HomeMy WebLinkAbout20240605084310385COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
This form ts Jolntiy Issued and published by the Executive O(flce forAdminlsLrationand Ftnanc (ANF)the Office of the Comoholler (CTR) and the Operational Services Dh4slon (OSDI
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-mnBlGing terms may be added by Attachment. Contractors may not require any additional agreements, engagement letters, contract forms orotheradditionai
terms as part of this Contract withotprior Department approval. Cook onhypedinksfordeMitions,InsWctionsand Lost requirements that are inco ratedbvreferencelntothls
Contract. An electronic mnvnflhtcrnrmiasvna"w"sr,......
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CONTRACTOR LEGAL NAME: Town of Mansfield
orvenaors-r-orms orwwwmassaovfosd underOSDFarms.
COMMONWEALTH DEPARTMENT NAME:
(anddlbla): MansfioldCERT
Massachusetts Emergency Management Agency
MMARS Department Code: CDA
Legal Address: (W9, W4,T&C): 6 Park ROW, Mansfield, MA 02048
Business Mailing Address: 400 Worcester Road, Framingham, MA 01702
Contrat
Manager: Chief Neal Boldrighini
Billing Address (if different):
M: nboldrighinl@mansfieldma,com
ContractMananar: Paula Krumsiek,Grants Management specialist
P one: 508-261.7490 IF=
E-I'�all: Paula.Krumsiftstate.ma.us
Contractor Vendor Code: VC6000191861
Ph—one:508-8204424 Fax; 508-820.1468
Vendor Code Address ID (e.g. "AD001"): AD_
MMARS DoclDWs FYI8CCP16000000MANSF
(Note: The Address Id Must be set up for EFT payments.)
RFRIPracurement or OLh"r ID N mbar. 2018 SHSP CCP
X NEW CONTRACT
CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTION TYPE: (Check one option only)Enter
—
Current Contract End Data Priorto Amendment 20_
_StatyAdeContract (OSDoranOSDdesgnatedDepartment)
CDlleclive Purchase (Attach OSD approval, scope, budget)
Enter Amendment Amount:$ .(or°no change')
X DeuartmentProcurement (includes State orFederal grants 5 R2.0
�-�—
AMENDMENT TYPE: (Check one option only. Attach details of Amendment changes.)
(Attach RFR and Response or other procurement supporting documentation)
_ Amendment to Scone or Budget (Attach updated scope and budget)
_E a enc Contract(Altach Justificetlon for emergency, scope, budget)
_ n
I terim Contrail (Attach justification for interim Contract and updated scope/budget)
_ Contract Emotovas (Attach Er ant Status Form scope, budget)
_ Contract Emolovee (Attach any updates to scope or budget)'
_ LLggislauven eaal or Other: (Attach authorizing languageJJustiBption, scope and
budget)
_ LeoislalivelLeoal or Other., (Attach authodzing language4usti0callon and updated
scope and budget)
The following 9QMMONWEALTH TERMS AND CONDITION (T8C) has been executed,
filed with CTR anti Is Incorporated by reference into this Contract.
X Commonwealth Terms and Conditions _ Commonwealth Terns 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 Conbactwill be supported
In the state accoun5ng 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 toms are being amended.)
L Maximum Obligation Contract Enter Total Maximum Obligation for total duration of this Contract (or now Total If Contract Is being amended). 13,500.00
PROMPT PAYMENT DISCOUNTS (PPD)• Commonwealth 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 PPD; Payment Issued within 15 days °k 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 _ statutory4egal or Ready Payments (G.L c 29.4 23A); X only initial
payment (subsequent
payments scheduled to support standard EFT 45 daypayment cycle. See ro t a Disco is P I
BRIEFDESCRIPTIONOPCONTRACTPERFORMAN EorREASONFORAMENDMENT (Enter the Contract too, purpose, fiscal year(s) and a detailed description of the scope
of performance orwhat Is being amended for a Contract Amendment Attach
all supporting documentation and justifications.)
Fun
ing
r this grant Is provided through the FFY2016 State
eland
067.dCo tractor/Sub•Recplentwillperform activities as stated Inrtheirappoved 016SHSram PrCCPapplicatioant. The onnumber Is 97-
of Faccorda
Domestic AssistanceTTermsandConditions
and Inue
and MEMA-PMOSpecial Terms and Conditions. cewithDHSIFEMAederal
ANTICIPATED START DATE: (Complete ONE option only) The Department and Contractor ce* for this Contract or Contract Amendment that ContrM obligations:
X 1. maybe Incurred as of the Effective Do a (latest signature date below) and loft obligations have been Incurred prior to the Mg& Do
.
_ 2. maybe Incurred as of � 20_, a date LATER than the Effective Date below and ng obligations have been incurred udy to the Effective Date..
_3. were Incurred as of_, 20_, a data PRIOR to the Effective Dal a 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 that
payments, and 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 05-31.2018, with no new obligations being Incurred after this date unless the Contract is property amended,
provided that the terns of this Contract and performance expectations and obligations shall Its
survive termination for the purpose of resolving any claim or dispute, for completing
any negotiated tams 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 Certifiptlons (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 Commomwealth Terms and
Qondliforrs this Standard Contract Form including the In dons and Contractor Certifications
the Request for Response (RFR) or other solldlallon, the Contractoes 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 terns result In best value, lower coal,, or a more cost effecthe Contract.
AUTHORIZING SIGNURE F T E CONTRA .TOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH:
X: �i�--f�-� — Date: s--/a3/ri X, Date:
(Signature and Date Must Be Handwritten At Time of Signature) (Signature and Date Must Be Handwritten At Time of Signature)
PrintNams:.✓EPrint Name: DavldMahr
Print TI(le: +�7`+E cyhtfv EyiN b/�epcYey¢_ Print Title: Chief Administrative Officer
(Updated 3/2112014) Page 1 of 6
Massachusetts Emergency Management Agency,
Reimbursement Request, Match, and Close -Out Form
(EMPG, CCP, and HMEP)
This form must be completed and submitted (pages 1 through 3) when seeking
reimbursement. Please submit one form per contract. All costs must be allowable under the
grant program seeking reimbursement from and represent costs associated with the MEMA-
approved scope of services.
ENTITY (City/Town); and GRANT PROGRAM; and FEDERAL FISCAL YEAR and
Contract MMARS DOC ID: FY17EMPG1600000MANSF
COMPLETED BY: Neal Boldrighini DATE: 06/24/2017
TELEPHONE: 508-968-4695
E-MAIL: nboldrighini@mansfieidma.com
1. Complete the table below listing expenditures made via this grant up to the award
amount.
Description of
Grant Activity
Date(s) of
EMPG/CCP
Quantity
Reimbursement Amount
(Portable Radio,
Activity
AEL Reference
and Unit
Reverse 911
#
Cost
Service, etc.)
(if applicable)
(if
applicable)
Honda EU3000IS
02/15/2017
1OGE-00-GFNR -
2 @ $1885.00
$ 3,770.00
Generator
Generators
AED Training
02/15/2017
21GN-00-CCEQ
2 @ $471.00
$ 942.00
Simulator
M & A
N/A
N/A
1 @ 248.00
$ 248.00
Total Reimbursement Request:
$4,960.00
2. For grants requiring a match, complete the table below to document the
match amount met at this time of reimbursement.
Date(s) Match
Made
Item or Service
for In -Kind;
Funding Source
for Cash Match
individual(s)
(for in -kind as
applicable)
Purpose
Cost/Value for
In -Kind; Cash
Amount for
Cash(Match
02/02/17-
06/13/17
In -Kind;
Volunteer Time
N/A
Volunteer duties
during the
$12,020.70
referenced
period (volunteer
rate of $29.88
/hour) See
attached
volunteer
s readsheet
3. For final reimbursement requests, please provide:
a) A brief summary of how these expenditures positively impacted your program:
Utilizing the Generators has given the agency the ability to operate in the field
without available power. Using the AED Trainers has given the agency to train more
CERT members in the proper use of an AED
b) All sub -recipients are required to maintain an electronic inventory of equipment
purchased via grant funds. Please review MEMA's Inventory Tracking Guidance
for a definition of equipment and the information that must be tracked. Please
submit your electronic equipment inventory (as applicable) with your final'
reimbursement request.
*See Attached spreadsheet
Back-up documentation ('proof of payment') and, as applicable, 'proof of match'
must be submitted with reimbursement requests.
Please attach adequate supporting documentation for expenditures and, as applicable,
identified match above. Please refer to MEMA's Reimbursement Policy and Match
Policy for additional information.
By signing this report, I certify to the best of my knowledge and belief that the report is
true, complete, and accurate, and the expenditures, disbursements and cash receipts
are for the purposes and objectives set forth in the terms and conditions of the Federal
award. I am aware that any false, fictitious, or fraudulent information, or the omission of
any material fact, may subject me to criminal, civil or administrative penalties for fraud,
false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title
31, Sections 3729-3730 and 3801-3812)."
Authorized Signature:�"�
John Stanbrook
From:
Neal Boldrighini
Sent:
Wednesday, July 27, 2016 8:30 AM
To:
David Cramer
Cc:
John Stanbrook
Subject:
FW: 2015 2016 HMEP Finalized Contract
Attachments:
201607270727.pdf
Importance: High
Just so you both see the finished (I hope), signed contract.
From: Krumsiek, Paula (CDA) [mailto:Paula KrumsiekCaMassMail.State.MA.US]
Sent: Wednesday, July 27, 2016 7:43 AM
To: Neal Boldrighini
Cc: Mannion, James A. (CDA)
Subject: 2015 2016 HMEP Finalized Contract
Importance: High
Your contract has been finalized and a copy has been attached to this email. Please let me know if you did not receive
this copy.
• The start date for program activities (including purchasing) is 07-26-16; the date the contract was signed by
MEMA. NO GOODS/SERVICES MAY BE PROCURED BEFORE THIS DATE.
• The end date of your contract is 09-30-16 ; no goods/services may be procured after this date. ALL GOODS AND
SERVICES PROCURED MUST BE RECEIVED OR COMPLETED BY THIS DATE.
Your contract does/does not cross the State Fiscal Year. $2,300.00 will be expended by 09-30-16.
MEMA's Grant Policies MEMO, Listing the various grant policies and forms, may be found on our website
here: http //www mass gov/eopss/agencies/mema/empg-and-ccp-and-hmep-grants html
This is a reimbursement -based grant program and reimbursements must be submitted to MEMA HQ no later than
10/30/16.
The reimbursement request form and instructions may be found on MEMA's website
here: http //www mass gov/eopss/agencies/mema/empg-and-ccp-and-hmep-grants html.
Reimbursements must be mailed to my attention (address below). Please contact me with any questions you may have
regarding this contract. For your records, the Catalog of Federal Domestic Assistance (CFDA) number is 20.703
Thank you,
Paula Krumsiek
Grants Management Specialist
Massachusetts Emergency Management Agency (MEMA)
400 Worcester Road
Framingham, MA 01702
508-820-1424
Eleanor iLallier
From:
John Stanbrook
Sent:
Thursday, September 22, 2016 10:24 AM
To:
David Cramer
Cc:
Neal Boldrighini; Eleanor Lallier; Barbara Guilbault; Jennifer Kinney
Subject:
RE: New 2015 SHSP CCP Grant
Hi, Dave.
