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2026FIFAPublicHealth_FEC_Award — File 26-1130

File 26-1130·9 pages·📄 Original PDF (city portal)·sha256 28759902f045…
Enclosed please find an Engagement Contract package for you to review and sign via DocuSign. Please take note of the following: • NEW ENGAGEMENT CONTRACT/AMENDMENT/RENEWAL FORM This form must be signed with an authorized signatory, dated, and returned via DocuSign. All attachments must be completed for your contract package to be processed. If you have programmatic questions about your engagement contract package, please contact your Bureau Program Manager Please sign with an authorized signatory and return the contract package via DocuSign no later than close of business on The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108 MAURA T. HEALEY Governor KIMBERLEY DRISCOLL Lieutenant Governor Attn: R/E: Contract #: KIAME MAHANIAH, MD, MBA Secretary ROBERT GOLDSTEIN, MD, PhD Commissioner Tel: [phone removed] www.mass.gov/dph 06/18/2026 CITY OF SOMERVILLE 93 HIGHLAND AVE SOMERVILLE, MA 02143 Lauren Mahoney INTF1200P01236938373 The Massachusetts Department of Public Health, DPH Offices is awarding you an engagement contract in accordance with RFQ# 262369380326 - Local Public Health Funding for FIFA 2026 World Cup Community Events. The engagement contract will be in effect through 09/30/2026. Diana Acosta at Diana.C.Acosta@mass.gov. 6/22/2026. Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
Sincerely, Bureau Director Sam Wong Office of Local and Regional Health Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
Award Letter Additional Information Contract ID#: INTF1200P01236938373 This will be a special circumstance that there will be only one payment voucher due to time constraints of FIFA events. Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
DPH MASTER AGREEMENT ENGAGEMENT FORM Vendor Code: Vendor Email: Procurement No: Bureau: Engagement Contract ID: Vendor Name: Vendor Contact: Master Agreement Id: Procurement Name: New Dates of Service: Anticipated Start Date*: End Date: Total Engagement Maximum Obligation attached Vendor response RFQ NOI Confidentiality Agreement Amendment Original Start Date: Current End Date: New End Date: Current Total Engagement Maximum Obligation Engagement Amendment Amount (+ or -) New Total Engagement Maximum Obligation DPH MA PP Budget Attached Expenditures must be made in accordance with the approved budget for this engagement and the terms and conditions of the procuring agency’s RFR and contract. Periodic Scheduled Payment Installments: Payments will be made upon the submission of a payment voucher(s) that are complete and that include appropriate documentation in accordance with the terms of the service scope and governing contract. Expenditure Reporting: Triannual or quarterly narrative reports and expenditure reports Funding: Funding for this engagement is subject to the appropriation of funds by the Massachusetts legislature or the federal government for the year(s) in which services are delivered. Changes to Scope and /or Terms: Any changes to this engagement must be agreed upon in writing by both parties. Termination: The Department, upon prior written notice, may terminate this engagement without cause and without penalty, or may terminate or suspend an engagement if the vendor breaches any material term or condition or fails to perform or fulfill any material obligation required by this engagement, or in the event of an elimination of an appropriation or absence of sufficient funds for the purposes of an engagement, or in the event of an unforeseen public emergency mandating immediate department action. Vendor Authorized Signature _______________________________________________ Authorized Vendor Signature and Date _______________________________________________ Print Name and Title Department Authorized Signatures __________________________________________________ Authorized DPH Bureau Representative Signature and Date __________________________________________________ Print Name and Title * The effective start date of this Engagement or Amendment shall be the latest date this document has been executed by an authorized signatory of the Vendor, the Department or a later Engagement or Amendment start date specified above NOI RFQ Amendment Type: DPH Program Manager Email: DPH Program Manager: PUBLIC HEALTH SERVICES AT THE LOCAL AND REGIONAL LEVEL INTF1200P01236938373 236938 VC6000192138 DPH Offices $14,974.64 Diana.C.Acosta@mass.gov 262369380326 09/30/2026 Diana Acosta CITY OF SOMERVILLE 07/01/2026 lmahoney@somervillema.gov MUNICIPALPHSERVICES0 Lauren Mahoney Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
Scope of Services Contract ID#: Created 7/11/2011/Updated Oct 7, 2011 New Contract INTF1200P01236938373 Local Public Health Funding for FIFA 2026 World Cup Community Events Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
