HomeMy WebLinkAbout20240604110145928COMMONWEALTH OF MASSACHUSETTS -- STANDARD CONTRACT FORM
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This form is jointly issued and published by the Executive Office for Administration and Finance (ANF), 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-confiicfing 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 hyperlinks for definitions, instructions and legal requirements that are incorporated by reference into this
Contract. An electronic copy of this form is available at www.mass.00v/osc under Guidance For Vendors - Forms orwww.mass.aov/osd under OSD Forms.
CONTRACTOR LEGAL NAME: Town of Mansfield
COMMONWEALTH DEPARTMENT NAME: Massachusetts Emergency Management
(and dib/a): Mansfield CERT
Agency
MMARS Department Code: CDA
Legal Address: (W-9, W-4,T&C): 6 Park Row, Mansfield, MA 02048
Business Mailing Address: 400 Worcester Road, Framingham, MA 01702
Contract Manager: Chief Neal Boldrighini
Billing Address (if different):
E-Mail: nboldrighini@mansfiefdma.com
Contract Manager: Paula Kmmsiek
Phone: 508.261.7490
Fax:
E-Mail: Paula.Krumsiek@state.ma.us
Contractor Vendor Code: VC6000191867
Phone: 508-820-1424
Fax: 508-820-146B
Vendor Code Address ID (e.g. "AD001"): AD_
MMARS Doc ID(s): FYI6CCP1400000MANSF*
(Note: The Address Id Must be set up for EFT payments.)
RFRIProcurement or Other ID Number: 2014 SHSP CCP AGF:
X NEW CONTRACT
_ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTION TYPE: (Check one option only)
Enter Current Contract End Date Prior to Amendment: , 20_
_ Statewide Contract (OSD or an OSD-designated Department)
Enter Amendment Amount: $ . (or "no charge')
—Collective Purchase (Attach OSD approval, scope, budget)
AMENDMENT TYPE: (Check one option only. Attach details of Amendment changes.)
X_ Department Procurement (includes State or Federal grants 815 CMR 2.00)
_ Amendment to Scope or Budget (Attach updated scope and budget)
(Attach RFR and Response or other procurement supporting documentation)
Interim Contract (Attach justification for Interim Contract and updated scope/budget)
Emergency Contract (Attach justification for emergency, scope, budget)
—
_
_ Contract Employee (Attach Employment Status Form, scope, budget)
_Contract Employee (Attach any updates to scope or budget)
_ LegislativelLegal or Other: (Attach authorizing languageljuslification, scope and
_ LegislativelLegal or Other: (Attach authorizing languagefjustifcabon and updated
budget)
scope and budget)
The following COMMONWEALTH TERMS AND CONDITIONS (T&C) has been executed, filed with CTR and is incorporated by reference Into this Contract.
X Commonwealth Terms and Conditions Commonwealth Terms and Conditions For Human and Social Services
COMPENSATION: (Check ONE option): The Department certifies that payments for authorized performance accepted in accordance with the terms of this Contract will be supported
in the state accounting system by sufficient appropriations or other non -appropriated funds, subject to intercept for Commonwealth owed debts under 815 CMR 9.00.
Rate Contract (No Maximum Obligation. Attach details of all rates, units, calculations, conditions or 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 amended) $ 5,000.00
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 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 _ statutoryllegal or Ready Payments (G.L. c. 29 & 23A); -L only initial
payment (subsequent payments scheduled to support standard EFT 45 day payment cycle. See Prompt Pay Discounts Policy.
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract life, purpose, fiscal years) and a detailed description of the scope
of performance or what Is being amended for a Contract Amendment. Attach all supporting documentation and justifications.) Funding for this grant is provided through the
FFY2014 State Homeland Security Program grant. The catalogue of Federal Domestic Assistance (CFDA) number is 97.067. The CERT intends to purchase a Fast
Sheler, lighting and an air mover.
ANTICIPATED START DATE: (Complete ONE option only) The Department and Contractor certify for this Contract, or Contract Amendment, that Contract obligations:
X 1. may be incurred as of the Effective Date (latest signature date below) and no obligations have been incurred prior to the Effective Dale.
_ 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.
_3. were incurred as of _, 20_, a date PRIOR to the Effective Date below, and the parties agree that payments for any obligations incurred prior to the Effective Date are
authorized to be made either as sefflement 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 05.31.16 , with no new obligations being incurred after this dale unless the Contract is property amended,
provided that the terms of this Contract and performance expectations and obligations shall survive its termination for the purpose of resolving any claim or dispute, for completing
any negotiated terms and warranties, to allow any close out or transition performance, reporting, invoicing or final payments, or during any lapse between amendments.
CERTIFICATIONS: Notwithstanding verbal or other representations by the parties, the "Effective Date" of this Contract or Amendment shall be the latest date that this Contract or
Amendment has been executed by an authorized signatory of the Contractor, the Department, or a later Contract or Amendment Start Date specified above, subject to any required
approvals. The Contractor makes all certifications required under the attached Contractor 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 allached 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 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 oufiined in 801 CMR 21.07. incorporated herein, provided that any amended RFR or Response terms result in best value, lower costs, or more cost effective Contract
AUTHORIZING SIGNATURE FOR THE CONTRACTOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH:
X: . Dale: X: . Date:
(Signature and Date Must Be Handwritten At Time of Signature) (Signature and Date Must Be Handwritten At Time of Signature)
Print Name: Neal A. Boldrighini Print Name: David Mahr
Print Title: Fire Chief/Emergency Management Director Print Title: Chief Administrative Officer
(Updated 3/2112014) Page 1 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
INSTRUCTIONS AND CONTRACTOR CERTIFICATIONS
The following instructions and terms are incorporated by reference and apply to this
Standard Contract Form. Text that appears underlined indicates a °hypedink" to an Internet
or bookmarked site and are unofficial versions of these documents and Departments and
Contractors should consult with their legal counsel to ensure compliance with all legal
requirements. Using the Web Toolbar will make navigation between the form and the
hyperlinks easier. Please note that not all applicable laws have been cited.
CONTRACTOR LEGAL NAME (AND DIBIA): Enter the Full Legal Name of the
Contractors business as it appears on the Contractors W-9 or W-4 Form (Contract
Employees only) and the applicable Commonwealth Terms and Conditions If Contractor
also has a "doing business as" (dlbla) name, BOTH the legal name and the "d/bla' name
must appear in this section.
