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HomeMy WebLinkAboutMEMA_FEMA ContractsDeval L. Patrick Governor Andrea J. Cabral Secretary October 10, 2014 THE COMMONWEALTH OF MASSA, EXECUTIVE OFFICE OF PUBLIC SAFETY MASSACHUSETTS EMERGENCY MANAGEM 400 Worcester Road Framingham, MA 01702 Tel:508-820-2000 Fax:508-820-2030 Website: www.iiiass.gov/iiieiii�i Ms. Linda Darling Town of Mansfield 6 Park Road Mansfield, MA 02048 RE: Time Extension for Public Assistance (PA) Grants, 2013 February Blizzard Dear Ms. Darling, iy 01 Kurt N. Schwartz Director As you are aware, the FEMA PA program staff is currently in the process of performing a self -initiated re - review of all project worksheets (PWs) written for Hurricane Sandy (DR-4097) and the 2013 February Blizzard, Nemo (DR-4110). This quality assurance re -review has delayed reimbursement and approval of PWs for many projects. Despite the re -review process, time extension requirements to complete PA projects still apply and may impact your project eligibility/ reimbursement. Time extensions for all projects less than 100% complete are required if work is not complete within the established project completion time limit, regardless of FEMA's project approval (i.e. even if a PW has not been awarded for a particular project). The deadline dates for completing disaster -related work are established from the date of the disaster declaration, not from the PIN award date. If your 2013 February Blizzard (Nemo) related proiect(s) was less than 100% complete as of the dates listed in the chart below you will need an approved time extension for each project Without an extension, all project related costs incurred after the deadline date are at risk of being deemed as ineligible and may not be reimbursed. Type of Work Months from Declaration Date (April 19, 2013) Category A and B, Emergency Work: Includes emergency protective 6 Months (October 19, 2013) measures, (e.g. police/fire overtime, and debris clearance/debris removal) Categories C-G, Permanent Work: Includes repair of roads/bridges, 18 Months (October 19, 2014) buildings, water control and utilities, parks/recreation For your convenience, I am enclosing a copy of the time extension request form. Please complete and return a separate form for each PA project that is less than 100% complete to MEMA no later than October 31, 2014. If you have completed all of your projects by the dates listed in the chart, please reply to this letter no later than October 31, 2014 confirming completion of all your projects. I thank you for your assistance in this matter. If you have any questions, please contact Gina Valentine at 508-820-2004 or at gina.valentine@state.ma.us. Sincerely, r Scott MacLeod Mitigation & Disaster Recovery Section Chief Enclosure: Time Extension Request Form TIME EXTENSION REQUEST COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORMul-11- This form is Jointly Issued and published by the Executive Office for Administration and Finance (ANFI, the Office of the Comptroller (CTR) and the Operational Services Division IOSD) as the default contract for all Commonwealth Departments when another form is not prescribed by regulation or policy. Any changes to the official printed language of this form shall be void. Additional non-con01cting terms may be added by Attachment Contractors may not require any additional agreements, engagement letters, contract forms or other additional terms as pad of this Contract without prior Department approval. Click onhyperiinksfor definitions, Instructions and legal requirements that are Incorporated by reference into this Contract. An electronic copy of this form Is available atwww.mass.00v/osc under GuidanceFor Vendors - Forms or www.mass.aov/osd under OSD Forms. CONTRACTOR LEGAL NAME: Town of Mansfield COMMONWEALTH DEPARTMENT NAME: CDA Massachusetts Emergency (and dlbla): Management Agency MMARS Department Code: CDA Legal Address: (W9, W4,T&C): 6 Park Road, Mansfield, MA 02048 Business Malian Address: 400 Worcester Road, Framingham, MA 01702 Contract Manager: Ms. Linda Darling Billing Address (if different): E-Mail: Idarling@mansfieldma.com Contract Manager: Paula Krumsiek, Contract Specialist Phone: 508-851.6436 Fax: 508.261.1083 E-Mail: Paula.Krumsiek@state.ma.us Contractor Vendor Code: VC6000191867 - Phone: 508.820.1424 1 Fax: 508.8204404 Vendor Code Address ID (e.g. "AD00P'): AD_ MMARS Doc ID(s1: CTFEMA4110MANSFOO473 (Note: The Address id Must be set up for EFT payments.) RFR/Procurement or Other ID Number: FEMA4110-DR-MA February 2013 Blizzard x NEW CONTRACT _ CONTRACT AMENDMENT PROCUREMENT OR EXCEPTION TYPE: (Check one option only) Enter Current Contract End Date Prior to Amendment: 20_ _StalewideContract(OSDoranOSD-designated Department) Enter Amendment Amount:$ .(or'nochange) Collective Purchase (Attach OSD approval, scope, budget) AMENDMENT TYPE: (Check one option only. Attach details of Amendment changes.) —DeparlmentProcurement(includes State orFederal grants 816CMR2.001 _ Amendment toScope orBudget (Attach updated scope and budget) (Attach RFR and Response or other procurement supporting documentation) Interim Contract (Attach justi0callon for Interim Contract and updated scope/budget) —EmergencyContract (Attach justification for emergency, scope, budget) Contract Emplovee (Attach Employment Status Form, scope, budget) _ — ConlractEmplovee(Attachanyupdalestoscopeorbudget) x LeglslativelLenal or Other: (Attach authorizing Ianguagerjustiticelion, scope and —LenlslalivelLenal or Other: (Attach authorizing Ianguage1justi0callon 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. _2L Commonwealth Terms and Conditions Commonwealth Terms and Conditions For Human and Social Services COMPENSATION: (Check ONE option): The Department certifies that payments for authorized pedornance,aocepted in accordance with the terms of this Contract wi 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 terms and any changes If rates or terms are being amended.) x Maximum Oblination Contract Enter Total Maximum Obligation for total duration of this Contract (or newTotal If Contract Is being amended), $16,604,09:: PROMPT PAYMENT DISCOUNTS (PPD): Commonwealth payments are Issued through EFT 45 days from Invoice recelpL Contractors requesting accelerated payments must identity a PPD as follows: Payment Issued within 10 days —°h PPD; Payment issued within 15 days —% PPD; Payment Issued within 20 days — % PPD; Payment Issued within 30 days —% PPD. if PPD percentages are Jeff blank, Identify reason: —agree to standard 45 day cycle — stalutoryllegal or Ready Payments (G.L, c. 29. S 23A); x only, Initlal payment (subsequent payments scheduled to support standard EFT 45 day payment cycle. See Prom t Pa Discounts Policy.) BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract fitie, purpose, fiscal year(s) and a detailed description of the scope of performance or what Is being amended for a Contract Amendment. Attach all supporting documentation and just ficetions.) (Reference CFDA If 97.036) PW00473 To reimburse for FEMA 4110 February 8.9, 2013 Blizzard — The applicant took such actions as necessary to save lives, protect public health and safety and protect Improved property Townwide. Assistance for emergency protective measures and debits removal under Category A&B under the FEMA Public Assistance Program ANTICIPATED START DATE: (Complete ONE option only) The Department and Contractor certify for this Contract, or Contract Amendment, that Contract obligations: _ 1. may be Incurred as of the Effective Date (latest signature date below) and no obligations have been incurred prior to the Effective Date. _ 2. may be Incurred as of 20_, a date LATER than the Effective Date below and no obligations have been Incurred prior to the Effective Date. x 3. were incurred as of 21812013, a date PRIOR to the Effective Date below, and the parties agree that payments for any obligations Incurred prior to the Effective 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 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 1213112013, with no new obligations being Incurred after this date unless the Contract is property amended, provided that the leans of this Contract and performance expectations and obligations shall survive Its termination for the purpose of resolving any claim or dispute, for oompiefing any negotiated terms and warranties, to allow any close out or transition performance, reporting, Invoicing or final payments, orduring 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 dale 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 Contact 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 terns, provided that additional negotiated terms will take precedence over (he relevant terms In the RFR and the Contractor's Response only if made using he 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. ALIT HOR/IZ/I G�SIGNATURE FOR THE, C uTRACTOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH: X: � Date: C�� X: Date: . . (Signature and Date uslB Handwritten At Time of Signature) (Signature and Date Must Be Handwritten At Time of Signature) � Print Name:)4), /m -5:5 Print Name: David Mahr Print Title: :z �///% Print Title: Chief Fiscal Officer (Issued 6/2712011) Page t.of 5. EMMIE Page 1 of 1 kapta uRe nateros/ luo0 • o Federal Emergency Management Agency Project Application Grant Report (P.2) Disaster: FEMA-4110-DR-MA Number of Records: 1 - Applicant ID: 005-38225-00 Bundle N: PA-01-MA-4110•State-0016 (15) Applicant: MANSFIELD (TOWN OF) PW H ! Cat Cost Share Projected Completion Date Approved PW Amount ($) PA 01-MA 4110 PW-00473(0) _ B N 10 19 2013 22,138.78' Facility Number: Facility Name: Town of Mansfield _ Location: Town of Mansfield Scope of Work: The applicant took such actions as necessary to save lives, protect public health and safety, and protect' Improved property. The applicant used force account tabor of 534 hours which included 424 qualified ;overtime hours ($18,377.46) and force account equipment, 132 hours,($18,520.50)to respond to 30 storm related calls. The applicant is responsible for fire and ambulance services for the town's 22,414 citizens who reside in the town's 20.7 square mile area . All documentation was reviewed / verified and costs found reasonable by the FEMA Project Specialist. assigned. I Note: the fire dept. does not use time sheets but instead uses a roster which is attached. WORK COMPLETED: All documentation was reviewed/verified and found reasonable by the FEMA Project Specialist assigned. Copies of all contracts, applicant's pertinent pre -disaster policies, codes and i standard upgrade requirements, invoices allowed and samples of payroll data attached. DECLINING DIRECT ADMINISTRATIVE COSTS: The Applicant has declined to request reimbursement I records adequately and documenting the source and application of funds as required in 44 CFR part 13. I PROCUREMENT: The Applicant has been advised by FEMA PAC and/or Project Specialist that in the seeking of proposals and letting of contracts for eligible work, the Applicant must comply with its Local, State and/or Federal procurement laws, regulations, and procedures. RECORD RETENTION: As described in 44 CFR 13.42 (2)(b), 3(c), Subgrantee must maintain all work - related records for a period of three (3) years from Subgrantee closure (final payment), all records i relative this project worksheet are subject to examination and audit by the State, FEMA and the Comptroller General of the United States and must reflect work related to disaster specific costs. IInsurance Purchase Requirement. Applicant must obtain and maintain insurance coverage to cover the subject facility for the hazard for which this disaster was declared and which caused the subject toss. Evidence of insurance purchase above must be submitted to FEMA prior to award of any assistance for this disaster event. If the requirement to purchase all insurance is not met, FEMA will not provide assistance for the damage sustained in the current or a future disaster of the same type. If the applicant does not maintain all required insurance, FEMA will not provide any assistance for that facility in future disasters of the same I type. Small projects, any category. For small projects FEMA pays based on the actual or estimated cost in order to expedite the funds (PA Digest pg. 121.) FEMA does not perform final inspections on small projects; however, the state must certify compliance. The applicant does have the ability to request a small project netting (appeal) i if/when significant net small over -runs occur. This process will involve a review of atl documentation 1 j for all small projects and an adjustment will be made for the total actual eligible dollars spent (over - Scope of Work: ; run/under-run). A I ---- —1 PPW — ,PWs ($) I -Subgrantee Admin Exp. ($) —_ --_ Total ( Amount Eligible $) 22,138 78 0.00 _ 22,138.78�, Federal Share ($) _ -- ,- 16 604 09 , 0.09j 16,604.09 https:llconnect2.dhs. gov/enunie/,Danalnfo=isource.fema.net,SSL+search.do?grantProgram... 9/9/2013 Federal Emergency Management Agency E-Grants Page 1 of 2 P 01-M 10- - 0473(0) P ApplicantName: Application Title: MANSFIELD (TOWN OF) MSF13MS2 emergency fire protective measures Period of Performance Start: Period of Performance End: 04-19-2013 10-19-2013 Bundle Reference # (Amendment #) JDate Awarded PA-01-MA-4110-Slate-0016(15) 09-07-2013 Subgrant Application - FEMA Form 90-91 Note: The Effective Cost Share for this application is 75% FEDERAL EMERGENCY MANAGEMENT AGENCY PROJECT WORKSHEET DISASTER PROJECT NO. I PA ID NO. DATE CATEGORY MSFBMS2 005-38225- 08-22-2013 B FEMA 4110 - DR -MA 1 00 APPLICANT: MANSFIELD (TOWN OF) WORK COMPLETE AS OF: 06.25-2013 : 100 % Site 1 of 1 DAMAGED FACILITY: COUNTY: Bristol Town of Mansfield LOCATION: - LATITUDE: LONGITUDE: 42.023648 -71.216227 PA-01-MA-41 10-PW-00473(0): Town of Mansfield DAMAGE DESCRIPTION AND DIMENSIONS: PA-01 -MA-41 10-PW-00473(0): Damage Description & Dimensions: During the declared incident period of and following February 8th, 2013 through February 10th, 2013, the applicant's county had record or near record snowfall. It has been determined that it was beyond both local and slate capabilities to adequately respond. Record or near record snowfall accompanied by icing conditions was deposited on public roads, Right of Ways, pedestrian walkways, parking lots, and other publicly maintained properties causing large scale power disruptions, loss of heal to residences and numerous auto accidents. It Is the charge of Mansfield fire dept to maintain public safety. SCOPE OF WORK: PA-01-MA-4110-P W-00473 (0): Scope of Work: The applicant took such actions as necessary to save lives, protect public health and safely, and protect improved property. The applicant used force account labor of 534 hours which included 424 qualified overtime hours ($18,377.46) and force account equipment, 132 hours, ($181520.50)to respond to 30 storm related calls. The applicant is responsible for fire and ambulance services for the town's 22,414 citizens who reside In the town's 20.7 square mile area. All documentation was reviewed I verified and costs found reasonable by the FEMA Project Specialist assigned. Note: the fire dept. does not use time sheets but Instead uses a roster which is attached. WORK COMPLETED: All documentation was reviewed/verified and found reasonable by the FEMA Project Specialist assigned. Copies of https://connect2.dhs. gov/emmie/,Danalnfo=isource.fema.net,SSL+internalIntegration?appli... 9/9/2013 Federal Emergency Management Agency E-Grants Page 2 of 2 all contracts, applicant's pertinent pre -disaster policies, codes and standard upgrade requirements, invoices allowed and samples of payroll data attached. DECLINING DIRECT ADMINISTRATIVE COSTS: The Applicant has declined to request reimbursement records adequately and documenting the source and application of funds as required In 44 CFR part 13. PROCUREMENT: The Applicant has been advised by FEMA PAC and/or Project Specialist that in the seeking of proposals and letting of contracts for eligible work, the Applicant must comply with its Local, Stale and/or Federal procurement laws, regulations, and procedures. RECORD RETENTION: As described in 44 CFR 13.42 (2)(b), 3(c), Subgrantee must maintain all work -related records for a period of three (3) years from Subgrantee closure (final payment), all records relative this project worksheet are subject to examination and audit by the State, FEMA and the Comptroller General of the United States and must reflect work related to disaster specific costs. Insurance Purchase Requirement. Applicant must obtain and maintain insurance coverage to cover the subject facility for the hazard for which this disaster was declared and which caused the subject loss. Evidence of insurance purchase above must be submitted to FEMA prior to award of any assistance for this disaster event. If the requirement to purchase all insurance is not met, FEMA will not provide assistance for the damage sustained in the current or a future disaster of the same type. If the applicant does not maintain all required insurance, FEMA will not provide any assistance for that facility In future disasters of the same type. Small projects, any category. For small projects FEMA pays based on the actual or estimated cost In order to expedite the funds (PA Digest pg. 121.) FEMA does not perform final inspections on small projects; however, the state must certify compliance. The applicant does have the ability to request a small project netting (appeal) if/when significant net small over -runs occur. This process will involve a review of all documentation for all small projects and an adjustment will be made for the total actual eligible dollars spent (over-run/under-run). A Does the Scope of Work change the pre -disaster conditions al the site? ❑Yes El No Special Considerations Included? El Yes ❑✓ No Hazard Mitigation proposal Included? ❑ Yes 0 No Is there insurance coverage on this facility? El Yes 2 No PROJECT COST ITEM CODE NARRATIVE QUANTITY/UNIT UNIT PRICE COST 1 0000 ******* WORK COMPLETED *****,**,**** 0/LS $ 0.00 $ 0.00 2 9007 LABOR 1/LS $ 11,026.48 $ 11,026.48 3 9008 EQUIPMENT 1/LS $ 11,112.30 $ 11,112.30 4 9903 No Direct Administrative Costs 1/LS $ 0.00 $ 0.00 TOTAL COST $ 22,138.78 PREPARED BY MARK M STEINBERG TITLE PROJECT SPECIALIST SIGNATURE APPLICANT REP. Betty Peter TITLE DPW office manager SIGNATURE https:Hconnect2. dhs. gov/emmie/,Danalnfo=isource.fema.net,SSL+internallntegration?appli... 