RFR 2009 - Phase I Response Template.docx

[Insert Company Name]

[Company name] Response to Massachusetts State Lottery Commission Request for Response for Corrugated Boxes

RFR LOT# 2009

Submitted on [date of submittal]

Response Due Date: January 10, 2020 at 3:00 PM EST

Response Checklist

Template Page Number

Disclosure Statement

10-12

Certificate of Compliance Concerning Personal Data and Personal Information

General Instructions – MUST BE FOLLOWED Instructions: The following pages are the exact form and format that all responses are to follow and use. For each form or document there is a brief “Instructions” section that precedes the form or document giving bidders as much information as possible explaining how to fill in the form. Please follow these instructions exactly.

Do not change the order of the forms or documents when providing a response. If you must separate your response into different files due to size or logistical constraints, please provide the files in a manner that retains the sequence defined herein and name the files [Bidder Name] - File x of y, where “x” is the sequence of the files and “y” is the total number of separate files.

Please make sure that all signatures on all forms are listed in the table at the top of the form called “Contractor Authorized Signatory Listing.” There should be no signature on any form that is not listed in that table. Also, please make sure you fill in all required lines, boxes, etc. on each form as the instructions dictate.

Do not put any cost related information in the main portion of the response. All cost related information, either direct, or that can be derived, must only be in the cost proposal portion of the response.

Do not delete or remove any forms. All forms are REQUIRED even if in some cases you are simply signing the form or you feel the form does not apply to your company. There is no form or submission that is considered optional. If you need to separate the forms in order to get them signed and scanned either put them in the file (PDF) in the same order or add them as a separate file as indicated above.

Cover Letter Instructions Instructions: Fill in the cover letter as detailed below making sure that the appropriate blanks are filled in, and that the signature block is fully filled in and signed by an individual with the authority to bind the company contractually. Such person should be listed in the table on the upper half of the Contractor Authorized Signatory Listing form.

Do not list multiple names for the “Primary Point of Contact.”

Cover Letter [Insert Company Logo if desired] Company Name:

Company Address:

Name of Primary Contact:

Title of Primary Contact:

Address of Primary Contact:

Phone Number of Primary Contact:

Email Address of Primary Contact:

Confirmation of Key RFR Requirements Instructions: Checking the boxes below confirms acceptance of these proposal commitments. Any unchecked items can be considered grounds for elimination from this procurement. This form must to be signed by a person who has authority to legally bind the company and is listed on the Contractor Authorized Signature Verification form.

· This proposal is a company and irrevocable offer that will be valid for 150 days from the date of submission.

· Bidder confirms that it agrees with and its proposal is in conformance with all requirements and terms in this RFR.

· Bidder confirms that the signature below binds the Company to all statements, enclosures and attachments contained within this proposal response document.

Statement of Minimum Qualifications Instructions: Check each minimum qualification that your company meets. If your company meets the qualification (by checking the box), state the basis for your company’s affirmative assertion. If your company does not meet the qualification as stated, provide information explaining why this minimum qualification does not apply to your company. It is in the PMT’s sole discretion to determine if a minimum qualification will result in disqualification.

· Bidder must have been in a business similar to that described in this Request for Response for a minimum of three (3) years within the industry and have demonstrated experience and capacity to handle the requirements herein.

[Replace this text with either your basis for your positive assertion (e.g. what is the basis for checking the box above, or the reason why this minimum qualification does not apply to your company for this procurement].

· Bidder must acknowledge its understanding that the Lottery cannot accept a delivery that exceeds 5% of the requested order.

[Replace this text with either your basis for your positive assertion (e.g. what is the basis for checking the box above, or the reason why this minimum qualification does not apply to your company for this procurement].

Representations and Warranties Compliance with all criteria listed below is mandatory in order for a bid to be accepted for further review. Lack of compliance may result in disqualification of the Bidder.

Note: By checking each box your company confirms that the submitted bid meets these requirements. This form should be signed by an authorized signatory of your company.

· Our company warrants that all of the information it provides in its response to the RFR is true and correct and does not omit any material facts or information that is responsive.

· Our company warrants that it carries a fidelity bond that will be applicable to respondent's actions under the Contract. (Provide a copy of a Certificate of Liability Insurance indicating that all employees who perform work under the contract are covered, unless exempt and an explanation of the exemption is attached).

· Our company warrants that it will not delegate its responsibilities assumed under the Contract without prior written approval from the MSLC.

· Our company warrants that it has not been in bankruptcy and/or receivership within the last three (3) calendar years.