Contractor Legal Address: Enter the Legal Address of the Contractor as it appears on
the Contractors W-9 or W4 Form (Contract Employees only) and the applicable
Commonwealth Terns and Conditions, which must match the legal address on the 10991
table in MMARS (or the Legal Address in HR/CMS for Contract Employee).
Contractor Contract Manager: Enter the authorized Contract Manager who will be
responsible for managing the Contract. The Contract Manager should be an Authorized
Signatory or, at a minimum, a person designated by the Contractor to represent the
Contractor, receive legal notices and negotiate ongoing Contract issues. The Contract
Manager is considered "Key Personnel" and may not be changed without the prior written
approval of the Department If the Contract is posted on COMMBUYS, the name of the
Contract Manager must be included in the Contract on COMMBUYS.
Contractor E-Mail Address/PhonelFax: Enter the electronic mail (e-mail) address,
phone and fax number of the Contractor Contract Manager. This information must be kept
current by the Contractor to ensure that the Department can contact the Contractor and
provide any required legal notices. Notice received by the Contract Manager (with
confirmation of actual receipt) through the listed address, fax number(s) or electronic mail
address will meet any written legal notice requirements.
Contractor Vendor Code: The Department must enter the MMARS Vendor Code
assigned by the Commonwealth. If a Vendor Code has not yet been assigned, leave this
space blank and the Department will complete this section when a Vendor Code has been
assigned. The Department is responsible under the Vendor File and W-9s Policy for
verifying with authorized signatories of the Contractor, as part of contract execution, that
the legal name, address and Federal Tax Identification Number (TIN) in the Contract
documents match the state accounting system.
Vendor Code Address ID: (e.g., "AD001") The Department must enter the MMARS
Vendor Code Address Id identifying the payment remittance address for Contract
payments, which MUST be set up for EFT payments PRIOR to the first payment under the
Contract in accordance with the Bill Paying and Vendor File and W-9 policies.
COMMONWEALTH DEPARTMENT NAME: Enter the full Department name with the
authority to obligate funds encumbered for the Contract.
Commonwealth MMARS Alpha Department Code: Enter the three (3) letter MMARS
Code assigned to this Commonwealth Department in the stale accounting system.
Department Business Mailing Address: Enter the address where all formal
correspondence to the Department must be sent. Unless otherwise specified in the
Contract, legal notice sent or received by the Department's Contract Manager (with
confrmalion of actual receipt) through the listed address, fax number(s) or electronic mail
address for the Contract Manager will meet any requirements for legal notice.
Department Billing Address: Enter the Billing Address or email address if Invoices must
be sent to a different location. Billing or confirmation of delivery of performance issues
should be resolved through the listed Contract Managers.
Department Contract Manager: Identify the authorized Contract Manager who will be
responsible for managing the Contract, who should be an authorized signatory or an
employee designated by the Department to represent the Department to receive legal
notices and negotiate ongoing Contract issues.
Department E-Mail Address/PhonelFax: Enter the electronic mail (e-mail) address,
phone and fax number of the Department Contract Manager. Unless otherwise specified in
the Contract, legal notice sent or received by the Contract Manager (with confirmation of
actual receipt) through the listed address, fax number(s) or electronic mail address will
meet any requirements for written notice under the Contract.
MMARS Document ID(s): Enter the MMARS 20 character encumbrance transaction
number associated with this Contract which must remain the same for the life of the
Contract. If multiple numbers exist for this Contract, identify all Doc Ids.
RFR/Procurement or Other ID Number or Name: Enter the Request for Response
(RFR) or other Procurement Reference number, Contract ID Number or other
reference/tracking number for this Contract or Amendment and will be entered into the
Board Award Field in the MMARS encumbrance transaction for this Contract.
NEW CONTRACTS (left side of Form):
(Updated 3/21/2
Complete this section ONLY if this Contract is brand new. (Complete the
CONTRACT AMENDMENT section for any material changes to an existing or an
expired Contract, and for exercising options to renew or annual contracts under a
multiyear procurement or grant program.)
PROCUREMENT OR EXCEPTION TYPE: Check the appropriate type of procurement or
exception for this Contract. Only one option can be selected. See State Finance Law and
General Reouiremenls, Acquisition Policy and Fixed Assets, the Commodities and
Services Policy and the Procurement Information Center (Department Contract Guidance)
for details.
Statewide Contract (OSO or an OSD.designated Department). Check this option for a
Statewide Contract under OSD, or by an OSD-designated Department,
Collective Purchase approved by OSD. Check this option for Contracts approved by
OSD for collective purchases through federal, state, local government or other entities.
Department Contract Procurement. Check this option for a Department procurement
including stale grants and federal subyrants under 815 CMR 2,00 and State Grants and
Federal Subgrants Policy, Departmental Master Agreements (MA). If multi -Department
user Contract, identify multi -Department use is allowable in Brief Description.
Emergency Contract. Check this option when the Department has determined that an
unforeseen crisis or incident has arisen which requires or mandates immediate purchases
to avoid substantial harm to the functioning of government or the provision of necessary or
mandated services or whenever the health, welfare or safety of clients or other persons or
serious damage to property is threatened.
Contract Employee. Check this option when the Department requires the performance of
an Individual Contractor, and when the planned Contract performance with an Individual
has been classified using the Employment Status form (prior to the Contractors selection)
as work of a Contract Employee and not that of an Independent Contractor.
Legislative/Legal or Other. Check this option when legislation, an existing legal
obligation, prohibition or other circumstance exempts or prohibits a Contract from being
competitively procured, or identify any other procurement exception not already listed.
Legislative "earmarks" exempt the Contract solely from procurement requirements, and all
other Contract and stale finance laws and policies apply. Supporting documentation must
be attached to explain and justify the exemption.
CONTRACT AMENDMENT (Right Side of Form)
Complete this section for any Contract being renewed, amended or to continue a lapsed
Contract. All Contracts with available options to renew must be amended referencing the
original procurement and Contract doc ids, since all continuing contracts must be
maintained in the same Contract file (even if the underlying appropriation changes each
fiscal year.) "See Amendments Suspensions and Termination Policy.)
Enter Current Contract End Date: Enter the termination date of the Current Contract
being amended, even if this dale has already passed. (Note: Current Start Date is not
requested since this date does not change and is already recorded in MMARS.)
Enter Amendment Amount: Enter the amount of the Amendment increase or decrease to
a Maximum Obligation Contract. Enter "no change" for Rate Contracts or if no change.