I have set up this new grant in Softright as follows:
22-291-005 - State Grants MEMA SHSP Grant
22-291-005-460000 - State Grants MEMA SHSP Grant State Revenue
22-291-005-510000 - State Grants MEMA SHSP Grant Personal Services
22-291-005-530000 - State Grants MEMA SHSP Grant Professional & Technical Expenses
22-291-005-540000 - State Grants MEMA SHSP Grant Supplies
22-291-005-570000 - State Grants MEMA SHSP Grant Misc. Expenses
22-291-005-580000 - State Grants MEMA SHSP Grant Capital Outlay
Please let me know if you have any questions.
Thanks!
John F. Stanbrook
Finance Director/Town Accountant
Town of Mansfield
508-851-6435
-----Original Message -----
From: David Cramer
Sent: Tuesday, September 20, 2016 9:42 AM
To: John Stanbrook
Cc: Neal Boldrighin!
Subject: New 2015 SHSP CCP Grant
John,
Attached is the new 2015 SHSP CCP Grant for MEMA funding
Please provide line items for the budgeted items.
I have attached the contract and budget page from the Grant, let me know if you need anything else
Respectfully,
M17/'Y
COMMONWEALTH OF MASSACHUSETTS _STANDARD CONTRACT FORM*01
This Wan Is jointly issued and published by the Executive Office for Administration and Finance IANFi, the Office of the Comptroller ICTRI and the Operational Services Division (OSDI
as the default contract forall Commonwealth Departments when another form is not prescribed by regulation or porq. Any changes to the official printed language of this torn shall be
void. Additional non-cord6dtingterms may be added by Attachment Contractors may not require any additional agreements, engagement Men. contract fortes or other additional
terms as part of this Contract without prior Department approval. Click on hypedinks for definitions, instructions and legal requirements that are incorporated by reference Into this
Contract An electronic copy of this form is available r ....... ^+_« nnvrasc under Guidance For Vendors - Forms or www.mass.govlosd under OSD Forms.
CONTRACTOR LEGAL NAME: Town of Mansfie d { �s2 �� `�' COMMONWEALTH DEPARTMENT NAME: Massachusetts Emergency Management
(and dlbla : Mansfield CERT jly PW�wv07 S A
,.y� MMARS Department Code: CDA
Legal Address: III W4,T&C): 6 Park Row, Mara f�5 a: 16oclb, Business Maifina Address: 400 Worcester Road, Framingham, MA 01702
Contract Manager. Neil Boldrighini Bitting Address (if different:
E•Mail: nbotdrighinRlmansfieldma.cem YN Contract Manager. Paula Krumsisk, Grants Management Specialist
Phone: or Vendor
: , ,_nit'" ti>4�� Phorre:50&U 14241e1k@state.rrra.us Fax: 508.621468
Contractor Vendor Code: VC6000191867 �Y" ! _
Vendor Code Address ID (e.g. "AQOOT'): AD_j J. MMARS Doc WLsI: FY17CCP15000000MANSF
(Note: The Address k1 Must be set up for EFT P1: RFRIProcurement or Other ID Numbs 2015 SHSP CCP
X t NEW CO _ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTION TYPE: (Check:one option only). Enter Current Contract End Date Prforto Amendment:_, 20_
Statewide Contra ct(OSDoran.OSD-designated Department) EkderAmendmentAmount•$ :.,(or"nodtartge")
Collective Purchase (Attach OSD approval, scope, budget) AMENDMENT TYPE: (Check one option only. Attach details of Amendment changes.)
?L Department Procurement (includes State or Federal grants 815 CMR 2.00 _ Amendment to Scope or Budget (Affach updated scope and budget)
(Attach RFR and Response or other procurement supporting documentation) Interim Contract (Attach justification for Interim Contract and updated soopelbudget)
_ Emergency Contract (Atladljusg8catbn foremergency, scope, budget)
_ Contract Employee (Attach Employment Status Form, scope, budget _ Contract Employee (Attach any updates to scope or budget)
_ LegislativelLeaal or Other. (Attach authorizing larguageljustifcation, scope and _ LegisetivelLegai or Other: (Attach authorlAng languagefius5fication 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 Tema and Conditions For Human and Social Services
COMPENSATION: (Check ONE option): The Department certifies that payments for authorized perfomtance accepted in accordance with the terns of this Contract will be supported
in the state accounting system by sufficient appropriations or other nor appropriated funds, subject to intercept for Commonwealth owed debts under 815 CMR @.Op.
Rate Contract (No Maximum Obligation. Attach details of all rates, units, calculations, conditions or ems and any changes if rates or terms are being amended.)
X Maximum Obligation Contract Enter Total Maximum Obligation forWtal duration of this Contract (or new Total if Contract is being amended).$ 3 00
PROMPT PAYMENT DISCOUNTS (PPDi: Commonwealth payments are issued through EFT 45 days from invoice receipt Contractors requesting accelerated payments must
klengly a PPD as follows: Payment issued within 10 days _% PPD; Payment issued within 15 days _ % PPD; Payment Issued within 20 days _ % PPD; Payment issued whin
30 days _°.6 PPD. If PPD percentages are left blank,identify reason: _agree to standard 45 day cycle _ setuloryliegal or Ready Payments (Gk. c. 29 6:23A); X only initial
payment (subsequent payments scheduled to supportstandard EFT 45 day payment cycle. See P P Dis nts Po'
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract title, purpose, fiscal year(s) and a detailed description M 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
FFY2015 State Homeland Security Program grant The catalogue of Federal Domestic Assistance (CFDA) nurturer Is 97-067. The CERT intends to purchase a portable
airconditioner.
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 Date.
_ 2. maybe incurred as of_, 20_, a date LATER than the Effective Date below and no obligations have been incurred rp_ror 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 settlement payments or as authorized reimbursement payments, and that the details and circumstances M all obligations under this Contract are
attached and incorporated into this Contract Acceptance of payments forever messes the Commonwealth from further claims related tothese obliffations.
CONTRACT END DATE: Contract performance shall ermine as of 044304017, with no new obligations being incurred after this data unless the Contract is properly amended,
provided that the tents M this Contract and performance expectations and obigations shall survive its termination for the purpose of resolving any claim or dispute, for completing:
any negotiated terms and warranties, to allow any dose out or transition performance, reporting, invoicing or final payments, or during any lapse between amendments.
CERTIFICATIONS: Notwithstanding verbalor other representations by the parties, the "Effective Date" of this Contract or Amendmentshall be the latest date that this Contractor
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 terns 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 soMfion, the ConracOr's Response,
and additional negotiated terms, provided that additional negotiated turns Will take precedence over the relevant terms in the RFR and the Contractor's Response only If made using
the process outlined in 801 CMR.21.07, incorporated herein, provided that any amended RFR or Response terms result in best value, lower costs, or a more cost effective Contract
AUTHORIZING SIGNATURE FOR THE CONTRACTOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH,
X: f °``"st"/..... Date: e�. X: . Data: ?! 44
(Signature and Date Must Be Handwritten AtTime of Signature) — (�S goat and Date Must Be Handwritten At Time of Signature)
Print Name: Neil Boldd hint : pavid Mahr
Print Titie: Fire ChieOEM Director Chief Administratne Officer
Rol
SEP12206
<iwFuareu me va i•q gage , V1 u
9. Budget Detail
Funding Population Tier Number: Tier 2
Amount of SHSP funding REQUESTED: $ 3,500.00
9a. Budget Detail for Period: July 1, 2016 -April 30, 2017
Cost Category
Description
AEL #
Quantity
Unit Cost
Total
(Planning,
Organizational,
Equipment, Training,
Exercises, M&A)
• •
'• .• � • •ql • -
11
111 11
'. C 1�1111
•�
•• _WMEMIM
OFFICE OF THE GOVERNOR
COMMONWEALTH OF MASSACHUSETTS
STATE HOUSE • BOSTON, MA 02133
(617)725-4000
CHARLES D. BAKER
GOVERNOR
January 27, 2017
Chief Neal A. Boldrighini
Mansfield Fire Department
10 Plymouth Street
Mansfield, MA 02048-2033
Dear Chief Boldrighini:
KARYN E. POLITO
LIEUTENANT GOVERNOR
Congratulations! We are pleased to inform you that the Mansfield Fire Department has been
awarded $4,540.00 for Student Awareness of Fire Education (S.A.F,E.) and $2,796.00 for
Senior SAFE grants. We look forward to working with you and your community on this
public fire and life safety initiative.
Additional correspondence, including all the necessary documents needed to execute this
award will be provided by the Executive Office of Public Safety and Security, Department of
Fire Services within the next two weeks.
Feel free to contact Cynthia Ouellette at cynthia.ouellette@state.ma,us if you have any
questions.
Sincerely,
Governor Charles D, Baker Lt, Governor Karyn E. Polito
QT!,
COMMONWEALTH OF MASSACHUSETTS STANDARD CONTRACT FORM
This form Is jointly Issued and published by the Executive Office for Administration and Finance (ANF), the Office of the Comptroller (CTRI and the Oceralionai Services Division (OSDI
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-con0icling terms may be added by Attachment. Contractors may not require any additional agreements, engagement letters, contract forms orother additional
terms as pad of this Contract without prior Department approval. Click on hypedinks for deflnl(ions, Instructions and legal requirements that are incorporated by reference Into this
Contract. An electronic cony of this form is available at wwwmass.govlosc under Guidance For Vendors - Forms or w in ss.govlosd under OSD Forms.
CONTRACTOR LEGAL NAME: Town of Mansfield
COMMONWEALTH DEPARTMENT NAME: Massachusetts Emergency management
(and d/bia): Greater Attleboro REPC
Agency
MMARS Department Code: CDA
Legal Address: (W9, W4,T&C):6 Park Row, Mansfield, MA 02048
Business Mailing Address: 400 Worcester Road, Framingham, MA 01702
Contract Manager. Neal Boldrighinl
Billing Address (if different):
E-Mail: nholdrighinl@mansfieldma.com
Contract Manager: Paula Krumslek
Phone: 508-261-7493
Fax:
EE�I: Paula.Kruntsleit@state.ma.us
Contractor Vendor Code: VC6000191867
Phone: 508,820.1424
Fax: 508.820.2030
Vendor Code Address ID (e.g. "AD001"): AD_
MMARS Doc ID(s1: FY17HMEP1700000MANSF
RFR/Procurement or Other ID Number: 2016 2017 HMEP
(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 Contract End Date Prior to Amendment:
Statewide Contract(OSD or an OSO-designated Department)
Enter Amendment Amount:$ .(or°no change')
—
—Collective Purchase (Attach OSD approval, scope, budget)
AMENDMENT TYPE: (Check one option only. Attach details of Amendment changes.)
X Department Procurement (includes Slate or federal grants 815 CMR 2.001
Amendment to Scope or Budget (Attach updated scope and budget)
(Attach RFR and Response or other procurement supporting documentation)
_
Interim Contract (Attach justification for Interim Contract and updated scopabudgel)
—Emergency Contract (Attach Justification for emergency, scope, budget)
Employee (Attach Employment Status Form, scope, budget)
_
—Contract Employee (Attach any updates to scope or budget)
—Contract
Legislative/Legal or Other: (Attach authorizing languagefjusti0cation, scope and
— LeAll"l tivelLegal or Other: (Attach authorizing IanguagefjusUfcalion and updated
_
budget)
scope and budgelt
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 codifies 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 816 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), $2,200.00
PROMPT PAYMENT DISCOUNTS (PPDI: 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 —°/u PPD. If PPD percentages are left blank, identify reason: —agree to standard 45 day cycle — statutory/legal or Ready Payments (G L. c. 29 4 23A); X any initial
payment (subsequent payments scheduled to support standard EFT 45 day payment cycle. See Prompt Pay Discounts Pot .