· Our company warrants that it has completed, obtained and performed all registrations, filings, approvals, authorizations, consents or examinations required by a government or governmental authority for acts contemplated by the Contract.

· Our company warrants that it will adhere to the fee prices and/or discounts outlined in the Cost Proposal, any subsequently requested Best and Final Offer and any Contract.

· Our company warrants that it agrees to meet every specification, requirement or condition set forth in the RFR and any additional contract document executed by the parties.

· Our company warrants that it shall maintain workers compensation insurance, vehicle insurance if providing actual delivery, and general liability insurance.

Legal and Other Requirements Instructions: Confirm by checking each legal and other requirement. Where an item cannot be checked as 100% compliant, provide an explanation or clarification of why the item could not be checked or where there are stipulations on the verification of the requirement as stated.

· Solvency: Our Company has not been in bankruptcy and/or receivership within the last three calendar years.

· Company’s State of Incorporation/Organization: [Insert state name or if not incorporated identify the company’s legal structure.]

· Corporate Good Standing: Our Company is in good standing in our state of incorporation / organization and has complied with all filing requirements of the state of incorporation / organization. If the state of incorporation / organization is not Massachusetts, our company agrees to comply with all filing requirements of the Secretary of the Commonwealth within thirty days of contract award if selected.

· Licenses and Registrations: Our Company meets all applicable state and federal requirements, and has all the licenses and registrations necessary to perform the contract.

· Pending Litigation (None): There are no material judgments, criminal convictions, investigations or litigations pending against our company or any of its officers, partners, or employees of which our company is aware. The Massachusetts State Lottery Commission (“MSLC”) reserves the right to reject a response based on this information. If separate responses are required for different divisions or subsidiaries of the Bidder, the Bidder must submit a separate response for each division or subsidiary.

· Pending Litigation (Yes): Our Company is aware of the following material judgments, criminal convictions, investigations and/or litigations pending against our company and/or any of our officers, partners, or employees.

[List and detail any pending litigation here.] The MSLC reserves the right to reject a response based on this information. If separate responses are required for different divisions or subsidiaries of the company, the company must submit a separate response for each division or subsidiary.

· Compliance with RFR Requirements: Our Company agrees to meet every specification, requirement or condition set forth in the RFR.

· Cease and Desist: If selected for any services solicited through this RFR, the company agrees to immediately notify the MSLC of any cease and desist order issued.

· Confidentiality: Our Company acknowledges that all materials and information provided to the Contractor by the MSLC or acquired by the Contractor on behalf of the MSLC shall be regarded as confidential information in accordance with federal and state law, and ethical standards. The Contractor must take all necessary steps to safeguard the confidentiality of such materials or information.

· Limitation of Liability and Indemnification: MSLC shall not be liable to our company under any theory of liability for any direct or indirect damages that may be incurred from shipping and delivery of our company’s productions. To maximum extent permitted by law, our company agrees to defend, indemnify and hold harmless the MSLC, its directors, officers and employees from and against any and all third party claims, actions, suits, or proceedings arising out of or accruing from any violation of this agreement and our product infringing upon any patent or any other intellectual property right of any person or entity which arises out of any breach of warranty or representation.

COMMONWEALTH OF MASSACHUSETTS

MASSACHUSETTS STATE LOTTERY COMMSSION

Disclosure Statement Instructions: Companies seeking to provide professional services (the “engagement”) to the Massachusetts State Lottery Commission (“MSLC”) must complete a disclosure statement providing complete and accurate responses to the questions below. Companies selected to provide such services have a continuing obligation to update responses to these questions, in writing, immediately upon any change to such responses. The questions in this Disclosure Statement should be read broadly, and any perceived ambiguity should be resolved in favor of disclosure. Any questions concerning the disclosures required should be directed to the MSLC.

Note: The total response to this disclosure should not exceed four single-sided pages.

1. Provide a general description of your company’s organizational structure, identify any members of the management committee, officers and/or directors, and, for any affiliate entities, the managing partners, officers, and directors (all such individuals or entities hereinafter collectively referred to as the “Company”).

[Insert response here.]

2. Identify any relationship of the company, its joint ventures, consultants, lobbyists, subcontractors or third-party contractors that relate in any way to the engagement.

[Insert response here.]

3. Aside from the engagement, describe any services provided by the Company to the Commonwealth.

[Insert response here.]

4. Aside from the services described in response to Question 3, above, describe any services and/or donations provided by the company to the Office of the State Treasurer and Receiver General or any trust, board, commission or authority of which the State Treasurer and Receiver General is a member or trustee by virtue of her office. (A list of such entities is attached as Appendix A to the Disclosure Statement.)