AMENDMENT TYPE: Identify the type of Amendment being done. Documentation
supporting the updates to performance and budget must be attached. Amendment to
Scope or Budget. Check this option when renewing a Contract or executing any
Amendment ("material change" in Contract terms) even if the Contract has lapsed, The
parties may negotiate a change in any element of Contract performance or cost identified
in the RFR or the Contractors response which results in lower costs, or a more cost-
effective or better value performance than was presented in the original selected response,
provided the negotiation results in a better value within the scope of the RFR than what
was proposed by the Contractor in the original selected response. Any 'material" change
in the Contract terms must be memorialized in a formal Amendment even if a
corresponding MMARS transaction is not needed to support the change. 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
Interim Contracts. Check this option for an Interim Contract to prevent a lapse of Contract
performance whenever an existing Contract is being re -procured but the new procurement
has not been completed, to bridge the gap during implementation between an expidng and
a new procurement, or to contract with an interim Contractor when a current Contractor is
unable to complete full performance under a Contract.
Contract Employee. Check this option when the Department requires a renewal or other
amendment to the performance of a Contract Employee.
LegislativelLegal or Other. Check this option when legislation, an existing legal
obligation, prohibition or other circumstance exempts or prohibits a Contract from being
competitively procured, or identify any other procurement exception not already listed.
Legislative "earmarks" exempt the Contract solely from procurement requirements, and all
other Contract and state finance laws and policies apply. Attach supporting documentation
to explain and justify the exemption and whether Contractor selection has been publicly
014) Page 2 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
rtv
posted.
COMMONWEALTH TERMS AND CONDITIONS
Identify which Commonwealth Terms and Conditions the Contractor has executed and is
incorporated by reference into this Contract. This Form is signed only once and recorded
on the Vendor Customer file (VCUST). See Vendor File and W-9s Policy.
COMPENSATION
Identfy if the Contract is a Rate Contract (with no stated Maximum Obligation) or a
Maximum Obligation Contract (with a stated Maximum Obligation) and identify the
Maximum Obligation. If the Contract is being amended, enter the new Maximum
Obligation based upon the increase or decreasing Amendment. The Total Maximum
Obligation must reflect the total funding for the dates of service under the contract,
including the Amendment amount it the Contract is being amended. The Maximum
Obligation must match the MMARS encumbrance. Funding and allotments must be
verified as available and encumbered prior to incurring obligations. If a Contract includes
both a Maximum Obligation component and Rate Contract component, check off both,
specific Maximum Obligation amounts or amended amounts and Attachments must clearly
outline the Contract breakdown to match the encumbrance.
PAYMENTS AND PROMPT PAY DISCOUNTS
Payments are processed within a 45 day payment cycle through EFT in accordance with
the Commonwealth Bill Paving Policv for investment and cash flow purposes.
Departments may NOT negotiate accelerated payments and Payees are NOT entitled to
accelerated payments UNLESS a prompt payment discount (PPD) is provided to support
the Commonwealth's loss of investment earnings for this eadier payment, or unless a
payments is legally mandated to be made in less than 45 days (e.g., construction
contracts, Ready Payments under G.L. c 29 s. 23A1. See Prompt Pay Discounts Policy,
PPD are identified as a percentage discount which will be aulomatcally deducted when an
accelerated payment is made. Reduced contracts rates may not be negotiated to replace a
PPD. If PPD fields are left blank please identify that the Contractor agrees to the standard
45 day cycle; a statutory/legal exemption such as Ready Payments (G.L. c 29 11 23A1; or
only an initial accelerated payment for reimbursements or start up costs for a grant, with
subsequent payments scheduled to support standard EFT 45 day payment cycle. Financial
hardship is not a sufficient justification to accelerate cash flow (or all payments under a
Contract. Initial grant or contract payments may be accelerated for the first invoice or initial
grant Installment, but subsequent periodic installments or invoice payments should be
scheduled to support the Payee cash flow needs and the standard 45 day EFT payment
cycle in accordance with the Bill Paying Policy. Any accelerated payment that does not
provide for a PPD must have a legal justification in Contract file for audit purposes
explaining why accelerated payments were allowable without a PPD.
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE
Enter a brief description of the Contract performance, project name andfor other identifying
information for the Contract to specifically identify the Contract performance, match the
Contract with attachments, determine the appropriate expenditure code (as listed in the
Exoenditure Classification Handbook) or to identify or clarity important information related
to the Contract such as the Fiscal Year(s) of performance (ex. "FY2012" or "FY2012-14').
Identify settlements or other exceptions and attach more detailed justification and
supporting documents. Enter "Multi -Department Use" if other Departments can access
procurement. For Amendments, identify the purpose and what items are being amended.
Merely stating "see attached" or referencing attachments without a narrative description of
performance is insufficient
ANTICIPATED START DATE
The Department and Contractor must certly WHEN obligations under this
ConlractfAmendment may be incurred. Option 1 is the default option when performance
may begin as of the Effective Date (latest signature date and any required approvals). If
the parties want a new Contract or renewal to begin as of the upcoming fiscal year then list
the fiscal year(s) (ex. `FY2012' or 'FY2012-14") in the Brief Description section.
Performance starts and encumbrances reflect the default Effective Date (if no FY is listed)
or the later FY start date (if a FY is listed). Use Option 2 only when the Contract will be
signed well in advance of the start date and identify a specific future start date. Do not use
Option 2 for a fiscal year start unless it is certain that the Contract will be signed prior to
fiscal year. Option 3 is used in lieu of the Settlement and Release Form when the
ContracYAmendment is signed late, and obligations have already been Incurred by the
Contractor prior to the Effective Date for which the Department has either requested,
accepted or deemed legally eligible for reimbursement, and the Contract includes
supporting documents justifying the performance or proof of eligibility, and approximate
costs. Any obligations incurred outside the scope of the Effective Date under any Option
listed, even if the incorrect Option Is selected, shall be automatically deemed a settlemen
included under the terms of the Contract and upon payment to the Contractor will release
the Commonwealth from further obligations for the identified performance. All settlemen
payments require justification and must be under same encumbrance and object codes as
the Contract payments. Performance dates are subject to G.L. c.4 9.
t
t
CONTRACT END DATE
The Department must enter the date that Contract performance will terminate. If the
Contract is being amended and the Contract End Date is not changing, this date
must be re-entered again here. A Contract must be signed for at leas(the initial duration
but not longer than the period of procurement listed in the RFR, or other solicitation
document (if applicable). No new performance is allowable beyond the end date without
an amendment, but the Department may allow a Contractor to complete minimal close out
performance obligations if substantial performance has been made prior to the termination
date of the Contract and prior to the end of the fiscal year in which payments are
appropriated, provided that any close out performance is subject to appropriation and
funding limits under slate finance law, and CTR may adjust encumbrances and payments
in the state accounting system to enable final close out payments. Performance dates are
subject to G.L. cA 9.