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: Funding for this grant Is provided through the 2016.2017 USDOT, The CFDA
number is 20.703. The REPC Intends hire a contractor to hold a table top exercise and purchase office supplies.
ANTICIPATED START DATE: (Complete ONE oplbn only) The Department and Contractor certify for this Contract, or Contract Amendment, that Contract obligations:
_X J. may be Incurred as of the Effective Date (latest signature dale below) and no obligations have been incurred rriior to the Effective Dale.
_ 2. may be incurred as of _,a date LATER than the Effective Date below and no obligations have been Incurred Prior to the Eff"We 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 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 06.30.2017, with no new obligations being incurred after this date unless the Contract Is property amended,
provided that the terms of this Contract and performance expectations and obligations shall survive its termination for the purpose of resolving any claim or dispute, for completing
any negotiated terms and warranties, to allow any close out or transition performance, reporting, Invoicing or final payments, or during any lapse between amendments.
CERTIFICATIONS: Notwithstanding verbal or other representations by the parties, the "Effective Date" of this Contract or Amendment shall be the latest date that this Contract or
Amendment has been executed by an authorized signatory of the Contractor, the Department, or a later Contract or Amendment Start Date specified above, subject to any required
approvals. The Contractor makes all certifications required under the attached Contractor Codifications (incorporated by reference if not attached hereto) under the palms and
penalties of perjury, agrees to provide any required documentation upon request to support compliance, and agrees that all terms governing performance of this Contract and doing
business In Massachusetts are attached or incorporated by reference herein according to the following hierarchy of document precedence, the applicable Commonwealth Terms and
Conditions, this Standard Contract Form Including the Instructions and Contractor Certifications, the Request for Response (RFR) or other solicitation, the Contractor's Response,
and additional negotiated terms, provided that additional negotiated terms will lake precedence over the relevant terms In the RFR and the Contractor's Response only If made using
the process outlined in 801 CMR 21.07, Incorporated herein, provided that any amended RFR or Response terms result in best value, lower costs, or a more cost effective Contract.
AUTHORIZING SIGNAT REFORTH CONTRACTOR: AUTHORIZING SIGNATURE FOR THE COMMONWEALTH:
Y
ly -
X� - J �- - f5 ; _�4, . —' Date: i L /? , /� X: %it.'... .Date: 7 2
(Signature and Dale Must Be Handwdffen At Time of ignal re) (Signature and Dale Must Be Handwritten At TI a of Ignalure)
Print Name: Neal Botdrighinl Print Name: David Mahr
Print Title: EMDIFire Chlef D ( (7 (i., (( �Rflat('tCti : Chief Administrative Officer
I(Updated 3/21/2014) Pag�1 of 6
BV—� - _____.--__—
1. Please provide your budget detail below; all activities must be completed by 9/30/17
Budget Detail for Period: 10/1/16 - 6/30/17
Cost Category Description
Quantity Unit Cost
Total
(e.g., Planning,
Exercises, EPC Office
Supplies)
Applicants with questions may contact their respective MEMA Regional Office and/or MEMA Local
Coordinator. Applicants may also contact Paula Krumsiek (Paula Krumsiek state.ma us;
508.820.1424)
COMMONWEALTH OF MASSACHUSETTS ^ STANDARD CONTRACT FORM s
This form Is jointly Issued and published by the Exeadve Office for Administration and Finance (ANF) the Office of the Comptroller (CTR) and the Operational Services Division (OSD)
as the default contract for all Commonwealth Departments when another form Is not prescribed by regulation a policy. Any changes to the official printed language of this form shall be
void. Additional non -conflicting terms maybe added byAtiachment. Contactors may not require any additional agreements, engagement letters, contract forms or other additional
forms as pad of This Contract without prior Department approval. Click on hyper inks for definitions, Instructions and legal requirements that are Incorporated by reference Into this
Contract. An electronic copy of this form Is available at www_.m mossaoyloso under Guidance For Vendors - Forms of www.mass.aoviosd under OSD Forms.
CONTRACTOR LEGAL NAME: (and dlble): MANSFIELD, Town of
COMMONWEALTH DEPARTMENT NAME: Massachusetts Emergency Management
Agency
MMARS Department Code:
Legal Address: (W-9, W-4,T&C): B Park Row, Mansfield, MA 02048.2433
us nose Mallim Address: 400 Worcester Road, Framingham, MA 01702.5399
Contract Manager: Neal Boklrighini
Billing Address Of different): name
g_-Mall: nboiddghinin@mansfieldma.com
Contract Manager. Lord Gifford
Phone: 508.261,7400
Fax:
9 M I: lorri.girford@massmall.state,ma,us
Contractor Vendor Code: VC6000191667
Phone: 508.820.1407
1 Fax: 508.020.2030
Vendor Code Address ID (e.g. "AD001"): ADS
MMARS Doc ID(sl: FY17EMPG1600000MANSF
(Note: The Addrese Id Must beset upfor EFL payments.)
RFRIProcurement or Other ID Number: FFY2016 EMPG
I& NEW CONTRACT
_ CONTRACT AMENDMENT
PROCUREMENT OR EXCEPTION TYPE: (Check one option only)
Enter Current Contract End Date Ito Amendment: .20_,
_ Statewide Contract(080 or an OSD-designated Department)
Enter Amendment Amount: $_(or'no ehangel
_ Colledlya Purchase (Attach OSD approval, scope, budget)
AMENDMENT TYPE (Check one option only. Attach details of Amendment changes.)
$ Department Procurement(Indudes State w 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. (Aflachjusification for emergency, scope, budget)
_ Contract Employee (Attach Employment Status Form scope, budget)
_ContractEmolovee(Attach any updates to scope or budget)
_Lealalalivell-eaelor Other.(Attach authorizing languagefustifiealion, scope and
_ Lit9islattvalLeael or Other, (Attach authorizing languallp4ostficalion and updated
budget)
scope and budget)
The following COMMONWEALTH TERMS AND CONDITIONS (TSC) has been executed, filed with CTR and Is Incorporated by reference Into this Contract.
A Commonwealth Terms and Conditions _Commonwealth Tens and Conditions For Human and Social Services
COMPENSATION: (Chad ONE option): The Department cantles 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-appropdaled funds, subject to Intercept for Commonwealth owed debts under 1115 CMR 9.00.
_ Rate Contract (No Maximum Obligation. Attach details of all rates, units, calculations, conditions or terms and any changes if rotes or terms are being amended.)
X Maximum Obligation Contract Enter Total Maximum Obligation for total duration of this Contractor new Total If Contract is being amendecip"N"(W
PROMPT PAYMENT DISCOUNTS IPPDI: Commonwealth payments are Issued through EE, J 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 _ slaluloryllegai or Ready Payments (G.L. c. 29,4 23A1; g only Initial
payment (subsequent payments scheduled to support standard EFT 45 da a menl de. See Pr m 1 P Disoou Is P
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract the, purpose, fiscal year(s) and a detailed description of the scope
of performance orwhat Is being amended for a Conked Amendment. Attach all supporting documentation and justifications.)
Funding for this grant Is provided via a federal Fiscal Year 2016 (FFY16) Emergency Management Performance Grant (EMPG), CFDA 097.042 and has a required dollar
for dollar match. The ConfractodSubreciplent will perform activities as slated In your approved 116EMPG application and In accordance with OHSIFEMA Terms and
Conditions, and MEMA•PA10 Special Terms and Conditions.
ANTICIPATED START DATE: (Complete ONE option only) The Department and Contractor car* for this Contrad, of Contract Amendment, thalContract obligations:
_& I. may be Incurred as of the Effective Date (latest signature dale below) anti/g2 obligations have been incurred 2rior to the Effective Date.
_ 2. may be Incurred as of 20_, a date LATER than the Effective Date below and D4 obligations have been Incurred 2d0r to the Effective Dale.
_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 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. Acre lance of a ments forever releases the Commonwealth from furtherdalms related to these obliliabons.
CONTRACT END DATE; Contract performance shall terminate as of June 30, 2017 . 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 dose outfit bansfion 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 shell 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 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 Farm Including the Instructions and Contractor Codifications, the Request for Response (RFR) or other solicitation, the Contractor's Response,
and additional negotiated terms, provided that additional negotiated lama will take precedence over the relevant terms in the RFR and the Contractor's Response only R made using
the process outlined in 801 CMR 21.07. incorporated herein, provided that any amended RFR or Response terms resultin best value, lower costs, or a more cost effective Contract.
AUTHORIZING SIB A U EF THECONTRACTOR: I AUTHORIZING SIGNATURE FOR THE COMMONWEALTH:
1 -date: / Zf ! 7 X:C... .Data:
(Signature arld-B a Must Be Handwritten At Time of Signature) (Signature and Date Most Be Handwritten Al Time ofSignature)
Print Name: EVEN,[ 4 d0ab 2i6,rfiwi Print Name: David Mahr
Print Title: rti- C/rritC PrintTitle: Chief Administrative Officer
(Updated 3121/2014) Page 1 of 14
J.f• „h
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM
"M1M
INSTRUCTIONS AND CONTRACTOR CERTIFICATIONS
NEW CONTRACTS (left side of Form):
The following Instructions and terms are incorporated by reference and apply to this
Complete this section ONLY if this Contract is brand new, (Complete the
Standard Contract Form. Text that appears underlined Indicates a 'hyperlink' to an Internet
CONTRACT AMENDMENT section for any material changes to an existing or an
or bookmarked site and are unofficial versions of these documents and Departments and
expired Contract, and for exercising options to renew or annual contracts under a
Contractors should consult with their legal counsel to ensure compliance with all legal
multi -year procurement or grant program.)
requirements. Using the Web Toolbar will make navigation between the form and he
PROCUREMENT OR EXCEPTION TYPE: Check the appropriate type of procurement or
hyperiinks easier. Please note that not all applicable laws have been cited.
exception for this Contract. Only one option can be selected. See State Finance Law and
CONTRACTOR LEGAL NAME (AND DIBIA): Enter the Full Legal Name of the
General Requirements, Acquisition Policy and Fixed Assets. the Commodities and
Contractor's business as it appears on the Contractors W-9 or W-4 Form (Contract
Services Policy and the Procurement Information Center (Department Contract Guldancel
Employees only) and the applicable Commonwealth Terms and Conditions If Contractor
for details.
also has a "doing business as" (d/bla) name, BOTH the legal name and the "dlb/a" name
Statewide Contract (OSD of an OSD•designated Department). Check this option for a
must appear In this section.
Statewide Contract under OSD, or by an OSD-designated Department.
Contractor Legal Address: Enter the Legal Address of the Contractor as it appears on
Collective Purchase approved by OSD. Check his option for Contracts approved by
the Contractors W-9 or W-4 Form (Contract Employees only) and the applicable
OSD for collective purchases throughfederal,state, local government or other entities.
Commonwealth Tens and Conditions which must match the legal address on the 10991
Department Contract Procurement. Check this option for a Department procurement
table in MMARS (or the Legal Address in HR/CMS for Contract Employee).
including stale grants and federal sub -grants under 815 CMR 2.00 and State Grants and
Contractor Contract Manager: Enter the authorized Contract Manager who will be
Federal Subgrants Policy Departmental Master Agreements (MA). If multi -Department
responsible for managing the Contract. The Contract Manager should be an Authorized
user Contract, Identify multi-Departmenl use is allowable In Brief Description.
