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: 205421F2-44A2-4B60-B32A-147638246D53
0.00
127
3100932-59324
6-19
0.00
extension contract. preparation and submittal to the
Massachusetts Historical Commission and United States Department
of the Interior for a National Historic District in Florence
$5,000.00
Borrowing
3 years from contract execution
0.00
$5,000.00
$5,000.00
0.00
0.00
Flore
Abolition
Hist Dist
The Committee for Northampton, Inc
CPA c/o Planning & Sustainability
0.00
X
X
0.00
0.00
Grant
45403
0.00
Revolving 0.00
Carolyn S. Misch 3/21/2023 | 2:04 PM EDT
3/21/2023 | 2:09 PM EDTJoyce Karpinski
William Coffey 3/22/2023 | 10:02 AM EDT
Charlene Nardi 3/22/2023 | 12:08 PM EDT
3/22/2023 | 1:15 PM EDTGina-Louise Sciarra
50-20-1