Name: Aicetoge A e cHElj Print Name: David Mahr
Print Title: Print Title: Chief Administrative Officer
(Updated 312112014) Page 1 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM C( )
INSTRUCTIONS AND CONTRACTOR CERTIFICATIONS Complete this section ONLY if this Contract is brand now. (Complete the
CONTRACT AMENDMENT section for any material changes to an existing or an
The following instructions and terms are incorporated by reference and apply to this
Standard Contract Form Text that appears underlined indicates a'hyperlink"to an Internet expired Contract,and for exercising options to renew or annual contracts under a
or bookmarked site and are unofficial versions of these documents and Departments and multiyear procurement or grant program.)
Contractors should consult with their legal counsel to ensure compliance with all legal PROCUREMENT OR EXCEPTION TYPE: Check the appropriate type of procurement or
requirements Using the Web Toolbar will make navigation between the form and the exception for this Contract. Only one option can be selected. See State Finance Law and
hyperlinks easier. Please note that not all applicable laws have been cited. General Reguirrments, Acquisition Policy and Fixed Asset, the Commodities and
CONTRACTOR LEGAL NAME (AND DIBlA}: Enter the Full Legal Name of the Services Policy and the ProcurementInformation Center p m n ContractGuidance)
for details.
Contractor's business as it appears on the Contractor's W-9 or VVA Form (Contract
Employees only)and the applicable mmonwealth Te s and Conditions If Contractor Statewide Contract der or an OSD-designated an OSD-designated
Department). Check th s option for a
also has a'doing business as'(dlbla)name,BOTH the legal name and the'dlbla'name Statewide Contract under 05D,or by an OSD designated Department,
must appear in this section. Collective Purchase approved by OSD. Check this option for Contracts approved by
Contractor Legal Address: Enter the Legal Address of the Contractor as it appears on OSD for collective purchases through federal,state,local government or other entities.
the Contractors W-9 or W-0 Form (Contract Employees only) and the applicable Department Contract Procurement. Check this option for a Department procurement
mmonwealth Terms and Con ition ,which must match the legal address on the 10991 including state grants and federal sub-grants under 815 CMR 2.Q4 and State Gran*and
table in MMARS(or the Legal Address in HRICMS for Contract Employee). Federal Subgrants Polio, Departmental Master Agreements (MA). If mu&Department
Contractor Contract Manager: Enter the authorized Contract Manager who will be user Contract,identify multi-Department use is allowable in Brief Description.
responsible for managing the Contract. The Contract Manager should be an Authorized Emergency Contract. Check this option when the Department has determined that an
Signatory or, at a minimum, a person designated by the Contractor to represent the unforeseen crisis or incident has arisen which requires or mandates immediate purchases
Contractor, receive legal notices and negotiate ongoing Contract issues. The Contract to avoid substantial harm to the functioning of government or the provision of necessary or
Manager is considered'Key Personnel'and may not be changed without the prior written mandated services or whenever the health,welfare or safety of clients or other persons or
approval of the Department. If the Contract is posted on COMMBUYS,the name of the serious damage to property is threatened.
Contract Manager must be included in the Contract on COMMBUYS. Contract Employee. Check this option when the Department requires the performance of
Contractor E•Mail AddressfPhonefFax: Enter the electronic mail (e-mail) address, an Individual Contractor,and when the planned Contract performance with an Individual
phone and fax number of the Contractor Contract Manager. This information must be kept has been classified using the Employment-Status Farm(prior to the Contractors selection)
current by the Contractor to ensure that the Department can contact the Contractor and as work of a Contract Employee and not that of an Independent Contractor,
provide any required legal notices. Notice received by the Contract Manager (with Legislative/Legal or Other. Check this option when legislation, an existing legal
confirmation of actual receipt)through the listed address,fax number(s)or electronic mail obligation, prohibition or other circumstance exempts or prohibits a Contract from being
address will meet any written legal notice requirements. competitively procured, or identify any other procurement exception not already listed.
Contractor Vendor Code: The Department must enter the MMARS Vendor Code Legislative'earmarks'exempt the Contract solely from procurement requirements,and all
assigned by the Commonwealth.If a Vendor Code has not yet been assigned,leave this other Contract and state finance laws and policies apply.Supporting documentation must
space blank and the Department will complete this section when a Vendor Code has been be attached to explain and justify the exemption.
assigned. The Department is responsible under the Vendor File and W-9s Policy for _ CONTRACT AMENDMENT(Right Side of Form) _
verifying with authorized signatories of the Contractor,as part of contract execution,that Complete this section for any Contract being renewed,amended or to continue a lapsed
the legal name, address and Federal Tax Identification Number (TIN) in the Contract Contract. All Contracts with available options to renew must be amended referencing the
documents match the state accounting system. original procurement and Contract doc ids, since all continuing contracts must be
Vendor Code Address ID: (e.g., 'AD001') The Department must enter the MMARS maintained in the same Contract file(even if the underlying appropriation changes each
Vendor Code Address Id identifying the payment remittance address for Contract fiscal year.)'See Amendments,Sus nspe ions.Ind Termination Policy.)
payments,which MUST be set up for EFT payments PRIOR to the first payment under the Enter Current Contract End Date: Enter the termination date of the Current Contract
Contract in accordance with the Bill Paying and Vendor File and W-9 policies. being amended,even if this date has already passed. (Note: Current Start Date is not
COMMONWEALTH DEPARTMENT NAME: Enter the full Department name with the requested since this date does not change and is already recorded in MMARS.)
authority to obligate funds encumbered for the Contract. Enter Amendment Amount:Enter the amount of the Amendment increase or decrease to
Commomvealth MMARS Alpha Department Code: Enter the three(3) letter MMARS a Maximum Obligation Contract. Enter'no change'for Rate Contracts or if no change.
Cade assigned to this Commonwealth Department in the state accounting system. AMENDMENT TYPE: Identify the type of Amendment being done. Documentation
Department Business Mailing Address: Enter the address where all formal supporting the updates to performance and budget must be attached. Amendment to
correspondence to the Department must be sent. Unless otherwise specified in the Scope or Budget. Check this option when renewing a Contract or executing any
Contract, legal notice sent or received by the Department's Contract Manager (with Amendment('material change' in Contract terms)even if the Contract has lapsed. The
confirmation of actual receipt)through the listed address,tax numbers)or electronic mail parties may negotiate a change in any element of Contract performance or cost identified
address for the Contract Manager will meet any requirements for legal notice. in the RFR or the Contractors response which results in lower costs, or a more cost-
Department Billing Address: Enter the Billing Address or email address if invoices must effective or better value performance than was presented in the original selected response,
be sent to a different location. Billing or confirmation of delivery of performance issues provided the negotiation results in a better value within the scope of the RFR than what
should be resolved through the listed Contract Managers. was proposed by the Contractor in the original selected response. Any'material'change
Department Contract Manager: Identify the authorized Contract Manager who will be in the Contract terms must be memorialized in a formal Amendment evert if a
responsible for managing the Contract, who should be an authorized signatory or an corresponding MMARS transaction is not needed to support the change. Additional
employee designated by the Department to represent the Department to receive legal negotiated terms will take precedence over the relevant terms in the RFR and the
notices and negotiate ongoing Contract issues. Contractors Response only if made using the process outlined in 8QJ CMR 21,07.
Department E-Mail AddresslPhonelFax: Enter the electronic mail (e-mail) address, incorporated herein, provided that any amended RFR or Response terms result in best
phone and fax number of the Department Contract Manager,Unless otherwise specified in value,lower costs,or a more cost effective Contract.
the Contract,legal notice sent ar received by the Contract Manager(with confirmation of Interim Contracts.Check this option for an Interim Contract to prevent a lapse of Contract
actual receipt) through the listed address, fax numbers)or electronic mail address wilt performance whenever an existing Contract is being re-procured but the new procurement
meet any requirements for written notice under the Contract, has not been completed,to bridge the gap during implementation between an expiring and
MMARS Document ID(s): Enter the MMARS 20 character encumbrance transaction a new procurement,Or to contract with an interim Contractor when a current Contractor is
number associated with this Contract which must remain the same for the life of the unable to complete full performance under a Contract.
Contract. If multiple numbers exist for this Contract,identify all Doc Ids. Contract Employee.Check this option when the Department requires a renewal or other
RFR1Procurement or Other ID Number or Name: Enter the Request for Response amendment to the performance of a Contract Employee.
(RFR) or other Procurement Reference number, Contract ID Number or other Legislative/Legal or Other. Check this option when legislation, an existing legal
reference/tracking number for this Contract or Amendment and will be entered into the obligation, prohibition or other circumstance exempts or prohibits a Contract from being
Board Award Field in the MMARS encumbrance transaction for this Contract. competitively procured, or identify any other procurement exception not already listed.