Signatory or, at a minimum, a person designated by the Contractor to represent the
Emergency Contract. Check this option when the Department has determined that an
Contractor, receive legal nofxis and negotiate ongoing Contract Issues. The Contract
unforeseen crisis or Incident has arisen which requires or mandates immediate purchases
Manager is considered "Key Personnel' and may not be changed without the prior written
to avoid substantial harm to the functioning of government or the provision of necessary or
approval of the Department. If the Contract is posted on COMMBUY , the name of the
mandated services or whenever the health, welfare or safety of clients or other persons or
Contract Manager must be Included in the Contract on COMMBUYS.
serious damage to property is threatened.
Contractor E•Mall Address/Phone/Fax; Enter the electronic mail (e-mail) address,
Contract Employee, Check this option when the Department requires the performance of
phone and fax number of the Contractor Contract Manager. This Information must be kept
an Individual Contractor and when the planned Contract performance with an Individual
current by the Contractor to ensure that the Department can contact the Contractor and
has been classified using the Employment Status Form (prior to the Contractors selection)
provide any required legal notices. Notice received by the Contract Manager (with
as work of a Contract Employee and not that of an Independent Contractor.
confirmation of actual receipt) through the listed address, fax number(s) or electronic mall
Legislative/Legal or Other. Check this option when legislation, an existing legal
address will meet any written legal notice requirements.
obligation, prohibition or other circumstance exempts or prohibits a Contract from being
Contractor Vendor Code: The Department must enter the MMARS Vendor Code
compefitively procured, or Identify any other procurement exception not already listed.
assigned by the Commonwealth. If a Vendor Code has not yet been assigned, leave this
Legislative "earmarks exempt the Contract solely from procurement requirements, and all
space blank and the Department will complete this section when a Vendor Code has been
other Contract and state finance laws and policies apply. Supporting documentation must
assigned. The Department Is responsible under the Vendor File and W-9s Policy for
be attached to explain and Justify the exemption,
verifying with authorized signatories of the Contractor, as part of contract execution, that
CONTRACT AMENDMENT (Right Side of Form)
the legal name, address and Federal Tax Identification Number (TIN) in the Contract
documents match the state accounting system.
Complete this section for any Contract being renewed, amended or to continue a lapsed
Vendor Code Address ID: (e.g., "AD0011 The Department must enter the MMARS
Contract, All Contracts with available options to renew must be amended referencing the
original procurement and Contract doe ids, since all continuing contracts must be
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
maintained In the same Contract file (even if the underlying appropriation changes each
Contract in accordance with the Bill Paying and Vendor File and W-9 policies.
fiscal year.)'See Amendments Suspensions and Termination Policy.)
COMMONWEALTH DEPARTMENT NAME: Enter the full Department name with the
Enter Current Contract End Dale: Enter the termination date of the Current Contract
authority to obligate funds encumbered for the Contract.
being amended, even if this date has already passed. (Note: Current Start Date Is not
requested since this date does not change and is already recorded in MMARS)
Commonwealth MMARS Alpha Department Code: Enter the three f31 letter MMARS
Code assigned to this Commonwealth Department In the state accounting system.
Enter Amendment Amount: Enter the amount of the Amendment Increase or decrease to
Department Business Mailing Address: Enter the address where all format
a Maximum Obligation Contract. Enter'no change" for Rate Contracts or 9 no change.
correspondence to the Department must be sent. Unless otherwse specified in the
Contract, legal notice sent or received by the Departments Contract Manager (with
AMENDMENT TYPE: Identify the type of Amendment being done. Documentation
supporting the updates to performance and budget must be attached. Amendment to
confirmation of actual receipt) through the listed address, fax number(s) or electronic mail
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
address for the Contract Manager will meet any requirements for legal notice,
parties may negotiate a change in any element of Contract performance or cost Identified
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
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,
should be resolved through the listed Contract Managers,
provided the negotiation results In a better value within the scope of the RFR than what
Department Contract Manager: Identity the authorized Contract Manager who will be
was proposed by he Contractor in the original selected response. Any "m v change
responsible for managing the Contract, who should be an authorized signatory or an
the Contract terms must be memorialized in a formal Amendmeentnt even If a
employee designated by the Department to represent the Department to receive legal
corresponding MMARS transaction is not needed to support the change. Additional
c
notices and negotiate ongoing Contract issues.
negotiated terms will lake precedence over the relevant terms In the RFR and the
Department E-Mail AddresslPhonelFax: Enter the electronic mail (e-mall) address,
Contractors Response only if made using the process outlined In 801 CMR 2107
phone and fax number of the Department Contract Manager. Unless otherwise specified In
incorporated herein, provided that any amended RFR or Response terms result in best
the Contract, legal notice sent or received by the Contract Manager (with confirmation of
value, lower costs, or a more cost effective Contract.
actual receipt) through the listed address, fax number(s) or electronic mail address will
Interim Contracts. Check this option for an Interim Contract to prevent a lapse of Contract
meet any requirements for written notice under the Contract.
performance whenever an existing Contract is being re -procured but the new procurement
MMARS Document ID(s): Enter the MMARS 20 character encumbrance transaction
has not been completed, to bridge the gap during Implementation between an expiring and
number associated with this Contract which must remain the same for the life of the
a now procurement, or to contract with an Interim Contractor when a current Contractor is
Contract. If multiple numbers exist for this Contract, Identify all Doc Ids.
unable to complete full performance under a Contract.
RFRIProcurement or Other ID Number or Name: Enter the Request for Response
Contract Employee. Check this option when the Department requires a renewal or other
(RFR) or other Procurement Reference number, Contract ID Number or other
amendment to the performance of a Contract Employee.
referenceltracking number for this Contract or Amendment and will be entered Into the
LegislallveRegal or Other. Check this option when legislation, an existing legal
Board Award Field in the MMARS encumbrance transaction for this Contract,
obligation, prohibition or other circumstance exempts or prohibits a Contract from being
compefifively procured, or identify any other procurement exception not already listed.
Legislative "earmarks" exempt the Contract solely from procurement requirements, and all
(Updated 3/21/2014) Page 2 of 14
3•• z
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM ''�(
l�J
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
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
Identify if the Contract is a Rate Contract (with no staled Maximum Obligation) or a
Maximum Obligation Contract (with a slated Maximum Obligation) and ideality 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 if 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 deady
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 Paying Policy 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 earlier payment, or unless a
payments is legally mandated to be made in less than 45 days (e.g., constructioncontracts, Ready Payments under G.L. c 29 s 23A). See Prompt Pay Discounts Policy.
PPD are Identified as a percentage discount which will be automatically 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 identity that the Contractor agrees to the standard
45 day cycle; a stalutoryfiegal exemption such as Ready Payments (G.L. c. 29, S 23A); 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 for 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 PPD.
BRIEF DESCRIPTION OF CONTRACT PERFORMANCE
Enter a brief description of the Contract performance, project name and/or 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
Expenditure Classification Handbook) or to identify or dadly Important information related
to the Contract such as the Fiscal Year(s) of performance (ex.'FY2012" or "FY2012-14').
Identify settlements or other exoepflons and attach more detalled justification and
supporting documents. Enter'Mulfi-Depanmenl Use" if other Departments can access
procurement. For Amendments, identity the purpose and what Items are being amended.
Merely staling "see attached' or referencing attachments v4lhoul a narrative description of
performance is Insufficient,
ANTICIPATED START DATE
The Department and Contractor must certify WHEN obligations under this
Contract/Amendment may be Incurred. Option 1 is the default option when performance
may begin as of the Effective Date (latest signature dale 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 dale (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
Contract/Amendment 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 he performance or proof of eligibility, and approximate
costs. Any obligations Incurad outside the scope of the Effective Date under any Option
listed, even If the Incorrect Option Is selected, shall be automatically deemed a settlement
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 settlement
a4u p°t
payments require jusgficalion and must be under same encumbrance and object codes as
the Contract payments. Performance dates are subject to G.L. c.4.g9.
CONTRACT END DATE
The Department must enter the dale that Contract pedormance will terminate. If the
Contract Is being amended and the Contract End Date is not changing, this dale
must be re-entered again here. A Contract must be signed for at least the initial duration
but not longer than the period of procurement listed in the RFR, or other solicitation
document Of applicable). No new performance is allowable beyond the end date without
an amendment, but the Department may allow a Conbaclor to complete minimal dose out
performance obligations if substantial performance has been made prior to the termination
dale of the Contract and prior to the end of the fiscal year in which payments are
appropriated, provided that any dose out performance is subject to appropriation and
funding limits under stale finance law, and CTR may adjust encumbrances and payments
In the stale accounting system to enable final dose out payments. Performance dales are
subject to G.L. cA 9.
CERTIFICATIONS AND EXECUTION
See Department Head Signature Authorization Policy and the Contractor Authorized
SignatoryListing for 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'Andcloated Contract Start Date". Acceptance of payment by the
Contractor shall waive any right of the Contractor to claim the ContracbAmendment 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 fritle: The Contractor Authorized Signatory's name and life must
appear legibly as it appears on the Contractor Authorized Siggatory Listing,
Authorizing Signature For CommonwealthfDale: 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 "Anticipated 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 IIS& A Department may not contract for performance to be delivered to or by
another slate department without specific legislative authorization (unless this Contract Is a
Statewide Contract). For Contracts requiring Secretarial slgnoff, evidence of Secretariat
signet must be Included In the Contract file.
Department Name /Title: Enter the Authorized Signatorys name and fife legibly.
CONTRACTOR CERTIFICATIONS AND LEGAL REFERENCES
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 Stan Dale 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 enfided to ownership and possession of all 'deliverables"
purchased of 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 quaffed and shall at all times remain qualified
to perform this Contract; that performance shall be timety and meet or exceed Industry
standards for the performance required, Including obtaining requisite licenses,
registrations, permits, resources for performance, and sufficient professional, liabllity; and
other appropriate Insurance to cover the performance. If the Contractor Is a business, the
Contractor certifies that it is listed under he Secretary of Slate's websile 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 competition are prohibited by law, and shall be grounds for
rejection or disqualification of a Response or termination of this Contract.