[Insert response here.]

5. Aside from the services and/or donations described in responses to Questions 3 and 4, above, describe any services provided by the company to any of the political subdivisions of the Commonwealth.

[Insert response here.]

6. Did or will the company provide or share, agree to provide or share, or arrange to provide or share any compensation or benefit, direct or indirect, to any individual or entity for assisting the company in:

If the answer to Question 6 is “yes,” provide for each the individual or entity:

[Insert response here.]

7. Does the company have any ongoing relationship, arrangement or agreement with any individual or entity with respect to sharing compensation for services to:

If the answer to Question 7 is “yes,” provide for each such individual or entity:

[Insert response here.]

Signed under the penalties of perjury this _______day of ________________, 2018.

Signature: __________________________________________

Title: __________________________________________

Appendix A to the Disclosure Statement

TREASURER’S PRINCIPAL BOARDS, COMMISSIONS AND AUTHORITIES*

1. Advisory Board to the Comptroller – M.G.L. c. 7A, § 2

2. State Retirement Board – M.G.L. c. 10, § 18

3. State Lottery Commission – M.G.L. c. 10, § 23

4. Board of Bank Incorporation – M.G.L. c. 26, § 5 (Division of Banks and Loan Agencies)

5. Water Pollution Abatement Trust (now known as the Clean Water Trust) – M.G.L. c. 29C, § 2

6. Pension Reserves Investment Management Board – M.G.L. c. 32, § 23(2A)

7. Massachusetts Convention Center Authority – Chapter 190 of the Acts of 1982 § 31-48

8. Massachusetts School Building Authority – M.G.L. c. 70B, §§ 1A & 3A; see also M.G.L. c. 10, § 35BB

9. Teachers’ Retirement Board – M.G.L. c. 15, § 16

10. Alcoholic Beverages Control Commission – M.G.L. c. 10, § 70

11. Health Care Security Trust – M.G.L. c. 29D, § 4

12. Commissioners on Fireman’s Relief – M.G.L. c. 10, § 21

13. Economic Empowerment Trust Fund – M.G.L. c. 10, § 35QQ

* The above-listed Boards, Commissions or Authorities are any which are a Treasury Department, Division or Affiliated Entity or by statute have a position which may be held by the State Treasurer and Receiver General or her designee.

MANDATORY FORMS AND ENCLOSURES

Note: Each and every form in this section must be filled in. Where the form provides a signature line, the form must be signed. All signatures must be legible, please also print the person’s name next to the signature. All signatories must be listed as a valid authority of the organization as indicated on the Contractor Authorized Signatory Listing contained within this section.

Commonwealth Terms and Conditions

Instructions: The Commonwealth Terms and Conditions shall be incorporated by reference into any contract for services executed pursuant to this RFR. Click on the link below to open a copy of the Commonwealth Terms and Conditions Form. Please initial both pages and include in response submission. This form cannot be changed or modified.

Attachment A:

Standard Contract Form

Instructions: This form must be executed in order to be awarded a contract. This document shall not become a final contract unless and until the MSLC accepts the Bidder's response and the Standard Contract Form is executed by an authorized signatory of the MSLC. Click on the link below to open a copy of the Standard Contract Form. Fill in boxes highlighted in yellow. Please ensure you sign the form.

Attachment B:

Massachusetts Substitute W-9 Form

Instructions: Click on the link below to open a copy of the W-9 form. Follow the instructions and paste the filled in form on this page or provide as an attachment. Filling in the form and signing is required. You do not need to provide a copy of the 2nd page instructions.

Attachment C:

Contractor Authorized Signatory Listing

Instructions: Please note this form typically accounts for 80% of the cures necessary during procurements due to bidders not following the instructions. Please read all instructions carefully at the bottom of this page is a link to the proper Contractor Authorized Signatory Form. Follow the instructions below and paste the filled in form on this page or provide as an attachment. Filling in the form and signing is required. It is essential that the person signing the cover letter and all forms is listed on this form as a signature legally authorized to bind the company. Please enter your company’s name at the top of the form where it says “Contractor Legal Name”.

The person signing the proposal documents must be listed here.

This signature must be one of these corporate officers and Bidder must supply notarized corporate documents showing that the signatory has the right to delegate binding corporate authority.