NEW CONTRACTS(left side of Form): Legislative'earmarks'exempt the Contract solely from procurement requirements,and all
ether Contract and state finance laws and policies apply.Attach supporting documentation
to explain and justify the exemption and whether Contractor selection has been publicly
(Updated 312112014) Page 2 of 5
J�COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM 4
posted. CONTRACT END DATE
COMMONWEALTH TERMS AND CONDITIONS The Department must enter the date that Contract performance will terminate. If the
Identify which Commonwealth Terms and Conditions the Contractor has executed and is Contract is being amended and the Contract End Date is not changing,this date
incorporated by reference into this Contract.This Form is signed only once and recorded must be re-entered again here. A Contract must be signed for at least the initial duration
on the Vendor Customer File(VCUST).See Vendor Fite and W-95 Polity. but not longer than the period of procurement listed in the RFR, or other solicitation
COMPENSATION document(it applicable). No new performance is allowable beyond the end date without
an amendment,but the Department may allow a Contractor to complete minimal close out
Identify if the Contract is a Rate Contract (with no stated Maximum Obligation) or a performance obligations if substantial performance has been made prior to the termination
Maximum Obligation Contract (with a stated Maximum Obligation) and identify the date of the Contract and prior to the end of the fiscal year in which payments are
Maximum Obligation. If the Contract is being amended, enter the new Maximum appropriated, provided that any dose out performance is subject to appropriation and
Obligation based upon the increase or decreasing Amendment. The Total Maximum funding limits under state finance law,and CTR may adjust encumbrances and payments
Obligation must reflect the total funding for the dates of service under the contract, in the state accounting system to enable final close out payments, Performance dates are
including the Amendment amount if the Contract is being amended. The Maximum subject toG L•c�4.6 9.
Obligation must match the MMARS encumbrance. Funding and allotments must be CERTIFICATIONS AND EXECUTION
verified as available and encumbered prior to incurring obligations. If a Contract includes
both a Maximum Obligation oomponent and Rate Contract component, check off both, See Department Head Signature Authorization Policy and the Qonlractof Ag(horzed
specific Maximum Obligation amounts or amended amounts and Attachments must clearly Sktnatory Listing for policies on Contractor and Department signatures,
outline the Contract breakdown to match the encumbrance. Authorizing Signature for ContractorlDate'.The Authorized Contractor Signatory must
PAYMENTS AND PROMPT PAY DISCOUNTS (in their own handwriting and in inky sign AND enter the date the Contract is signed. See
section above under'An ip a ntr
-aa Stan Date". Acceptance a1 payment by the
Payments are processed within a 45 day payment cycle through EFT in accordance with Contractor shall waive any right of the Contractor to claim the ConlradAmendment is not
the Commonwealth Bill Paying Policy for investment and cash flow purposes. valid and the Contractor may not void the Contract. Rubber stamps,typed or other
Departments may NOT negotiate accelerated payments and Payees are NOT entitled to images are not acceptable. Proof of Contractor signature authorization on a Contractor
accelerated payments UNLESS a prompt payment discount(PPD)is provided to support Authorized Signatory Listing maybe required by the Department if not already on file.
the Commonwealth's loss of investment earnings for this earlier payment, or unless a Contractor Name !Title: The Contractor Authorized Signatory's name and title must
payments is legally mandated to be made in less than 45 days (e.g., construction
contracts, Ready Payments under G.L.c.29.s.23A1.See Prompt Pay Discounts Pofictir. appear legibly as it appears on the Contractor Authorized Signatory Listing.
PPD are identified as a percentage discount which will be automatically deducted when an Authorizing Signature For CommonwealthfDate:The Authorized Department Signafory
accelerated payment is made.Reduced contracts rates may not be negotiated to replace a must(in their own handwriting and in ink)sign AND enter the date the Contract is signed.
PPD. If PPD fields are tell blank please identify that the Contractor agrees to the standard See section above under "Anticipated Start Date". Rubber stamps, typed or other
45 day cycle;a statuloryllegal exemption such as Ready Payments(G.L.c.29§23A1;or images are not accepted. The Authorized Signatory must be an employee within the
only an initial accelerated payment for reimbursements or stars up costs for a grant,with Department legally responsible for the Contract. See Department head Signature
subsequent payments scheduled to support standard EFT 45 day payment cycle.Financial Authorization. The Department must have the legislative funding appropriated for all the
hardship is not a sufficient justification to accelerate rash flow for all payments under a costs of this Contract or funding allocated under an apprioved InLgirdepartmental Service
Contract. Initial grant or contract payments may be accelerated for the first invoice or initial Agreement(ISA). A Department may not contract for performance to be delivered to or by
grant installment, but subsequent periodic installments or invoice payments should be another stale department without specific legislative authorization(unless this Contrad is a
scheduled to support the Payee cash flow needs and the standard 45 day EFT payment Statewide Contract). For Contracts requiring Secretariat sgnoff,evidence of Secretariat
cycle in accordance with the Bill Paying Policy.Any accelerated payment that does not sgnoff must be included in the Contract file,
provide for a PPD must have a legal justification in Contract file for audit purposes Department Name!Title:Enter the Authorized Signatory's name and title legibly.
explaining why accelerated payments were allowable without a PPD, CONTRACTOR CERTIFICATIONS AND LEGAL REFERENCES
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE Notwithstanding verbal or other representations by the parties,the"Effective Date"of this
Enter a brief description of the Contract performance,project name and/or other identifying Contract or Amendment shall be the latest date that this Contract or Amendment has been
information for the Contract to specifically identify the Contract performance, match the executed by an authorized signatory of the Contractor,the Department,or a later Contract
Contract with attachments, determine the appropriate expenditure code(as listed in the or Amendment Start Date specified, subject to any required approvals. The Contractor
Expenditure Classification Handbook)or to identify or clarify important information related makes all certifications required under this Contract under the pains and penalties of
to the Contract such as the Fiscal Year(s)of performance(ex.'FY2012"or'FY2012-14'), perjury, and agrees to provide any required documentation upon request to support
Identify settlements or other exceptions and attach more detailed justification and compliance,and agrees that all terms governing performance of this Contract and doing
supporting documents, Enter 'Multi-Department Use' if other Departments can access business in Massachusetts are attached or incorporated by reference herein:
procurement. For Amendments,identify the purpose and what items are being amended. Commonwealth and Contractor Ownership Rights,The Contractor certifies and agrees
Merely stating"see attached"or referencing attachments without a narrative description of that the Commonwealth is entitled to ownership and possession of all 'deliverables'
performance is insufficient purchased or developed with Contract funds. A Department may not relinquish
ANTICIPATED START DATE Commonwealth rights to deliverables nor may Contractors sell products developed with
Commonwealth resources without just compensation. The Contract should detail all
The Department and Contractor must certify WHEN obligations under this Commonwealth deliverables and ownership rights and any Contractor proprietary rights.
ContradVAmendment may be incurred. Option 1 is the default option when performance Qualifications. The Contractor certifies it is qualified and shall at all times remain qualified
may begin as of the EffWive Date(latest signature date and any required approvals). It to perform this Contract; that performance shall be timely and meet or exceed industry
the parties want a new Contract or renewal to begin as of the upcoming fiscal year then list standards for the performance required, including obtaining requisite licenses,
the Fiscal year(s) (ex, 'FY2012' or 'FY2012-14') in the Brief Description section. registrations, permits,resources for performance,and sufficient professional, liability;and
Performance starts and encumbrances reflect the default Effective Date(if no FY is listed) Other appropriate insurance t0 cover the performance. If the Contractor is a business,the
or the later FY start date(if a FY is listed). Use Option 2 only when the Contract will be Contractor certifies that it is listed under the Secretary of Sta s we ite as licensed 10 do
signed well in advance of the start date and identify a specific future start date. Do not use --� —
business in Massachusetts,as required by law.
Option a for a fiscal year start unless it is certain that the Contract will be signed prior a Business Ethics and Fraud,Waste and Abuse Prevention.The Contractor certifies that
fiscal year. Option 3 is used it lieu of the obligSett�eations
have
and Release Form when the performance under this Contract,in addition to meeting the terms of the Contract,will be
Contract/Amendment is signed late, and obligations have already been incurred by the g
Contractor prior to the E,ff dvg Date for which the Department has either requested, made using ethical business standards and good stewardship of taxpayer and other public
accepted or deemed legally eligible for reimbursement, and the Contract includes funding and resources to prevent fraud,waste and abuse.
supporting documents justifying the performance or proof of eligibility, and approximate Collusion. The Contractor certifies that this Contract has been offered in good faith and
costs. Any obfigations incurred outside the scope of the Effective Date under any Option without collusion,fraud or unfair trade practices with any other person,that any actions to
listed,even if the incorrect Option is selected,shall be automatically deemed a settlement avoid or frustrate fair and open competition are prohibited by law,and shall be grounds for
included under the terms of the Contract and upon payment to the Contractor will release rejection or disqualification of a Response or termination of this Contract.
the Commonwealth from further obligations for the identified performance, All settlement Public.Records and Access The Contractor shall provide full access to records related to
payments require justification and must be under same encumbrance and object codes as performance and compliance to the Department and officials listed under Executive Order
the Contract payments. Performance dates are subject t0 G.L.c•4,6 9. 195 and G.L.c. 11.s.12 seven(7)years beginning on the first day after the final payment
(Updated 3/21/2014) Page 3 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM 7
under this Contract or such longer period necessary for the resolution of any litigation, services are required to identify any potential conflict with representation of any
claim,negotiation,audit or other inquiry involving this Contract.Access to view Contractor Department client in accordance with Massachusetts Board of Bar Overseers(BBO)rules.