CERTIFICATIONS AND EXECUTION
See Department Head Signature Authorization Policv and the Contractor Authorized
Signatory Ustingfor policies on Contractor and Department signatures.
Authorizing Signature for Contractor/Date: The Authorized Contractor Signatory must
(in their own handwriting and in ink) sign AND enter the date the Contract is signed. See
section above under 'Anticipated Contract Start Dale'. Acceptance of payment by the
Contractor shall waive any night of the Contractor to claim the Contract/Amendment is not
valid and the Contractor may not void the Contract. Rubber stamps, typed or other
images are not acceptable. Proof of Contractor signature authorization on a Contractor
Authorized Signatory Listing may be required by the Department if not already on file.
Contractor Name ITitle: The Contractor Authorized Signatory's name and title must
appear legibly as it appears on the Contractor Authorized Signatory Listing.
Authorizing Signature For CommomvealthlDate: The Authorized Department Signatory
must (in their own handwriting and in ink) sign AND enter the date the Contract is signed.
See section above under'Anficioated Stan Date`. Rubber stamps, typed or other
images are not accepted. The Authorized Signatory must be an employee within the
Department legally responsible for the Contract. See Department Head Signature
Authorization. The Department must have the legislative funding appropriated for all the
costs of this Contract or funding allocated under an approved Interdepartmental Service
Agreement NSA). A Department may not contract for performance to be delivered to or by
another state department without specific legislative authorization (unless this Contract is a
Statewide Contract). For Contracts requiring Secretariat signoff, evidence of Secretariat
signoff must be included in the Contract file.
Department Name rritle: Enter the Authorized Signatory's name and title legibly.
CONTRACTOR CERTIFICATIONS AND LEGAL REFERENCES
Notwithstanding verbal or other representations by the parties, (he "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 Stan Date specified, subject to any required approvals. The Contractor
makes all certifications required under this Contract under the pains and penalties of
perjury, and 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:
Commonwealth and Contractor Ownership Rights. The Contractor certifies and agrees
that the Commonwealth is entitled to ownership and possession of all "deliverables
purchased or developed with Contract funds. A Department may not relinquish
Commonwealth rights to deliverables nor may Contractors sell products developed with
Commonwealth resources without just compensation. The Contract should detail all
Commonwealth deliverables and ownership rights and any Contractor proprietary rights.
Qualifications. The Contractor certifies it is qualified and shall at all fines remain qualified
to perform this Contract; that performance shall be fimely and meet or exceed industry
standards for the performance required, including obtaining requisite licenses,
registrations, permits, resources for performance, and sufficient professional, liability; and
other appropriate insurance to cover the performance. If the Contractor is a business, the
Contractor certifies that it is listed under the Secretary of State's website as licensed to do
business in Massachusetts, as required by law.
Business Ethics and Fraud, Waste and Abuse Prevention. The Contractor certifies that
performance under this Contract, in addition to meeting the terms of the Contract, will be
made using ethical business standards and good stewardship of taxpayer and other public
funding and resources to prevent fraud, waste and abuse.
Collusion. The Contractor certifies that this Contract has been offered in good faith and
without collusion, fraud or unfair trade practices with any other person, that any actions to
avoid or frustrate fair and open competifion are prohibited by law, and shall be grounds for
rejection or disqualification of a Response or termination of this Contract.
Public Records and Access The Contractor shall provide full access to records related to
performance and compliance to the Department and officials listed under Executive Order
195 and G.L. c. 11 s.12 seven (7) years beginning on the first day after the final payment
(Updated 312112014) Page 3 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
under this Contract or such longer period necessary for the resolution of any litigation,
claim, negottation, audit or other inquiry involving this Contract. Access to view Contractor
records related to any breach or allegation of fraud, waste and/or abuse may not be denied
and Contractor can not claim confidentiality or trade secret protections solely for viewing
but not retaining documents. Routine Contract performance compliance reports or
documents related to any alleged breach or allegation of non-compliance, fraud, waste,
abuse or collusion may be provided electronically and shall be provided at Contractors
own expense. Reasonable costs for copies of non -routine Contract related records shall
not exceed the rates for public records under 950 C.M.R. 32.00.
Debarment. The Contractor certifies that neither it nor any of its subcontractors are
curremy debarred or suspended by the federal or state government under any law or
regulation including, Executive Order 147; G.L. c. 29, s. 29F G.L. 00 fi 39R, G.L. 049. &
27C G.L. c.149,§ 44C, G.L. 049. fi 148B and G.L. c. 152 s. 25C.
Applicable Laws. The Contractor shall comply with all applicable state laws and
regulations including but not limited to the applicable Massachusetts General Laws; the
Official Code of Massachusetts Regulations; Code of Massachusetts Regulations
(unofficial); 801 CMR 21.00 (Procurement of Commodity and Service Procurements,
Including Human and Social Services); 815 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. c. 66A; and the
Massachusetts Constitution Article XVIII if applicable.
Invoices. The Contractor must submit invoices in accordance with the terms of the
Contract and the Commonwealth Bill Paving Policy. Contractors must be able to reconcile
and properly attribute concurrent payments from multiple Departments. Final invoices in
any fiscal year must be submitted no later than August 150 for performance made and
received (goods delivered, services completed) prior to June 301h, 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 151^ or other date listed in
the Contract shall authorize the Department to issue an estimated payment based upon
the Department's determination of performance delivered and accepted. The Contractors
acceptance of this estimated payment releases the Commonwealth from further claims for
these invoices. If budgetary funds revert 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, § 27 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 4 9C. A
Department cannot authorize or accept performance in excess of an exisfing appropriation
and allotment, or sufficient non -appropriated available funds. Any oral or written
representations, commitments, or assurances made by the Department or any other
Commonwealth representative are not binding. The Commonwealth has no legal
obligation to compensate a Contractor for performance that 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 815 CMR 9,00. Contract overpayments will be subject to immediate
Intercept or payment offset. The Contractor may not penalize any stale Department or
assess late fees, cancel a Contract or other services if amounts are intercepted or offset
due to recoupment of an overpayment, outstanding taxes, child support, other overdue
debts or Contract overpayments.