9/9/2013 COMMONWEALTH OF MASSACHUSETTS 155 z oa ay CONTRACTOR AUTHORIZED SIGNATORY LISTING FEMA-4110-DR-MA CONTRACTOR LEGAL NAME: Town of Mansfield CONTRACTOR VENDOR/CUSTOMER CODE: VC6000191867 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. 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. &/ cG� �— Date: Signature Title. 040AyI Telephone: Fax: 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. COMMONWEALTH OF MASSACHUSETTS Iss2004 May CONTRACTOR AUTHORIZED SIGNATORY LISTING FEMA 4110-DR-MA CONTRACTOR LEGAL NAME: Town of Mansfield CONTRACTOR VENDOR/CUSTOMER CODE: VC6000191867 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): e �?71CeIO' Title: X Signature as it will appear on contract or other document (Complete only in presence of notary): AUTHENTICATED BY NOTARY OR CORPORATE CLERK (PICK ONLY ONE) AS FOLLOWS: I, (NOTARY) as a notary public certify that I witnessed the signature of the aforementioned signatory above and I verified the individual's identity on this date: 20 My commission expires on: AFFIX NOTARY SEAL c / O [t9n I, MI. (L 1 0 4 A 01 _ �" i t 9Ib CLERK) certify that I witnessed the signature of the aforementioned signatory above, hat I vented the individual's identity and confirm the individual's authority as an authorized signatory for th� Contractor on this date: \fir nI V I� 20 /--3. AFFIX CORPORATE SEAL 'S THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY 400 Worcester Road Framingham, MA 01702-5399 Tel:508-820-2000 Fax:508-820-2030 Deval L. Patrick Website: www,mass.gov/mema Governor Andrea J. Cabral Secretary Date: September 16, 2013 MEMA Scope, Terms, and Conditions (Attachment A) CTFE MA4110MAN S F00473 KurtN. Schwartz Director Disaster Declaration On February 8" - 91h 2013 a winter storm and snowstorm impacted all fourteen (14) Massachusetts counties. As a result, Massachusetts received a Presidential declaration of disaster designated FEMA-4110-DR-MA on April 19, 2013 for Barnstable, Berkshire, Bristol, Dukes, Essex, Franklin, Hampden, Hampshire, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk and Worcester Counties. Parties Town of Mansfield ("Contractor" or "Sub -grantee") is an eligible public or private not -for -profit entity that has submitted a request for public assistance as an applicant to the Federal Emergency Management Agency (FEMA) Public Assistance Program and has received an approved award. The Commonwealth of Massachusetts, acting through its Massachusetts Emergency Management Agency ("Department"), is the Federal Grantee responsible for administering all public assistance as pass -through grants for FEMA. The Contractor is a Sub - Grantee of. the Commonwealth of Massachusetts that enters into contract # CTFEMA4110MANSF00473 as described in this Attachment A. Applicable Laws and Regulations This contract is issued as a grant by the Commonwealth of Massachusetts and is subject to all applicable laws and regulations including, but not limited to, MGL Chapter 29, 815 CMR 2.00 and the Commonwealth Standard Terms and Conditions. Funding is provided to the Commonwealth by FEMA as federal assistance for the major disaster designated FEMA-4110- DR-MA under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§ 5121-5207 (Stafford Act), in accordance with 44 CFR. The Contractor is responsible for compliance with any and all applicable federal and state laws, statutes, rules, regulations, and policies. It is also the responsibility of the Contractor to maintain detailed records of documents concerning the bidding, execution, payment, and completion of this project in compliance with state and federal audit requirements. Audit Responsibilities Contractor, as sub -grantee, is subject to the above federal and state regulations and related requirements. 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 any of its obligations. Should a state, federal, or local audit reveal that actions taken by the Contractor, regardless of previous approval by either FEMA or MEMA, do not comply with regulations, the Contractor agrees to repay the required amounts in the manner and timeframe expected. Purpose The FEMA Public Assistance (PA) program reimburses approved applicants for the federal share (75%) of eligible costs incurred by the Contractor for emergency protective measures taken by the Contractor to save lives, protect public health and safety, or prevent damage to improved public or private property or for permanent work to restore a damaged facility to its pre -disaster status as a result of damage from this declared disaster. This sub -grant contract provides federal share funding, through the Department, for the specific projects listed in the attached PW — Project Worksheet FEMA Form 90-91 Subgrant Application (PW-00473). Valid Contract Dates Due to the unexpected nature of disasters, the effective contract start date on the Standard Contract signature page will most often be earlier than the dated signatures for both the Department and Contractor. The Contractor may be reimbursed for approved activity taking place no earlier than the effective start date as indicated on the Standard Contract signature page and extending to no later than 12/31/2013. All performance must be completed within these dates unless a State Standard Contract Amendment is executed by both parties prior to the current end date. Project extensions may be granted by either FEMA or MEMA on a case - by -case basis in accordance with FEMA PA program policy. It is the responsibility of the Contractor to submit a completed time extension request to MEMA before the established time frame for completing eligible work expires. FEMA regulations provide reimbursement only for those costs incurred up to the latest approved completion date for a particular project. Completion of Work Work must be completed based on FEMA's time limits for each category. The contract end date only applies to the contract, and is not the date of which work is to be completed. Budget The Contractor has applied to FEMA for disaster assistance and has been approved for 22 138.78 in total eligible costs. This contract is awarded to reimburse Contractor for 75% of eligible costs based on FEMA PA requirements. Funds may be expended only for the purposes described within the Scope of Work of the approved Project Worksheet, which is hereby incorporated into this contract. The total value of this contract is determined by the FEMA-approved Project Worksheet. Funding is made available over the life of the contract and is allocated based on state fiscal year projections (July 1 — June 30). The total value of this contract is $16,604.09. Fiscal year spending is projected as follows: FYI 4: $16,604.09 2 FY15: Amendments to fiscal year projections must be requested no later than May 1 to ensure a revised contract is executed prior to the end of the state fiscal year. FEMA approval is not required for an amendment to the state fiscal year budget as long as activity remains within the FEMA approved period of performance. Contractors cannot be reimbursed for costs over and above the fiscal year budget. Payments The Contractor is responsible for procurement, documentation, and expenditure of all funds used to support the project. All payments are subject to verification by the Department. Due to the unplanned nature of disasters, it is understood that many projects will have incurred 100% of their costs prior to contracting with MEMA. The Contractor agrees that any overpayment of funds to the Contractor will be returned promptly to MEMA, in the manner and time frame determined by MEMA. 'Small' and 'Large' Project Payments A 'Small Project' is eligible for payment immediately after execution of the state contract. FEMA-designated Small Projects (less than $67,500) will be fully reimbursed after a state contract has been properly executed, even if the work has not been completed (44 CFR 13.21 and 206.205). Sub -recipients must submit all required documentation and a signed PA when the work is completed. The Department will review documentation to ensure work was related to the approved project. Per 44 CFR 206,205, if actual spending on a Small Project is less than the approved project amount, the sub -recipient is not required to return the funds. However, any Contractors seeking additional funds for Small Projects must apply overages from other Small Projects before additional federal funds can be approved. Failure to complete a small project may require that reimbursement of federal funds be returned to the Department. FEMA-designated 'Large Projects' (greater than $67,500 for FFY2013) are paid on actual costs incurred for eligible work (not on cost estimates) and payment will be made upon receipt of all required supporting documentation. If the project is 100% complete at the time of FEMA approval, the Contractor must provide a signed PA as an invoice/payment request. Projects that are not 100% complete may be paid at the completion of the project or periodically throughout the life of the project as partial payments for actual costs incurred for FEMA-eligible work. All payment requests must be accompanied by proper back-up documentation including proof of payment. The Contractor will be reimbursed only for the amount of eligible, documented actual costs incurred. A signed PA is required for final payment of large projects accompanied by an approved 100% FEMA PW. All projects are subject to periodic inspection and verification by FEMA and/or MEMA personnel. Payment for Large Projects shall be no more than 75% of actual work supported by documentation of the work and match. Sub -recipient Match The use of FEMA funds for their stated purposes requires a 25% non-federal cost -share contribution from the Contractor per 44 CFR 206.65, Cost -share contributions may be satisfied by either or both of: (1) allowable costs incurred under the scope of performance for the PW funded by this contract and paid from non-federal sources, and/or (2) the value of third party in - kind contributions applicable to the period to which the cost -sharing requirements apply. Allowable costs paid from non-federal sources must not count towards satisfying a cost -sharing or matching requirement of any other award of federal funds. Execution of this contract constitutes the Contractors certification that it is applying non-federal sources to meet its cost - share obligation (44 CFR 13.24). All recipients are required to establish and maintain accounting systems and financial records to accurately account for funds awarded to them. These records shall include both Federal funds and all matching funds of State, local, and private organizations, when applicable. MEMA will verify match at time of payment for Large Projects or at Close-out for Small Project through an examination and accounting of invoices submitted equal to 100% of the approved work. Reporting Contractor is a federal grant sub -recipient and therefore subject to all federal reporting requirements associated with FEMA-4110-DR-MA. For any 'large project' not 100% completed at the time of contracting the Contractor must submit quarterly progress reports as required by the Department. The Contractor must submit a PA Report for any 100% completed PW to certify that reported costs were incurred in the performance of eligible work, that the approved work was completed, that the project was completed and payments were made in compliance with the provisions of this contract and all other applicable governing documents. 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. A-133 Audit Reports Per Office of Management and Budget (OMB) regulations, sub -recipient is subject to A-133 audit requirements. Sub -recipient agrees to submit a copy of any A-133 audits reports to MEMA. Sub -recipient further agrees to notify MEMA of any A-133 audit findings specifically related to FEMA 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 A-133 acknowledgement form as part of this contract package. Records Management Contractor is responsible for compliance with all state and federal audit requirements either as the subject of direct federal or state audits or indirectly as a sub -recipient of the state. Eligible work will be determined by FEMA at the time the PW is approved. All work must be compliant with approved project and documented as such. Expenditures are subject to requirements set forth in OMB Circular A-133. The Contractor agrees that all financial and programmatic records, supporting documents, statistical records, and other records associated with this contract are required to be retained for to a period of six (6) years, beginning on the first day after the final payment under this contract, or such longer period as is necessary for the resolution of any litigation, claim, negotiation, audit or any inquiry involving this contract and/or any approved PWs funded by it. All of the following records may not be applicable to every project, but everything that does pertain to a project should be filed with the corresponding Project Worksheet. Checklist for Each Project Completed Project Worksheet Completed Special Considerations Questions form Estimated and actual costs Force account labor Force account equipment Rented equipment Materials and purchases Photographs of damage, work underway, work completed Insurance information Environmental and/or historic alternatives and hazard mitigation opportunities considered for large, improved or alternate projects Environmental Review Documents Records of donated goods and services Required Contract Forms The Contractor must complete and return the required forms. All forms must be submitted at the time of this contract execution and prior to the release of any funds for reimbursements. Copies of all executed documents shall be returned to Contractor for record retention purposes. • Contractor Authorized Signatory Listing (CASL) (if applicable) • State Standard Contract Package • State Standard Contract Form • Attachment A • Project Grant Application (P.z) • Project Worksheet (PW)- Form go-9i (including any FEMA environmental/historic preservation conditions or other special review conditions such as insurance issues or hazard mitigations proposals) • Project Completion and Certification Form (P.4) • FEMA Summary Sheet for Assurance and Certification (Forms 20-16) (if not already on file) • Terms and Conditions (if not already on file) • W9 & DUNS Number- (if not already on file) • Electronic Funds Transfer (EFT) - (if not already on file) • Federal Funding Accounting and Transparency Act (FFATA) Form • OMB A-133 Sub -recipient Form By signing below, the Contractor is acknowledging and certifying they understand and will comply with the scope, terms and conditions as described above: Ci55 1), //Z 11 /)�) Print Name _0 Signature Title Date C' oro�? ro Q H w � m N 'J � N N PO o w w w o ono 0�0 z a v b Iro E # O 3 � M' m A �n O N yY 0 r � Iw Y A to M 1i it p C a Ctl C ' y' O w 3 :� ro lowl� �� ro ro -,04 N � C Io, 28. o 19 a aye x Pao 1,.� rtI 0 � ^ n v �a ort 3 � w m C7 m an .w. R � /(� ) \Z m,m § .!¥ e I± R !; f z & } �\ | E[ )i ! §{n\ ({ %/ �p0� { \ \ ■ U.S. DEPARTMENT OF HOMELAND SECURITY I E.M.B.s o. 1660- 0025 007 FEDERAL EMERGENCY MANAGEMENT AGENCY SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS roR CA FOR (Name of Recipient) FY "�Al This summary sheet includes Assurances and Certifications that must be read, signed, and submitted as a part of the Application for Federal Assistance. An applicant must check each item that they are certifying to: Part 1 FEMA Form 20-16A, Assurances-Nonconstruction Programs Part 11 FEMA Form 20-16B, Assurances -Construction Programs Part III EMA Form 20-16C, Certification Regarding Lobbying; Debarment, Suspension, and Other Responsibility Matters; and Drug -Free Workplace Requirements Part IV p 3-/SF LLL, Disclosure of Lobbying Activities (If applicable) As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified attached assurances and certifications. 112 . Typed Name of AdIhortzed Representative Title Signature of Authorized Representative Date Signed NOTE: By signing the certification regarding debarment, suspension, and other responsibility matters for primary covered transaction, the applicant agrees that, should the proposed covered transaction be entered into, it shall -not knowingly enter into any lower tier covered transaction with a person who is 'debarred, suspended, declared ineligible, or voluntarily'excluded from participation in this covered transaction, unless authorized by FEMA entering into this transaction. The applicant further agrees by submitting this application that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Ter Covered Transaction," provided by the FEMA Regional Office entering into this covered transaction, without modification,in all lower tier covered transactions and in' all solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.) Paperwork Burden Disclosure Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing, reviewing, and maintaining the data needed, and completing and submitting the form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472. You are not required to complete this form unless a valid OMB control number is displayed in the upper corner on this form. Please do not send your completed form to the above address. FEMA Form 20.16, OCT 04 . PREVIOUS EDITION OBSOLETE FEDERAL EMERGENCY MANAGEMENT AGENCY ASSURANCES -NON -CONSTRUCTION PROGRAMS Note: Certain of these assurances may not be applicable to your project or program. If you have any questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be uotifled. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non -Federal share of project costs) to ensure proper planning, management and completion of the project described in this application. . 2.. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Section 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration) 5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color ornational origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. Sections 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. Section 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of . alcohol abuse or alcoholism;.(g) Sections 523 and 527 of the Public Health Service Act of 1912.(42 U.S.C. 290-dd-3 and 290-ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIR of the Civil Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j).the requirements of any other nondiscrimination statate(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Title If and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment -of persons displaced or whose property is acquired as a result of Federal or Federally assisted programs. These requirements apply to all interest in real property acquired for project purposes regardless of Federal participation in purchases. S. Will comply with provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. Sections 276a to 276a- 7), the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333), regarding labor standards for federally assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. FEMA Form 20-16A, JUN 94 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO)11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in ffoodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. Section 1451 et seq.); (t) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. Section 7401 et seq.); (g) protection of underground sources of drinidngwater under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (b) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. Section 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. Section 4301 et seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. 19. It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act (29 U.S.C. 201), as they apply to employees of institutions of higher education, hospitals, and other non-profit organizations. :FNA Form 20A 6A (BACK) FEDERAL EMERGENCY MANAGEMENT AGENCY ASSURANCES -CONSTRUCTION PROGRAMS NOTE: Certain .of these assurances may not be applicable to your project or program. If you have any questions, please contact the awarding agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, 9. Will comply with the Lead -Based Paint Poisoning and the institutional, managerial and financial capability Prevention Act (42 U.S.C. Sections 4801 et seq.) which (including funds sufficient to pay the non -Federal share of prohibits the use of lead based paint in construction or project costs) to ensure proper planning, management and rehabilitation of residence structures. completion of the project described in this application. 2. Will give the awarding agency, the Comptroller' General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related.to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will not dispose of, modify the use of, or change the terms of the real property title, or other interest in the site and facilities without permission and instructions from the awarding agency. Will record the Federal interest in the title of real property in accordance with awarding agency directives and will include a covenant in the title of real property acquired in whole or in part with Federal assistance funds to assure nondiscrimination during the useful life of the project. 4. Will comply with the requirements of the assistance awarding agency with regard to the drafling,.review and approval of construction plans and specifications. 5. Will provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and will furnish progress reports and such other information as may be required by the assistance awarding agency or state: 6. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 8. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Sections 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R 900, Subpart F). 10. Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. Sections 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; .(e) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. Section 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to non-discrimination on the basis of drug abuse; (i) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P:L. 91-616), as amended, relating to non-discrimination on the basis of alcohol abuse or alcoholism; (g) Sections.523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VD1 of the Civil'Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.), as amended, relating to non-discrimination in the.sale, rental or financing of housing; (i) any other non-discrimination provision in the specific statate(s) under which application for Federal assistance is being made; and 0) the requirements of any other non-discrimination statute(s) which may apply to the application. 11. Will comply, or has already complied, with the requirements of Title II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or Federally assisted programs. These requirements apply to all interest in real property acquired for project purposes regardless of Federal participation in purchase. 12. Will comply with provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. _van . e._-... nn .eo III on 13. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. Sections 276a to 276a-7), the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Section 874), the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333) regarding labor standards for federally assisted construction subagreements. 14. Will comply with the flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 15. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990i (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. Section 1451 et seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. Section 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 16. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. Section 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 17. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and preservation of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.). 18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984. 19. Will comply with all applicable requirements of all other Federal laws, Executive Orders, regulations and policies governing this program. 20. It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act (29 U.S.C. 201), as they apply to employees of institutions of higher education, hospitals, and other non-profit organizations. 21. It will obtain approval by the appropriate Federal agency of the final working drawings and specifications before the project is advertised or placed on the market for bidding; that it will construct the project, or cause it to be constructed, to fmal completion in accordance with the application and approved plans and specifications; that it will submit to the appropriate Federal agency for prior approval changes that alter the cost of the project, use of space, or functional layout, that it will not enter into a construction contract(s) for the project or undertake other. activities until the conditions of the construction grant program(s) have been met. 22. It will operate and maintain the facility in accordance with the minimum standards as may be required or prescribed by the applicable Federal, State, and local agencies for the maintenance and operation of such facilities. 23. It will require the facility to be designed to comply with the "American Standard Specifications for Malting Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped," Number A117. - 1961, as modified (41 CFR 101-17.703). The applicant will be responsible for conducting inspections to ensure compliance with these specifications by the contractor. 24. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer of such property, any transfer, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. 25: In making suligrants with nonprofit institutions under this Comprehensive Cooperative Agreement, it agrees that such grants will be subject to OMB Circular A-122, "Cost Principles for Non-profit Organizations" included in Vol. 49, Federal Register, pages 18260 through 18277'(April 27, 1984). °c-t A Form 20-16B FEDERAL EMERGENCY MANAGEMENT AGENCY CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicai should also review the instructions for certification included in the regulations before completing this form. Signature on this farm provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions on Lobbying; and 28 CF. Part 17, "Government -wide Debarment and suspension (Nouprocurement) and'Government-wide Requirements for Drug -Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Federal Emergency Management Agency (FEMA) determines to award the covered transaction, grant, or cooperative agreement. 1. A. As required by section 1352, Title 31 of the U.S. Code, and Implemented at 44 CFR Part 18, for persons entering into a grant or cooperative agreement over $100;000, as defined at 44 CFR Part 18, the applicant certifies that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting 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 the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement; (b) If any other funds than Federal appropriated funds have been paid or will be paid to any person for Influencing or attempting to. Influence an officer or employee of any agency, a Member of Congress, an officer or an employee of Congress, or employee . of a member of Congress in connection with this Fedeial grant or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure of Lobbying Activities," in accordance with Its m6tructlons; (c) The undersigned shall -require that the language of this certification be included In the award documents for all subawards at all tiers (Including subgranls, contracts under grants and cooperative agreements, and sgbcontract(s) and that all subreciplents shall certify and disclose accordingly. Standard Form LLL, "Disclosure of Lobbying Activities" attached. (This form must -be attached to certification if nonappropriated funds are to be used to influence activities.) 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT) As required by Executive Order 12549, Debarment and Suspension, and Implemented at 44 CFR Pan 67, for prospective participants in primary covered transactions, as defined at 44 CFR Pad 17, Section 17,510-A. The applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a Stale or Federal court, or voluntarily excluded from covered transactions by (b) Have not within a Three. -year perioa preceamg mis appncauon oeen convicted of ar had a civilian Judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or perform a public (Federal, Slate, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destructlon'of records, making false statements, or receiving stolen property; (c) Are not presently Indicted.for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this application had one or more public t ransactions (Federal, State, or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the statements In this certification, he or shall shall attached an explanation to this application. 3. DRUG -FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug -Free Workplace Act of 1988, and implemented at 44 CFR Part 17, Subpart F, for grantees, as defined at 44 CFR Part.17, Sections 17.615 and 17.620: A. The applicant certifies that it will continue to privide a drug - free workplace by: ' (a) Publishing a statement notifying.employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance Is prohibited In the grantee's workplace and specifying the actions tht will be taken against employees for violation of such prohibition; (b) Establishing an on -going drug free awareness program to inform empoyees about: (1) The dangers of drug abuse in the workplace; (2) The grantee's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; Federal department or (c) Making it a requirement that each employee to be engaged in the performance of the grant to be given a copy of the statement required by paragraph (a); (d) Notifying the employee In the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employee in writing of his or her conviction for a violation of a criminal drug statute occurring In the workplace no later than five calendar days after such conviction: (e) Notifying the agency, In writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees m6st provide notice, including position title, to the applicable FEMA awarding office, i.e., regional office or FEMA office. (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who Is so convicted: (1) Taking appropriatepersonnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily In a drug abuse assistance or rehabilitation program approved for ' such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency. (g) Making a good faith effort to continue to maintain a drug free workplace through Implementation of paragraphs (a), (b), (c), (d), (a), and (f). 8, the grantee may insert in the space provided below the site(s) for the. performance of work done in connection with the specific grant: Place of Performance (Street address, City, County, State, Zip code) Check Elf there are workplaces on file that are not identified here. Section 17.630 of the regulations provide that a grantee that is a Stale may elect to make one certification in each Federal fiscal year, ,A copy of which should be included with each application for FEMA funding. States and Slate agencies may elect to use a Statewide certification. FEMA Form 20-16C (BACK) DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Camplete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 (See reverse for public burden disclosure) 1. Type of Federal Action:\Insurance 2. Status of Federal Action: 3. Report Type:_ - �a. co�a. bidloffertapptication . �a. Initial filing b: grb. Initial award b. material change c. cot c. post -award For Material Change Only: ' d. lo year quarter e. loa date of last report f. loa 1. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 Is Subawardee, Enter Name Prime - Subawardee and Address of Prime: Tier , If known: ]ongressional District, if known: Congressional District, if known: i. Federal DepartmentlAgency: 7. Federal Program Name/Description: CFDA Number, If applicable: 1. Federal Action Number, if known: S. Award Amount, If known: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if Individual, last name, first name, MI): - different from No. 10a) astname, first name, MI): '1. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities Is a material Signature: representation of fact upon -which reliance was placed by the tier above when this transaction was made or entered Into. This Print Name: disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be Title: ' ' available for public Inspection. Any person who fails to file the required disclosure shallbe subject to a civil penalty of not less Telephone No.: Date: than $10,000 and not more than $100,000 for each such fallure. deral Use].Only_ �--— �"-"-"' Authorized for Lo Reproduction grv11 _ Standard Form LLL (R .7-97) ���s�� _� Massachusetts Emergency Management Agency Federal OMB Circular A-133 Audit Reporting Form i Name of Organization: / v Address: r Was your local government or not for profit organization required to have an audit of Federal Funds performed for in the most recently closed fiscal year? (Spending of more than $500,000 in Federal Funds from all sources) If yes, please fill in the rest of this form. If no, please sign it and return. Yes ❑ No 15 Does your local government or not for profit organization have any findings or questioned costs related to grants administered by the Massachusetts Emergency Management Agency in your most recent Audit? Yes ❑ No ©� If yes is checked above, please fill in the summary work sheet attached, listing the number of the finding in the A-133 Audit, the title of the finding, the initial date of the finding and the status of the corrective action taken to eliminate the finding and if questioned costs were identified. If you have not fully implemented a corrective action plan, you may receive a letter from our office requesting a new date for the implementation of your corrective action plan. Failure to implement corrective action plans could result in a loss of funds administered by the Massachusetts Emergency Management Agency. I verify that the information presented in this form is accurate and to the best of my knowledge. Signature Date Title Printed Name q 0 d a U q q w" n« A .a. F ou a d W 00 a %o a W d b d' a c5 Federal Funding Accountability and Transparency Act Compliance Form Please complete and return this form with contracts. Part 1. In order to comply with the Federal Funding Accountability and Transparency Act (FFATA), the Massachusetts Emergency Management Agency may only award grants and contracts to entities with Dun and Bradstreet Data Universal Numbering System. numbers (DUNS). DUNS numbers are used as identifiers for tracking purposes and to validate address and point of contact information for federal assistance applicants, recipients, and subrecipients. The DUNS number will be used throughout a grant's life cycle. Please consult your accounting department to obtain your organization's nine -digit DUNS number. If necessary, you may obtain one by calling 1-866-705-5711 or by applying online at http://fedqov.dnb.com/webform/disl)lavHomePage.do. Table 1. Award Information Name of Entity Receiving Award v S Street Address City, State, Zip a Contact Name , o Contact's Phone Number Congressional District Amount of Award /G G D 6 Nine -digit DUNS Number z/ / Transaction Tye Grant CFDA number or NAICS code 97.036 Program Source DRMAP-4110 Award Title FEMA Public Asistance Part 2. In certain instances FFATA requires information be collected regarding executive compensation. If the gross revenue of your organization exceeds $25,000,000 and more than 80% of the gross revenue is from federal sources, the names, titles, and salaries of the executives with the five highest salaries must be provided. if your organization meets these criteria, please complete Table 2. If your organization does not meet these criteria, please check the statement above the table. The gross revenue of my organization does not exceed $25,000,000 and more than 80% of the gross revenue of my organization is not from federal sources. m i ame Signature of authorized official (signed in blue ink) ��ci Printed name of auth zed official Title Date C� Title ✓✓ =—� COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM This form Is jointly Issued and published by the Executive Office for Administration and Finance (ANFi the Office of the Comptroller (CTR) and the Operational Services Division 10801 as the default contract for all Commonwealth Departments when another form is not prescribed by regulation or policy. Any changes to the ofWal printed language of this form shall be void. Additional non-con81c6ng terms may be added by Attachment. Contractors may not require any additional agreements, engagement letters, contract forms or other additional terms as pad of this Contract without prior Department approval. Click on hypedinks for dentitions, Instructions and legal requirements that are Incorporated by reference into this Contract. An electronic copy of this form is available atwww.mass.00vtosc under Guidance Fnr Vendnm. Cnrme of wunu mace nm,/nod undo. men c„ma Mansfield (Town of) COMMONWEALTH DEPARTMENT NAME: Massachusetts Emergency Management Agency (Isom Address: (W•9, W4,T&C): 6 Park Road Mansfield, MA 2048 Business Mailing Address: 400 Worcester Road, Framingham, MA 01702 Conor 508.820.1462 Vendor Code Address ID (e.g. "ADOOI" ): AD_, I MMARS Doc IDfs):CTFEMA4110MANSF00662 (Note: The Address id Must be set up for EFT payments.) __.. _. I RFRIProcurement or Other lD Number: FEMA•4110•DR•MA Februarv2013 Blizzard X NEW CONTRACT _ CONTRACT AMENDMENT PROCUREMENT OR EXCEPTION TYPE: (Check one option only) Enter Current Contract End Date rtortoAmendment• _, 20_, _StatewideContract(OSDoran08Dt1esignatedDepartment) Enter Amendment Amou nt: $ .(or°nochangs') Collective Purchase (Attach OSD approval, scope, budget) AMENDMENT TYPE: (Check one option only. Attach details of Amendment changes.) X DepartmenlPfocuremenf(Includes State orFederal grants 815CMR2.001_gmendmenttoScopeorBudget(AttachupdaledscopeandbudgeQ (Attach RFR and Response or usher procurement supporting documentation) ontract (Attach (oremergency,scope, budget) _ interim Contract (Attach justifica8on for Interim Contract and updated soope/budget) _Emergency C _ Contract Emplovee (Attach Employment Status formscope, budget) _ Contract Employee (Attach any updates to scope or budget) _ Legislative/Legal or Other: (Attach authodzing languagerus6tlation, scope and _ Legislative/Legal or Other: (Attach authorizing Ianguage/justifiallon and updated budget) scope and budget) r ne rouowmg u7MMUNMALTH TERMS AND CONDITIONS (T&C) has been executed, filed with CTR and Is incorporated by reference into this Contract. gCommonwealth Terms and Conditions _ Commonwealth Terms and Conditions For Human and Social Services COMPENSATION: (Check ONE option): The Department certifies that payments for authorized pedommanoe accepted In accordance with the terms of this Contract will be supported'' : in the stale accounting system by suf Nent 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 terms and any changes if rates or terms are being amended.) x Maximum Obligation Contract Enter Total Maximum Obligation for total duration of this Contract (or new Total if Contract is being ended). $3,690.00 PROMPT PAYMENT DISCOUNTS (PPD): 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 ddays _ %PPD; Payment Issued within 20 days _ %PPD; Payment issued within 30 days _% PPD, If PPD percentages are left blank, Identify reason: _agree to standard 45 day cycle _ statutoryAegal or Ready Payments (G.L. c. 29, 8 23q); -2L only Initial nevmenl fm,Aennn...A ............,.. ..d...a.Ad • .. 1 , .,_.., art ie .. ... .... .... _ _.. .. � _. _ .. If 97.036) _ 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, maybe Incurred sent. 20_, a date LATER than the Effective Catte below and no obligations have been incurred prior to the Effective Date. Z(3. were Incurred as of2181201% a data PRIOR to the Effective Date below, and the parties agree that payments for any obligations Incurred prior to the Effective Data are authorized to be made either as settlement payments or as authorized reimbursement payments, and first the details and circumstances of all obligations under this Contract are attached CONTRACT END DATE; Contract performance shall terminate as of 6/3012017, 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 Mal 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 Certification s (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 Farm Including the Instructions and Contractor Certifications, the Request for Response (RFR) or other solicitation, the Contractors 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 UTHOR I IG SI T REFOR C TRACTOR: X: Date: J� AUTHORIZING SIGNATURE FOR THE COMMONWEALTH: �./YC . ��— (Signature and Date Must Be Handwritten At Time of Signature) X; — Date: Print Name: IA) i Islam �. lei OS $ (Signature and Date Must Be Handwrtten At Time of Signature) Print Title: � uJ AJ Q l� a t� Print Name: _ David Mahr Print Title: Chief Administrative Officer (Updated 3/21/2014) Page 1 of 6 COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM ,This form Is Jointly Issued and published by the Executive Offxxs (orAdminIstrallon and Flnanco IANFI, No Office of the Comptroller (CT RI and the Opemtiorial Services Division (OSDI as the delaull contract forall Commonwealth Departments When onothaf form N not prescribed by fegulalun or polky. Any changes to the official printed language a[this form shall bevoid, Additional nonconildrig forms may be added by Attachment Contractors may not require any addillonal agreements, engagement letters, contract forms oroftraddigonal terms as pad of this Contrac(wilhout pilorDopartmentappowal, Click onhypadinksfor definl0ons,Instructions and legalrequlromealslhatareIncorporatedbyreferenceIntothisContract. An eactronlo copy of this form Is available anwN&MO33so under Guidance For Vendors - Forms or wvAv.mass.00vfosdunder OSD.Forms. CONTRACTOR LEGAL NAME: Town of Mansfield COMMONWEALTH DEPARTMENT NAME: CDA Massachusetts Emergency (and d@la): Management Agency MMARS Department Codo: CDA Legal Addross:(W•9,W4,T&C):6ParkRoad,Manefield,MA02048 BuslnosshlallinaAddress: 400Worcester Road, Framingham, MA01702 Contact Manauor: Ms. Linda Boiling A01tna Address Of different): 1_Mpl1: fdariing@mansfieldma.com Conlraol Menapor: Peale Krnmsick, Contract Specialist Phono: 508-851.6436 Fax:508261.1083 E:M: Pauia.Krorrial @slalo.ma.us ConlraclorVondor Codo: VC6001101867 phone: 6084120d424 Fax: 508.8204404 Vendor Code Address ID (e.g. "AD001"): AD,_, MMARS Doc ID(s1: CTF$MA41 IOMANSFOO650 (Note: The Address Id Must be set up for EFT payments.) RFRIP(ocuromentor0thotiDNumber.FEMA•4110•DR•MA Febmary20l3Bl)zzard x NEW CONTRACT _ CONTRACT AMENDMENT PROCUREMENT OR EXCEPTION TYPE:(Chock one option only) Enter Current Controcl End Data Priorto Amendment: „_,,20,� �$lptgw di g.�lyl;c{(080 or an OSOdesgnaled Department) Enter Amendment Amount:$_.(or 'no change') Collective Purchase (Attach OSD approval, scope, budget) AMENDMENT TYPE: (Chook ono option only. Attach details of Amendment changes,) — Department Pfocumment(Includes Stale or Federal grants 815 (;MR 2.00) _, Amendment to Scope or Budget (Attach updated scope and budget) (Attach RFR and Response orother procurement supporting dmmenlaDan) Interim Cariboo l(Attach Justification (at Interim Contract and updated soopeAxMget) _ mow e c Contract (Attach Juslilloallon for emergency, scope, budget) Contract Emplovee (Attach Employment Status Fom , scope, budget) ,_ _ Contract Employee (Attach any updates to scope or budget) x Leglsialivoftogal or DID%(Attach autledzing looguagefjustificztlon, scope and ._Legislativeflegal or Other: (Attach authorizing languagefjuslifkallon and updated budget) scope and budget) The follovdng COMMONWEALTH TERMS AND CONDITIONS (T&C) has been executed, filed with CTR and Is incorporated by reference Into this Contract. 2L,Commonwealth Terms and Conditions _ Commonwealth Tom and Conditions For Human and Social Services COMPENSATION: (Check ONE opikm): The Department certifies that payments for authorized pedomenco accepted In accordance with the forms of this Contract will be supported In the slate accounting system by suffldent appropriations or other non -appropriated funds, subject to Intercept for Commonwealth owed debts under 615 CMR 9.00. _ Rate Contract(No Maximum Obligation, Attach details a[ all rates, units, calculations, oondi0onsor[am and any changes If rates of terms are being amended.) x Maximum ObllnationContract Erdef Total Maximum Obligation for total duration of Ude Contract (or nowTolol If Contract Is being amended). $2,9811.23 PROMPT PAYMENT DISCOUNTS (PPD): Comino mealth payments are Issued through EfT 45 days from Invoke receipt Contractors requesting accelerated payments must Identify a PPD as follows: Payment Issued within 10 days ^°h PPD; Payment issued within 15 days _ % PPD; Payment Issued wihb 20 days _ °%PPD; Payment Issued within 30 days _% PPD. If PPD percenloges are left bunk, Identify reason: agree to standard 45 day cycle _ stalulory8egal or Ready Paymenls (G.L. o. 29, § 23A); -- only inigal payment (subsequent paymentascluxluled to support standard EFT 45 day men! cycle. Sea rem LPa Du BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract Uto, purpose, fiscal years) and a detailed descviption of We scope of pedormancoorwhat Is beingamended for aContract Amendment Attach oil supportingdocumentatfanand justifications.)(Reference CFDA997,036)PW00650Toreimburse for FEMA 4110 February 8-9, 2013 Blluard —The applicant (00%such actions as necessary to save INas, protect public health and safety and protect Improved property To mvlde, Assistance for emergency protective measures and dab& removal under Category AW undo( the FEMA Publlc Assletance Program ANTICIPATED START DATE: (Compute ONE option only) The Department and Contractor co" for this Contract, or Contract Amendment, that Contract obfga9m: _ 1. maybe Incurred as of the E h%jDa (latest sgnature date bolov) and 84 obigalkos have been incurred Prior to the Effective Date. _ 2, may be Incurred as of. 20,_,-,, a dale LATER Nan the Effo*o Belo below and 04 obligations have been incurred prior to the Effective Dale. x 3. woro Incurred as of 2/812013, a dale PRIOR to the Effective Dafe baba, and the parties agree that payments for any obligations Incurred prior to the Effective Date are authorized to be made eltheras selilemenl payments or as authorized rehnbumemenl payments, end that the details and droumstaneas of all obligations under Nis Contract are attached and Incorporated Into this Contract Acoalentoof paymentsforeverreleasesSteCommonwealthfromfudherdolm3related(otheseobiations. CONTRACT END DATE: Contract performance shag terminate as of 06-302014, with no nex obligations being incurred alter this date unless the Contract Is property amended, provided that the terms of this Contract and performance oxpedatlons and obligations shall survive its termination for the purpose of resolving any claim or dupule, for computing any negotiated terms and warranties, to alloy any dose out or transition pofformanco, reporting, Invoicing or final payments, or during any lapse between amendments. CERTIFICATIONS: NoNdNslandkg verbal or other representations by the parties, the "Effective Dalo" of this Contract or Amendment shall be fie latest date that this Contract or Amendment has boon executed by an authorized signatory or the Contractor, the Departmi, or a later Contract or Amendment Start Date specified above, subect to any required approvals. The Contractor makes all certifications required under the attached Contractor CBrJfi0 ns (Incorporated by reference g not attached herolo) under the pains and ponaltios of poriury, agrees to provide any required documenlatkm upon request to support compliance, and agrees that all terms goeming perfomsnce 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 Terns and Condition , this Standard ContractFomt Including the Instructions and Contraclor Certirolbns the Request for Response (RFR) or other solicitation. the Contractor's Response, and additional negotiated terns, provided that additional negotiated terms will lake precedence over the relevant (one In the RFR and the Contractor's Response only 9 made using Ste process outlined in 801 CMR 21.07. incorporated herein, provided that any amended RFR or Response lams result in best value, lower costs, Ora more cost ellectho Contract 6UTHORIZ SIGNATURE FORT Co c AUTHORIZI G SIGNATURE FOR THE COMMONWEALTH: X Date l% )" J :�1 ) , > 3 ( Dole: X: , (Slgnnluroan�OntoMustffoHpndwriltenAtTlmeolSlgnaluro) ignatureand Date Must BeHandwriffonAtTime ofSignature) Print Name: %%. '," r) / Print Name: David Mahr , Print Title; `�tW V %'i 9R[ ��, Print Title: Chief Fiacal Officer L • f C) 0 (Issued 07/2011) Page Lof 5. Linda Darling From: Krumsiek, Paula (CDA) <paula.krumsiek@state.ma.us> Sent: Thursday, December 19, 2013 8:21 AM To: Linda Darling Subject: Feb Blizzard Reimbursement Attachments: 201312190802.pdf Importance: High Attached please find your copy of the executed contract for the above stated disaster. Please be advised that payment is scheduled for 12/23/13 and may take a few days to reach your account. Please do not hesitate to contact me with any questions you may have. Happy Holidays, Paula Krumsiek Disaster Recovery Contract Specialist Massachusetts Emergency Management Agency 400 Worcester Road Framingham, MA 01702 508-820-1424-ph 508-820-1404-fax Paula.Krumsiek@state,ma.us John Stanbrook From: Sent: To: Subject: Attachments: William R. Ross Town Manager Town of Mansfield Begin forwarded message: William Ross Friday, November 18, 2016 2:38 PM John Stanbrook; Lee Azinheira; Christina Collins Fwd: MEMA State Contract Payment — Feb 2013 Blizzard — FEMA-DR-4110 2016_11_18_13_21_18.pdf;ATT00001.htm From: "McCormack, Conor (CDA)" <conor.mccormack@state.ma.us> To: "William Ross" <wross a,mansfieldma.conv Subject: FW: MEMA State Contract Payment — Feb 2013 Blizzard — FEMA-DR-4110 Hi William, I am forwarding this message to you because Linda's email, our original point of contact, doesn't seem to be active anymore. Thanks, Conor McCormack From: McCormack, Conor (CDA) Sent: Friday, November 18, 2016 1:23 PM To:'Idarling(t�mansfieldma.com' <]darlingOmansfieldma.com> Subject: MEMA State Contract Payment — Feb 2013 Blizzard — FEMA-DR-4110 Hi Linda, Your MEMA contract package for PW-662 for the Febuary 2013 Blizzard, FEMA DR-4110, has been signed and executed. Your scheduled date of payment is 11/16/2016. Please also see the attached copy of page I of the signed State Contract, for your records. Please let me know if you have any questions. Thank you, Conor McCormack Disaster Recovery Contract Specialist Massachusetts Emergency Management Agency 400 Worcester Rd. Framingham, MA 01702 Ph: 508.820.1462 Fax: 508.820-1404 conor.mccormackgstate.nia.us<mailto:conor.mccormack@ tate.ma.us> S-7c.,*A bPV-) 12o�s 2 a �-►�� COMMONWEALTH OF MASSACHUSETTS a STANDARD CONTRACT FORM` (' This form is jointly Issued and published by the Executive OMcefor Administration and Finance (ANFl,the Officeof the Comptroller(CTRl and the Operational Services Division (OSD) as the default contract for all Commonwealth Departments when another form is not prescribed by regulation or policy. Any changes to the official printed language of this form shall be void. Additional non -conflicting terms may be added by Attachment. Contractors may not require any additional agreements, engagement letters, contract forms orotheradditionai terms as pad of this Contractwithout prior Department approval. Click on hyperlinks for definitions, Instructions and legal requirements that are incorporated by reference into this Contract. An electronleconv of this form is available al wmz.mass.goviosc under Guidance For Venetia- Fmm� ormm.mass.00vlosd under OSD Forms, CONTRACTOR LEGAL NAME: Town of Mansfield COMMONWEALTH DEPARTMENT NAME: Executive Office for Adminlslrallon and (and dlbla): Finance MMARS De a Woun tom: ANF Legal Address: (W•9, W4,7&C): 6 Park Row, Mansfield, MA 02040 Business Mallina Address: Massachusetts Stale House Room 373 Boston, MA 02133 Contract Mona -get: Lee Azinhelra Bglinn Address (if different): E•Mail: Iazinholra@niansfieldma.com Conlracl Manner. Tlm Dodd Phone: (508)•261.7330 E.Mall: Lot dod—ftstate ma us contractor Vendor Code: Vcfb000 Phone: (617)•727.2040 ext. 35405 Fax: Vendor Code Address 10(e.g."A0001"): AD— MMARSDoc ID(s)• RFRIProcuremont or Other ID Number: (Note: The Address Id Must be set up for EFT payments.) X NEW CONTRACT _ CONTRACT AMENDMENT PROCUREMENT OR EXCEPTION TYPE (Check one option only) Enter Current Contrac(End Dale Prior to Amendment: ,20_ _Statewide Contract (OSD or an OSOdeslgnaled Department) Enter Amendment Amount:$ . (of *no change`) Collective Purchase (Attach OSD approval, scope, budget) AMENDMENT TYPE: (Check one option only, Attach details of Amendment changes.) X Deparfment Promuument tindudes Slate or Federal grants 815 CMR 2.00) _ mendmenito Sconeor Budnel (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) _ Emergency Contract (Attach justification for emergency, scope, budget) Employee (Attach Employment Status Form. scope, budget) _Conlraclgmolovee(Allach any updates to scope or budget) _Contract _Lgdslathnitaual or Other (Attach authorizing languagefjustificalion, scope and _Loldslaliveileaalor Olher.