records related to any breach or allegation of fraud,waste and/or abuse may not be denied Federal Anti-Lobbying and Other Federal Requirements. If receiving federal funds,the
and Contractor can not claim confidentiality or trade secret protections solely for viewing Contractor certifies compliance with federal anti-tobbying requirements including 1 t 5C
but not retaining documents. Routine Coniact performance compliance reports or 1352;other fedeal requirements;Exemt-Ne Order 1129;Air Pollution Acl;Foeral Water
documents related to any alleged breach or allegation of non-compliance,fraud,waste, pollution Control Act and Federal Employment Laws.
abuse or collusion may be provided electronically and shall be provided at Contractor's Protection of Personal Data and Information. The Contractor certifies that all steps will
own expense. Reasonable costs for copies of non-routine Contract related records shall be taken to ensure the security and confidentiality of all Commonwealth data for which the
not exceed the rates for public records under 950 C.M.R.32.00. Contractor becomes a holder, either as part of performance or inadvertently during
Debarment. The Contractor certifies that neither it nor any of its subcontractors are performance,with special attention to restricting access,use and disbursement of personal
currently debarred or suspended by the federal or state government under any law or data and information under G.L�S3H and c.�A and Executive Order 504. The
regulation including,Executive Order 147;G.L.c.29,s.29F G.L.c.30.§39R,G.L.c.149 Contractor is required to comply with G.L.c.931 for the proper disposal of all paper and
27C.G.L.c.149.§44C, G.L.049,a 1488 and G.L.c.152.s.25C. electronic media,backups or systems containing personal data and information,provided
Applicable Laws. The Contractor shall comply with all applicable state laws and further that the Contractor is required to ensure that any personal data or information
regulations including but not limited to the applicable Massachusetts General Laws;the transmitted electronically or through a portable device be properly encrypted using(at a
Official Code of Massachusetts Regulations; Code of Massachusetts Regulations minimum) Information Technology Division (ISD) Protection of �gnsitive Information,
(unofficial); 8D1 CMR 21.00 (Procurement of Commodity and Service Procurements, provided further that any Contractor having access to credit card or banking information of
including Human and Social Services);815 CMR 2.00(Grants and Subsidies);808 CMR Commonwealth customers certifies that the Contractor is PC compliant in accordance with
1.00 (Compliance, Reporting and Auditing for Human And Social Services); AICPA the Payment Card Industfy Council Standards and shall provide confirmation compliance
Standards; confidentiality of Department records under G.L. c. 66A; and the during the Contract, provide further that the Contractor shall immediately notify, the
Massachusetts Constitution Article XVIII if applicable. Department in the event of any security breach including the unauthorized access,
Invoices. The Contractor must submit invoices in accordance with the terms of the disbursement, use or disposal of personal data or information, and in the event of a
Contract and the Commonwealth Bill Paying Policy.Contractors must be able to reconcile security breach,the Contractor shall cooperate fully with the Commonwealth and provide
and property attribute concurrent payments from multiple Departments. Final invoices in access to any information necessary for the Commonwealth to respond to the security
any fiscal year must be submitted no later than August 151b for performance made and breach and shall be fully responsible for any damages associated with the Contractor's
received (goods delivered, services completed) prior to June 30111, in order to make breach including but not limited to C.�.c.214,S.38.
payment for that performance prior to the close of the fiscal year to prevent reversion of Corporate and Business Filings and Reports. The Contractor certifies compliance with
appropriated funds.Failure to submit timely invoices by August 1511 or other date listed in any certification,filing,reporting and service of process requirements of the,S5gcretary oiof
the Contract shall authorize the Department to issue an estimated payment based upon the Commonwealth,the Office of the Attorney General or other Departments as related to
the Department's determination of performance delivered and accepted.The Contractor's its conduct of business in the Commonwealth;and with its incorporating state(or foreign
acceptance of this estimated payment releases the Commonwealth from further claims for entity).
these invoices. If budgetary funds revert due to the Contractor's failure to submit timely Employer Requirements. Contractors that are employers certify compliance with
final invoices,or for disputing an estimated payment,the Department may deduct a penalty applicable state and federal employment laws or regulations, including but not limited to
up to 10%from any final payment in the next fiscal year for failure to submit timely invoices. G.L.c.5.s.1(Prevailing Wages for Printing and Distribution of Public Documents);G.L•c•
Payments Subject To Appropriation. Pursuant to G.L. c. 29 § 26, § 27 and § 29. 7. s. 22 fPrevadino Wages for ConiMcIs for Meat Produc"d—Clothing and-Apparel;
Departments are required to expend funds only for the purposes set forth by the minimum wages and revailing wage ro9rams and Payments;unemoloymenf insurance
Legislature and within the funding limits established through appropriation,allotment and and contributions;workers'compensation and insurance,child labor laws,AGO fair labor
subsidiary, including mandated allotment reductions triggered by G.L. c. 29, § 9C. A practices;G.L.c. 149 (Labor and Industries);G.L.p.15 A(Labor Relations);GL c. 151
Department cannot authorize or accept performance in excess of an existing appropriation and 455 CMR 2.00(Minimum Fair Wages);G.L.c 151 A(Employment and Training);L;
and allotment, or sufficient non-appropriated available funds. Any oral or written c. 151B (Unlawful Discrimination); G.L. c, 151E (Business Discrimination); G.L. c. 152
representations, commitments, or assurances made by the Department or any other (Workers' Compensation); G.L. .1 (Liability for Injuries); 29 USC c. 8 (Federal Fair
Commonwealth representative are not binding. The Commonwealth has no legal Labor Standards);29 USC c.28 and the Viral Family and edicaLLeave A -
obligation to compensate a Contractor for performance that is not requested and is Federal And State Laws And Regulations Prohibiting Discrimination including but not
intentionally delivered by a Contractor outside the scope of a Contract.Contractors should limited to the Federal Eoual Emoloyment Oopurtunity (EE01 Laws the Arnedcans with
verify funding prior to beginning performance. Disabilities AcL;42U.S.0 Sec.12,101,Mug,the Rehab'il ati n Act,29 USC c.16 s.794;
Intercept. Contractors may be registered as Customers in the Vendor file if the Contractor 29_USC c.16.s.701;29 USC c.14,623;the 42 USC c.45;(Federal Fair housing Act);_Q�
owes a Commonwealth debt. Unresolved and undisputed debts, and overpayments of L. c. 151E(Unlawful Discrimination); G.I. c 151E (Business Discrimination);the Public
Contract payments that are not reimbursed timely shall be subject to intercept pursuant to Accommodations Law G.L. c. 272. s. 92A; G.L. c. 272, s. 98 and 98A, MaUlchusem
G.L.c.7A,s.3 and 815 CMR 9.00. Contract overpayments will be subject to immediate Constitution Article CXIV and G.L. c. 93, s. 103; 47 USC c. 5 , fl Part 11,
intercept or payment offset. The Contractor may not penalize any state Department or (Telecommunication Act; Chapter 149,Section 0 D,G.L.c.151C.G.L.c.272,Section
assess late fees,cancel a Contract or other services if amounts are intercepted or offset 92A Section 98 and Section 98A,and G.L. c. 111, Section 199A,and Massachusetts
due to recoupment of an overpayment, outstanding taxes, child support, other overdue Disability-Based Non-Discrimination S(a0dIrds For Executive 13rench Entities,and related
debts or Contract overpayments. Standards and Guidance, authorized under Massachusetts Executive Order or any
Tax Law Compliance, The Contractor certifies under the pains and penalties of perjury disability-based protection arising from state or federal law or precedent.See also MCAD
tax compliance with Federal lax laws;state tax taws including but not limited to G.L.c.62C, and MCAD links and Resources.
G.L.s 62C. s. 4K compliance with all state tax laws, reporting of employees and Small Business Purchasing Program(SBPP). A Contractor may be eligible to
contractors,withholding and remitting of tax withholdings and child support and is in good participate in the SBPP,created pursuant to ExeCutive Order 523,if qualified through the
standing with respect to all state taxes and returns due; reporting of employees and SBPP COMMBUYS subscription process at www.commb va s.com and with acceptance of
contractors under G L,c. 62E, withholding and remitting child support including aj.L the terms of the SBPP participation agreement.
119A,s.12;TIR 05:11:New Independent Contractor Provisions and applicable TIRs. Limitation of Liability for Information Technology Contracts(and other Contracts as
Bankruptcy,Judgments, Potential Structural Changes, Pending Legal Matters and Authorized). The Information Technology Mandatary Specifications and the TLAcguisition
Conflicts, The Contractor certifies it has not been in bankruptcy and/or receivership within Accessibility Contract Lamuagg are incorporated by reference into Information Technology
the last three calendar years,and the Contractor certifies that it will immediately notify the Contracts, The following language will apply to Information Technology contracts in the
Department in writing at least 45 days prior to filing for bankruptcy and/or receivership, U01, UO2, UO3, U04, U05, U06, U07, U08, U09, U10, U75, U98 object codes in the
any potential structural change in its organization,or if there is any risk to the solvency of Expenditure Classification Handbook or other Contracts as approved by CTR or OSO.