(Updated 312112014) Page 3 of 14
COMMONWEALTH OF MASSACHUSETTS - STANDARD CONTRACT FORM v
Public Records and Access The Contractor shall provide full access to records related to
subcontractors, Including any potential conflicts of interest of which the Contractor has
performance and compliance to the Department and officials listed under Executive Order
knowledge, or learns of during the Contract term. Law firms or Attorneys providing legal
195 and G.L. c. 11. s.12 seven (7) years beginning on the first day after the final payment
services are required to identify any potential conflict with representation of any
under this Contract or such longer period necessary for the resolution of any litigation,
Department dienl in accordance with Massachusetts Board of Bar Overseers (BBO) miss.
claim, negotiation, audit or other inquiry involving this Contract. Access to view Contractor
Federal Antl•Lobbying and Other Federal Requirements. If receiving federal funds, the
records related to any breach or allegation of fraud, waste anchor abuse may not be denied
Contractor certifies compliance with federal anti -lobbying requirements Including 31 USC
and Contractor can not claim confidentiality or trade secret protections solely for viewing
1352; other federal requirements; Executive Order 11246• Air Pollution Act; Federal Waler
but not retaining documents. Routine Contract performance compliance reports or
Pollution Control Act and Federal Employment Law,
documents related to any alleged breach or allegation of non-compliance, fraud, waste,
Protection of Personal Data and Information. The Contractor certifies that all steps will
abuse or collusion may be provided electronically and shall be provided at Conbaclors
be taken to ensure the security and confidentiality of all Commonwealth data for which the
own expense. Reasonable costs for copies of non -routine Contract related records shall
Contractor becomes a holder, either as part of performance or inadvertently during
not exceed the rates for public records under 950 C.M.R. 32.00.
performance, with special attention to restricting access, use and disbursement of personal
Debarment. The Contractor certifies that neither it nor any of Its subcontractors are
data and Information under G.L. c. 93H and c. 66A and Executive Order 504. The
currently debarred or suspended by the federal or slate government under any taw or
Contractor Is required to comply with G.L. c. 931 for the proper disposal of all paper and
regulation Including, Executive Order 147• G.L. c. 29, s. 29F G.L. c 30 6 39R, G.L. c.149
electronic media, backups or systems containing personal data and Information, provided
27C G.L. c 149 644C G.L. c.149.6148B and G.L. c 152 s 25C.
further that the Contractor is required to ensure that any personal data or Information
Applicable Laws. The Contractor shall comply with all applicable state laws and
transmitted electronically or through a portable device be properly encrypted using (al a
regulations Including but not limited to the applicable Massachusetts General Laws • the
minimum) Information Technology Division (ITD) Protection of Sensitive Information
Official Code of Massachusetts Regulations • Code of Massachusetts Regulations
provided further (hat any Contractor having access to credit card or banking information of
(unofficial); 801 CMR 21.00 (Procurement of Commodity and Service Procurements,
Commonwealth customers certifies that the Contractor is PCl compliant In accordance with
Including Human and Social Services); 815 CMR 2,00 (Grants and Subsidies); 808 CMR
the Payment Card IndusW Council Standards and shall provide confirmation compliance
1.00 (Compliance, Reporting and Auditing for Human And Social Services); IA CPA
during the Contract, provide further that the Contractor shall immediately notify the
Standards confidentiality of Department records under G.L. c. 66A and the
Department in the event of any security breach including the unauthodzed access,
Massachusetts Constitution ArUcle XVIII if applicable.
disbursement, use or disposal of personal data or information, and In the event of a
Invoices. The Contractor must submit invoices in accordance with the terns of the
security breach, the Contractor shall cooperate fully with the Commonwealth and provide
access to any information necessary for the Commonwealth to respond to the secudV
Contract and the Commonwealth Bill Paving Policy. Contractors must be able to reconcile
and property attribute concurrent payments from multiple Departments, Final Invoices in
breach and shall be fully responsible for any damages associated with the Contractors
any fiscal year must be submitted no later than August 166 for performance made and
breach including but not limited to G.L. c. 214, s. 3B.
received (goods delivered, services completed) prior to June 30%, in order to make
Corporate and Business Filings and Reports. The Contractor certifies compliance with
payment for that performance prior to the close of the fiscal year to prevent reversion of
any certification, filing, reporting and service of process requirements of the Secretary of
appropriated funds. Failure to submit timely Invoices by August 151, or other date listed in
the Commonwealth, the Office of the Attorney General or other Departments as related to
the Contract shall authorize the Department to Issue an estimated payment based upon
its conduct of business in the Commonwealth; and with its Incorporating state (or foreign
the Department's determination of performance delivered and accepted. The Contractors
entity).
acceptance of this estimated payment releases the Commonwealth from further claims for
Employer Requirements. Contractors that are employers certify compliance with
these Invoices. If budgetary funds revert due to the Contractors failure to submit timely
applicable slate and federal employment laws or regulations, Including but not limited to
final invoices, or for disputing an estimated payment, the Department may deduct a penalty
G.L. c. 5. a.1 (Prevailing Wages for Printing and Distribution of Public Documents); G.L. c.
up to 10%from any final payment in the next fiscal year for failure to submit Umely Invoices.
7 s 22(Prevailing Wages for Contracts for Meat Products and Clothing and Apparell:
Payments Subject To Appropriation. Pursuant to G.L, c. 29 § 26, § 27 and § 29,
minimum wages and prevailing wage programs and paymentsunemployment Insurance
Departments are required to expend funds only for the purposes set forth by the
and contributions; workers' comoensaUon and Insurance. child labor laws AGO fair labor
Legislature and within the funding limits established through appropdafion, allotment and
rap c6ces; G.L. c. 149 (Labor and Industries); G.L. c. 150A (Labor Relations); G.L. c. 151
subsidiary, including mandated allotment reductions triggered by G.L. c. 29, 6 9C. A
and 455 CMR 200 (Minimum Falr Wa ies): G.L. c. 151A (Employment and Training); G_L.
Department cannot authorize or accept performance In excess of an exisUng appropriation
c. 1518 (Unlawful Discrimination); G.L. c. 151E (Business Discrimination); G.L, c. 152
and allotment, or sufficient non -appropriated available funds. Any oral or written
(Workers' Compensation); G.L. 053 (Liability for Injuries); 29 USC c. 8 (Federal Fair
representations, commitments, or assurances made by the Department or any other
Labor Standards); 29 USC c. 28 and the Federal Family and Medical Leave Act.
Commonwealth representative are not binding. The Commonwealth has no legal
Federal And Slate Laws And Regulations Prohibiting Discrimination Including but not
obligation to compensate a Contractor for performance that Is not requested and Is
limited to the Federal Equal Employment Opourtunity (EEO) Laws the Americans with
Intentionally delivered by a Contractor outside the scope of a Contract. Contractors should
Disabilities Act; 42 U S C Sec 12101 et sea (he Rehabilitation Act 29 USC c 16 s 794
verify funding prior to beginning performance.
29 USC c. 16. s. 701: 29 USC c.14 623; the 42 USC c. 45• (Federal Fair Housing Act); G.
Intercept. Contractors may be registered as Customers in the Vendor file if the Contractor
L. c. 151E (Unlawful Discrimination); G.L. c. 151E (Business Discrimination); the Public
owes a Commonwealth debt. Unresolved and undisputed debts, and overpayments of
Accommodations Law G.L. c 272 s. 92A G.L. c 272 s. 98 and 98A, Massachusetts
Contract payments that are not reimbursed timely shall be subject to Intercept pursuant to
Constriction Acdcle CXIV and G.L. c 93 s. 103: 47 USC c 5 so. 11 Part 11, s. 255
G.L. c. 7A s. 3 and 815 CMR 9.00. Contract overpayments will be subject to Immediate
(Telecommunication Act; Chapter 149, Section 105D G.L. c. 151C G.L, c. 272, Sec ion
intercept or payment offset. The Contractor may not penalize any stale Department or
92A Section 98 and Section 98A. and G.L. c. 111. Section 199A, and Massachusetts
assess late fees, cancel a Contract or other services U amounts are Intercepted or offset
Disability -Based Non -Discrimination Standards For Executive Branch Entities, and related
due to recoupmen( of an overpayment, outstanding taxes, child support, other overdue
Standards and Guidance, authorized under Massachusetts Executive Order or any
debts or Contract overpayments.
disability -based protection arising from state or federal law or precedent. See also MCAD
Tax Law Compliance. The Contractor certifies under the pains and penalties of perjury
tax compliance with Federal lax laws; state tax laws Including but not limited to G.L. c. 62C,
and MCAD links and Resources.
Small Business Purchasing Program (SBPP). A Contractor maybe eligible to
G.L.c 62C s 49A• compliance with all state tax laws, reporting of employees and
participate In the S8PP, created pursuant to Executive Order 523, U qualified through the
contractors, withholding and remitting of tax withholdings and child support and Is In good
SBPP COMMBUYS subscription process at: www.comunbuys.com and with acceptance of
standing with respect to all state taxes and returns due; reporting of employees and
the terms of the SBPP participation agreement.
contractors under G.L. c. 62E withholding and remitting child sungort including G.cc
Limitation of Liability for Information Technology Contracts (and other Contracts as
119A s.12; TIR 05-1 V New independent Contractor Provisions and applicable Tins.
Authorized), The Information Technology Mandatory Specifications and the IT Acquisition
Bankruptcy,Judgments, Potential Structural Changes, Pending legal Matters and
Accessibility Contract Language are Incorporated by reference into lnformadon Technology
Contracts. The following language will apply to Information Technology contracts in the
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
U01, UO2, UO3, U04, U05, U06, U07, U08, U09, Ulf, U75, U98 object codes in the
Department In writing at least 45 days prior to filing for bankruptcy andhor receivership,
Expenditure Classificaflon Handbook or other Contracts as approved by CTR or OSO.
Pursuant to Section 11. Indemnification of the Commonwealth Terms and Conditions, the
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 fimely fulfill the terms of this
term "other damages" shall include, but shall not be limited to, the reasonable costs file
Contract or Amendment. The Contractor certifies that at any Ume during the period of 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
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
damages to the Commonwealth as a result of third party claims, provided, however, that
pending against the Contractor or any of its officers, directors, employees, agents, of
the foregoing In no way limits the Commonwealth's right of recovery for personal injury or
(Updated 3121/2014)
Page 4 of 14
COMMONWEALTH OF MASSACHUSETT
property damages or patent and copyright Infringement under Section 11 nor the
aide
Commonwealth's ability to join the contractor as a third party defendant. Further, the term
cam
'other damages" shall not Include, and in no event shall the contractor be liable for,
to In
damages for the Commonwealth's use of contractor provided products or services, loss of
and
Commonwealth records, or data (or other intangible property), loss of use of equipment,
was
lost revenue, lost savings or lost profits of the Commonwealth. In no event shall "other
awa
damages" exceed the greater of V00,000, or two times the value of the product or service
ove
(as defined in the Contract scope of work) that is the subject of the claim. Section 11 sets
Exe
forth the contractors entire liability under a Contract. Nothing in this section shall limit the
Eac
Commonwealth's ability to negotiate higher limitations of liability In a particular Contract,
Bra
provided that any such limitation must specifically reference Section 11 of the
rate
Commonwealth Terms and Conditions. In the event the limitation of liability conflicts with
Co
m
Page 6 of 14
Department of Homeland Security I Federal Emergency Management Agency
Federal Fiscal Year 2016 - Standard Terms and Conditions
Whistleblower Protection Act
All recipients must comply with the statutory requirements for whistleblower protections (if applicable) at 10 U.S.0
2409, 41 U.S.C. 4712, and W U.S.C. 2324, 41 U.S.C. 4304 and 4310.
Il. Use of DHS Seal. Logo and Flags
All recipients must obtain DHS's approval prior to using the DHS seal(s), logos, crests or reproductions of flags or
likenesses of DHS agency officials, including use of the United States Coast Guard seal, logo, crests or
reproductions of flags or likenesses of Coast Guard officials.
III. USA Patriot Act of 2001
All recipients must comply with the requirements of the Uniting and Strengthening America by Providing
Appropriate Tools Required to Intercept and Obstruct Terrorism Act (USA PATRIOT Act), which amends 18
U.S.C. section 175-175c.
IV. Universal Identifier and System of Award Management (SAM)
All recipients are required to comply with the requirements set forth in the government -wide Term regarding the
System for Award Management and Universal Identifier Requirements located at 2 C.F.R. Part 25, Appendix A,
the full text of which is incorporated here by reference in the terms and conditions of your award.