Tax Law Compliance. The Contractor certifies under the pains and penalties of perjury
tax compliance with Federal tax laws; state in laws including but not limited to G.L. c. 62C
G.L. c 62C s. 49A; compliance with all slate tax laws, reporting 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. c. 62E, withholding and remitting child support including G.L. c.
Ind 119A. s. 12; TIR 05-11; New ependent Contractor Provisions and applicable TIRs.
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 writing 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 certifies 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, or
subcontractors, including any potenfial 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
Department client in accordance with Massachusetts Board of Bar Overseers (BBO) rules.
Federal Anti -Lobbying and Other Federal Requirements. If receiving federal funds, the
Contractor cedifies compliance with federal anti -lobbying requirements including 31 USC
1352; other federal requirements; Executive Order 11246; Air Pollution Acl; Federal Water
Pollution Control Act and Federal Employment Laws.
Protection of Personal Data and Information. The Contractor certifies that all steps will
be taken to ensure the security and confidentiality of all Commonwealth data for which the
Contractor becomes a holder, either as part of performance or inadvertently during
performance, with special attention to restricting access, use and disbursement of personal
data and information under G.L. c. 93H and c. 66A and Executive Order 504. The
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 (at a
minimum) Information Technology Division (ITD) 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 compliant in accordance with
the Payment Card Industry Council Standards and shall provide confirmation compliance
during the Contract, provide further that the Contractor shall immediately nobly the
Department in the event of any security breach including, the unauthorized access,
disbursement, use or disposal of personal data or information, and in the event of a
security 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 Contractors
breach including but not limited to G.L. c. 214. s. 3B.
Corporate and Business Filings and Reports. The Contractor certifies compliance with
any certification, filing, reporting and service of process requirements of the Secretary of
the Commonwealth, the Office of the Attorney General or other Departments as related to
its conduct of business in the Commonwealth; and with its incorporating state (or foreign
entity).
Employer Requirements. Contractors that 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 Wages for Printing and Distribution of Public Documents); G.L. c.
minimum wages and prevailing wage Programs and payments; unemployment insurance
and contributions; workers' compensation and insurance, child labor laws AGO fair labor
radices; G.L. c. 149 (Labor and Industries); G.L. c. 150A (Labor Relations); G.L. c. 151
and 455 CMR 2.00 (Minimum Fair Wages); G.L. c. 151A (Employment and Training); GA.
c. 151B (Unlawful Discrimination); G.L. c. 151E (Business Discrimination); G.L. c. 152
(Workers' Compensation); G.L. c.153 (Liability for Injuries); 29 USC c. 8 (Federal Fair
Labor Standards); 29 USC c. 28 and the Federal Family and Medical Leave Act.
Federal And State Laws And Regulations Prohibiting Discrimination including but not
limited to the Federal Equal Employment Opportunity (EEO) Laws the Americans with
Disabilities Act,; 42 U.S.0 Sec 12101 of seq., the Rehabilitation Act, 29 USC c. 16 s. 794;
29 USC c. 16. s. 701; 29 USC c 14 623: the 42 USC c. 45: (Federal Fair Housing Act); G.
L. c. 151E (Unlawful Discrimination); G.L. c. 151E (Business Discrimination); the Public
Accommodations Law G.L. c 272 s. 92A; G.L. c 272 s. 98 and 98A, Massachusetts
Constitution Article CXIV and G.L. c. 93. s. 103; 47 USC c 5 sc. II Part 11 s 255
(Telecommunication Act; Chapter 149, Section 105D, G.L. c. 151C. G.L. c. 272, Section
92A Section 98 and Section 98A, and G.L. c. tit, Section 199A, and Massachusetts
Disability -Based Non -Discrimination Standards For Executive Branch Entities, and related
Standards and Guidance, authorized under Massachusetts Executive Order or any
disability -based 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
participate in the SBPP, created pursuant to Executive Order 523 if qualified through the
S8PP COMMBUYS subscription process at www.corrmbuvs.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 Information Technology Mandatory Specifications and the IT Acquisition
Accessibility Contract Language are incorporated by reference into Information Technology
Contracts. The following language will apply to Information Technology contracts in the
U01, UO2, UO3, U04, U05, U06, U07, U08, U09, U10, U75, U98 object codes 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, return, replace 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
the foregoing in no way limits the Commonwealth's right of recovery for personal injury or
property damages or patent and copyright infringement under Section 11 nor the
Commonwealth's ability to join the contractor as a third party defendant. Further, the term
(Updated 3/2112014) Page 4 of 5
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
"other damages" shall not include, and in no event shall the contractor be liable for,
damages for the Commonwealth's 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 limes the value of the product or service
(as defined in the Contract scope of work) that is the subject of the 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 liability 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 liability conflicts with
accounting standards which mandate that there can be no cap of damages, the limitation
shall be considered waived for that audit engagement. These terms may be applied to
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 certifies that it does not
discriminate in employment, compensation, or the terms, conditions and privileges of
employment on account of 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 of
sale of firearms, munitions, including rubber or plastic bullets, tear gas, armored vehicles or
military aircraft for use or deployment in any activity in Northern Ireland.
Pandemic, 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 if not contemplated under the original Contract or procurement.
Payments are subject to appropriation and other payment terms.
Consultant Contractor Certifications (For Consultant Contracts "HH" and "NN" and
"U05' object codes subject to G.L. Chaoter 29. s. 29A). Contractors must make required
disclosures as part of the RFR Response or using the Consultant Contractor Mandatory
Submission Form.
Attorneys. Attorneys or firms providing legal services or representing Commonwealth
Departments may be subject to G.L. c. 30, s. 65, and if providing lunation 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 conflicts of interest
arising under the Contract.
Subcontractor Performance. The Contractor certifies full responsibility for Contract
performance, including subcontractors, and that comparable Contract terms 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 state Departments, the Contractor certifies compliance with
applicable Executive Orders (see also Massachusetts Executive Orders), including but not
limited to the specific orders listed below. A breach during period of a Contract may be
considered a material breach and subject Contractor to appropriate monetary or Contract
sanctions.
Executive Order 481. Prohibiting the Use of Undocumented Workers on Stale Contracts.
For all state agencies in the Executive Branch, including all executive offices, boards,
commissions, agencies, Departments, divisions, councils, bureaus, and offices, now
existing and hereafter established, by signing this Contract the Contractor certifies 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 to 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, falsify, or accept altered
or falsified documents from any such worker
Executive Order 130, ti-Bov Ancott. 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 & 999fb)f3)-
(44), 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 limiting such other rights as it may have, the Commonwealth shall
be entitled to rescind this Contract. As used herein, an affiliated company shall be any
business entity of which at least 51% of the ownership interests are directly or indirectly
owned by the Contractor or by a person or persons or business entity or entities directly or
indirectly owning at least 51%of the ownership interests of the Contractor, or which directly
or indirectly owns at least 51%of the ownership interests of the Contractor.