Me Contractor that may impact the Contractor's ability to timely fulfill the terms of this Pursuant to Section 11.Indemnification of the Commonwealth Tema and Conditions,the
Contract or Amendment. The Contractor certifies that at any time during the period of the term'other damages'shall include, but shall not be limited to,the reasonable costs the
Contract the Contractor is required to affirmatively disclose in writing to the Department Commonwealth incurs to repair, return, replace or seek cover(purchase of comparable
Contract Manager the details of any judgment,criminal conviction,investigation or litigation substitute commodities and services)under a Contract.'Other damages`shaft not include
pending against the Contractor or any of its officers, directors, employees, agents, or damages to the Commonwealth as a result of third party claims,provided,however,that
subcontractors, including any potential conflicts of interest of which the Contractor has the foregoing in no way limits the Commonwealth's right of recovery for personal injury or
knowledge,or learns of during the Contract term. Law firms or Attorneys providing legal Property damages or patent and copyright infringement under Section 11 nor the
Commonwealth's ability to join the contractor as a third party defendant. Further,the term
(Updated 3/2112014) Page 4 of 6
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
"other damages' shall not include, and in no event shall the contractor be liable for, to include a specific prohibition against the hiring at any time during the term of Contract,
damages for the Commonwealth's use of contractor provided products or services,loss of and for any position in the Contractor's company,any state management employee who is,
Commonwealth records,or data(or other intangible property),loss of use of equipment, was, or will be involved in the preparation of the RFP, the negotiations leading to the
lost revenue, lost savings or lost profits of the Commonwealth. In no event shall'other awarding of the Contract, the decision to award the Contract, and/or the supervision or
damages'exceed the greater of$100,000,or two times the value of the product or service oversight of performance under the Contract.
(as defined in the Contract scope of work)that is the subject of the claim,Section I sets Executive Order 444, Disclosure of Family Relationships With Other State EmOovees.
forth the contractor's entire liability under a Contract.Nothing in this section shall limit the Each person applying for employment (including Contract work) within the Executive
Commonwealth's ability to negotiate higher limitations of liability in a particular Contract, Branch under the Governor must disclose in writing the names of all immediate family
provided that any such limitation must specifically reference Section 11 of the related to immediate family by marriage who serve as employees or elected officials of the
Commonwealth Terns and Conditions. In the event the limitation of liability conflicts with Commonwealth. All disclosures made by applicants hired by the Executive Branch under
accounting standards which mandate that there can be no cap of damages,the limitation the Governor shall be made available for public inspection to the extent permissible by law
shall be considered waived for that audit engagement. These terms may be applied to by the official with whom such disclosure has been filed.
other Contracts only with prior written confirmation from the Operational Services Division Executive Order 504. Regarding the Security and Confidentiality of Personal Information,
or the Office of the Comptroller.The terms in this Ciarification may not be modified. For all Contracts involving the Contractor's access to personal information,as defined in
Northern Ireland Certification. Pursuant to G.L. c. 7 s. 22C for state agencies,state G.L. H, and personal data, as defined in G.L. c, 66A, owned or controlled by
authorities,the House of Representatives or the state Senate,by signing this Contract the Executive Department agencies,or access to agency systems containing such information
Contractor certifies that it does not employ ten or more employees in an office or other or data(herein collectively'personal information'),Contractor certifies under the pains and
facility in Northern Ireland and if the Contractor employs ten or more employees in an office penalties of perjury that the Contractor (1) has read Commonwealth of Massachusetts
of other facility located in Northern Ireland the Contractor certifies that it does not Executive Order 504 and agrees to protect any and all personal information;and(2)has
discriminate in employment, compensation, or the terms, conditions and privileges of reviewed all of the Commonwealth InforMation Technology Division's SeEurhy
employment on account of religious or political belief;and it promotes religious tolerance Policies. Notwithstanding any contractual provision to the contrary,in connection with the
within the work place, and the eradication of any manifestations of religious and other Contractor's performance under this Contract, for all state agencies in the Executive
illegal discrimination;and the Contractor is not engaged in the manufacture,distribution or Department,including all executive offices,boards,commissions,agencies,departments,
sale of firearms,munitions,including rubber or plastic bullets,tear gas,armored vehicles or divisions, councils, bureaus, and offices, now existing and hereafter established, the
military aircraft for use or deployment in any activity in Northern Ireland. Contractor shall: (1) obtain a copy, review, and comply with the contracting agency's
Pandemic,Disaster or Emergency Performance. In the event of a serious emergency, Information Security Program(ISP)and any pertinent security guidelines,standards,and
pandemic or disaster outside the control of the Department,the Department may negotiate policies; (2) comply with all of the Commonwealth of Massachusetts Information
emergency performance from the Contractor to address the immediate needs of the Technology Divisioris'Security Policies) (3)communicate and enforce the contracting
Commonwealth even if not contemplated under the original Contract or procurement. agency's ISP and such Security Policies against all employees(whether such employees
Payments are subject to appropriation and other payment terms, are direct or contracted) and subcontractors; (4) implement and maintain any other
Consultant Contractor Certifications (For Consultant Contracts 'HH" and 'NN' and enable appropriate security procedures and practices necessary to protect personal
'U05'object codes subject to G.L.Chapter 29,s 29A1. Contractors must make required, information to which the Contractor is given access by the contracting agency from the
disclosures as part of the RFR Response or using the Consultant Contractor Mandatory unauthorized access,destruction,use,modification,disclosure or loss;(5)be responsible
Submission Form. for the full or partial breach of any of these terms by its employees (whether such
Attorneys. Attorneys or firms providing legal services or representing Commonwealth employees are direct or contracted) or subcontractors during or after the term of this
Departments may be subject to G.L.c.30,s.65,and it providing litigation services must be Contract,and any breach of these terms may be regarded as a material breach of this
approved by the Office of the Attorney General to appear on behalf of a Department,and Contract; (6) in the event of any unauthorized access, destruction, use, modification,
shall have a continuing obligation to notify,the Commonwealth of any conflicts of interest disclosure or loss of the persona!information(collectively referred to as the'unauthorized
arising under the Contract. use'):(a)immediately notify the contracting agency if the Contractor becomes aware of the
Subcontractor Performance. The Contractor certifies full responsibility for Contract unauthorized use;(b)provide full cooperation and access to information necessary for the
performance, including subcontractors, and that comparable Contract terms will be contracting agency to determine the scope of the unauthorized use; and(c)provide full
included in subcontracts, and that the Department will not be required to directly or cooperation and access to information necessary for the contracting agency and the
indirectly manage subcontractors or have any payment obligations to subcontractors.. Contractor to fulfill any notification requirements.Breach of these temms may be regarded
T EXECUTIVE ORDERS as a materal breach of this Contract,such that the Commonwealth may exercise any and
For covered Executive state Departments, the Contractor certifies compliance with all contractual rights and remedies, including without limitation indemnification under
Section 11 of the Commonwealth's Term�nd Conditions, withholding
applicable Executive Orders(see also Massachusetts Executive Orders},including but not payments,
limited to the specific orders listed below. A breach during period of a Contract may be Contract suspension, termination. addition, the Contractor may subject to
considered a material breach and subject Contractor to appropriate monetary or Contract applicable statutory or regulatory penalties,including and without limitation,those
hose imposed
pursuant to G.L.c.93H and under C.L.c.214.§3B for violations under M.G.L c.66A.
sanctions. Executive Orders 523 524 and 526. Executive Order 526 (Order Regarding Non-
Executive Order 481. Prohibiting the Use of Undocumented Workers on State Contracts, Discrimination, Diversity, Equal Opportunity and Affirmative Action which supersedes
For all state agencies in the Executive Branch, including ail executive offices, boards, Executive Order 478), Executing Order 524 (Establishing the Massachusetts Supplier
commissions, agencies, Departments, divisions, councils, bureaus, and offices, now Diversity Program which supersedes Executive Order 390). Executive Omer 523
existing and hereafter established, by signing this Contract the Contractor certifies under (Establishing the Massachusetts Small Business Purchasing Program.) All programs,
the pains and penalties of perjury that they shall not knowingly use undocumented workers activities, and services provided, performed, licensed, chartered, funded, regulated, or
in connection with the performance of this Contract;that,pursuant to federal requirements, contracted for by the state shall be conducted without unlawful discrimination based on
shall verify the immigration status of workers assigned to a Contract without engaging in race color, age, gender, ethnicity, sexual orientation, gender identity or expression,
unlawful discrimination;and shall not knowingly or recklessly after,falsify,or accept altered religion,creed,ancestry,national origin,disability,veteran's status(including Vietnam-era
or falsified documents from any such worker veterans), or background. The Contractor and any subcontractors may not engage in
Executive Order 130. Anti-Boycott. The Contractor warrants,represents and agrees that discriminatory employment practices; and the Contractor certifies compliance with
during the time this Contract is in effect,neither it nor any affiliated company,as hereafter applicable federal and state laws, rules, and regulations governing fair labor and
defined,participates in or cooperates with an international boycott(See IRC§999(b)(3)- employment practices,and the Contractor commits to purchase supplies and services from
U,and IRS Audit Guidelines Boycotts}or engages in conduct declared to be unlawful by certified minority or women-owned businesses,small businesses,or businesses owned by
G.L.c. 151 E,_52. A breach in the warranty,representation,and agreement contained in socially or economically disadvantaged persons or persons with disabilities These
this paragraph,without limiting such other rights as it may have,the Commonwealth shall provisions shall be enforced through the contracting agency, OSD, and/or the
be entitled to rescind this Contract. As used herein,an affiliated company shall be any Massachusetts Commission Against Discrimination. Any breach shall be regarded as a
business entity of which at least 51%of the ownership interests are directly or indirectly material breach of the contract that may subject the contractor to appropriate sanctions.
owned by the Contractor or by a person or persons or business entity or entities directly of
indirectly owning at least 51%of the ownership interests of the Contractor,or which directly
or indirectly owns at least 51%of the ownership interests of the Contractor.