V. Reporting of Matters Related to Recipient Integrity and Performance
If the total value of your currently active grants, cooperative agreements, and procurement contracts from all
Federal assistance office exceeds $10,000,000 for any period of time during the period of performance of this
Federal award, you must comply with the requirements set forth in the government -wide Term and Condition for
Recipient Integrity and Performance Matters located at 2 C.F.R. Part 200, Appendix Xii, the full text of which is
incorporated here by reference in the terms and conditions of your award.
VI. Rehabilitation Act of 1973
All recipients of must comply with the requirements of Section 504 of the Rehabilitation Act of 1973, 29 U.S.C.
section 794, as amended, which provides that no otherwise qualified handicapped individual in the United States
will, solely by reason of the handicap, be excluded from participation in, be denied the benefits of, or be subjected
to discrimination under any program or activity receiving Federal financial assistance.
VII. Trafficking Victims Protection Act of 2000
All recipients must comply with the requirements of the government -wide award term which implements Section
106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. section 7104), located at
2 CFR Part 175.16, November 13, 2007. Full text of the award terms and conditions of your award.
Terrorist Financing
All recipients must comply with U.S. Executive Order 13224 and U.S. law that prohibit transactions with, and the
provisions of resources and support to, individuals and organizations associated with terrorism. It is the legal
responsibility of recipients to ensure compliance with the E.O. and laws.
VIII. SAFECOM
All recipients who receive awards made under programs that provide emergency communication equipment
and its related activities must comply with the SAFECOM Guidance for Emergency Communication Grants,
including provisions on technical standards that ensure and enhance interoperable communications.
IX. Reporting Subawards and Executive Compensation
All recipients are required to comply with the requirements set forth in the government -wide Award Terms and on
Reporting Subawards and Executive Compensations located at 2 C.F.R. Part 170, Appendix A, the full text of
which is incorporated here by reference In the terms and conditions of your award.
(Updated 3/2112014) Page 6 of 14
Department of Homeland Security / Federal Emergency Management Agency
Federal Fiscal Year 2016 - Standard Terms and Conditions
X. Procurement of Recovered Materials
All recipients must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated
in guidelines of the Environmental Protection Agency (EPA) at 40 CFR Part 247 that contain the highest
percentage of recovered materials practicable, consistent with maintaining a satisfactory level of
competition.
Xl. Patents and Intellectual Property Rights
Unless otherwise provided by law, recipients are subject to the Bayh-Dole Act Publ. L. No 96-517, as amended,
and codified in 35 U.S.C. section 200 et seq. All recipients are subject to the specific requirements governing the
development, reporting, and disposition of rights to inventions and patents resulting from financial assistance
awards are located at 37 C.F.R. Part 401 and the standard patent rights clause in 37 C.F.R. section 401.14.
XII. Notice of Funding Opportunity Requirements
All of the instructions, guidance, limitations, and other conditions set forth in the Notice of Funding Opportunity
(NOFO) for this program are incorporated here by reference in the terms and conditions of your award. All
recipients must comply with any such requirements set forth in the program NOFO.
XIII. Non -supplanting Requirements
All recipients who receive awards made under programs that prohibit supplanting by law must ensure that
Federal funds do not replace (supplant) funds that have been budgeted for the same purpose through non -
Federal sources.
XIV. Lobbvina Prohibitions
All recipients must comply with 31 U.S.C. section 1352, which provides that none of the funds provided under an
award may be expended by the recipient to pay any person to influence, or attempt to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with any Federal action concerning the award or renewal.
XV. Limited English Proficiency (Civil Rights Act of 1964, Title VI)
All recipients must comply with the Title VI of the Civil Rights Act of 1964 (Title VI) prohibition against
discrimination on the basis of national origin, which requires that recipients of federal financial assistance take
reasonable steps to provide meaningful access to persons with limited English proficiency (LEP) to their programs
and services. For additional assistance and information regarding language access obligations, please refer to the
DHS Recipient Guidance https //www dhs goy/guidance-published-help-department-supported-organizations-
provide-meaningful-access-people-limited and additional resources on http://www.leo.gov.
XVI. Hotel and Motel Fire Safety Act of 1990
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990, 15 U.S.C. section 2225a, all
recipients must ensure that all conference, meeting, convention, or training space funded in whole or in part
with Federal funds complies with the fire prevention and control guidelines of the Federal Fire Prevention and
Control Act of 1974, as amended, 15 U.S.C. section 2225.
XVII. Fly America Act of 1974
All recipients must comply with Preference for U.S. Flag Air Carriers: (air carriers holding certificates under 49
U.S.C, section 41102) for international air transportation of people and property to the extent that such service is
available, in accordance with the International Air Transportation Fair Competitive Practices Act of 1974 (49
U.S.C, section 40118) and the interpretative guidelines issued by the Comptroller General of the United Slates in
the March 31, 1981, amendment to Comptroller General Decision B138942.
XVIII. Best Practices for Collection and Use of Personally Identifiable Information (PII
DHS defines personally identifiable information (Pit) as any information that permits the identity of an individual to
be directly or indirectly inferred, including any information that is linked or linkable to that individual. All recipients
who collect PII are required to have a publically-available privacy policy that describes standards on the usage and
maintenance of PII they collect. Award recipients may also find as a useful resource the DHS Privacy Impact
Assessments: Privacy Guidance and Privacy template respectively.
(Updated 312112014) Page 7 of 14
Department of Homeland Security / Federal Emergency Management Agency
Federal Fiscal Year 2016 - Standard Terms and Conditions
XIX. Americans with Disabilities Act of 1990
All recipients must comply with the requirements of Titles I, II, and III of the Americans with Disabilities Act, which
prohibits recipients from discriminating on the basis of disability in the operation of public entities, public and
private transportation systems, places of public accommodation, and certain testing entities (42 U.S.C.
section 12101-12213).
XX. Age Discrimination Act of 1975
All recipients must comply with the requirements of the Age Discrimination Act of 1975 (Title 42 U.S.Code section
6101 et seg.), which prohibits discrimination on the basis of age in any program or activity receiving Federal
financial assistance.
XXI. Activities Conducted Abroad
Ail recipients must ensure that project activities carried on outside the United States are coordinated as necessary
with appropriate government authorities and that appropriate licenses, permits, or approvals are obtained.
XXII. Acknowledgement of Federal Funding from DHS
All recipients must acknowledge their use of federal funding when issuing statements, press releases, and
requests for proposals, bid invitations, and other documents describing projects or programs funded in whole or
in part with Federal funds.
XXIII. Federal Leadership on Reducing Text Messaging while Driving
All recipients are encouraged to adopt and enforce policies that ban text messaging while driving as described in
E.O. 13513, including conducting initiatives described in Section 3(a) of the Order when on official Government
business or when performing any work for or on behalf of the federal government.
XXIV. Federal Debt Status
Ali recipients are required to be non -delinquent in their repayment of any Federal debt. Examples of relevant
debt include delinquent payroll and other taxes, audit disallowances, and benefit overpayments. See OMB Circular
A-129.
XXV. False Claims Act and Program Fraud Civil Remedies
All recipients must comply with the requirements of 31 U.S.C. section 3729 -3733 which prohibits the submission
of false or fraudulent claims for payment to the Federal Government. See 38 U.S.C. section 3801-3812 which
details the administrative remedies for false claims and statements made.
XXVI. Education Amendments of 1972 (Equal Opportunity in Education Act) —Title IX
All recipients must comply with the requirements of Title IX of the Education Amendments of 1972 (20 U.S.C.
section 1681 at seo.), which provides that no person in the United States will, on the basis of sex, be excluded
from participation in, be denied the benefits of, or be subjected to discrimination under any educational program or
activity receiving Federal financial assistance. DHS implementing regulations are codified at 6 C.F.R. Part 17 and
44 C.F.R. Part 19
XXVII. Energy Policy and Conservation Act
All recipients must comply with the requirements of 42 U.S.C. section 6201 which contain policies relating to
energy efficiency that are defined in the state energy conservation plan issues in compliance with this Act.
XXVIII. Duplication of Benefits
All costs allocable to a particular Federal award provided for in 2 C.F.R. Part 200, Subpart E may not be charged
to other Federal awards to overcome fund deficiencies, to avoid restrictions imposed by Federal statutes,
regulations, or terms and conditions of the Federal awards, or for other reasons. However, this prohibition would
not preclude a recipient form shifting costs that are allowable under two or more federal awards in accordance with
existing Federal statutes, regulations, or the terms and conditions of the Federal award.
XXIX. Drug -Free Workplace Regulations
All recipients must comply with the Drug -Free Workplace Act of 1988 (412 U.S.C. § 701 of seg.), which requires
that all organizations receiving grants from any Federal agency agree to maintain a drug -free workplace. DHS
has adopted the Act's implementing regulations at 2 C.F.R. Part 3001.
(Updated 3/21/2014) Page 8 of 14
Department of Homeland Security / Federal Emergency Management Agency
Federal Fiscal Year 2016 - Standard Terms and Conditions
XXX. Debarment and Suspension
All recipients are subject to the non -procurement debarment and suspension regulations implementing
Executive Orders 12549 and 12689, 2 C.F.R. Part 180. These regulations restrict awards, Subawards, and
contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for
participation in federal assistance programs or activities.
XXXI. Copyright
All recipients must affix the applicable copyright notices of 17 U.S.C. section 401 or 402 and an acknowledgement
of Government sponsorship (including award number) -to any work first produced under Federal financial
assistance awards.
XXXII. Civil Rights Act of 1968
All recipients must comply with Title Vill of the Civil Rights Act of 1968, which prohibits recipients from
discriminating in the sale, rental, financing, and advertising of dwellings, or in the provision of services in
connection therewith, on the basis of race, color, national origin, religion, disability, familial status, and sex (42
U.S.C. section 3601 et sea.), as implemented by the Department of Housing and Urban Development at 24 CFR
Part 100. The prohibition on disability discrimination includes the requirement that new multifamily housing with
four or more dwelling units—i.e., the public and common use areas and individual apartment units (all units in
buildings with elevators and ground -floor units in buildings without elevators) —be designed and constructed with
certain accessible features (see 24 CFR section 100.201).
XXXIII. Civil Rights Act of 1964 — Title VI
All recipients must comply with the requirements of Title VI of the Civil Rights Act of 1964 (42 U.S.C. section
2000d et seg.), which provides that no person in the United States will, on the grounds of race, color, or national
origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any
program or activity receiving Federal financial assistance. DHS implementing regulations for the Act are found at 6
C.F.R. section 100.201
XXXIV. DHS Specific Acknowledgements and Assurances
All recipients, Subrecipient, successors, transferees, and assignees must acknowledge and agree to comply
with applicable provisions governing DHS access to records, accounts, documents, information, facilities, and
staff.
1. Recipients must cooperate with any compliance review or complaint investigation conducted by DHS
2. Recipients must give DHS access to and the right to examine and copy records, accounts, and other
documents and sources of information related to the award and permit access to facilities, personnel, and other
individuals and information as may be necessary, as required by DHS regulations and other applicable laws or
program guidance.
3. Recipients must submit timely, complete, and accurate reports to the appropriate DHS officials and maintain
appropriate backup documentation to support the reports.
4. Recipients must comply with all other special reporting, data collection, and evaluation requirements,
as prescribed by law or detailed in program guidance.
