NCMC Fair Wage.docx.pdfCity of Northampton
Community Preservation Committee
210 Main Street, City Hall
Northampton, MA 01060
Fair Wage Compliance Certificate
Grantee Information Please Print Legibly_
Project Name: Northampton Community Music Center Exterior Rehabilitation
Business/Organization Name: Northampton Community Music Center
Address: 139 South Street
City/State/Zip: Northampton MA 01060
Phone #: 413-585-0001
The Northampton Community Preservation Committee requires certification of compliance with wage and hour laws
prior to issuance of contracts involving CPA funds. Each grantee must certify that they are not subject to a federal
or state criminal or civil judgment, administrative citation or final administrative determination resulting from a
violation of M.G.L. c149, c150, or the Fair Labor Standard Act. Any grantee who does not certify to the above may
be required by the City of Northampton to provide a wage bond or insurance prior to issuance of a contract for CPA-
funded work. Grantees shall obtain from any general contractor or construction supervisor a Fair Wage Compliance
Certification and shall require that such general contractor or construction manager obtain such Certification from
each subcontractor on the project. These certifications shall be provided to the CPC.
Grantees / contractors must check box 1 or box 2 as applicable and must sign this Form, certifying compliance with
the requirements set out in this Form.
This grantee/contractor is not subject to a federal or state criminal or civil judgment, administrative
citation, order or final administrative determination resulting from a violation of G.L. c. 149, c. 151, or
the Fair Labor Standards Act within the last five years.
This grantee/contractor is subject to a federal or state criminal or civil judgment, administrative citation,
order or final administrative determination resulting from a violation of G.L. c. 149, c. 151, or the Fair
Labor Standards Act within the last five years. This grantee will provide a wage bond or wage insurance
for the period of the contract.
Jason Trotta ______________________________
(Typed or printed name of person signing) Signature
________________________________
Date
DocuSign Envelope ID: FD9408DE-38A0-4AF4-A89B-79C5FF7F2CD8
3/1/2023 | 8:28 AM PST
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