Executive Order 346. Hiring of State Employees By State Contractors Contractor certifies
compliance with both the conflict of interest law G.L.c.268A fi II s.5 1 and this
order; and includes limitations regarding the hiring of state employees by private
companies contracting with the Commonwealth. A privatization contract shall be deemed
(Updated 3121/2014) Page 5 of 5
On Completing the Contractor Authorized Signatory List (CASL1 Document:
The person signing the contract must be authorized by the entity receiving the grant to sign
contracts.
The CASL document is the form used for this authorization.
This two-page form must be completed by MEMA sub-recipients (the "Contractor") in order to
process your contract; both pages must be completed -the second page must be notarized.
The Contractor (i.e., the entity receiving this grant - Municipality, Tribe, etc) must provide a
listing of individual(s) 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.
The person signing the contract must be listed in the table on page 1 of the CASL. In addition,
this person must provide a notarized specimen of their signature on page 2 of the CASL.
The individual who authorizes the above-referenced individual(s) must be either a Mayor, Town
Manager, President, CEO, CFO, Corporate Clerk, or Legal Counsel for the entity receiving the
contract. This authorizing individual would provide their: signature, date, and requested contact
information on page 1 of the CASL
The authorizing individual — unless they are the Mayor, Town Manager, President, CEO, CFO,
Corporate Clerk, or Legal Counsel - cannot authorize himself/herself to sign the contract.
MEMA must have the completed and original copy of the CASL in order to process contracts.
Fiscal Year 2015: DHS Standard Terms and Conditions
1. Assurances Administrative Requirements and Cost Principles
Recipients of DHS federal financial assistance must complete OMB Standard
Form 424B Assurances —Non-Construction Programs.ams. Certain assurances in
this document may not be applicable to your program, and the awarding
agency may require applicants to certify additional assurances. Please
contact the program awarding office if you have any questions.
The administrative, cost principles and audit requirements that apply to
DHS award recipients originate from.-
2 CFR Part 200, Section 3002, Uniform Administrative Requirement, Cost
Principles, and Audit Requirements for Federal Awards.
11. Acknowledgsment of Federal Fuming from OHS
All recipients must acknowledge their use of federal funding when issuing
statements, press releases, requests for proposals, bid invitations, and other
documents describing projects or programs funded in whole or in part with
Federal funds.
Ill. Activities Conducted Abroad
All recipients must ensure that project activities carried on outside the United
States are coordinated as necessary with appropriate government authorities
and that appropriate licenses, permits, or approvals are obtained.
IV. Age Discrimination Act of 1975
All recipients must comply with the requirements of the Age Discrimination Act of
1975 (42 U.S.C. § 6101 et seg.), which prohibits discrimination on the basis of
age in any program or activity receiving Federal financial assistance.
V. Americans with Disabilities Act of 1990
All recipients must comply with the requirements of Titles I, 11, and III of the
Americans with Disabilities Act, which prohibits recipients from discriminating on
the basis of disability in the operation of public entities, public and private
transportation systems, places of public accommodation, and certain testing
entities (42 U.S.C. §_§ 12101-12213).
VI. RestPsacticf for Collection and Use of Personally Identifiable Information
LIM
All recipients who collect PH are required to have a publically-available privacy
policy that describes what PH they collect, how they use the PII, whether they
share PH with third parties, and how individuals may have their PH corrected
where appropriate.
Standard Terms & Conditions: Version 5.0 January 21,2015
1
Award recipients may also find as a useful resource the DHS Privacy Impact
Assessments: Privacy Guidance and Privacy template respectively.
VI1. TMe V1 of the C' '
All recipients must comply with the requirements of Title VI of the Civil Rights Act
of 1964 (42 U.S.C. § 2000d et seg.), codified at 6 CFR Part 21 and 44 CFR Part
7, which provides that no person in the United States will, on the grounds of race,
color, or national origin, be excluded from participation in, be denied the benefits
of, or be subjected to discrimination under any program or activity receiving
Federal financial assistance.
VIII. Civil Rights Act of 1968
All recipients must comply with Title VI11 of the Civil Rights Act of 1968, which
prohibits recipients from discriminating in the sale, rental, financing, and
advertising of dwellings, or in the provision of services in connection therewith,
on the basis of race, color, national origin, religion, disability, familial status, and
sex (42 U.S.C. � 3601 et seq.), as implemented by the Department of Housing
and Urban Development at 24 CFR Part 100. The prohibition on disability
discrimination includes the requirement that new multifamily housing with four or
more dwelling units—i.e., the public and common use areas and individual
apartment,units (all units in buildings with elevators and ground-floor units in
buildings without elevators)—be designed and constructed with certain
accessible features (see 24 CFR_§ 100.201).
IX. Coo„yragh
All recipients must affix the applicable copyright notices of 17 U.S.C. 4 401 or
402 and an acknowledgement of Government sponsorship (including award
number) to any work first produced under Federal financial assistance awards,
Unless the work includes any information that is otherwise controlled by the
Government (e.g., classified information or other information subject to national
security or export control laws or regulations).
X. Debarment-and Sus ern§ion
All recipients must comply with Executive Orders 12549 and 12689, which
provide protection against waste, fraud and abuse by debarring or suspending
those persons deemed irresponsible in their dealings with the Federal
government.
XI. pig-Free W-o-rknlace R u�latiols
All recipients must comply with the Drug-Free Workplace Act of 1988 (412
U.S.C. § 701 et seq.), which requires that all organizations receiving grants from
any Federal agency agree to maintain a drug-free workplace. These regulations
are codified at 2 CFR 3001.
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2
XII. Dualication Qf Benefits .
State, Local and Tribal Recipients must comply with 2 CFR Part &225, Appendix
A, paragraph (C)(3)(c), which provides that any cost allocable to a particular
Federal award or cost objective under the principles provided for in this authority
may not be charged to other Federal awards to overcome fund deficiencies.
XII 1. Fnergy Policy and Conservation �t
All recipients must comply with the requirements of 42 U.S.C. §6201 which
contain policies relating to energy efficiency that are defined in the state energy
conservation plan issues in compliance with this Act.
XIV. &12orting Subawards and Executive Comjensation
A. First-tier Subawards.
All recipients, unless exempt as provided in paragraph D, must report each
action that obligates $25,000 or more in Federal funds that does not include
Recovery funds (as defined in section 1512(a)(2) of the American Recovery
and Reinvestment Act of 2009, Pub. L. 111-5) for a subaward to an entity.
Recipients must report the information about each obligating action in
accordance with the submission instructions posted at hftp:ll www.fsrs. ov
specify.
B. Total Compensation of Recipient Executives.
1. All recipients must report total compensation for each of the five most
highly compensated executives for the preceding completed fiscal year,
if,
a. the total Federal funding authorized to date under this award is
$25,000 or more,
b. in the preceding fiscal year, recipients received —
i. Eighty percent or more of the annual gross revenues from
Federal procurement contracts (and subcontracts) and Federal
financial assistance subject to the Transparency Act, as defined
at 2 CFR 170.320 (and subawards), and
ii. $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial
assistance subject to the Transparency Act, as defined at 2
CFR 170.320 (and subawards); and
c. The public does not have access to information about the
compensation of the executives through periodic reports filed the
Securities Exchange Act of 1934 and Internal Revenue Code of
1986.
2. Where and when to report. Recipients must report executive total
compensation described in paragraph b.1 of this award term:
a. As part of the registration profile at httpa/www.sam.gov.
b. By the end of the month following the month in which this award
is made, and annually thereafter.