5. If, during the past three years, the recipient has been accused of discrimination on the grounds of race, color,
national origin (including limited English proficiency), sex, age, disability, religion, or familial status, the recipient
must provide a list of all such proceedings, pending or completed, including outcome and copies of settlement
agreements to the DHS financial assistance office and the DHS Office of Civil Rights and Civil Liberties (CRCL)
by email at crcl anhg.dhs.gov or by mail at U.S. Department of Homeland Security Office for Civil Rights and
Civil Liberties Building 410, Mail Stop #0190 Washington D.C. 02528.
6. In the event any court or administrative agency makes a finding of discrimination on grounds of race, color,
national origin (including limited English proficiency), sex, age, disability, religion, or familial status against the
recipient, or the recipient settles a case or matter alleging such discrimination, recipients must forward a copy of
the complaint and findings to the DHS financial assistance office and the CRCL office by email or mail at the
address listed above.
(Updated 3/21/2014) Page 9 of 14
Department of Homeland Security f Federal Emergency Management Agency
Federal Fiscal Year 2016 - Standard Terms and Conditions
The United States has the right to seek judicial enforcement of these obligations.
XXXV. Assurances, Administrative Requirements and Cost Principles
DHS federal financial assistance recipients must complete either the OMB Standard Form 424E Assurances —
Non -Construction Programs or OMB Standard Form 424D Assurances — construction Programs as applicable.
Certain assurances in these documents may not be applicable to your program, and the DHS financial assistance
office may require applicants to certify additional assurances. Please contact the financial assistance office if you
have any questions.
DHS financial assistance recipients are required to follow the applicable provisions of the Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards located at 2 C.F.0 Part 200 and
adopted by DHS at 2 CFR Part 3002,
Print Name and Title: IVO*2- 80c) R-/lifh.W Date: 2 5-?
Signature:
(Updated 3/2112014) Page 10 of 14
Special Terms, Conditions, and Reporting Requirements for EMPG, CCP, and HMEP Sub -
Recipients
Parties
The "Contractor" or "Sub -recipient" is an eligible public or private not -for -profit entity that has submitted an application for
grant funding to the Massachusetts Emergency Management Agency (MEMA) and has received an approved award. The
sub -recipient must be represented by a duly authorized official(s) of the Contractor whose signature(s), authorization(s),
and/or certification(s) legally represent and bind the Contractor. The Commonwealth of Massachusetts, acting through the
Massachusetts Emergency Management Agency ("Department"), is responsible for administering this grant program.
Agreement
The Sub -recipient and Department will execute a State Standard Grant Contract through which the subrecipient agrees to
perform all activities as described in the attached application within the budget, dates of service, and other conditions set
forth below. The Department agrees to reimburse the Sub -recipient for all allowable costs incurred and to provide
technical assistance and support required to carry out the purposes of the grant.
Terms and Conditions
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. Any substantive adjustment to a sub -recipient's scope of work or budget must be reviewed and approved by MEMA
prior to expenditure. A contract amendment may be required prior to performance under an adjusted scope of work.
Work or expenditures made outside an approved scope of work or budget may not be reimbursed.
4. Sub -recipients agree to be compliant with the National Incident Management System (NIMS).
5. Sub -recipients agree to comply with the following:
• 2 CFR Part 200: Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards
815 CMR 2.00: State Grants, Federal Grant Awards, Federal Subgrants, and Federal Subsidies
6. Federal Funding Accounting and Transparency Act (FFATA). FEMA federal funds are subject to the Federal
Funding Accounting and Transparency Act (FFATA). Sub -recipient agrees to abide by FFATA regulations and to
submit the attached FFATA form along with its contract package for all contracts in excess of $26,000.
7. 2 CFR 200 SubpartF Audit Reports, SubpartF Form. (Replaces former A-133 Requirements). Per Office of
Management and Budget (OMB) regulations, sub -recipient may be subject to Subpart F audit requirements. Sub -
recipient agrees to submit a copy of any Subpart F audits reports as required by Subpart F. Sub -recipient further
agrees to notify MEMA of any Subpart F audit findings related to any federally funded activities. Sub -contractor
acknowledges that a Corrective Action Plan may be required by MEMA for related findings prior to execution of
contracts or issuance of payments. Sub -recipient agrees to abide by OMB regulations and to submit the attached
Subpart F acknowledgement form as part of this contract package.
8. Sub -recipient Risk Assessment and Monitoring. (Replaces former A-133 Monitoring Form). Per 2 CFR 200.331,
prior to awarding of this contract, the sub -recipient must provide to the Department the attached Sub -recipient Risk
Assessment Questionnaire and Response form. Sub -recipient further agrees to monitoring by the Department as a
result of its assessment of the sub -recipient's risk for non-compliance.
Page 11 of 14
9. Internal Controls. Per 2 CFR 200.303, sub -recipients must maintain and implement effective internal controls that
provide reasonable assurance that federal funds are managed in compliance with all statutes, regulations, and terms
and conditions.
Per 2 CFR 200.430 (Compensation), internal controls must cover payroll charges to federal awards such that payroll
charges are documented as accurate, allowable, and allocable, are reflected in the official records of the sub -recipient,
reasonably reflect the total activity for each employee (federal and non-federal), and comply with all accounting
policies and practices of the sub -recipient.
10, Procurement. Sub -recipient must conduct all procurements in compliance with 2 CFR 200.318-326. Specific policies,
procedures, and/or standards must be in place that meet or exceed these requirements at the time of procurement.
Costs incurred which are otherwise appropriate and reasonable, but which were procured in violation of federal
procurement requirements may result in disallowed costs or repayments (See Sub -recipient Non-compliance).
11. Procurement Contract provisions. Contracts utilized by sub -recipients for goods and services must contain the
applicable provisions described in 2 CFR 200 Appendix II and attached hereto.
12. Disclosures. Per 2 CFR 200.112, the sub -recipient must disclose in writing any potential conflicts of interest to the
Department.
13. Per 2 CFR 200. 113, the sub -recipient must disclose in writing all violations of federal criminal law involving fraud,
bribery, or gratuity violations potentially effecting the federal award.
14. Sub -recipients understand and agree that it cannot use any federal funds, either directly or indirectly, in support of the
enactment, repeal, modification or adoption of any law, regulation or policy, at any level of government without the
express prior written approval of U.S. DHS FEMA and/or U.S. DOT PHMSA.
15. Press. Sub -recipient agrees to proactively notify MEMA of any interactions or planned media outreach regarding
activities funded under this grant program.
16. Release of Information. All records, papers and other documents of any kind related to the funded activity in any
manner and kept by sub -recipients of these funds shall be made promptly available upon request to any person
authorized by MEMA for inspection and copying.
17. Application of Special Conditions to Sub -Recipient Grantees: if a sub -recipient proposes to engage in sub -
granting activities, it shall ensure its sub -grantees adhere to all applicable DHS/FEMA, U.S. DOT, and MEMA special
conditions.
18. Reporting. Sub -recipients agree to submit timely and accurate Close -Out and Match Reports as needed and directed.
Failure to comply with this condition may result in the withholding of sub -recipient funds until the delinquent report is
received.
19. Contractor/Consultant Rates. Compensation for individual consultant services is to be reasonable and consistent
with the amount paid for similar services in the market place. Consideration can be given to compensation, Including
fringe benefits, for those individuals whose employers do not provide the same. Time and effort reports are required
for consultants.
20. Copyright/Licenses. The sub -recipient acknowledges that MEMA, DHS, and DOT reserve a royalty -free, non-
exclusive, and irrevocable license to reproduce, publish, or otherwise use, and authorize others to use, for federal or
state purposes: (1) the copyright in any work developed under an award or sub -award; and (2) and rights of copyright
to which a sub -recipient or sub -grantee purchases ownership with Federal support.
21. Acknowledgement in Published Materials. EMPG and CCP sub -recipients agree that any publication (e.g.,
written, visual, or sound) it or its contractors issue describing programs or projects funded in whole or in part with
federal funds, contain the following statement:
"This document was prepared under a grant from FEMA's Grant Programs Directorate, U.S. Department of Homeland
Security. Points of view or opinions expressed in this document are those of the authors and do not necessarily
Page 12 of 14
represent the official position or policies of FEMA's Grant Programs Directorate or the U.S. Department of Homeland
Security."
22. Acknowledgement in Published Materials. HMEP sub -recipients agree that any publication (e.g., written, visual,
or sound) it or its contractors issue describing programs or projects funded in whole or in part with federal funds,
contain the following statement:
"This document was prepared under a grant from U.S. DOT PHMSA. Points of view or opinions expressed in this
document are those of the authors and do not necessarily represent the official position or policies of the U.S. DOT
PHMSA."
23, Disposal and sale of equipment purchased via federal grant funds. Any proposed sale and/or disposal must
adhere to current MEMA policy.
24. User Fees. Any proposed 'user fees' related to equipment, items, services, etc. acquired via DHS funding must be
pre -approved by MEMA.
25. Environmental Planning and Historic Preservation (EHP). EMPG and CCP sub -recipients shall not undertake
any project having the potential to impact Environmental or Historical Preservation (EHP) resources without the prior
approval of FEMA, which is done through MEMA.
26. Equipment acquired with grant funds. MEMA requires that equipment acquired with federal grant funds be tracked
and tagged per current MEMA policy.
27. Reporting of violations (fraud, waste, and abuse). It is the responsibility of all grant sub -recipients and their
respective agency personnel, grantees, and contractors under grants, to report to MEMA any alleged violations,
serious irregularities, sensitive issues, or overt or covert acts that would use public funds or perform program or
administrative requirements in a manner not consistent with grantor agency statutes, related laws and regulations,
appropriate guidelines, or purposes or objectives of the grant.
28. Internet Access. Sub -recipients must have Internet access.
29. Email addresses. Sub -recipient project directors of grant programs must have individual email addresses.
30, Sub -recipient Non-compliance. Contractor, as sub -recipient, is subject to the federal and state regulations and
related requirements set forth herein. Contractor non-compliance may result in an audit finding and subsequent
repayment of funds to the Federal Government. Approval of a project, project costs, contract or payment by either
FEMA or MEMA does not exempt the Contractor from requirements to repay funds. Should a state, federal, or local
audit reveal that actions taken by the Contractor as sub -recipient, or any of its contractors, regardless of previous
approval by either FEMA or MEMA, do not comply with policies, laws, or regulations, the Contractor agrees to repay
the required amounts in the manner and timeframe determined by FEMA and/or MEMA. Repayments not made as
expected will be considered debts and addressed under the Commonwealth's Debt Collection and Intercept policy
(815 CMR 9.00).
31, Monitoring. Sub -recipients agree to cooperate with MEMA monitoring and site visits.
32, Records Retention. The Contractor shall retain all related records for a minimum of six years from the date of the
Close -Out Report Submission. In cases of similar requirements at two or more levels, the more stringent of the
requirements must be followed.
33. Certifications (200.415). To assure that expenditures are proper and in accordance with the terms and conditions of
the Federal award and approved project budgets, the annual and final fiscal reports or vouchers requesting payment
under the agreements must include a certification, signed by an official who is authorized to legally bind the non -
Federal entity, which reads as follows: "By signing this report, I certify to the best of my knowledge and belief that the
report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes
and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or
fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties
Page 13 of 14
for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-
3730 and 3801-3812)."
Non-profit organizations must certify as appropriate that they did not meet the definition of a major corporation as
defined in 2 CFR 200.414 Indirect (F&A) costs, paragraph (a).
34. Prior to acceptance of these terms and conditions, Contractor must evaluate its policies, procedures, and
management systems for risk of non-compliance with any of the above terms and conditions, inclusive of all
requirements of FEMA and 2 CFR 200. Any identified areas of risk must be brought to the attention of MEMA prior to
the execution of the contract in order to determine and implement the appropriate remedy.