Executive Order 346. Hiring of State Employees By State Contractors Contractor certifies
compliance with both the conflict of interest law G.L. c. 268A specifically s. 5 ff) and this
order; and includes limitations regarding the hiring of state employees by private
companies contracting with the Commonwealth. A privatization contract shall be deemed
to include a specific prohibition against the hiring at any time during the term of Contract,
and for any position in the Contractors company, any stale 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, andlor the supervision or
oversight of performance under the Contract.
Executive Order 444. Disclosure of Family Relationships With Other State Employees.
Each person applying for employment (including Contract work) within the Executive
Branch under the Governor must disclose in writing the names 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 Executive Branch under
the Governor shall be made available for public inspection to the extent permissible by law
by the official with whom such disclosure has been filed.
Executive Order 504. Regarding the Security and Confidentiality of Personal Information.
For all Contracts involving the Contractors access to personal information, as defined in
G.L. c. 93H, and personal data, as defined in G.L. c. 66A, owned or controlled by
Executive Department agencies, or access to agency systems containing such information
or data (herein collectively "personal information"), Contractor certifies under the pains and
penalties of perjury that the 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, for 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 the Commonwealth of Massachusetts Information
Technology Division's "Security Policies") (3) communicate and enforce the contracting
agency's ISP and such Security Policies against all employees (whether 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 this
Contract, and any breach of these terms may be regarded as a material breach of this
Contract; (6) in the event of 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 to fulfill any notification requirements. Broach 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 Commonwealth's Terms and Conditions, withholding of payments,
Contract suspension, or termination. In addition, the Contractor may be subject to
applicable statutory or regulatory penalties, including and without limitation, those imposed
pursuant to G.L. c. 93H and under G.L. c. 214, F 3B for violations under M.G.L c. 66A.
Executive Orders 523 524 and 526. Executive Order 526 (Order Regarding Non -
Discrimination, Diversity, Equal Opportunity and Affirmative Action which supersedes
Executive Order 4781. 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 state 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, roles, 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, and/or 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.
(Updated 3/21/2014) Page 5 of 6
Issued May
COMMONWEALTH OF MASSACHUSET'T'S 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME: Town of Mansfield. d/b/a Mansfield CERT
CONTRACTOR VENDOR/CUSTOMER CODE: VC6000191867 ul
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 Conti -act 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 authorhy to
execute the document by the signatory.
For privacy proposes 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
Neal A. Boldrighini
Fire Chief/Emergency Management Director
William R. Ross
Town Manager
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.
Af , Date: "'2
Signature
Title: Mansfield Town Manager Telephone: 508-261-7370
Fax: 508-261-7498 Email: wross@mansfieldma.com
[Listing can not be accepted without all of this information completed.]
A copy of this listing must be attached to the "record copy" of a contract filed with the department.
Issued May
COMMONWEALTH OF MASSACHUSETTS 2004
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME: Town of Mansfield, d/b/a Mansfield CERT
CONTRACTOR VENDOR/CUSTOMER CODE: VC6000191867 UIV
PROOF OF AUTHENTICATION OF SIGNATURE
This page is optional and is available for a department to authenticate contract signatures.
It is recommended that Departments obtain authentication of signature for the signatory
who submits the Contractor Authorized Listing.
This Section MUST be completed by the Contractor Authorized Signatory in presence of notary.
n I
Signatory's full legal name (print or type): Uv/G��`��
Title:
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, I.i%t.cr-'( / �f/%//�/y' � ,/ (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:
�7 c3 20 DINGIVAN
NOTARY PUBaC
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I, (CORPORATE CLERK) certify that I witnessed the
signature of the aforementioned signatory above, that I verified the individual's identity and confirm the in ividaal's
authority as an authorized signatory for the Contractor on this date:
20
AFFIX CORPORATE SEAL
Massachusetts Emergency Management Agency
Federal OMB Circular A-133 Audit Reporting Form
Name of Organization: Town of Mansfield MA
Address: 6 Park Row Mansfield MA 02048
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 d
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 El
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.
CI �'L , w 1�' 1 6 �� S�
Signature Date
John Stanbrook
Printed Name
Finance Director/Town Accountant
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On Completinci the Contractor Authorized Signatory List (CASL) Document:
The person signing the contract must be authorized by the entity receiving the grant to
sign contracts.
The CASL document is the form used for this authorization.
This two -page form must be completed by MEMA sub -recipients (the "Contractor") in
order to process your contract; both pages must be completed - the second page must
be notarized.
The Contractor (i.e., the entity receiving this grant - Municipality, Tribe, etc) must provide
a listing of individual(s) who are authorized as legal representatives of the Contractor
who can sign contracts and other legally binding documents related to the contract on
the Contractor's behalf.
The person signing the contract must be listed in the table on page 1 of the CASL. In
addition, this person must provide a notarized specimen of their signature on page 2 of
the CASL.
The individual who authorizes the above -referenced individual(s) must be either a Mayor,
Town Manager, President, CEO, CFO, Corporate Clerk, or Legal Counsel for the entity
receiving the contract. This authorizing individual would provide their: signature, date,
and requested contact information on page 1 of the CASL
The authorizing individual — unless they are the Mayor, Town Manager, President, CEO,
CFO, Corporate Clerk, or Legal Counsel - cannot authorize himself/herself to sign the
contract.
MEMA must have the completed and original copy of the CASL in order to process
contracts.
MASSACHUSETTS EMERGENCY MANAGEMENT AGENCY
PROJECT MANAGEMENT OFFICE
Special Conditions and Reporting Requirements for EMPG, CCP, and HMEP Sub -
Recipients
1. Emergency Management Performance Grant (EMPG) and Citizen Corps Program
(CCP) sub -recipients agree to adhere to all policies and guidance documents set by the
U.S. Department of Homeland Security -Federal Emergency Management Agency
(DHS/FEMA) and the Massachusetts Emergency Management Agency (MEMA)
regarding use of the U.S. DHS-FEMA federal homeland security funding.
2. Hazardous Material Emergency Preparedness (HMEP) sub -recipients agree to
adhere to all policies and guidance documents set by the U.S. Department of
Transportation — Pipeline and Hazardous Materials Safety Administration
(DOT/PHMSA) and MEMA regarding use of the U.S. DOT-PHMSA funding.