Attachment D:

Tax Compliance Certification

Instructions: The Bidder must demonstrate that it is in compliance with all Federal and Commonwealth tax laws (regardless of corporate locations) including M.G.L. Chapter 62C, Section 49A. The Bidder must submit an original or photocopy of a Certificate of Tax Compliance in Good Standing, which has been issued by the Commonwealth of Massachusetts Department of Revenue (“DOR”) within the past year. This Certificate may be obtained by submitting a request to:

Taxpayer Services Division, Certificate Unit Department of Revenue PO Box 7066 Boston, Massachusetts 02204

(617) 887-6550

Even if the company has never had any business or tax registration in Massachusetts they still must submit to the Massachusetts DOR a request for a tax compliance certificate. If the Massachusetts DOR has no record of the bidder and is unable to provide a certificate of compliance they will provide such information to the bidder. However proof of requesting the certificate from the Massachusetts DOR is required.

The application must list the tax types for which the business is liable, including such items as meals, room occupancy, sales, use, withholding, corporate income and others as applicable. The issuance of the certificate normally takes several weeks and, as such, Bidders should indicate that their request for a certificate is sought in connection with a Commonwealth solicitation (with a deadline). If the Bidder does not submit the requested tax certificate with the proposal, the Bidder must submit documentation evidencing that the appropriate application has been filed. Evidence includes: facsimile transmittal, mailing receipt, receipt-stamped application, etc. The Certificate must be issued and provided to the Treasury prior to the final execution of the Standard Contract Form.

Simplified Instructions/Clarifications:

· A proper response to this requirement entails one of the following two submission requirements:

· If your company DOES NOT HAVE A CURRENT (within the past year) Massachusetts Compliance Certificate:

· If requested via FAX You must provide 2 things:

· A copy of the filled in request form that was sent to MA DOR. If this method is used, you simply need to print a copy of the request confirmation and insert an image or hardcopy in this response template.

· A copy of the transmission request. Make sure you retain a copy of the fax transmittal confirmation receipt and provide an image or Photocopy of the proof of transmittal along with a copy of the original form faxed.

· If you requested via the MA DOR Website at https://wfb.dor.state.ma.us/webfile/certificate/Public/Webforms/Welcome.aspx you only need to provide a screenshot or copy of the request confirmation showing the request number

· If your company DOES HAVE A CURRENT (within the past year) Massachusetts Compliance Certificate which is has a date of certificate no more than one year from your submission date of this proposal, then provide a copy of the certificate.

Do not provide a copy of the Secretary of State form from Massachusetts or your state of incorporation certifying that you are a registered corporation in your state or in Massachusetts. The form required is a Tax Compliance form that can only come from the Commonwealth of Massachusetts’ DOR. If you are not a registered tax-paying corporation in Massachusetts, the Massachusetts DOR will inform the requestor that a Certificate of Compliance cannot be provided. MA DOR not being able to provide a Certificate of Compliance to an unregistered company not doing business in Massachusetts is not grounds for disqualification.

Clicking on the link below is the PDF form to be sent to the Massachusetts DOR:

Attachment E:

Business Reference Form

Instructions: Bidders must identify three (3) customer references for which the Bidder has performed similar services to those described in this RFR or customers that can confirm the quality of the Bidder’s performance on previous contract work. Fill in the form below with the information for three (3) business references for which you have provided similar or related services as defined in this RFR:

Supplier Diversity Program

Instructions: Companies are required to fill in and submit these forms even if they choose not to participate in the program. If a company does not wish to participate they should only fill in the Bidder/Contractor Information of each and sign the form. Companies are welcome to cross out the other parts of the form to make it clear that they are not participating. Companies are not obligated to participate in this program. However, 5% of the scoring points are allocated to a high quality MSLC SDP.

Massachusetts Executive Order 524 established a policy to promote the award of state contracts in a manner that develops and strengthens Minority and Women Business Enterprises (M/WBEs) that resulted in the Supplier Diversity Program in Public Contracting. M/WBEs are strongly encouraged to submit Responses to this RFR, either as prime vendors, joint venture partners or other type of business partnerships. Similarly, Executive Order 546 established the Service-Disabled Veteran-Owned Business Enterprise (SDVOBE) Program to encourage the participation of businesses owned and controlled by service-disabled veterans in all areas of state procurement and contracting, thereby including them in the SDP. All Bidders must follow the requirements set forth in the SDP section of this RFR, which will detail the specific requirements relating to the prime vendor’s inclusion of M/WBEs and/or SDVOBEs. Bidders are required to develop creative initiatives to help foster new business relationships with M/WBEs and/or SDVOBEs within the primary industries affected by this RFR. In order to satisfy the compliance of this section and encourage Bidder’s participation of SDP objectives, the Supplier Diversity Program (SDP) Plan for large procurements greater than one hundred fifty thousand dollars ($150,000.) will be evaluated at 10% or more of the total evaluation. Once an SDP commitment, expressed as a percentage of contract revenues, is approved, the agency will then monitor the contractor’s performance, and use actual expenditures with Supplier Diversity Office (SDO) certified M/WBE contractors and the Center for Veterans Enterprise certified SDVOBEs to fulfill their own SDP expenditure benchmarks. M/WBE and SDVOBE participation must be incorporated into and monitored for all types of procurements regardless of size; however, submission of an SDP Plan is mandated only for large procurements over one hundred fifty thousand dollars ($150,000).