Contract Conditions Contract ID#: Provider Name: Signature: Date: _____________________________________________ ___________________ CITY OF SOMERVILLE We have read and will adhere and comply to the requirements in the attached Contract Conditions and Attachments. INTF1200P01236938373 Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
CONDITIONS City of Somerville RFQ File Name/Title: Local Public Health Funding for FIFA 2026 World Cup Community Events RFQ File Number: 262369380326 FIFA 2026 World Cup public viewing or fan-based community events (e.g. watch parties- organized public viewing events where matches are shown in parks, community centers, or other public spaces) in need of one-time funding (up to $15,000 per community event ) to support local public health (LPH), including but not limited to: LPH staffing, translation, supplies, and handwashing station rentals. Allowable Expenses • Local public health staffing beyond existing staffing levels (e.g. overtime or consultants) to support FIFA community events. For example, contracted inspectors to inspect increased food truck presence. • Condoms • Aloe vera lotion/cream • Rental of handwashing stations • Cooling/misting tents • Contracted inspectors • Translation services Municipalities may propose additional allowable expenses in their responses with justification; All proposed expenses are subject to OLRH final approval. All requested costs must be related to FIFA community events. Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
Department of Public Health Department of Public Health New Budget Only Workbook Should be saved as .XLSM file Format (workbook contains MACROS) Vendor Name DPH Bureau/Program Name Fiscal Year 2027 RFR# RFQ 262369380326 FTE NEW BUDGET Brief Justification $ $ $ $ $ $ $ $ - $ SUB TOTAL 0.00 $ - Fringe Benefits #DIV/0! 1. TOTAL PROGRAM STAFF $ - Program Component New Budget $ $ $ 14,974.64 water, hand sanitizer, sunscreen packets, bug repellant for community FIFA events (see quote) $ $ $ $ $ $ $ 2. TOTAL NON PERSONNEL $ 14,974.64 3. OCCUPANCY Program Facility $ - $ - 3. TOTAL OCCUPANCY $ - SUB TOTAL: 1 + 2 + 3 $ 14,974.64 Administrative Support Max Cap Amount: 0.00% 4. AGENCY ADMIN. SUPPORT $ - 5.PROGRAM SUPPORT* $ TOTAL 1+ 2 + 3 + 4 + 5 $ 14,974.64 City of Somerville, HHS Office of Local and Regional Health FIFA Community Events Vendor Code Today's Date VC6000192138 06/12/26 Contract Number INTF1200P01236938373 Program Component 1. Program Staff 2. NON PERSONNEL (Consultants - Consultant worksheet required), subcontractors, supplies, Brief Justification Enter the total dollar amount of Fringe Benefits (the percentage will be calculated) Consultant: Individual Consultant: Organization Subcontractors (Attach Subcontractor Identification List For Direct or Non-Direct Care Services public health supplies Brief Justification Enter the total dollar amount of Administrative Support (the percentage will be calculated) *Program Support: This component is for direct administrative program support that is associated with a single program(s) and NOT allocated across programs as an indirect cost or identified in admin support. Facility Operations, Maint. and Furn. Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB
PAYMENT VOUCHER - 1 The Commonwealth of Massachusetts Department /Organization Name Office of the Comptroller Revision Date 8/22/95 by VG Document ID Trans Dept R/Org Number PV Date Acctg Prd BFY Vendor Name and Address Action(E) Sch Pay Date Off Liab Acct Vendors’ Certification NAME: I certify that the goods were shipped or the ADDRESS: service rendered as set forth below. Ref Doc ID (Please sign in ink) Document Total Stxt Payment Ref Number Emp Vendor Code Reference Order Line Quantity Description Amount REFERENCE DOC ID LN Trans Dept R/Org Number Line Dept Approp Sub Org S/Org Obj Prog Ty Proj/Cl/Grc Actv Rpfg Fund BS Acct Payment Reference Number Description MSA# Line # Disc Quantity Line Amount I/D P/F Dates of Service TO THE COMPTROLLER OF THE COMMONWEALTH OF MASSACHUSETTS: INSTRUCTIONS I hereby certify under the penalties of perjury that all laws of the Commonwealth governing disbursements of public funds and the regulations thereof have been complied with and observed. TO VENDORS Prepared By: Title: Date: • Sign Payment Voucher • Direct inquires to state organization • Retain copy Entered By: Title: Date: Pg of The undersigned authorized signatory approving this document certifies that this document and any attachments are accurate and complete and comply with all applicable general and special laws and regulations. Approved By: Title: Date Phone #: DPH/OFF PRC DPH OFF INTF1200P01236938373 - 1 $14,974.64 INTF1200P01236938373 - 1 PRC DPH OFF INTF1200P01236938373 - 1 VC6000192138 $14,974.64 Local Public Health Funding for FIFA 2026 World Cup Community Events CITY OF SOMERVILLE 93 HIGHLAND AVE SOMERVILLE, MA 02143- 1740 Docusign Envelope ID: 043A87E0-04E0-8237-8036-49E30D309BEB