3. All sub -recipients agree that a detailed budget and plan must be submitted to MEMA for
review and approval prior to execution of a contract for grant activities. EMPG and CCP
budgets and plans shall adhere to the applicable U.S. DHS program guidelines and
application kit. HMEP budgets and plans shall adhere to the U.S. DOT PHMSA program
guidelines.
4. Any adjustment within a sub -recipient's approved budget in excess of ten percent (10%)
of the approved budget must be reviewed and approved by MEMA prior to expenditure.
A contract amendment may be required prior to performance under an adjusted budget.
5. Any substantive adjustment to a sub -recipient's scope of work (e.g., conduct of two
exercises rather than four) must be reviewed and approved by MEMA prior to
expenditure. A contract amendment may be required prior to performance under an
adjusted scope of work.
6. Sub -recipients agree to be compliant with the National Incident Management System
(NIMS). This includes participation (when requested) in the annual, on-line NIMSCAST.
NRAS is a comprehensive incident response system, developed by the Department of
Homeland Security as required by HSPD-5. Implementation of and compliance with
NIMS is critical to ensuring full and robust preparedness across the nation and in the
Commonwealth of Massachusetts.
7. Sub -recipients agrees to comply with the following:
Administrative Requirements
44 CFR Part 13, Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments;
2 CFR Part 215, Uniform Administrative Requirements for Grants and Agreements with
Institutions of Higher Education, Hospitals, and Other Non -Profit Organizations (OMB
Circular A-110);
Cost Principles
2 CFR Part 225, Cost Principles for State, Local, and Indian Tribal Governments (OMB
Circular A-87);
2 CFR Part 220, Cost Principles for Educational Institutions (OMB Circular A-21);
2 CFR Part 230, Cost Principles for Non -Profit Organizations (OMB Circular A-122);
Federal Acquisition Regulations (FAR), Part 31.2 Contract Cost Principles and
Procedures, Contracts with Commercial Organizations.
Audit Requirements
OMB Circular A-133, Audits of States, Local Governments, and Non -Profit
Organizations
8. Sub -recipients agree that federal funds under this award will be used to supplement, and
not supplant, state or local finds.
9. Sub -recipients understand and agree that it cannot use any federal funds, either directly or
indirectly, in support of the enactment, repeal, modification or adoption of any law,
regulation or policy, at any level of government without the express prior written
approval of U.S. DHS and/or U.S. DOT.
10. Press. Sub -recipient agrees to proactively notify MEMA of any interactions or planned
media outreach regarding activities funded under this grant program.
11. Release of Information. All records, papers and other documents of any kind related to
the funded activity in any manner and kept by sub -recipients of these funds shall be made
promptly available upon request to any person authorized by MEMA for inspection and
copying.
12. Civil Rights Requirements. All sub -recipients, regardless of the type of entity or the
amount awarded, are subject to the prohibitions against discrimination in any program or
activity and may be required by the DHS, DOT, or MEMA, through selected compliance
reviews, to submit data to ensure their services are delivered in an equitable manner to all
segments of the service population and their employment practices comply with equal
employment opportunity requirements.
13. Limited English Proficiency. All sub -recipients of funding under this grant are required
to take reasonable steps to ensure that persons of limited English proficiency have
meaningfid access to assistance services regarding the development of proposals and
budgets and conducting grant funded activities.
14. Americans with Disabilities Act. All federal grant sub -recipients must comply with the
Americans with Disabilities Act (ADA); (i.e., "all state and local government entities do
not discriminate against people with disabilities in their programs, services and activities.
State and local governments must take steps to examine their programs and establish a
plan for compliance with the law.")
15. Discrimination Prohibited. No person shall on the grounds of race, color, religion,
national origin, sex or sexual orientation be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under or denied employment in connection
with any programs or activity funded through MEMA and shall otherwise comply with
all applicable state anti -discrimination law including but not limited to the provisions of
G.L. c. 15113. Sub -recipients of finds are also subject to the provisions of Title VI of the
Civil Rights Act of 1964; Section 504 of the Rehabilitation Act of 1974, as amended;
Title IX of the Education Amendments of 1972, 20 U.S.C. § 1681; the Age
Discrimination Act of 1975, 42 U.S.C. § 6102; and DOJ Non -Discrimination Regulations
28 CFR Part 42, Subparts C, D, E, and G.
16. Reporting of Adverse Finding of Discrimination. It is the responsibility of all sub -
recipients, sub -grantees, and contractors under grants, to report to MEMA, any finding of
discrimination after a due process hearing, on the basis of race, color, religion, national
origin, sex or sexual orientation by a federal or state court or administrative agency.
17. Equal Opportunity Program Requirements. It is the responsibility of all sub -
recipients to ensure that their employment practices comply with Equal Opportunity
Requirements, 28 CFR 42.207 and 42.301.
18. Application of Special Conditions to Sub -Recipient Grantees: If a sub -recipient
proposes to engage in sub -granting activities, it shall ensure its sub -grantees adhere to all
applicable DHS/FEMA, and/or U.S. DOT, and MEMA special conditions.
19. Reporting. Sub -recipients agree to submit timely and accurate Close -Out, Match, and
De -Obligation Reports as needed and directed. Failure to comply with this condition may
result in the withholding of sub -recipient finds until the delinquent report is received.
20. Cash Management. Sub -recipients acknowledge that this program is a reimbursable
grant program and that under no circumstances may federal finds be held in an account
pending payment of an invoice for more than 72 (business) hours from the time the funds
are transferred from the Commonwealth to the grant sub -recipient.
21. Contractor/Consultant Rates. Compensation for individual consultant services is to be
reasonable and consistent with the amount paid for similar services in the market place.
Consideration can be given to compensation, including fringe benefits, for those
individuals whose employers do not provide the same. Time and effort reports are
required for consultants.
22. Monitoring. Sub -recipients agree to cooperate with MEMA monitoring and site visits.
23. Safeguarding and Access to Security Sensitive Data and Information. All sub -
recipients agree to adhere to proper administrative handling when handling grant -
program related documents labeled Sensitive Security Information (SSI), Protected
Critical Infrastructure Information (PCII), For Official Use Only (FOUO), etc.
24. Copyright/Licenses. The sub -recipient acknowledges that MEMA, DHS, and DOT
reserve a royalty -free, non-exclusive, and irrevocable license to reproduce, publish, or
otherwise use, and authorize others to use, for federal or state proposes: (1) the copyright
in any work developed under an award or sub -award; and (2) and rights of copyright to
which a sub -recipient or sub -grantee purchases ownership with Federal support.