Standard Terms& Conditions; Version 5.0 January 21, 2015
3
C. Total Compensation of Subrecipient Executives.
All recipients unless exempt as provided in paragraph d. of this award
term, for each first-tier subrecipient. Recipients must report the names
and total compensation of each of the subrecipient's five most highly
compensated executives for the subrecipient's preceding completed
fiscal year, if
a. in the subrecipient's preceding fiscal year, the subrecipient
received—
i. 80 percent or more of its annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal
financial assistance subject to the Transparency Act, as
defined at 2 CFR 170.320 (and subawards); and
ii. $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts), and Federal
financial assistance subject to the Transparency Act (and
subawards); and
b. The public does not have access to information about the
compensation of the executives through periodic reports filed
under section 13(a) or 15(d) of the Securities Exchange Act of
1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal
Revenue Code of 1986.
D. Exemptions
All recipients' gross income, from all sources of the previous tax year,
under $300,000, are exempt from the requirements to report:
a. Subawards, and
b. The total compensation of the five most highly compensated
executives of any subrecipient.
XV. False Claims Act and Program Fraud Civil Remedies
All recipients must comply with the requirements of 31 U.S.C. U729 which set
forth that no recipient of federal payments shall submit a false claim for payment.
See also 38 U.S.C. 3801-3812 which details the administrative remedies for
false claims and statements made.
XVI. Federal DebLStatus
All recipients are required to be non-delinquent in their repayment of any
Federal debt. Examples of relevant debt include delinquent payroll and other
taxes, audit disallowances, and benefit overpayments. See OMB Circular A-129
and form SF-42413, item number 17 for additional information and guidance.
XVII. Fly America Act of 1974
All recipients must comply with Preference for U.S. Flag Air Carriers: (air
carriers holding certificates under 49 U.S.C. 41102) for international air
transportation of people and property to the extent that such service is available,
in accordance with the International Air Transportation Fair Competitive
Practices Act of 1974 (49 U.S.C. _. 40118) and the interpretative guidelines
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4
issued by the Comptroller General of the United States in the March 31, 1981,
amendment to Comptroller General Decision B138942.
XVI11. Hotel and Motel Fire Safety Act of 1990
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990,
15 U.S.C, $2225a, all recipients must ensure that all conference, meeting,
convention, or training space funded in whole or in part with Federal funds
complies with the fire prevention and control guidelines of the Federal Fire
Prevention and Control Act of 1974, 15 U.S.C. §2225.
XIX. Limited English Proficient Civil Rights Act of 1964 Title VI
All recipients must comply with the Title VI of the Civil Rights Act of 1964 (Title
VI) prohibition against discrimination on the basis of national origin, which
requires that recipients of federal financial assistance take reasonable steps to
provide meaningful access to persons with limited English proficiency (LEP) to
their programs and services. Providing meaningful access for persons with LEP
may entail providing language assistance services, including oral interpretation
and written translation. In order to facilitate compliance with Title VI, recipients
are encouraged to consider the need for language services for LEP persons
served or encountered in developing program budgets. Executive Order 13166,
Improving Access to Services for Persons with Limited English Proficiency
(August 11, 2000), requires federal agencies to issue guidance to recipients,
assisting such organizations and entities in understanding their language access
obligations. DHS published the required recipient guidance in April 2011, DHS
Guidance to Federal Financial Assistance Recipients Regarding Title VI
Prohibition Against National Origin Discrimination Affecting Limited English
Proficient Persons, 76 Fed. Reg. 21755-21768, (April 18, 2011). The Guidance
provides helpful information such as how a recipient can determine the extent of
its obligation to provide language services; selecting language services; and
elements of an effective plan on language assistance for LEP persons. For
additional assistance and information regarding language access obligations,
please refer to the DHS Recipient Guidance https:l/www.dhs.govlguidance-
published-help-department-supported-organizations-provide-meaningful-access-
people-limited and additional resources on .http://www.lel?.-qov.
XX. LLo ,byIng RmWbitio-ns
All recipients must comply with 31 U.S.C. §1352, which provides that none of the
funds provided under an award may be expended by the recipient to pay any
person to influence, or attempt to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with any Federal action
concerning the award or renewal.
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5
XXI. Non-suQPlanting Requirement
All recipients who receive awards made under programs that prohibit
supplanting by law must ensure that Federal funds do not replace
(supplant) funds that have been budgeted for the same purpose through
non-Federal sources. Where federal statues for a particular program
prohibits supplanting, applicants or recipients may be required to
demonstrate and document that a reduction in non-Federal resources
occurred for reasons other than the receipt of expected receipt of Federal
funds.
XXII. Patents gnd Intellectual Property Rjgbts
Unless otherwise provided by law, recipients are subject to the Ba h-Dole Act
Publ. L. No 96-517, as amended, and codified in 35 U.S.C. section 200 et seq.
All recipients are subject to the specific requirements governing the
development, reporting, and disposition of rights to inventions and patents
resulting from financial assistance awards are in 37 C.F.R. Part 401 and the
standard patent rights clause in 37 C.F.R. section 401.14.
XXIII. ProcurgMent of Becover2d Materials
All recipients must comply with section 6002 of the Solid Waste Disposal
act, as amended by the Resource Conservation and Recovery Act. The
requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 CFR part
247 that contain the highest percentage of recovered materials practicable,
consistent with maintaining a satisfactory level of competition, where the
purchase price of the item exceeds $10,000 or the value of the quantity
acquired by the preceding fiscal year exceeded $10,000; procuring solid
waste management services in a manner that maximizes energy and
resource recovery; and establishing an affirmative procurement program for
procurement of recovered materials identified in the EPA guidelines.
XXIV. Contract Provisions for Non-federii Enfily Contracts under Federal Awards
a. Contracts for more than the simplified acquisition threshold set at
150 000.
All recipients who have contracts exceeding the acquisition threshold
currently set at $150,000, which is the inflation adjusted amount
determined by Civilian Agency Acquisition Council and the Defense
Acquisition Regulation Council as authorized by 41 U.S.C. M 908,
must address administrative, contractual, or legal remedies in
instance where contractors violate or breach contract terms and
provide for such sanctions and penalties as appropriate.
b. Contracts in excess of$10,000.
All recipients that have contracts exceeding $10,000 must address
termination for cause and for convenience by the non-Federal entity
Standard Terms& Conditions: Version 5.0 January 21, 2015
6
including the manner by which it will be effected and the basis for
settlement.
XXV. SAFECOM
All recipients who receive awards made under programs that provide
emergency communication equipment and its related activities must comply
with the SAFECOM Guidance for Emergency Communication Grants,
including provisions on technical standards that ensure and enhance
interoperable communications.
XXVI. Terrorist Financing E.O. 13224
All recipients must comply with U.S. Executive Order 13224 and U.S. law that
prohibit transactions with, and the provisions of resources and support to,
individuals and organizations associated with terrorism. It is the legal
responsibility of recipients to ensure compliance with the E.O. and laws.
XXVI I.Title IX of the Education Amendments of 1 75(Eaual OR ortu ' Y in
EducationAct)
All recipients must comply with the requirements of Title IX of the Education
Amendments of 1972 (20 U.S.C. § 1681 et seq.), which provides that no person
in the United States will, on the basis of sex, be excluded from participation in, be
denied the benefits of, or be subjected to discrimination under any educational
program or activity receiving Federal financial assistance. These regulations are
codified at 6 CFR Part 17 and 44 CFR Part 19
XXVIII. Tmfficking Victims Protection Act of 2000
All recipients must comply with the requirements of the government-wide award
term which implements Section 106(g) of the Trafficking Victims Protection Act
(TVPA) of 2000, as amended (22 U.S.C. § 7104), located at 2 CFR Part 175.
This is implemented in accordance with OMB Interim Final Guidance, Federal
Register, Volume 72, No. 218, November 13, 2007. Full text of the award term is
provided at 2 CFR § 175.15.
XX1X. Rehabilitation Act of 1973
All recipients of must comply with the requirements of Section 504 of the
Rehabilitation Act of 1973, 29 U.S.C.§794, as amended, which provides that no
otherwise qualified handicapped individual in the United States will, solely by
reason of the handicap, be excluded from participation in, be denied the benefits
of, or be subjected to discrimination under any program or activity receiving
Federal financial assistance. These requirements pertain to the provision of
benefits or services as well as to employment.
XXX.
Standard Terms& Conditions: Version 5.0 January 21,2015
All recipients must comply with the requirements of the Uniting and
Strengthening America by Providing Appropriate Tools Required to Intercept
and Obstruct Terrorism Act (USA PATRIOT Act), which amends 18 U.S.C. §&
175-175c. Among other things, the USA PATRIOT Act prescribes criminal
penalties for possession of any biological agent, toxin, or delivery system of a
type or in a quantity that is not reasonably justified by a prophylactic, protective,
bona fide research, or other peaceful purpose.
XXXI. Use of DHS $eal. Logo and Flags
All recipients must obtain DHS's approval prior to using the DHS seal(s), logos,
crests or reproductions of flags or likenesses of DHS agency officials, including
use of the United States Coast Guard seal, logo, crests or reproductions of flags
or likenesses of Coast Guard officials.