(Attach authorizing language(justification 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. _L Commonwealth Terms and Conditions _ Gommonweaitit Terms and Conditions For Human and Social Services COMPENSATION: (Check ONE option): The Department certlffes that payments for authorized performance accepted in accordance with the terms of this Contract will be supported In the state accounting system by sufficient appropdagons 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 tales,units,calculations, conditions or terms and any changes if rates or terms are being amended.) —L Maximum Obligation Contract EnlerTotal Maximum Obligation (or total duration of (his Contractor newTolal if Contract is being amended),•$ 8o g00. PROMPT PAYMENT DISCOUNTS fPPD): 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 left blank. Identify reason: _agree to standard 45 day cycle _ slalutoryllegal or Ready Payments (G L c 29 6 23A); —only initial payment (subsequent payments scheduled to supe2it standard EFT 45 day payment cycle. See tom I Pa Dlscoums Polic . BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract title, purpose, Fiscal yom(s) and a detalled description of the scope of performance or what is being amended for a Contract Amendment. Attach all supporting documentation and justifications.) This award Is being made through the Community Innovation Challenge grant program. The recipient will need to follow the elements outlined in the attached "Community Innovation Challenge Grant Project Agreement," Including Attachments A and S. ANTICIPATED START DATE: (Complete ONE option only) The Department and Contractor codifyfor this Contract, or Contrac(Amendmen6 that Contract obligations: X 1. may be Incurred as of the Effective Dale (latest signature dale below) and no obligations have been Incurred prior to the Effgc ive Dale. - _ 2. maybe Incurred as of_, 20_, a date LATER titan the Effective Date below and go obligations have been Incurred Prior to Me Effective Dalo. 3. were Incurred as of 20_, a dale PRIOR (o the Effective Dale below, and the parties agree that payments for any obligations Incurred prior to the Effective Date are _, authorized to be made either as seitiement payments or as authorized reimbursement payments, and that the details and circumstances of all obligations under this Contract are attached and Into omted Into this Contract. Acceptance of a menls forever releases the Commonwealth from further claims related to these obligations. CONTRACT END DATE: Contract performance shall terminate as of April 1 , 2015. with no new obligations being Incurred after this dale unless the Contract Is property amended, provided that the terms of [his Contract and performance expectations and obligations shall survive ila termination for the purpose of resolving any claim or dispute, for complegng 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, [he "Effective Date" of this Contract or Amendment shall be the latest dale that this Contract or Amendment has been executed by an authorized signatory of the Contractor, the Department, or a later Contract or Amendment Staff Dale 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 Commonwealth Terms and Conditions, this Standard Contract Form Including the Lnsiruclions and Contractor Cedificaffons, the Request for Response (RFR) or other solicitallon, (he Contractors 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 oulllned In 001 CMR 21.07, Incorporated herein, provided That any amended RFR or Response term result in best value, lower costs, o a more cost effective Contract. AUTHORIZING SIGN FOR// CONTRAC OR• AUTHO IN IGNATU E FO COMMONWEALTH: ,��T��,RR{�E ® X.G ve(pt /(,cue . Dale: X: Dale: i (Slgnaluroand1 leMu/sl�!eEandwrlilen At Time of Signature) (Sionaturoan I,e"Mus an written Al Tlnm o(Sig attire) Print Name: �rl�Lr/W !fi /1e3 Prbml Name: C 40 Sr'Oi Prins Tlilo: _%fl 3/f( z�lU ee"v.�C Print Title: SC � J (Issued 612712011) Page i.of 6. ,M1 u 4 rcy COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM (Issued 6Y/.712011) Page 10l6 COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM INSTRUCTIONS AND CONTRACTOR CERTIFICATIONS PROCUREMENT OR EXCEPTION TYPE: Check the appropriate type The tollowrn Instructions end terms are incorporated by relerome end apply to this of procurement or exception for This Contrail. Only one option can be selected. See Slate g Finance Law and General Requirements, Acquisition Policy and Fixed Assets, the Standard Contract Form. Text thalappears underlined indlor a'hyperlink' to an Internet Comnmodities and Services policy and tea Procurement Infommalion Center (Denartinent or booform"d site and are unot"I d versions of Ojos documents and Depadmenl$ end Contract Guidance) for details. Contractors should consult with their Legal counsel to ensure compliance with all legal Statewide Contract (OS or an OSD•designated DeParlmonq, Check this option for a requtrein is. Using the Web Toolbar will make navigation between the term and the Statewide Contract under OSD, or by an OSD-designated Department. hyped castor. pieasenola Lai not all applicable laws have been cited. Collective Purchase approved by OZD. Check this option for Contrails approved by CONTRACTOR LEGAL NAME (AND D1BIA): Enfer the Full Legal Name of the OSD for collective purchases troughfederal,stale, )oral govemmonlorolherenlilles. Cc niraclofs business as It appears on the Coniraclofs W-9 or W-4 Form (Contract Department Contract Procurement. Check this option for a Department procurement Employees only) and to applicable) r Commonwealth nBOTH Terms andConditionsante If Contractorme including stale grants and federal subgranls under 815 CMR 2.00 and State Grants and also has a'doing business as (alb/a) name, BOTH the legal name and the'dlbla' name Federal Suburanis Policv, Departmental Master Agreements (MA). If multi-Departmonl must appear In this section, user Contract, identify mull -Department use is allowable in Brief Description. Contractor Legal Address: Enter the Legal Address of the Contractor as it appears on Emergency Colluncl, Check this option when the Department has delmmirred that an the Contractors W 9 or W-A Form (Contract Employees only) and the applicable unforeseen crisis or Incident has arisen which requires or mandates Immediale purchases Commonwealth Tenne and Conditions, which must motile the le al address on to 10991 to avoid subsenfial harm to the functioning of govemmenl or the provision of necessary or table t MMARS (or the Legal Address In HRICMS for Contract Employee). mandated services or whenever the health, welfare or safely of clients or other persons or Contractor Contract Manager: Enter the authorized Contract Manager who will be serious damage to property is threatened. responsible for managing the Contract. The Contract Manager should be an Authorized Contract Employee. Check this option when the Department requires the performance of Signatory or, at a minimum, a person designated by the Contractor to represent the an Individual ontractor, and when the planned Contract performance with an Individual Contractor, receive legal notices and negotiate ongoing Contract Issues. The Contract has been classified using the Emolovmen, Status Form (prior to the Contractors selection) Manager o considered 'Key Personnel' If Candmay notate changedmPASout theprior written as work of a Contract Emtoee andnot that of an Independent Contractor. approval of to Department. If the Contract Is posted on Comm PASS, the Contract p y Manager must be listed on Ole Vendor Section lab. LeglslalfvelLeUal or Other. Check this option when legislation, an existing legal Contractor E•Mail AddresslPhoneiFax: Enter the electronic mail (e-mail) address, phone obligation, prohlbiton or other circumstance exempts or prohibits a Contract from being and lax number of the contractor Contract Manager. This Information must be kept current competitively procured, or idonfify any other procurement exception not already listed. by the Contractor to ensure that the Department can contact the Contractor and provide Legislative 'earmarks' exempt the Contract solely from procurement requirements, and all any required legal notices. Notice received by the Contract Manager (wit confirmation of other Contract and slate finance laws and policies apply. Supporting documentation must actual receipt) trough the listed address, tax number(s) or electronic mall address will be attached to explain and justify the exemption. meet any written legal notice requirements. CONTRACT AMENDMENT (Rigimt Zaire of Fornl) Contractor Vendor Code: The Department must enter the MMARS Vender Code Complete [his section for any Contract being renewed, amended or to continue a lapsed assigned by the Commonwealth. If a Vendor Code has not yet been assigned, leave this Contract. All Contacts with available options to renew must be amended referencing the space blank and the Department will complete this section when a Vendor Code has been original procurement and Contract doc Ids, since all continuing contracts must be assigned. The Department Is responsible under the Vendor File and W-Ps Policv for maintlned in the same Contract tde (even it the im dying appropriation changes each verifying with authorized signatories of the Contractor, as part of contract execution, that the fiscal year.)"See Amendmisnis a e^Rnsions and Terminalien policy.) legal name, address and Federal Tax Identification Number (TIN) in the Contract Enter Current Oonlract End Date: Enter the termination dale of the Current Contract documents match the state accounting system. being amended, even if Lis dale has already passed. (Note: Current Shad Data Is not Vendor Code Address ID: (e.g., 'AD001') The Department must enter the MMARS requested since this date does not change and Is already recorded In MMARS.) Vendor Code Address Id Identifying the payment remittance address for Contract Enter Amendment Amount: Enter the amount of the Amendment increase or decrease to payments, which MUST be set up for EFT payments PRIOR to the first payment under the a Maximum Obligation Contract. Emer'no change for Rate Contracts or it no change. contract in accordance with the Bill Pavin° and Vendor File and W-9 policies. AMENDMENT TYPE: Identify the type of Amendment being done. Documentation COMMONWEALTH DEPARTMENT NAME: Enter the full Department name with the supporting the updates to performance and budget must be attached. Amendment to authority to obligate funds encumbered for the Contract. Scope or Budget. Check this option when renewing a Contract or executing any comalonwealth MMARS Alpha Department Code: Enter the three (3) letter MMARS Amendment ('material change" in Contract terms) even if the Contract has lapsed. The Code assigned to this Commonwealth Department In the slate accoonUng system. parties may negodale a change In any element of Contract performance or cost Identified In Department Business Mailing Address: Enter the address where all formal the RFR or the Contractors response which results In lower costs, or a more cost-effective correspondence to the Department must be sent. Unless otherwise specified In the or better value performance than was presented In the original selected response, provided Convect, legal notice sent or received by the Department's Contract Manager (with the negogation results in a better value within the scope of the RFR tan what was confirmation of actual receipt) through the listed address, fax number($) or electronic mail proposed by the Contractor In the original selected response. Any'nnatedal' change In the addressor the Contract Managerwfrl meet any requirements for legal notice. Contract terms must be memorialized in a formal Amendment even if a corresponding Department Billing Address: Enter the Billing Address or email address if Invoices must MMARS transaction is not needed to support the change. Additional negotiated terms will be sent to a different location. Billing Of confirmation of delivery of performance Issues take precedence over the relevant terms In Die RFR and the Contractors Response only it should be resolved Through to listed Contrail Managers. made using the process outlined In 801 CMR 21.07, Incorporated herein, provided that any Department Contract Manager: Identify the authorized Contract Manager who will be amended RFR or Response terms result in best value, lower costs, or a more cost effective responsible for managing the Contract, who should be an authorized signatory or an contract, employee designated by the Department to represent the Department to receive legal interim Contracts. Check this option for an Interim Contract to prevent a lapse of Contract notices and negotiate ongoing Contract Issues. performance whenever on existing Contract Is being re -procured but the new procurement Department E-Mail AddresslPhoneiFax: Enter the electronic mail (o-mail) address, has not been completed, to badge the gap during implamenlallun between an expiring and phone and fax number of the Department Contract Manager. Unless otherwise specified In a new procurement, or to contract wit an Interim Contractor when a current Contractor Is the Contract, legal notice sent or received by the Contract Manager (with confirmation of unable to complete full performance under a Contract. actual receipt) through the listed address, fax number(s) of electronic mall address will Contract Employee. Check this option when the Department requires a renewal or other meet any requirements for written notice under the Contract. amendment to the performance of a Contract Employee. MMARS Document ID(s): Enter the MMARS 20 character encumbrance transaction LagislallvelLogal or Other. Check this option when legislation, an existing legal number associated with this Contract which must remain time same for the life of the obligation, prohibition or other clicumstance exempts or prohibits a Contract from being Contract. If multiple numbers exist for this Contract, Idenbly all Doc ids. compettvely procured, or Identify any other procurement exception not already listed. RFRIPmourenenl or Other ID Number or Name: Enter the Request for Response Legislative `earmarks' exempt the Contract solely Iron procurement requirements, and all (RFR) or other Procurement Reference number, Contract ID Number or other other Contract and slate finance laws and policies apply. Attach supporting documentation reference/tracking number for [his Contract or Amendment and will be entered into the to explaln and justly the exemption and whethor Contractor selection has been publicly Board Award Field In the MMARS encumbrance transaction for this Contract. posted COMMONWEALTH TERMS AND CONDITIONS NEW CONTRACTS (left side of Form): Complete thls sectlon ONLY It this Contract Is brand now. (Complete the CONTRACT Identify which Commonwealth Terms and Conditions the Contractor has executed and is T section for any material changes to an oxislhng or an expired Contract, incorporated by feferonce Into this Contract. This Form Is signed only once and recorded on AMENOh1EN nU options to renew or amoral contracts under a multi -year the Vendor Customer File(VCUST). See Vendor File and W-9s Policy. and for oxorcisi procurenonl or grant progranm.j (Issued 612712011) Page 2 or 6 f 4 COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM t COMPENSATION performance obligations it substantial performance has been made prior to the termination data of the Contract and pilot to the end of the fiscal year in which Identify it the Contract Is a Rate Contract (wish no slated Maximum Obligation) or a are provided that any close out performance is subject to Maximum Obligation Contract (with a stated Maximum Obligation) and Idengly the appropPayments and landing limits under slate finance taw, and may adjust ndfunapproprding enable encumbrances and payments in the slate accounting system to enable final close out Maximum Obligation. Il the Contract is being amended, enter the new Maximum Obligation encumbrances based upon the Increase or decreasing Amendment The Total Maximum Obligation must Payments. Performance dates are subject to G.L. c.49 reflect the total funding for the dates of service under the contract, Including the CERTIFICATIONS AND EXECUTION Amendment amount if the Contract is being amended. The Maximum Obligation must match the MMARS encumbrance. Funding and allotments must be verified as available See Deoanmenl Head SMnalure Aulhonzelion Policy and the Contractor Authorized and encumbered prior to Incurring obligations. If a Contract Includes both a Maximum Signatory Usling for policies on Contractor and Department signatures. Obligation component and Rate Contract component, check oil both, specific Maximum Authorizing Signature for Contractor/Dato: The Authorized Contractor Signatory must (in Obligation amounts or amended