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: 36FC1AF2-B019-4466-991C-ED9264F627FB
0.00
Grant
Mortgage
Subsidy VCDC
0.00
0.00
0.00
Alexis Breiteneicher
230,100
X
0.00
X
3 years from execution
3100933-59333
8-22
Borrowing
22835
direct home purchase downpayment assistance through a deferred
(interest and principal) payment loans each to four homebuyers
earning less than 100% of area median income
230,100
0.00
0.00
Valley Community Development Corporation
0.00
0.00
230,100
155
0.00
Revolving
Wayne Feiden, Director of Planning & Sustainability2/17/2022 | 12:16 PM EST
Joyce Karpinski 2/17/2022 | 12:18 PM EST
2/23/2022 | 9:42 AM ESTJoe Cook
2/23/2022 | 9:45 AM ESTCharlene Nardi
2/23/2022 | 10:52 AM ESTGina-Louise Sciarra
236-22