35. The Contractor certifies that it understands all obligations and has in place or will implement policies and procedures
that meet or exceed the standards and requirements above. Acceptance of payment for the activities under this
agreement indicates that all actions taken by the subrecipient for the purposes of this grant program were done so in
compliance with all grant requirements and all applicable laws and regulations, including the certification statement
above.
Print Name and Title: /✓��� Q�� a/j�i�/ ✓� hxr c,H�EF Date: ! Zr 7
Signature:
Page 14 of 14
COMMONWEALTH OF MASSACHUSETTS
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME: Town of Mansfield Massachusetts
CONTRACTOR VENDORICUSTOMER 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 ivalner of any defense by
the Contractor challenging the existence of a Pallor Contract due to an alleged lack of actual authority to
erecate the document Air 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 pail 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 Chic9EM Director
John Stanbrook Finance Director and Town Accountant
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 1 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. state or
CountyN r.l.
This Instrument as acknowledgedqpt,ome
on! `Lda ofil iL•, Y
y
Signature 11 [ , (r I YU 0. Q,tc 0
tyyi oPublic Signature r
My Commission Expires '-ki-
Title; 'Town Manager Telephone: (508) 261-7370
Fax: (508) 261-7498 Email: wross mansfieldma.co ,C MARIANNE E. STAPLES
Notary Public
[Listing cannot be accepted without all of this information complet COMMONWEALTH OF MASSACHNSETfS
t, y Commission Expires
A copy of this listing must be attached to the "record copy" of a contract filed with the d Mayes
a
2016 Mansfield EMA EMPG Application
1. Entity submitting this Application
Community(s)/Tribe(s): - Town of Mansfield Emergency Management Agency
Point of Contact Name (only one POC for joint applications): Neal Boldrighini
Title: Fire Chief/Emergency Management Director
Telephone: 508-261-7490
Email: nboldrighini(@mansfieldma.com
Organization DUNS Number (required): 099419954
Fiscal Point of Contact (if different than above)
Name: John Stanbrook
Telephone: 508-261-7348
Email: istanbrook@mansfieldma.com
This 2016 EMPG application is submitted by:
Name: Neal Boldrighini
Title: Fire Chief/Emergency Management Director
Telephone: 5 08-2 61-7490
Email: nboldrighini0mansfieidma.com
2. Project Description
The proposed project for the Town of Mansfield EMA is a purchase of portable equipment to include: Honda EU30001S
Generator and Portable battery pack with LED Lights.
Over the past year Mansfield EMA has become very active in both planned and unplanned events. We staff over 50
planned events over the course of a year that include First Aid for sporting events, road races, town family events, as
well as charitable events such as the Relay for Life, Autism walks and Special Olympics. Many of these events are
remote and require auxiliary power.
Mansfield EMA in conjunction with our CERT group has also developed a fire rehab team for the Mansfield and local
Fire Departments. Our team responds to first alarms in support with our Fire Fighter Rehab unit. We provide on -site
hydration, food and rest area for fire fighters. Our Rehab team has supported several large scale operation in
Mansfield during night and evening operations. The Portable battery pack with LED Lights would have been a valuable
asset during a deployment for this type of rehab deployment for safety and security of first responders.
Procurement of a portable lighting equipment will be used in different configurations based on actual needs at the
time of the event along with hydration that are critical to complete the specific needs of every event or deployment.
This equipment would support three of the five FEMA Mission areas:
• Prevention: Operational Coordination.
• Protection: Physical Protective Measures.
• Response: Health and Safety, Fire Management, Mass Care Services, On -Scene Security, Protection,
Healthcare, and Medical Services.
This equipment would support the following four of the thirty-two FEMA core capabilities as identified In the
National Preparedness Goal:
• Physical Protective Measures: Protecting people, structures, materials, products, and systems
associated with key operational activities and critical infrastructure sectors.
• Fire Management and Suppression: Provide specialized firefighting capabilities to manage fires of
all types and complexities while protecting the lives, property, and the environment in the affected
area.
• Mass Care Services: Provide life -sustaining and human services to the affected population, to
include hydration and distribution of emergency supplies.
• On -Scene Security, Protection, And Law Enforcement: Ensure a safe and secure environment
through related security and protection operations for people and communities located within
affected areas and also for response personnel engaged in lifesaving and life -sustaining operations.
This equipment would support two of the following Commonwealth of Massachusetts Homeland Security
goals:
• Increase the ability to effectively provide prompt and accurate public awareness during emergency
operations.
• Increase Capacity to effectively respond to all emergency situations.
The purchase of the additional needed equipment will enhance our EMA and CERT unit's capability to
deploy, respond and coordinate our operations for the many events that we support year round in the
Mansfield area.
3. Funding Amount
Amount of Community/Tribe FFY 2016 EMPG funding: $ $ 4960,00
4. Budget Detail
Complete this budget table to itemize all proposed grant expenditures from date of award
through 6/30/17
il�scrtptiQiirf�ach
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.
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Honda EU30001S
10GE-00-
Portable
1
$ 1,885.00
$ 1,885.00
Generator
GENR-
Generators
Portable battery pack
01AR-03-
Portable
2
$1,450.00
$ 2,900.00
with LED Lights
PAPB
M&A
N/A
N/A
1
$ 175.00
$ 175.00
Total
$ 4960.00
5. Match
Per FEMA, the EMPG requires a dollar -for -dollar match. The provided match must be verifiable (i.e.;
adequate back-up documentation must be maintained) and relate to an allowable cost under the
EMPG.
Mansfield EMA will purchase authorized equipment base on the FEMA AEL list for EMPG
equipment during the budget period of the 2016 EMPG contract. Equipment will be purchased
using the Mansfield EMA equipment operating budget. A secondary source of funding will come
from training that is offered to members of Mansfield EMA using the Mansfield EMA operating
training budget. Cash Match amount will be verifiable with reports and warrants from the
Town Accountant.
6. Match Questions
1. Match amount to be provided (match amount must equal the amount of the grant): The
Match amount from our operating budget which will be equal or greater than the grant
amount of $4,960.00.
2. Type of match (Cash and/or In -kind): Cash Match
3. The specific match source(s): Mansfield EMA will purchase authorized equipment base on
the FEMA AEL list for EMPG equipment during the budget period of the 2016 EMPG
contract. Equipment will be purchased using the Mansfield EMA equipment operating
budget. A secondary source of funding will come from training that is offered to members
of Mansfield EMA using the Mansfield EMA operating training budget.
4. For Cash and In -kind match, the date(s) when the match will be available to be expended or
provided: The Operating 2017 budget year is from July 1, 2016 - June 30, 2017
S. For Cash match, the date when the match will be fully expended by the applicant: No later
than June 30, 2017
John Stanbrook
From:
Sent:
To:
Subject:
Attachments:
Importance:
Resending as it bounced back
Gifford, Lorri (CDA) <lorri.gifford@state.ma.us>
Wednesday, January 25, 2017 9:26 AM
John Stanbrook
FW: 16EMPG - Mansfield
Mansfield contract.pdf; Mansfield CASL.pdf
High
Lord Gifford
Grants Management Specialist
Massachusetts Emergency Management Agency
400 Worcester Road
Framingham, MA 01702-5399
Desk: 508.820,1407
Fax: 508.820.2030
lorri.gifford@rnassmail.state.ma.us
From: Gifford, Lorri (CDA)
Sent: Wednesday, January 25, 2017 9:21 AM
To: DPH-OEMS-NBoldrighini<nboldrighini@mansfieldma.com>;'jstandbrook@mansfieldma.com'
<*standbrook@mansfieIdma.com>
Cc: Mannion, lames A. (CDA) <James.A.Mannion@MassMaii.State.MA.US>
Subject: 16EMPG - Mansfield
Importance: High
On behalf of Massachusetts Emergency Management Agency Director Kurt Schwartz, I am pleased to provide
a FFY 2016 EMPG (16EMPG) contract to your community.
Please find the following two (2) attachments:
• Contract
• CASL
We recently updated our contract to include all related terms and conditions/special terms and conditions. Please
review your contract documents closely as there are several pages that require an original signature (page 1,10, and
14). Only those listed on the attached scanned copy of your CASL are authorized to sign your contract and related terms
and conditions.
Please return the signed, original contract to me, at the mailing address below, within ten (10) business days.
Please remember- funds cannot be spent at this point, do not proceed with your project until a finalized contract, signed
by MEMA, is returned to you.
When MEMA receives your signed contract documents we will review and process. Once MEMA signs the contract, It
will be finalized. We will send you a copy of your finalized contract via email, authorizing you to begin your approved
project.
Don't forget to checkout our website for the latest policies, EMPG guidance and forms:
http://www.mass.gov/eopss/agencies/mema/resources/grants/`empg
11Thank you, and please let me know if you have any questions on this.
Lord Gifford
Grants Management Specialist
Massachusetts Emergency Management Agency
400 Worcester Road
Framingham, MA01702-5399
Desk: 508.820.1407
Fax: 508.820.2030
lon LgifforcIpmassmail.state .ma.us
John Stanbrook
From:
Sent:
To:
Subject:
Attachments:
Importance:
Resending as it bounced back
Gifford, Lorri (CDA) <lorri.gifford@state.ma.us>
Wednesday, January 25, 2017 9:26 AM
John Stanbrook
FW: 16EMPG - Mansfield
Mansfield contract.pdf; Mansfield CASL.pdf
High
Lord Gifford
Grants Management Specialist
Massachusetts Emergency Management Agency
400 Worcester Road
Framingham, MA 01702-5399
Desk: 508.820,1407
Fax: 508.820.2030
lorri gifford(Tmassmail.state.ma.us
From: Gifford, Lord (CDA)
Sent: Wednesday, January 25, 2017 9:21 AM
To: DPH-OEMS-NBoldrighini<nboldrighini@mansfieldma.com>;'Jstandbrook@mansfieldma.com'
<istandbrook@mansfieldma.com>
Cc: Mannion, James A. (CDA) <James.A.Mannion@MassMail.State.MA.US>
Subject: 16EMPG - Mansfield
Importance: High
On behalf of Massachusetts Emergency Management Agency Director Kurt Schwartz, I am pleased to provide
a IFFY 2016 EMPG (16EMPG) contract to your community.
Please find the following two (2) attachments:
• Contract
• CASL
We recently updated our contract to include all related terms and conditions/special terms and conditions. Please
review your contract documents closely as there are several pages that require an original signature (page 1, 10, and
14). Only those listed on the attached scanned copy of your CASL are authorized to sign your contract and related terms
and conditions.
Please return the signed, original contract to me, at the mailing address below, within ten (10) business days.
Please remember - funds cannot be spent at this point, do not proceed with yourproject until a finalized contract, signed
by MEMA, is returned to you.
When MEMA receives your signed contract documents we will review and process, Once MEMA signs the contract, it
will be finalized. We will send you a copy of your finalized contract via email, authorizing you to begin your approved
project.
Don't forget to checkout our website for the latest policies, EMPG guidance and forms:
http://www.mass.gov/eopsslagencies/mema/resources/grants/`empg/
Thank you, and please let me know if you have any questions on this.
Lord Gifford
Grants Management Specialist
Massachusetts Emergency Management Agency
400 Worcester Road
Framingham, MA 01702-5399
Desk:508.820.1407
Fax: 508.820.2030
lorri Rifford@massmail.state.ma.us