amounts and Attachments most clearly outline the their own handwnfng and In Ink) slgn AND enter the date the Contract is signed. See Contract breakdown to match the encumbrance, section above under 'Anticipated Conlracl Start Dalo. Acceptance of payment by the Contractor shall welve any right of the Contractor to claim the ConlractlAmandmeni Is not PAYMENTS AND PROMPT PAY DISCOUNTS Payments are processed within a 45 day payment cycle through EFT In accordance will, valid and the Contractor may not volt the Contract. Rubber stamps, typed of other images aro not acceptable. Proof of Contractor signature authorization on a Cotmractor Ole Commonwealth Bill Paying Pollcv for investment and psi tow purposes. Departments may NOT negotiate accelerated payments and Payees are NOT entitled to accelerated ontonzen Slgnalory Listing maybe required by the Signatory s not already fi file. Contractor Name little: The Contractor Authorized Signatory's name and figs must payments UNLESS a prompt payment discount (PAD) Is provided to support the loss of Investment earnings for this earlier payment, or unless a payments appear legibly as happears on the Contractor Authorized Signatory Within. Commonwealth's Is legally mandated to be made In less than 45 days (e.g., construction coattail, Ready Authorizing signature For Commonweallh(Date: The Au mod ad Department Slgnalory must ((a their own handwriting and in Ink) sign AND enter the date the Contract is signed. Payments under 01, c 29 s 23A1. Sera Prompt Pay Discounts Pollcv. PPP are Identified as a percentage discount which will be automatically deducted when an accelerated See section above under `&mbpaled Start Date'. Rubber stamps, typed or other The Authorized Signatory must be an employee within the payment Is made. Reduced contracts rates may not be negotiated to replace a PPD. If PPD fields are left blank please Idenfly that the Contractor agrees to the standard 45 day images are not accepted. Department legally responsible for Ole convect. See Domanmenl Head Signature Department have the legislative funding appropriated for all the cycle; astatutory/legal exemption such as Ready Payments (G L c 29 6 23A); or only an Initial accelerated payment for reimbursements or start up costs for a grant, with Aulhodzation. The must costs of this Contract or funding allocated under an aoarood Interdepartmental Service A Department may not contract for pedormance to be delivered to or by subsequent payments scheduled to support standard EFT 45 day payment cycle. Financial hardship is not a sufficient justification to accelerate cash flow for all payments under a Agreement (ISA). another state department without specific legislative authorization (unless this Convect is a Secretarial Conlracl. InWal grant oroontract payments maybe accelerated for the firs( Invoice or Initial be Statewide Contract). For Contracts requiring Secretarial signal(, evidence of sgnolf must be Included in the Contract Ole. grant Installment, but subsequent periodic Installments or Invoice payments should scheduled to support the Payee cash flow needs and the standard 45 day EFT payment Department Name /Tits: Enter the Authorized Signatory's name and titre legibly. cycle in accordance with Ole Bill Paying Policy. Any accelerated payment that does not CONTRACTOR CERTIFICATIONS AND LEGAL REFERENCES provide for a PPD must have a legal juslifkagon In Contract file ter audit purposes Notwithstanding verbal or other representations by the panics, the "Effective Date" of this explaining why accelerated payments were allowable without a PPD. Contract of Amendment shall be the latest date that (his Contract or Amendment has been BRIEF DESCRIPTION OF CONTRACT PERFORMANCE executed by an authorized signatory of the Contractor, the Department, or a later Contract Enter a brief description of the Contract performance, project name and/or other Identifying or Amendment Stan Dale specified, subject to any required approvals. The Contractor required under this Contract under the pains and penalties of Information for the Contract to specllicatty identify Ole Contract performance, match the Contract determine the appropriate expenditure code (as listed In the makes all cerUfcallons perjury, and agrees to provide any required documentation upon request to support with attachments, Expenditure Classification Handbgii or to identify or chaffy Important information totaled (o the Contract such as the Fiscal Year(s)or penormance tax. 'rf2012' or'FY2012.14'), compliance, and agrees Ojai all terms governing performance of this Contract and doing business In Massachusetts are attached or incorporated by reference herein: Identify settlements or other exceptions and attach more detailed jusffication and Commonwealth and Contractor Ownership Rights. The Contractor certifies and agrees the Commonwealth is entitled to ownership and possession of all 'deliverables" supporting documents. Enter'MulO40epadmenl Use If other Departments can access For Amendments, Identify the purpose and what items are being amended. that purchased or developed with Contract funds. A Department may riot relinquish procurement. Merely stating °sea attached' or referencing attachments without a narrative descdpdon of Commonwealth rights to deliverables nor may Conveclors sell products developed with without just compensation. The Contract should detail all performance is Insufficient. Commonwealth resources Commonwealth deliverables and ovmershtp rights and any Contractor proprietary rights. ANTICIPATED START DATE Qualifications. The Contractor certifies it is qualified and shall at all times remain qualified The Department and Contractor must certify WHEN obligations under this to perform this Contact that pedormance shall and meet exceed Industry ConhacOAmendment may be Incurred. Option 1 Is the default option when performance bin iningtimel n standards for the performance required, Including obtaining requisite licenses, tegisirations, may begin as of the Effective Dale (latest signature date and any required approvals). If permits, resources for performance, and sufficient professional, liability; and other the parties want a new Contract or renewal to begin as of the upcoming fiscal year then list appropriate Insurance to cover the performance. If the Contractor is a business, the the fiscal years) (ex. 'FY2012' or 'FY2012.14`) In the Brief Description section. Contractor cedifes tat it is listed under the Secretary of Status website as licensed to do Performance starts and encumbrances reflect fie default Effective Dale (if no FY is listed) business In Massachusetts, as required by taw. or (he later FY start date (if a FY Is listed). Use Option 2 only when the Contract will be Business Ethics and Fraud, Waste and Abuse Prevention. The Contractor certifies that signed well In advance of the start date and Identity a specific future start date. Do not use performance under (his Contract, in addition to meeting the terms of the Contract, will be Option 2 for a fiscal year start unless it Is certain that the Contract will be sgnod prior (o made usingethical business standards and good stewardship of taxpayer and other public fiscal year. Option 3 is used in lieu of the Settlement and Release Form when the ContrectAmendmenf Is signed late, and obligations have alreadybeen incurred by the funding and resources to prevent fraud, waste and abuse. 9 Collusion. The Contractor ceNfies that this Contract has been offered In good lalth and Contractor prior to the Effective Dale for which the Department has either requested, accepted or deemed legally eligible for reimbursement, and the Contract includes without collusion, fraud or unfair trade practices with any other person, that any actions to are by law, and shall be grounds for supposing documents Justifying the performance or proof of eligibility, and approximate Any obligations incurred outside the scope of the Effective Da a under any Option avoid or frustrate fair and open compofilion prohibited rejection or dlsqualificalion of a Response or termination of this Contract. to costs. listed, even if the Incorrect Opton Is selected, shall be automatically deemed a sel(iemenl Public Records and Access The Contractor shall provide full access to records related and compliance to the Department and officlals listed under Executive Order Included under the (arms of the Contract and upon payment to the Contractor will release front further obligations for the Mangled performance. All selOement performance 195 and G l c 11 s.i2 seven (7) years beginning on the first day after the final payment go Commonwealth payments require jusglication and must be under same encumbrance and object codes as under this Contract or such longer period necessary for the resolution of any litigation, claim, negotiation, audit or other inquiry Involving this Contract. Access to view Contractor the Contract payments. Performance dales are subject to G.L, c.A 9. records related to any breach or allegation of fraud, waste and/or abuse may not be denied CONTRACT END DATE and Contractor can not claim confidentiality or trade social protections solely for viewing but The Department must enter Ne date at Contract performance will terminate. If the not relating documents. Routine Contract pedormance compliance reports or documents Contract Is being amended and the Contract End Dale is not chanting, this dale related to any alleged breach or allegation of non compliance, fraud, waste, abuse or must be re -mitered again hero. A Contract must be signed for at least the Initial duralion collusion may be provided electronically and shall be provided at Contractor's own but not longer than the period of procurement listed In the RFR, or other so11 It expense. Reasonable costs for copies of non•rou(ine Contract related records shall not document (if applicable). No now peKnoll Is allowable beyond (he end date without exceed the tales for public records under 950 C.M.R. 32 00. an amendment, but the Department may allow a Contractor to complete minimal close out (Issued 612712011) Page 3 of 6 le; COMMONWEALTH OF MASSACHUSETTS ^ STANDARD CONTRACT FORM Debarment, The Contractor certifies that neither it nor any of its subcontractors are currently debarred or suspended by the federal or state government under any law or regulation including, Execgjwa Other 147; G.L c 29 s 29F G L c 30 5 39R, G,L. 049 270,9L c149644C GLc14981488 and G.L. c 162 $. 25C. Applicable Laws. The Contractor shall comply with all applicable stale laws and regulations Including but not limited to the applicable Massachusetts General Laws; the Official Code of Massachusetts Rwula(ons; Cale of Massachusetts Regulations (unofficial); 801 CMR 21.00 (Procurement of Commodity and Service Procurements, Including Human and Social Services); 015 CMR 2.00 (Grants and Subsidies); 808 CMR 1.00 (Compliance, Reporting and Auditing for Human And Social Services); AICPA Standards; confidentiality of Department records under G.L. a 66A; and the Massachusetts Constitution Arlicle XVIII if applicable. Invoices. The Contractor must submit Invoices in accordance with the terms of the Contract and the Commonwealth Bill Pavino Policy. Contractors must be able to reconcile and properly attribute concurrent payments from multiple Departments. Final Invoices in ally fiscal year must be submitted no later than August 15e for performance made and received (goods delivered, services completed) prior to June 30, In order to make payment for That performance prior to the close of the fiscal year to prevent reversion of appropriated funds. Failure to submit timely Invoices by August 15a or other date listed in the Contract shall authorize the Department to Issue an estimated payment based upon the Department's delemination of performance delivered and accepted. The Contractors acceptance of this estimated payment releases the Commonwealth from further claims for these Invoices. It budgetary funds roved due to the Contractors failure To submit timely final invoices, or for disputing an estimated payment, the Department may deduct a penalty up to 10%from any final payment in the next fiscal year for failure to submit timely invoices. Payments Subject To Appropriation. Pursuant to G.L. c. 29 § 26, 1127 and § 29, Departments are required to expend funds only for the purposes set forth by the Legislature and within the funding limits established through appropriation, allotment and subsidiary, Including mandated allotment reductions triggered by G.L. c 29, 8 9C. A Department cannot authorize or accept pedor anc¢ In excess of an existing appropriation and allotment, or sufficient non -appropriated available funds. Any oral or written representations, commitments, or assurances made by the Department or any other Commonweallh representative are not binding. The Commonwealth has no legal obligation to compensate a Contractor for performance the( Is not requested and is Intentionally delivered by a Contractor outside the scope of a Contract. Contractors should verify funding prior to beginning performance. Intercept. Contractors may be registered as Customers in the Vendor file If the Contractor owes a Commonwealth debt Unresolved and undisputed debts, and overpayments of Contract payments that are not reimbursed timely shall be subject to Intercept pursuant to G.L. c. 7A. s. 3 and 816 CMR 9.00. Contract overpayments will be subject to Immediate Intercept or payment offset The Contractor may not penalize any slate Department or assess late fees, cancel a Contract or other services If amounts are Intercepted or offset due to reoupmenl of an overpayment outstanding taxes, child support, other overdue debts or Contract overpayments. Tax Law Compliance, The Contractor ceNfies under the pains and penalties of perjurytax compliance with Federal lax laws• Slate tax laws Including but not limited to G.L. c. 62C, G L c 62C s 49A; compliance with all state tax laws, repeNng of employees and contractors, withholding and remitting of tax withholdings and child support and is In good standing with respect to all stale taxes and returns due; reporting of employees and contractors under G.L. o. 62E, withholding and nualUng child suppod Including G.L, c. 119A s. 12;TIR05-11• New independent Contractor Provistalsand applicable Eft Bankruptcy, Judgments, Potential Structural Changes, Pending Legal Matters and Conflicts. The Contractor certifies it has not been In bankruptcy and/or receivership within the last three calendar years, and the Contractor certifies that It will immediately notify the Department in wiling at least 45 days prior to filing for bankruptcy and/or receivership, any potential structural change In Its organization, or if there is any risk to the solvency of the Contractor that may Impact the Contractors ability to timely fulfill the terms of this Contract or Amendment, The Contractor codifies that at any time during the period of the Contract the Contractor is required to affirmatively disclose In writing to the Department Contract Manager the details of any judgment, criminal conviction, Investigation or litigation pending against the Contractor or any of Its officers, directors, employees, agents, of subcontractors, Including any potential conflicts of Interest of which the Contractor has knowledge, or learns of during the Contract term. Law firms or Attorneys providing legal services are required to Identify any potential conflict with representation of any Depadmenl client In accordance with Massachusetts Board of Bar Overseers (BBO) rules. Federal Anti -Lobbying and Other Federal Requirements, if receiving federal funds, file Contractor orUfias compliance with federal an84obbying requirements Including 31 USC 1352; other federal (entitlements; Executive Order 11246; Air Pollution Act • Federal Wadel Pollution Control Acl and Federal Employment Laws. Protection of Personal Data and information. The Contractor cedlies that all steps wil be taken to ensure the secudty and confidentiality of all Commonwealth data for which the Contractor becomes a holder, either as part of performance or Inadvertently durq performance, with special aflentlon to restricting access, use and disbursement of persona data and Information under G.L. c. 9 and c. 66A and Executive Order 694. Thu Contractor is required to comply with G.L. c. 931 for the proper disposal of all paper and electronic media, backups or systems containing personal data and Information, provided further that the Contractor Is required to ensure that any personal data or information transmitted electronically or through a portable device be property encrypted using (al a minimum) Information Technology Division fITD) Protection of Sensitive Information, provided further that any Contractor having access to credit card or banking information of Commonwealth customers certifies that the Contractor is PCI compllanl In accordance with the Payment Card Induslry Council Standards and shall Provide confirmation compliance during the Contract, provide further that the Contractor shall immediately notify the Department in the event of any security breach Including the unaumodzed access, disbursement, use or disposal of personal data or Information, and In the even) of a secudty breach, the Contractor shall cooperate fully with the Commonwealth and provide access to any Information necessary for the Commonwealth to respond to the security breach and shall be fully responsible for any damages associated with the Conlractofs breach Including but not limied to 01. c 214 s. 3B. Corporate and Business Filings and Reports. The Contractor certifies compliance with any ceriicalion, filing, reporting and service of process requirements of the Secretary of the Commonweallh, the Office of the Attomev Geneml or other Departments as related to Its conduct of