XXXII.Whistleblower Protection Act
All recipients must comply with the statutory requirements for whistleblower
protections (if applicable) at 10 U.S.0 2409, 41 U.S.C. 4712, and 10 U.S.C. 2324,
41 U.S.C. 4304 and 4310.
XXXIII. DHSSpecific Acknowledgements and Assurances
All recipients must acknowledge and agree—and require any sub-recipients,
contractors, successors, transferees, and assignees acknowledge and
agree—to comply with applicable provisions governing DHS access to
records, accounts, documents, information, facilities, and staff.
1. Recipients must cooperate with any compliance review or complaint
investigation conducted by DHS.
2. Recipients must give DHS access to and the right to examine and copy
records, accounts, and other documents and sources of information related to
the grant and permit access to facilities, personnel, and other individuals and
information as may be necessary, as required by DHS regulations and other
applicable laws or program guidance.
3. Recipients must submit timely, complete, and accurate reports to the
appropriate DHS officials and maintain appropriate backup documentation to
support the reports.
4. Recipients must comply with all other special reporting, data
collection, and evaluation requirements, as prescribed by law or
detailed in program guidance.
5. If, during the past three years, the recipient has been accused of
discrimination on the grounds of race, color, national origin (including limited
English proficiency), sex, age, disability, religion, or familial status, the
recipient must provide a list of all such proceedings, pending or completed,
Standard Terms & Conditions: Version 5.0 January 21, 2015
8
including outcome and copies of settlement agreements to the DHS awarding
office and the DHS Office of Civil Rights and Civil Liberties.
6. In the event any court or administrative agency makes a finding of
discrimination on grounds of race, color, national origin (including limited English
proficiency), sex, age, disability, religion, or familial status against the recipient,
or the recipient settles a case or matter alleging such discrimination, recipients
must forward a copy of the complaint and findings to the DHS Component
and/or awarding office.
The United States has the right to seek judicial enforcement of these obligations.
Signature of Authorized Signatory Date
�Ng-Ya� ,�kA��
Printed Name
Standard Terms& Conditions: Version 5.0 January 21, 2015
9
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 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
I certify that I am the President,Chief Executive 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.
,C__ . yC Date:
i.S DEC 20)j
Signature
Title: M,q y o t< Telephone: 1113 - 7 St -4 5 Z t'o
Fax: `f t3- 7�� rc��v7 7 Email: /4fliLL(p Cr"111� . 4"A. Lt 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: UT
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): f?/G Title: fn,q 1 t1 r`—
X2 vi
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, 4 (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 dot
- ,2o I�
My commission expires on: 11—LI ~0701-1,p,
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
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME :
CONTRACTOR VENDORICUSTOMER CODE: UT
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 sccurity 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
C 6177 fVl �e - Lz&
1 certify that I am the President, Chief Executive 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.
/ "121"� a 6 ?,�7
✓
Date:
Signature
Title: #74yD2 Telephone: q13 - 796-0q-00 x RZ00
Fax: 11/3-7ft- �9/ PP I Email:
[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: UT
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):
Title:
Signature as it will appe*oontract or other docume r omplete only in presence of notary):
AUTHENTICATED BY NOTARY OR CORPORATE CLERK(PICK ONLY ONE)AS FOLLOWS:
1, &k • - ' (NOTARY)as a notary public certify that I witnessed
the signature of the aforementio ed signatory above and 1 verified the individual's identity on this date:
a,c, 1 t� ,20 15�
My commission expires on: u J v;�
AFFIX NOTARY SEAL.
I, (CORPORATE CLERK)certify that 1 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 MANAGNMENT OFFICE
Special Terms, Conditions, and Reporting Requirements for EMPG, CCP, and
HMEP Sub-Recipients
September 2015
Parties
The"Contractor"or"Sub-recipient" is an eligible public or private not-for-profit entity that has
submitted an application for grant funding to the Massachusetts Emergency Management Agency
(MEMA)and has received an approved award. The sub-recipient must be represented by a duly
authorized official(s) of the Contractor whose signature(s), authorization(s), and/or
certification(s) legally represent and bind the Contractor. The Commonwealth of Massachusetts,
acting through the Massachusetts Emergency Management Agency("Department"), is
responsible for administering this grant program.
Agreement
The Sub-recipient and Department will execute a State Standard Grant Contract through
which the subrecipient agrees to perform all activities as described in the attached
application within the budget, dates of service, and other conditions set forth below. The
Department agrees to reimburse the Sub-recipient for all allowable costs incurred and to
provide technical assistance and support required to carry out the purposes of the grant.
Terms and Conditions
I. Emergency Management Performance Grant(EMPG) and Citizen Corps Program
(CCP) sub-recipients agree to adhere to all policies and guidance documents set by the
U.S. Department of Homeland Security-Federal Emergency Management Agency _
(DHS/FEMA)and the Massachusetts Emergency Management Agency(MEMA)
regarding use of the U.S. DHS-FEMA federal homeland security funding.
2. Hazardous Material Emergency Preparedness (HMEP) sub-recipients agree to
adhere to all policies and guidance documents set by the U.S. Department of
Transportation—Pipeline and Hazardous Materials Safety Administration
(DOTIPHMSA)and MEMA regarding use of the U.S. DOT-PHMSA funding.
3. Any substantive adjustment to a sub-recipient's scope of work or budget must be
reviewed and approved by MEMA prior to expenditure. A contract amendment may be
required prior to performance under an adjusted scope of work. Work or expenditures
made outside an approved scope of work or budget may not be reimbursed.
4. Sub-recipients agree to be compliant with the National Incident Management System
(NIMS).
1
5. Sub-recipients agree to comply with the following:
■ 2 CFR Part 200: Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for Federal Awards
■ 815 CMR 2.00: State Grants,Federal Grant Awards,Federal Subgrants,
and Federal Subsidies
6. Federal Funding Accounting and Transparency Act (FFATA). FEMA federal funds
are subject to the Federal Funding Accounting and Transparency Act(FFATA). Sub-
recipient agrees to abide by FFATA regulations and to submit the attached FFATA form
along with its contract package for ail contracts in excess of$25,000,
7. 2 CFR 200 Subpart F Audit Reports, Subpart F Form. (Replaces former A-133
Requirements). Per Office of Management and Budget(OMB)regulations, sub-recipient
may be subject to Subpart F audit requirements. Sub-recipient agrees to submit a copy of
any Subpart F audits reports as required by Subpart F. Sub-recipient further agrees to
notify MEMA of any Subpart F audit findings related to any federally funded activities.
Sub-contractor acknowledges that a Corrective Action Plan may be required by MEMA
for related findings prior to execution of contracts or issuance of payments. Sub-recipient
agrees to abide by OMB regulations and to submit the attached Subpart F
acknowledgement form as part of this contract package.
8. Sub-recipient Risk Assessment and Monitoring. (Replaces former A-133 Monitoring
Form). Per 2 CFR 200.331, prior to awarding of this contract, the sub-recipient must
provide to the Department the attached Sub-recipient Risk Assessment Questionnaire and
Response form. Sub-recipient further agrees to monitoring by the Department as a result
of its assessment of the sub-recipient's risk for non-compliance.
9. Internal Controls. Per 2 CFR 200,303, sub-recipients must maintain and implement
effective internal controls that provide reasonable assurance that federal funds are
managed in compliance with all statutes, regulations, and terms and conditions.
Per 2 CFR 200.430(Compensation), internal controls must cover payroll charges to
federal awards such that payroll charges are documented as accurate, allowable, and
allocable, are reflected in the official records of the sub-recipient, reasonably reflect the
total activity for each employee (federal and non-federal), and comply with all
accounting policies and practices of the sub-recipient.
10. Procurement. Sub-recipient must conduct all procurements in compliance with 2 CFR
200.318-326. Specific policies, procedures, and/or standards must be in place that meet
or exceed these requirements at the time of procurement. Costs incurred which are
otherwise appropriate and reasonable, but which were procured in violation of federal
procurement requirements may result in disallowed costs or repayments(See Sub-
recipient Non-compliance).
11. Procurement Contract provisions. Contracts utilized by sub-recipients for goods and
services must contain the applicable provisions described in 2 CFR 200 Appendix II and
attached hereto.
12. Disclosures. Per 2 CFR 200.112,the sub-recipient must disclose in writing any potential
conflicts of interest to the Department.
13. Per 2 CFR 200. 113, the sub-recipient must disclose in writing all violations of federal
criminal law involving fraud, bribery, or gratuity violations potentially effecting the
federal award.
2
14. Sub-recipients understand and agree that it cannot use any federal funds, either directly or
indirectly, in support of the enactment, repeal, modification or adoption of any law,
regulation or policy, at any level of government without the express prior written
approval of U.S. DHS FEMA and/or U.S. DOT PHMSA.
15. Press. Sub-recipient agrees to proactively notify MEMA of any interactions or planned
media outreach regarding activities funded under this grant program.
16. Release of Information.All records, papers and other documents of any kind related to
the funded activity in any manner and kept by sub-recipients of these funds shall be made
promptly available upon request to any person authorized by MEMA for inspection and
copying.
17. Application of Special Conditions to Sub-Recipient Grantees: if a sub-recipient
proposes to engage in sub-granting activities, it shall ensure its sub-grantees adhere to all
applicable DHS/FEMA, U.S. DOT, and MEMA special conditions.