25. Acknowledgement in Published Materials. EMPG and CCP sub -recipients agree
that any publication (e.g., written, visual, or sound) it or its contractors issues describing
programs or projects funded in whole or in part with federal funds, contain the following
statement:
"This document was prepared under a grant from FEMA's Grant Programs Directorate,
U.S. Department of Homeland Security. Points of view or opinions expressed in this
document are those of the authors and do not necessarily represent the official position or
policies of FEMA's Grant Programs Directorate or the U.S. Department of Homeland
Security."
26. Acknowledgement in Published Materials. FEWEP sub -recipients agree that any
publication (e.g., written, visual, or sound) it or its contractors issues describing programs
or projects funded in whole or in part with federal funds, contain the following statement:
"This document was prepared under a grant from U.S. DOT PHMSA. Points of view or
opinions expressed in this document are those of the authors and do not necessarily
represent the official position or policies of the U.S. DOT PHMSA."
27. Procurement. Sub -recipient agrees to adhere to the applicable state, local, and other
applicable procurement requirements.
28. Equipment Specifically Intended for Regional -Use: Sub -recipients who procure these
equipment items (e.g., regional emergency shelter trailers, regional foam trailers, etc)
shall, at a minimum, meet the following requirements:
i. identify one entity as the owner who will be responsible for storage and maintenance of
the item;
ii, ensure notification, as appropriate, is provided to the surrounding communities about the
item, its use, and how to obtain further information related to the item;
iii. ensure a Standard Operation Procedure (or like document) document is developed that
details, at a minimum, the proper storage, deployment, use, and maintenance of the item;
iv. ensure a Memorandum of Understanding is developed and agreed to, as appropriate, by
entities who may request the item.
29. Disposal and sale of equipment purchased via DHS funds. Any proposed sale and/or
disposal must adhere to current MEMA policy.
30. User Fees. Any proposed `user fees' related to equipment, items, services, etc acquired
via DHS funding must be pre -approved by MEMA.
31. Environmental Planning and Historic Preservation (EHP). EMPG and CCP sub -
recipients shall not undertake any project having the potential to impact Environmental
or Historical Preservation (EHP) resources without the prior approval of FEMA, which is
done through MEMA. EHP activities include, but are not limited to, communications
towers, physical security erdiancements, new construction, and modifications to
buildings, structures and objects that are 50 years old or greater. Sub -recipients must
comply with all conditions placed on the project as the result of the EHP review. Any
change to the approved project scope of work will require re-evaluation for compliance
with these EHP requirements. If ground disturbing activities occur during project
implementation, the sub -recipient must ensure monitoring of ground disturbance, and if
any potential archeological resources are discovered, the sub -recipient will immediately
cease construction in that area and notify FEMA, MEMA, and the appropriate State
Historic Preservation Office. Any construction activities that have been initiated without
the necessary EHP review and approval will result in a non-compliance finding and will
not be eligible for FEMA funding.
32. Property acquired with grant funds. MEMA requires that properly - with a unit cost of
$500.00 or greater and that has a shelf -life of one year or greater - acquired with federal
homeland security grant funds be tagged and tracked using a computer -based inventory
system. EMPG and CCP sub -recipients agree, when practicable, any equipment
purchased with homeland security grant finding shall be prominently marked as follows:
"Purchased with fiords provided by the U.S. Department of Homeland Security."
33. Reporting of violations (fraud, waste, and abuse). It is the responsibility of all grant
sub -recipients and their respective agency personnel, grantees, and contractors under
grants, to report to MEMA any alleged violations, serious irregularities, sensitive issues,
or overt or covert acts that would use public funds or perform program or administrative
requirements in a manner not consistent with grantor agency statutes, related laws and
regulations, appropriate guidelines, or purposes or objectives of the grant.
34. Federal Drug Free Workplace Requirements. As required by the Drug -Free
Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67 Sections 67.615 and 67.620—
A. The applicant certifies that it will or will continue to provide 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 that will be taken against employees for
violation of such prohibition;
(b) Establishing an on -going drug -free awareness program to inform
employees 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;
(c) Making it a requirement that each employee to be engaged in the
performance of the grant 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 terns of the statement; and
(2) Notify the employer 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 must provide notice, including position title, to:
Department of Justice, Office of Justice Programs, ATTN: Control
Desk, 810 7`h Street, N.W., Washington, D.C. 20531. Notice shall
include the identification number(s) of each affected grant;
(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 appropriate personnel 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), (e),
and (f).
B. 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)
35. Lobbying. As required by Section 1352, Title 31 of the U.S. Code, and implemented at
28 CFR Part 69, for persons entering into a grant or cooperative agreement over
$100,000, as defined at 28 CFR Part 69, the sub -recipient certifies that:
(a) No Federal appropriated fiends 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 funds other 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 employee of Congress, or an employee of a Member of Congress in
connection with this Federal grant or cooperative agreement, the
undersigned shall complete and submit Standard Form - LLL,
"Disclosure of Lobbying Activities," in accordance with its
instructions;
0
(c) The undersigned shall require that the language of this certification be
included in the award documents for all sub -awards at all tiers
(including sub -grants, contracts under grants and cooperative
agreements, and subcontracts) and that all sub -recipients shall certify
and disclose accordingly.
36. Debarment, Suspension, and Other Responsibilities. As required by Executive Order
12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective
participants in primary covered transactions, as defined at 28 CFR Part 67, Section
67.510—
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, sentenced to a denial of Federal benefits by a State
or Federal court, or voluntarily excluded from covered transactions by
any Federal department or agency;
(b) Have not within a three-year period preceding this application been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (Federal, State,
or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making -
false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State, or local) with
commission of any of the offenses enumerated in paragraph (1)(b) of
this certification; and
(d) Have not within a three-year period preceding this application had one
or more public transactions (Federal, State, or local) terminated for
cause or default; and
B. Where the applicant is unable to certify to any of the statements in this
certification, he or she shall attach an explanation to this application.
37. Internet Access. Sub -recipients must have Internet access.
38. Email addresses. Sub -recipient project directors of grant programs must have individual
email addresses.
As the duly authorized representative of the sub -recipient, I hereby certify that the sub -
recipient will comply with the above conditions.
Signature of Authorized Signatory Date
Neal A. Boidriahini Fire Chief/EMD
Printed Name Title