business In the Commonwealth; and with its Incorporating stale (or foreign entity). Employer Requirements. Contractors (hat are employers certify compliance with applicable state and federal employment laws or regulations, including but not limited to G.L. c. 5. s. 1 (Prevailing Wanes for Printing and Dlst ibulion of Public Documents); G.C. c Federal And State Lawn And Regulations Prohibiting Discrimination including but not limited to the Federal Equal Employment On up duaity fEEO) Laws the Americans will) and lion Act; Chapter 149, Section 165D, G.L. c. 1UL D.L. c. M. wagon 3 and Section 98A, and G.L. o. 111, Section 199A, and klassachusells NorvDiscriminaton Standards For Executive Branch Ent1hes, and related Guidance, authorized under Massachusetts Executive Order or any protection arising from state or federal law or precedent. See also MCAD and MCAD links and Resources. Small Business Purchasing Program (SBPP). A Contractor may be eligible to padicipale In the SBPP, created pursuant to Executive Order 523, it qualified through One SBPP SmariBld subscription process aC �s.com and with acceptance of the terms of the SBPP participation agreement. Limitation of Liability for Information Technology Contracts (and other Contracts as Authorized). The In mullion Technology Mandatory Soecifcations and the IT Acquisition Accessibility Contract Language are Incorporated by reference Into Information Technology Cori The following language will apply to Information Technology contracts In the U01, UO2, UO3, U04, U05, U06, U07, U08, U09, U10, U75, U98 object odes in the Expenditure Classification Handbook or other Contracts as approved by CTR or OSD. Pursuant to Section 11. Indemnification of the Commonwealth Terms and Conditions, the term 'other damages' shall Include, but shall not be limited to, the reasonable costs the Commonwealth Incurs to repair, velum, replan or seek cover (purchase of comparable substitute commodities and services) under a Contract. °Other damages' shall not Include damages to the Commonwealth as a result of third party claims, provided, however, that (he foregoing In no way limits the Commonwealth's right of recovery for personal Injury or properly 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 lemn 'other damages shall not Include, and In no event shall the contractor be liable for, damages for the Commodwe illlys use of contractor provided products or services, loss of Commonwealth records, or data (or other Intangible property), loss of use of equipment, lost revenue, lost savings or lost profits of the Commonwealth. In no event shall -other damages' exceed the greater of $100,000, or two gees the value of the product or service (as defined In the Contract scope of work) that Is the subject of (he claim. Section 11 sets forth the contractors entire liability under a Contract. Nothing In this section shall limit the Commonwealth's ability to negotiate higher limitations of lability in a particular Contract, provided that any such limitation must specifically reference Section 11 of the Commonwealth Terms and Conditions. In the event the limitation of Ilabillty conflicts with according standards which mandate that there can be no cap of damages, the limitation shall be considered waived for that audit engagement. These tens may be applied to (Issued 612712011) Page 4 of 6 COMMONWEALTH OF MASSACHUSETTS a STANDARD CONTRACT FORM other Contracts only with prior written confirmation from the Operational Services Division or the Office of the Comptroller. The terms in this Clarification may not be modified. Northern Ireland Certification. Pursuant to G.L. c. 7 s. 22C for state agencies, state authorities, the House of Representatives or the state Senate, by signing this Contract the Contractor certifies that it does not employ ten or more employees In an office or other facility In Northern Ireland and If the Contractor employs ten or more employees In an office or other facility located In Northern Ireland the Contractor ceNfies that it does not discriminate In employment, compensa0on, or the terms, conditions and privileges of employment on account or religious or political belief and It promotes religious tolerance within the work place, and the eradication of any manifestations of religious and other Illegal discrimination; and the Contractor Is not engaged in the manufacture, distribution or sale of firearms, munitions, Including rubber or plastic bullets, fear gas, armored vehicles or military aircraft for use or deployment in any activity in Northern Ireland, Pandandc, Disaster or Emergency Performance. In the event of a serious emergency, pandemic or disaster outside the control of the Department, the Department may negotiate emergency performance from the Contractor to address the immediate needs of the Commonwealth even 11 not contemplated under the original Contract or procurement. Payments are subject to appropriation and other payment terms. Consultant Contractor Cedi(icallons (For Consultant Contracts'HH" and'NN' and'U05' object codes subject to G.L. Chapter 29, s 29A). Contractors must make required disclosures as part of the RFR Response or using the Consultant Contractor Mandatory SubmIssIQ0 Fom. Attorneys. Attorneys or firms providing legal services or representing Commonwealth Departments may be subject to G.L. c. 30, s. 65, and If providing litigation services must be approved by the Office of the Attorney General to appear on behalf of a Department, and shall have a continuing obligation to notify the Commonwealth of any carbide of Interest arising under the Contract. Subcontractor Performance. The Contractor ceNfies full responsibility for Contract pedonnance, Including subcontractors, and that comparable Contract (arms will be Included In subcontracts, and that the Department will not be required to directly or indirectly manage subcontractors or have any payment obligations to subcontractors EXECUTIVE ORDERS For covered Executive slate Departments, the Contractor cadges compliance with applicable ExecuWe Orders (see also Massachusetts Executive Orders), Including bud nol limited (o the specific orders listed below. A breach during period of a Contract may be considered a material breach and subject Contractor to appropdale monetary or Contract sancttons. Executive Order 461. Prohibiting (he Use of Undocumented Workers on Slate Contracts. For all stale agencies In the Executive Branch, Including all executive offices, boards, commissions, agencies, Departments, divisions, counclls, bureaus, and offices, now existing and hereafter established, by signing this Contract the Contractor codifies under the pains and penalties of perjury that they shall not knowingly use undocumented workers In connection with the performance of this Contract; that, pursuant (o federal requirements, shall verify the Immigration status of workers assigned to a Contract without engaging in unlawful discrimination; and shall not knowingly or recklessly alter, falsity, or accept altered or falsified documents from any such worker Executive Order 130. Anil-Boyoot. The Contractor warrants, represents and agrees that during the time this Contract Is in effect, neither it nor any affiliated company, as hereafter defined, participates In or cooperates with an International boycott (See IRC 6 999161131441, and IRS Audit Guidelines Boycotts) or engages In conduct declared to be unlawful by G_L. c. 151E s 2. A breach In the warranty, representation, and agreement contained In this paragraph, without Iimitiig such other rights as It may have, the Commonwealth shall be enUlled to rescind Nis Contract. As used herein, an affiliated company shall be any business entity of which at least 51% of tie ownership Interests are directly or indirectly owned by the Contractor or by a person or persons or business enfity or entitles dlrecty or Indirectly owning at least 51%of the ownership Interests of the Contractor, or which directly or Indirectly owns al least 51%of the ownership Interests of the Contractor. Executive Order 346. Hiring of State Employees By Slade Contractors Contractor certifies compliance with both the conflict of Interest law G.L. c. 260A specifically s. 5 (1) arid (his order; and Includes limitations regarding the hiring of state employees by private companies contracting with the Commonwealth. A privatization contract shall be deemed to Include a specific prohibition against the hiring at any time during the lam of Contract, and for any position in the Contractors company, any state management employee who is, was, or will be Involved in the preparation of the RFP, the negotiations leading to the awarding of the Contract, the decision to award the Contract, and/or the supervision or oversight of performance under the Contract. Executive Ordor 444. Disclosure of Family Relallonshlns With Other Slate Emolovees. Each person applying (or employment (including Contract work) within (he Executive Branch under the Governor must disclose in writing the manes of all Immediate family related to Immediate family by marriage who serve as employees or elected officials of the Commonwealth. All disclosures made by applicants hired by the ExecuUve Branch under the Governor shall be made available for public inspection to the extent permissible by law by the official Willi whom such disclosure has been filed. Executive Order 504, Regarding the Security end Confidentiality of Personal Information. For all Contracts Involving (he Contractors access to personal Information, as defined In G.L. c. 93H, and personal data, as defined in G.L. c. Qi A, owned or controlled by Executive Department agencies, or access to agency systems containing such Information or data (herein collectively 'personal information'), Contractor cedifies under the pains and penalties of perjury that (he Contractor (1) has read Commonwealth of Massachusetts Executive Order 504 and agrees to protect any and all personal Information; and (2) has reviewed all of the Commonwealth information Technology Division's Security Policies, Notwithstanding any contractual provision to the contrary, in connection with the Contractors performance under this Contract, Ion all state agencies in the Executive Department, Including all executive offices, boards, commissions, agencies, departments, divisions, councils, bureaus, and offices, now existing and hereafter established, the Contractor shall: (1) obtain a copy, review, and comply with the contracting agency's Information Security Program (ISP) and any pertinent security guidelines, standards, and policies; (2) comply with all of tine Commonwealth of Massachusetts Information Technology Division's'Sacudly Policies') (3) communicate and enforce the contracting agency's ISP and such Security Policies against all employees (whetter such employees are direct or contracted) and subcontractors; (4) implement and maintain any other reasonable appropriate security procedures and practices necessary to protect personal information to which the Contractor is given access by the contracting agency from the unauthorized access, destruction, use, modification, disclosure or loss; (5) be responsible for the full or partial breach of any of these terms by Its employees (whether such employees are direct or contracted) or subcontractors during or after the term of (his Contract, and any breach of these forma may be regarded as a material breach of this Contract; (6) in the event or any unauthorized access, destruction, use, modification, disclosure or loss of the personal Information (collectively referred to as the "unauthorized use'); (a) Immediately notify the contracting agency If the Contractor becomes aware of the unauthorized use; (b) provide full cooperation and access to Information necessary for the contracting agency to determine the scope of the unauthorized use; and (c) provide full cooperation and access to Information necessary for the contracting agency and the Contractor (o fulfill any notification requirements. Breach of these terms may be regarded as a material breach of this Contract, such that the Commonwealth may exercise any and all contractual rights and remedies, Including without limitation indemnification under Section 11 of the Commenweallh's Terms and Conditions, withholding of payments, Contuse( suspension, or termination. In addition, the Contractor may be subject to applicable statutory or regulatory penalties, Including and without Itmtladion, those Imposed pursuant to G.L. c. 93H and under G.L. a 214. E 3B for violations under M.G.L c. 66A. Executive Orders 523 524 and 526 Executive Order 526 (Order Regarding Nom Discrimination, Diversity, Equal Opportunity and Affirmative Action which supersedes Executive Order 470). Executive Order 524 (Establishing the Massachusetts Supplier Diversity Program which supersedes Executive Order 390). Executive Order 523 (Establishing the Massachusetts Small Business Purchasing Program.) All programs, activities, and services provided, performed, licensed, chartered, funded, regulated, or contracted for by the stale shall be conducted without unlawful discrimination based on race, color, age, gender, ethnicity, sexual orientation, gender Identity or expression, religion, creed, ancestry, national origin, disability, veteran's status (including Vietnam -era veterans), or background. The Contractor and any subcontractors may not engage In discriminatory employment practices; and the Contractor certifies compliance with applicable federal and state laws, rules, and regulations governing fair labor and employment practices; and the Contractor commits to purchase supplies and services from certified minority or women -owned businesses, small businesses, or businesses owned by socially or economically disadvantaged persons or persons with disabilities. These provisions shall be enforced through the contracting agency, OSD, andlor the Massachusetts Commission Against Discrimination. Any breach shall be regarded as a material breach of the contract that may subject the contractor to appropriate sanctions. (Issued 6/2712011) Page 5 of 6 COMMONWEALTH OF MASSACHUSETTS CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME: CONTRACTOR VENDOR/CUSTOMER CODE: Issued May 2004 In � n 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 contacts and other legally binding documents related to the contract on the Contractor's behalf. In addition to this listing, any state department may requite additional proof of authority to sign contacts 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 Contact or other legal document was actually made by the COrrtaeter'S authorized signatory, and not by a representative, designee or other individual.) NOTICE: Acceptance ofany payment (miler a Contract or Grant shall operate as a maiper of ony defense by the Contractor challenging the existence of a pall/ Contract (lire to an alleged lack o.f actual authority to evecute 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 Contactor and as an authorized officer of the Contactor 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 contacts with the Commonwealth of Massachusetts on behalf of the Contactor. I understand and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state department with which the Contractor does business whenever the authorized signatories above retire, are otherwise terminated from the Contractor's employ, have their responsibilities changed resulting in their no longer being authorized to sign contracts with the Commonwealth or whenever new signatories are designated. Date: Signature Title:Telephone:Jl/d�`a?�l' Fax: .hfi�—�iv�' %/� Email: �/i��>S �7a�ls%�P�✓/(zeT c'e'r� [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 contact filed with the department. COMMONWEALTH OF MASSACHUSETTS CONTRACTOR AUTHORIZED SIGNATORY LISTING CONTRACTOR LEGAL NAME CONTRACTOR VENDOR/CUSTOMER CODE: Issued May COMMONWEALTH OF MASSACHUSETTS 2004 CONTRACTOR AUTHORIZE, D SIGNATORY LISTING f 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 1'or the signatory who submits the Contractor Authorized Listing, This Section MUST be completed by the Contractor Authorized Signatory is presence of notary. Signatory's full legal name (print or type): loee ,Iimw /` 11AV Title: �lC�/✓' ���'!