18. Reporting. Sub-recipients agree to submit timely and accurate Close-Out and Match
Reports as needed and directed. Failure to comply with this condition may result in the
withholding of sub-recipient funds until the delinquent report is received.
19. Contractor/Consultant Rates. Compensation for individual consultant services is to be
reasonable and consistent with the amount paid for similar services in the market place.
Consideration can be given to compensation, including fringe benefits, for those
individuals whose employers do not provide the same. Time and effort reports are
required for consultants.
20. Copyright/Licenses. The sub-recipient acknowledges that MEMA, DHS, and DOT
reserve a royalty-free, non-exclusive, and irrevocable license to reproduce, publish, or
otherwise use, and authorize others to use, for federal or state purposes: (1)the copyright
in any work developed under an award or sub-award; and (2) and rights of copyright to
which a sub-recipient or sub-grantee purchases ownership with Federal support.
21. Acknowledgement in Published Materials. EMPG and CCP sub-recipients agree
that any publication (e.g.,written, visual, or sound) it or its contractors issue describing
programs or projects funded in whole or in part with federal funds, contain the following
statement:
"This document was prepared under a grant from FEMA's Grant Programs Directorate,
U.S. Department of Homeland Security. Points of view or opinions expressed in this
document are those of the authors and do not necessarily represent the official position or
policies of FEMA's Grant Programs Directorate or the U.S. Department of Homeland
Security."
22. Acknowledgement in Published Materials. HMEP sub-recipients agree that any
publication (e.g., written, visual, or sound) it or its contractors issue describing programs
or projects funded in whole or in part with federal funds, contain the following statement:
"This document was prepared under a grant from U.S. DOT PHMSA. Points of view or
opinions expressed in this document are those of the authors and do not necessarily
represent the official position or policies of the U.S. DOT PHMSA."
3
23. Disposal and sale of equipment purchased via DHS funds. Any proposed sale and/or
disposal must adhere to current MEMA policy.
24. User Fees. Any proposed `user fees' related to equipment, items, services, etc acquired
via DHS funding must be pre-approved by MEMA.
25. Environmental Planning and Historic Preservation (EHP). EMPG and CCP sub-
recipients shall not undertake any project having the potential to impact Environmental
or Historical Preservation (EHP)resources without the prior approval of FEMA, which is
done through MEMA.
26. Equipment acquired with grant funds. MEMA requires that equipment acquired with
federal grant funds be tracked and tagged per current MEMA policy.
27. Reporting of violations (fraud,waste, and abuse). It is the responsibility of all grant
sub-recipients and their respective agency personnel, grantees, and contractors under
grants,to report to MEMA any alleged violations, serious irregularities, sensitive issues,
or overt or covert acts that would use public funds or perform program or administrative
requirements in a manner not consistent with grantor agency statutes, related laws and
regulations, appropriate guidelines, or purposes or objectives of the grant.
28. Internet Access. Sub-recipients must have Internet access.
29. Email addresses. Sub-recipient project directors of grant programs must have individual
email addresses.
30. Sub-recipient Non-compliance. Contractor, as sub-recipient, is subject to the federal
and state regulations and related requirements set forth herein. Contractor non-
compliance may result in an audit finding and subsequent repayment of funds to the
Federal Government. Approval of a project, project costs,contract or payment by either
FEMA or MEMA does not exempt the Contractor from requirements to repay funds.
Should a state, federal, or local audit reveal that actions taken by the Contractor as sub-
recipient, or any of its contractors, regardless of previous approval by either FEMA or
MEMA, do not comply with policies, laws, or regulations,the Contractor agrees to repay
the required amounts in the manner and timeframe determined by FEMA and/or MEMA.
Repayments not made as expected will be considered debts and addressed under the
Commonwealth's Debt Collection and Intercept policy(815 CMR 9.00).
31. Monitoring. Sub-recipients agree to cooperate with MEMA monitoring and site visits.
32. Records Retention. The Contractor shall retain all related records for a minimum of six
years from the date of the Close-Out Report Submission. In cases of similar requirements
at two or more levels,the more stringent of the requirements must be followed.
33. FEMA Required assurances. All sub-recipients must review and sign the attached
Summary Sheet for Required Assurances and any associated assurances required.
4
34. Certifications (200.415). To assure that expenditures are proper and in accordance with
the terms and conditions of the Federal award and approved project budgets, the annual
and final fiscal reports or vouchers requesting payment under the agreements must
include a certification, signed by an official who is authorized to legally bind the non-
Federal entity, which reads as follows: "By signing this report, I certify to the best of my
knowledge and belief that the report is true, complete, and accurate, and the expenditures,
disbursements and cash receipts are for the purposes and objectives set forth in the terms
and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent
information, or the omission of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code
Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)."
Non-profit organizations must certify as appropriate that they did not meet the definition
of a major corporation as defined in 2 CFR 200,414 Indirect(F&A)costs, paragraph (a).
35. Prior to acceptance of these terms and conditions, Contractor must evaluate its
policies, procedures, and management systems for risk of non-compliance with any of the
above terms and conditions, inclusive of all requirements of FEMA and 2 CFR 200. Any
identified areas of risk must be brought to the attention of MEMA prior to the execution
of the contract in order to determine and implement the appropriate remedy.
36. By signing below, the Contractor certifies that it understands all obligations and has in
place or will implement policies and procedures that meet or exceed the standards and
requirements above. Acceptance of payment for the activities under this agreement
indicates that all actions taken by the sub recipient for the purposes of this grant program
were done so in compliance with all grant requirements and all applicable laws and
regulations, including the certification statement above.
/sec .moo/,Sy
Signature of Authorized Signatory Date
Printed Name Title
5
including outcome and copies of settlement agreements to the DHS awarding
office and the DHS Office of Civil Rights and Civil Liberties.
6. In the event any court or administrative agency makes a finding of
discrimination on grounds of race, color, national origin (including limited English
proficiency), sex, age, disability, religion, or familial status against the recipient,
or the recipient settles a case or matter alleging such discrimination, recipients
must forward a copy of the complaint and findings to the DHS Component
and/or awarding office.
The United States has the right to seek judicial enforcement of these obligations.
Signature of Authorized Signatory Date
P,4 0P- F1G#4 Ff e Hj5N
Printed Name
Standard Terms &Conditions: Version 5.0 January 21, 2015
9
MEMA Subrecipient Pre-Award Risk Assessment Questionnaire
Subreciplent Name: �ToWJ1I 4l�- 176,41464m
(Includes all departments,divisions, or units within the Municipality or Not-far-Profit receiving federal grant funds)
Per 2 CFR 200.331 section (b), MEMA is required to "evaluate each subrecipient's risk of non-compliance
with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of
determining the appropriate subrecipient monitoring." Please provide the information requested below
with your signed contract package. MEMA may be required to follow up with you regarding your
responses to discuss monitoring requirements.
200.331(b)(1): Has Subrecipient been the direct recipient or a subrecipient of MEMA-issued federal
funds within the last two fiscal years:
Yes Q No ❑
(if yes, please complete corresponding section on next page)
200.331(b)(2): Was Subrecipient required (OMB A-133 or 2 CFR 200 Subpart F)to have an audit of
Federal Funds performed in the two most recently closed fiscal years?
Yes ❑ No
r
Does Subrecipient have any findings or questioned costs related to MEMA federal grants administration
in the last two most recently closed fiscal year Audits?
Yes ❑ No Is
(if yes, please complete corresponding section on next page)
200.331(b)(3): Has Subrecipient employed new personnel or implemented new or substantially
changed systems related to Federal Grant Management in the last calendar year
Yes ❑ No X
(if yes, please complete corresponding section on next page)
200.331(b)(4): Has Subrecipient been monitored by any Federal Agency as a direct recipient of Federal
Funding in the last two fiscal years.
Yes ❑ No
(if yes, please complete corresponding section on next page)
Under pains and penalties of perjury, the authorized signatory for this contracts attests to the
accuracy of the above responses and corresp nding information attached:
Signatures Date / ��
Printed Name Ll ei*t;:71V Title I..4 7¢z
MEMA Sub-recipient Pre-Award Risk Assessment Questionnaire
Response Form
200.331(b)(1): Please list below(or attach)all MEMA federal awards received as a direct recipient or
subrecipient in the last two fiscal years:
Federal Award Name Purpose q�. Amount Start Date End Date
200.331(b)(2): Please list below(or attach)the results of any A-133 or Subpart F audits for the last two
fiscal years of subrecipient:
Grant Audited Finding Date Finding Description
MEMA will send a letter to subrecipient seeking additional details on the above finding(s),requesting subrecipient
response and Corrective Action Plan, and setting a schedule for MEMA to issue a Management Decision.
Additional monitoring and follow up may take place prior to or after MEMA's decision has been issued. Failure to
implement corrective action plans could result in a loss of funds administered by the Massachusetts Emergency
Management Agency.
200.331(b)(3): Please describe any new systems or staffing that may impact federal grant award
administration:
i
200.331(b)(4): Please describe (or attach)the results of federal monitoring received within the last two
fiscal years.
J"