blank vendor cover-DS-1.doc.pdfMayor’s/CP docs/Procedures/VENDOR.COVER SHEET.UPDATED.6-02 cp
City of Northampton
Vendor Contract Cover Sheet
(To Accompany All City Contracts to City Auditor, Purchasing and Mayor’s Office)
1. Department and/or Division Name:
2. Vendor Name:
3. Munis Vendor I.D.#:____________ Department Contract # (if any):
4. Source and Amount of Funds: Please Fill in Below
Source: (Please check
all that apply) Account
Name:
Account
Number:
Amount: Total Per
Source
Budget:
Total of Contract
5. Period of Contract Coverage (If Applicable) ___________________________________________
6. Brief Description of Goods and/or Services being provided (e.g., Is this a part of a larger project,
stand alone, or is it an amendment to a contract?):
7. Does the vendor have a Northampton Office: ____ Yes _ No
(if local) Taxes owed: ____ Yes ____ No
8. Please list time and dates that contracts were delivered:
Signature Date
Department Head, _________________ ___ _______________
Auditor, _________________________ ___ _______________
Chief Procurement Officer, __________ _____________________ _______________
Finance Director, __________________ ___ _______________
Mayor ___________________________ ___ _______________
Contract #:
DocuSign Envelope ID: E32FA40A-5164-44D1-9672-0BC33174F036
15,000
0.00
Borrowing
X
preparation of a formal survey of the Massachusetts length of
the Canal and related inventory documentation
0.00
Revolving
0.00
3 years from execution
0.00
0.00
Grant
X
3100932-59325
4-22 0.00
Pioneer Valley Planning Commission
Office of Planning & Sustainability
0.00
8749 r1
15,000
0.00
0.00
0.00
CPA Canal
146
15,000
1/26/2022 | 5:26 PM ESTWayne Feiden, Director of Planning & Sustainability
1/27/2022 | 9:02 AM ESTJoyce Karpinski
1/31/2022 | 9:31 AM ESTJoe Cook
Charlene Nardi 1/31/2022 | 8:29 PM EST
2/1/2022 | 8:54 AM ESTGina-Louise Sciarra
216-22