18-09Nth Contract Docs for SignatureCOMMONWEALTH OF MASSACHUSETTS
CONTRACTOR AUTHORIZED SIGNATORY LISTING
CONTRACTOR LEGAL NAME: City of Northampton
CONTRACTOR VENDOR/CUSTOMER CODE: VC6000192124
Issued May
2004
INSTRUCTIONS: Any Contractor (other than a sole-proprietor or an individual contractor) must provide a listing of
individuals who are authorized as legal representatives of the Contractor who can sign contracts and other legally binding
documents related to the contract on the Contractor’s behalf. In addition to this listing, any state department may require
additional proof of authority to sign contracts on behalf of the Contractor, or proof of authenticity of signature (a notarized
signature that the Department can use to verify that the signature and date that appear on the Contract or other legal
document was actually made by the Contractor’s authorized signatory, and not by a representative, designee or other
individual.)
NOTICE: Acceptance of any payment under a Contract or Grant shall operate as a waiver of any defense by the
Contractor challenging the existence of a valid Contract due to an alleged lack of actual authority to execute the
document by the signatory.
For privacy purposes DO NOT ATTACH any documentation containing personal information, such as bank account
numbers, social security numbers, driver’s licenses, home addresses, social security cards or any other personally
identifiable information that you do not want released as part of a public record. The Commonwealth reserves the right to
publish the names and titles of authorized signatories of contractors.
AUTHORIZED SIGNATORY NAME TITLE
I certify that I am the President, Chief Executive Officer, Chief Fiscal Officer, Corporate Clerk or Legal Counsel for the
Contractor and as an authorized officer of the Contractor I certify that the names of the individuals identified on this listing
are current as of the date of execution below and that these individuals are authorized to sign contracts and other legally
binding documents related to contracts with the Commonwealth of Massachusetts on behalf of the Contractor. I understand
and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state
department with which the Contractor does business whenever the authorized signatories above retire, are otherwise
terminated from the Contractor’s employ, have their responsibilities changed resulting in their no longer being authorized
to sign contracts with the Commonwealth or whenever new signatories are designated.
_________________________________ _______________________________
Signature Date
__________________________________ ________________________________
Title Telephone
_________________________________ ________________________________
Fax e-mail
[Listing can not be accepted without all of this information completed.]
A copy of this listing must be attached to the “record copy” of a contract filed with the department
MayorDavid J. Narkewicz
Mayor 413-587-1049
Mayor@NorthamptonMA.gov
David J. NarkewiczMayor
Wayne Feiden Director Planning and SustainabilityWayne Feiden, FAICP, Director of Planning & Sustainability210 Main Street Northampton 01060413-587-1265 WFeiden@NorthamptonMA.govDavid J. Narkewicz, Mayor210 Main Street Northampton 01060413-587-1049Mayor@NorthamptonMA.gov
David J. Narkewicz Mayor
Federal Funding Accountability and
Transparency Act Compliance Form
Please complete and return this form with contracts.
Part 1. In order to comply with the Federal Funding Accountability and Transparency Act (FFATA), the
Massachusetts Emergency Management Agency may only award grants and contracts to entities with the
Dun and Bradstreet Data Universal Numbering System numbers (DUNS). DUNS numbers are used as
identifiers for tracking purposes and to validate address and point of contact information for federal
assistance applicants, recipients, and sub-recipients. The DUNS number will be used throughout a grant’s life
cycle. Please consult your accounting department to obtain your organization’s nine-digit DUNS number. If
necessary, you may obtain one by calling 1-866-705-5711 or by applying online at
http://fedgov.dnb.com/webform/displayHomepage.dio.
Table 1. Award Information
Name of Entity Receiving Award City of Northampton
Street Address 210 Main Street
City, State, Zip Northampton, MA 01060
Contact Name David Narkewicz, Mayor
Contact Phone Number (413)587-1266
Congressional District 2nd
Amount of Award $25,000.00
Nine-Digit DUNS Number 079217444
Transaction Type Reimbursement
CFDA number or NAICS code 97.047
Program Source Pre-Disaster Mitigation Competitive
Award Title Hazard Mitigation Plan Update
Part 2. FFATA requires information be collected regarding executive compensation. If the gross revenue of
your organization exceeds $25,000,000, more than 80% of the gross revenue is from federal sources, and the
public does not have access to this information through other government reports the names, titles, and
salaries of the executives with the five highest salaries must be provided. If your organization meets these
criteria, please complete Table 2. If your organization does not meet these criteria, please check the statement
above the table.
_____ The gross revenue of my organization does not exceed $25,000,000 and more than 80% of the gross
revenue of my organization is not from federal sources and or compensation information is available
to the general public.
OR
Table 2 Executive Compensation (by Salary)
First and Last Name Title Annual Salary
_______________________________________ ____________________________
Signature of authorized official (signed in blue ink) Date
_______________________________________ ____________________________
Printed name of Authorized Official Title
Information is available to the public on the City's website,
www.NorthamptonMA.gov, Mayor's landing page.
David J. Narkewicz Mayor