✓rid Signature as it will appear on contract or other document (Complete only in presence of no(ary): AUTHENTICATED BY NOTARY OR CORPORATE CLERIC (PICI(ONI,Y ONE) AS FOLLOWS: 1, (NOTARY) as a notary public certify that I witnessed the signature of the aforementioned signatory above and I verified the individual's identity on this date: 20 My commission expires on: AFFIX NOTARY SEAL I, __ _ signahu•e of the aforementioned signatory above, that I verified tine authority as an authorized signatory for the Contractor on this date: 20 ATE CLERK) certify that I witnessed the identity and confirm the individual's AFFIX CORPORATE SEAL Community Innovation Challenge Grant Project Agreement Between Connuolnwealth of Massachusetts Executive Office for Administration and Finance AND The Town of Mansfield GRANT AGREEMENT This Grant Agreement ("Agreement") dated March 14, 2014 is made by and between the Commonwealth of Massachusetts, acting by and through its Secretary of the Executive Office for Administration and Finance (EOAF) and the Manchester -Essex Regional School District ("Grantee") acting through its Superintendent of Schools. PRELIMINARY STATEMENT • Chapter 38 of the Acts of 2013, Item 1599-0026 establishes a multi -year competitive grants program, entitled the Community Innovation Challenge Grant Program (CIC Grant), to provide financial support for one-time or transition costs related to regionalization and other efficiency initiatives with allowable applicants to include; municipalities; regional schools; school districts considering forming a regional school district or regionalizing services; and regional planning agencies and councils of government. Regional planning agencies and councils of government may also serve as administrative and fiscal agents on behalf of a group of municipalities. • Grantee applied for a CIC Grant and received $80,000 to develop a regional stornuwater collaborative program ("Project"). • EOAF has approved Grantee's proposed scope of (lie Project and agrees to obligate a CIC Grant in an amount up 'to, but not to exceed $80,000, for Grantee to carry out and complete the Project. The CIC Grant shall be used exclusively for planning, transition, and seed money, under the terms of this Agreement and Attaclunenls A and B. • It is understood that the Grantee shall exercise frill responsibility and assume liability for the management of the Project in collaboration with my public entity having a direct or indirect interest in the Project. Grantee further agrees that the Commonwealth's provision of financial assistance under this Agreement shall not in any way be construed as assuming responsibility or liability for the completed Project by the Commonwealth. In acceptance of the CIC Grant, Grantee hereby acknowledges and agrees to comply with the Commonwealth Terms and Conditions attached to this Agreement as Attachment A and all applicable laws and regulations governing the distribution and expenditure of state funds. Now Therefore, in consideration of the foregoing and of other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, EOAF and Grantee agree as follows: SECTION 1. PROJECT SCOPE The scope of the Project to be funded by EOAF is described in this Agreement, including Attachments A and B. The Project shall be monitored by a Program Manager designated by EOAF. SECTION 2. TERM AND TERMINATION a) The term of this Agreement shall commence on March 14, 2014 and, unless terminated earlier, shall end once the final report is filed no later than April 1, 20t5. b) EOAF's requirement to disburse finds shall end 15 days after the filing of the third Reporting Period Report, which is due within 15 days of January 15, 2015, SECTION 3. DISBURSEMENT OF EOAF GRANT 3.1 Timeline Disbursement of finds from the EOAF Grant under this Agreement shall be made according to the schedule in Attachment A. 3.2 Reporting On a trimonthly basis, the Grantee will provide a report to update EOAF on the progress of the Project. A reporting period report will be filed 15 days after the close of each quarter. Grantees will also be required to submit a final report at the end of the Project, due on April 1, 2015, and annual reports through April 1, 2018, 3.2.1 Reporting Period Reports All reporting period reports must be filed with the EOAF Program Manager using the Reporting Period Report Form which will be provided to grantee by the EOAF Program Manager. Each report must include: • Implementation- An explanation of the role that each original applicant and partner has played thus far in the development and implementation of the project; • Progress Update- Explanation of the progress during the past quarter. This section must include any obstacles faced and changes made; • Benefits- An outline of the intended benefits of the program and whether they have been realized; • Budget- Inclusion of the original budget, as submitted, along with any finds that have been expended and those that remain; • Timeline- hnclusion of the timeline originally submitted that details the completed milestones as well as those in progress and those yet to be implemented. Acknowledgement of any additions or deletions that were made, with a description of why each change was made; • Measures of Success- Description of the original criteria used to establish measurements of success; • Applicability- Explanation of any steps made to apply your project to other local governments; AND • Supporting Documentation- Submission of any primary documents related to the successful implementation of the grant. This may include copies of press releases, newspaper articles, public information and education items, workshop agendas, public service announcements, attendance rosters, videos, letters from constituents and/or public officials, and anything else relevant to your project. 3.2.2 ISnal Report The final report must be filed electronically, by email and using the form that will be provided by the EOAF Local Government Program Manager, with the EOAF Local Government Program Manager to the Program Manager. The final report must include the following items: • Current status and issues; • Shared service recommendations and review of possible solutions; • Grant application and projected cost summary; • Implementation plan; AND • Cost analysis 3.2.3 Annual Reports The Grantee shall file an amnral report with EOAF for three years following the final report, from 2016 to 2018. The annual report shall be filed electronically by email to the EOAF Local Government Program Manager. The animal report shall be filed on April I" of each year, and should follow a standard form provided by the EOAF Local Government Program Manager. The purpose of the annual report is for Grantees to provide updates regarding the achievements of the outcomes agreed upon in Attachment A. SECTION 4. PROJECT OVERSIGHT In order to ensure the continued progression of the Project, the Program Manager (Employee of EOAF) may perform site visits to meet with stakeholders and observe the status of the Project. Site visits will be announced by the Program Manager to the lead applicant no less than three days before the visit. SECTION 5. COMPLIANCE WITH ALL APPLICABLE LAWS/REGULATIONS 5.1 General Compliance The Town and its consultants shall comply with any and all federal, state and local laws, rules and regulations, orders or requirements that apply to the Project, including but not limited to: (i) Executive Order 478 relating to nondiscrimination, diversity, equal opportunity and affirmative action in hiring and employment practices; (ii) the State, Prevailing Wage Law (MGL. Ch. 149, Sections 26 to 27H); (iii) Title VI of the Civil Rights Acts of 1964, as amended; (iv) Environmental hnpact Requirements (MGL. Ch. 30, Sections 61 to 621); and (v) Historic Preservation Requirements (MGL. Ch. 9, Sections 26 to 28) and applicable regulations. 5.2 Compliance with Existing Laws This agreement shall in no way relieve the Town from time fall force and application of any laws, rules, regulations, or requirements. SECTION 6. INTEREST OF MEMBERS OR EMPLOYEES OF THE (TOWN OR DISTRICT) No officer, servant, agent, or employee of the Town has participated or will participate in any decision relating to the development and implementation of the Project that affects directly or indirectly his/her personal interest or the interest of any corporation, partnership, or proprietorship with which the person is directly or indirectly affiliated. Furthermore, no officer, servant, agent or employee of the Town shall have any interest directly or indirectly in any contract with connection with the Project or shall in any way violate MGL Ch.268A. SECTION 7. DEFAULT Failure to complete milestones in the Project timeline or failure to submit required reports may result in default of the agreement. If the Grantee fails to submit a quarterly report within the required 15 days, fiords will be withheld until the quarterly report is received. If the Grantee fails to submit a quarterly report within 30 days of the end of the quarter, the Grantee shall be deemed to have defaulted on this agreement. SECTION 8. AMENDMENT PROCESS The Grantee may petition EOAF for an amendment of this agreement. Amendments shall be entertained only for the following sections; • Project Scope (Section l) • Term and Termination (Section 2) • Disbursement of EOAF Grant (Section 3) The Grantee may not petition for an amendment of any other section. The Grantee may request a modification using the Agreement Amendment Form. The Grantee shall receive a written response from EOAF regarding whether the change was accepted, and a reason for the decision, within 15 clays of the receipt of the form. SECTION 9. SEVERABILITY OF PROVISIONS if any provision of this Agreement is held invalid by any court of competent jurisdiction, the remaining provisions shall not be affected thereby, and all other parts of the Agreement shall remain in frill force and effect. SECTION 10. NOTICE Any notice tinder this Agreement shall be in writing and shall be sent either (i) by facsimile, (ii) by courier, (iii) by email or (iv) by first class mail, postage, prepaid, to the address as set forth below (or to such other address as a party may provide by notice to the other party under this Section), and shall be effective (i) if dispatched by facsimile and delivery is electronically confirmed by said media, the day such electronic confirmation is received, (ii) if sent by courier, one business day after dispatch, (iii) if sent by first class mail, five business days after its date of posting. Tim Dodd Local Government Program Manager Executive Office for Administration and Finance Massachusetts State House Room 373 Boston, MA 02133 Tinl,Dodd@stato.ma.us Scope of Work for the Community innovation Challenge Grant Program Goad: Regionalizing Mwricipal Stornnvater Mrtntrgentent in Southeastern Massachusetts through Collaborative Education, Data Managenient, antl Pollcy Developurent through the Southeastern Massoehusetts Storanvater Collaborative (SEA4SWC). CONTRACT PREPARATION FEBRUARY 15, 2013- MARCH 20, 2013 1. Work Plan Activity Details Budget Product Develop contract A draft contract and project agreement will be created None Draft contract by the EOAF program manager and provided to (lie Town of Mansfield. Contract approved The contract will be approved and signed by EOAF None Finalized and signed Secretes and the'1'own of Mansfield. contract II. Deliverables During this period, EOAF will work with the Town of Mansfield to develop a contract. The contract will be signed by the appropriate signatories at EOAF and the Town of Mansfield. A&F must receive the following deliverables before the project can proceed: ■ Signed contract III. Reporting No reports are required during this period. IV. Budget Appropriation $52,000 will be disbursed within 15 days of March 14, 2014, the effective date of the contract. ATTACHMENT A Project Agreement REPORTING PERIOD 1 MARCH 14, 2014- JUNE 30, 2014 I. Work Plan Activity Detail Product Initiate development Prepare and compile educational information Training outline and schedule to of a Training Session and relevant short videos that will provide be provided during individual and DVD/CDs necessary information for the Training sessions with Town Employees, (CET-1 & CET-3) Sessions and to be included on the and DPW/Volunteers; as well DVD/CDs. Schedule training session with copies of the Training DVD/CDs. SEMSWC DPW departments and volunteers for each Town, Emphasis on IDDE, Municipal Housekeeping and Pollution Prevention Initiate development Initiate the development of the website. Draft outline of web design as of an educational Begin to assemble maps and documents from well as a list of references and website each contributing Town to be included, documents to have external links (CET-2) Gather relevant documents and references on the SEMSWC website for from the EPA website and other stormwater review and comments from coalitions to be included in the SEMSWC SEMSWC contributors. website. Prepare bid items for Prepare a list of bid items with descriptions Bid items with descriptions for draft RFP for General as part of the Request for Proposals for review and continents from Consulting Services General Consulting Services for the SEMSWC contributors. SPP-3 SEMSWC, Facilityand Manage Chant process, draft progress Reporting Period I Progress Coordination reports, and track budget I Report II. Deliverables During the first Reporting Period, SEMSWC will begin the process of implementation of the program. Within 15 days of the close of the Reporting Period, the SEMSWC will file a Reporting Period report with EOAF. The report will follow the standard form and will include concrete evidence to show that the following deliverables have been met: • Training Outline • Training Schedule (DPW Workers/Volunteer Session) i • Training DVD/CD • Draft Outline of web design/layout • List of references and documents for inclusion on the website • Draft bid items as part of the RFP for General Consulting Services III. Reporting The Reporting Period l report must be filed electronically with EOAF by July 15, 2014, IV. Budget Appropriation $20,000 will be disbursed within 15 days after the filing of the Reporting Period 1 report. V. Outcomes The SEMSWC will develop documentation to show that they are working towards the achievement of the following benchmarks: • # of communities scheduled/received training session • % complete in development of the educational website • % complete in development of the RFP REPORTING PERIOD 2 JULY 1, 2014- SEPTEMBER 30, 2014 I. Work Plan Activity Detail Product Provide Training Session to Perform I -hour Training Session with DPW Provide Session Sign-hn log DPW Workers and Project Workers and Project Volunteers for each for each of the completed Volunteers Town (18 training sessions), Schedule Training Sessions for (CET-1 & CET-3) training session with SEMSWC Department documentation. Provide Heads for each Town. Schedule for upcoming Sessions. Provide DVD video of presentation. Continue to build website Build upon existing website design. Continue Provide web address of framework, and improve to compile maps and documents from each website with preliminary content and attachments contributing Town to be included on the design and documents in (CET-2) website. Continue to gather relevant place for continuous review documents and references from the EPA and feedback from website and other stormwater coalitions to be SEMSWC contributes. included in (lie SEMSWC website. Prepare draft RFP for Prepare draft Request for Proposals for Draft RFP for review and General Consulting Services General Consulting Services for the comments from SEMSWC (SPP-3) SEMSWC after incorporating comments from contributors. bid items. Facility and Coordination Manage Grant process, draft progress reports, Reporting Period 2 Progress and track budget Report It. Deliverables Daring the second Reporting Period, the SEMSWC will hnplenrent the program. Within 15 days of the close of the Reporting Period, SEMSWC will file a Reporting Period report with EOAF. The report will follow the standard form and will include concrete evidence to show that the following deliverables have been met: • Completed Training Sessions Documentation • Training Schedule (Department Heads) • Up & Running website for continuous review • Draft RFP for General Consulting Services I1I. Reporting The Reporting Period 2 report must be filed electronically with A&F by October 15, 2014, IV. Budget Appropriation No budget appropriation will be disbursed after Reporting Period 2. V. Outcomes SEMSWC will develop documentation to show that they are working towards the achievement of the following benchmarks: • # of communities scheduled/received training session • % complete in development of the educational website • % complete in development of the RFP SEMSWC will report on initial successes related to these outcomes in the final report, due on April 1, 2015. Subsequently, SEMSWC will report on successes related to these outcomes in annual reports, due on June 1, 2016; June 1, 2017; and June 1, 2018. REPORTING PERIOD 3 OCTOBER 1, 2014- December 31, 2014 I. Work Plan Activity Detail Product Provide Training Session to Perform 1-hour Training Session with Department Provide Session Sign -In Department Beads Heads for each'fown (18 training sessions). log for each of the (CET-1 & CET-3) completed Training Sessions for documentation. Complete design of Complete design o eeducational website, maintain Completed website for education website content and external links where necessary. SEMSWC, with (CET-2) continuous maintenance for a dates and new material when necessary. Prepare final RFP for Deliver final Request for Proposals for General Final RFP. General Consulting Consulting Services for the SEMSWC. Services (SPP-3 Facility and Coordination Manage Grant process, draft progress reports, hack Reporting Period 3 budget, and drill sustainability plan. Progress Repot and Suslainabilit Plau II. Deliverables During the third Reporting Period, SEMSWC will implement the program. By January 15a', 2015, SEMSWC will file an electronic report with EOAF. The report will follow the standard form and will include concrete evidence to show that the following deliverables have been met: • Completed Training Sessions Documentation • Up & Running website for continuous review • Final RFP for General Consulting Services • Sustainability Plan III. Reporting The Reporting Period 3 report shall be Sled by January 15, 2015. The final project report shall be filed by April 1, 2015. IV. Budget Appropriation $8,000 will be disbursed within 15 days upon the filing of the Reporting Period 3 report. V. Outcomes SEMSWC will develop documentation to show that they are working towards the achievement of the following benchmarks: • # of communities scheduled/received training session • % complete iu development of the educational website • % complete in development of the RFP SEMSWC will report on initial successes related to these outcomes in the final report, due on April 1, 2015, Subsequently, SEMSWC will report on successes related to these outcomes in annual reports, due on July 1, 2016; July 1, 2017; and July 1, 2017. ATTACHMENT B Project Budget Budget for the Community Innovation Challenge Grant Program I. Line Item Budget BUDGET TOTAL: $80,000