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: 1390193F-8879-4A39-A8A0-61A49A6F1475
3100932-59325
9-23
0.00
0.00
Community Preservation c/o Office okf Planning & Sustainability
500,000
X
Borrowing
0.00
500,000
0.00
Exterior repairs and rehabilitation to the former st john cantius
church at 20 hawley street
0.00
Revolving
500,000
X
20 Hawley Street LLC
0.00 0.00
0.00
159
20 Hawley
Rehab
0.00
Grant 0.00
3 years from contract execution
51525
Carolyn S. Misch 9/22/2023 | 10:11 AM EDT
Joyce Karpinski 9/22/2023 | 10:37 AM EDT
9/22/2023 | 2:44 PM EDTWilliam Coffey
9/22/2023 | 5:03 PM EDTCharlene Nardi
Gina-Louise Sciarra 9/22/2023 | 6:27 PM EDT
140-24