SDP Resources Resources available to assist prime Bidders in finding potential M/WBE partners can be found at www.mass.gov/sdp.

Resources available to assist prime Bidders in finding potential SDVOBE partners can be found on the Operational Services Division’s SDO webpage at www.mass.gov/sdo.

The Operational Services Division’s Supplier Diversity Program offers training on the SDP Plan requirements. The dates of upcoming trainings can be found at:www.mass.gov/anf/budget-taxes-and-procurement/procurement-info-and-res/osd-events-and-training/osd-training-and-outreach.html. In addition, the SDP Webinar can be located on the SDP website at www.mass.gov/SDP.

Supplier Diversity Program Subcontracting Policies In addition to the Subcontracting Policies (see Subcontracting Policies section below and see Subcontracting By Contractor, in the Commonwealth Terms and Conditions) that apply to all subcontracted services, agencies may define specific required deliverables for a contractor’s SDP Plan, including, but not limited to, documentation necessary to verify subcontractor commitments and expenditures with Minority- or Women-Owned Business Enterprises (M/WBEs) and Service-Disabled Veteran-Owned Business Enterprises (SDVOBE) for the purpose of monitoring and enforcing commitments made in a contractor’s Supplier Diversity Program (SDP) Plan.

Attachment G:

Invest in Massachusetts Plan

Instructions: The MSLC encourages investment in our local economy and is committed to advancing the creation and preservation of jobs in the Commonwealth. Companies are required to fill in and submit this form even if they choose not to participate in the program. If a company does not wish to participate they should fill in Part I completely and in Part II check the “no” box. Companies are welcome to cross out the other parts of the form to make it clear that they are not participating. Companies are not obligated to participate in this program. However, 5% of the scoring points are allocated to a high quality Invest in Massachusetts plan.

A link for the Invest in MA response form is located below. Provide the form (not the instructions also included in a link below) along with your response in this section.

Attachment H:

Certificate of Non-Collusion

Instructions: Bidders are advised that they are required to certify that the bid that they are submitting has not been arrived at because of any collusive activity. A link to the Certificate of Non-Collusion response form is located below. Insert a signed version of this form here (either as a pasted image or as a hardcopy).

Attachment I:

Insurance Policy

Instructions: Bidders are required to provide a copy or proof of any fidelity bond or liability insurance policy extending to any or all employees who perform work under the contract.

EFT Form Attachment J:

Prompt Payment Discount Form Attachment K:

Certificate of Compliance Concerning Personal Data and Personal Information Attachment L:

StandardContractFormAndInstructions.pdf

COMMONWEALTH OF MASSACHUSETTS ~ STANDARD CONTRACT FORM

(Updated 10/25/2019) Page 1 of 1

This form is jointly issued and published by the Office of the Comptroller (CTR), the Executive Office for Administration and Finance (ANF), and the Operational Services Division (OSD) as the default contract for all Commonwealth Departments when another form is not prescribed by regulation or policy. The Commonwealth deems void any changes made on or by attachment (in the form of addendum, engagement letters, contract forms or invoice terms) to the terms in this published form or to the Standard Contract Form Instructions, Contractor Certifications and Commonwealth Terms and Conditions which are incorporated by reference herein. Additional non-conflicting terms may be added by Attachment. Contractors are required to access published forms at CTR Forms: https://www.macomptroller.org/forms. Forms are also posted at OSD Forms:

https://www.mass.gov/lists/osd-forms.

CONTRACTOR LEGAL NAME:

(and d/b/a):

COMMONWEALTH DEPARTMENT NAME:

MMARS Department Code:

Legal Address: (W-9, W-4): Business Mailing Address:

Contract Manager: Phone: Billing Address (if different):

E-Mail: Fax: Contract Manager: Phone:

Contractor Vendor Code: VC E-Mail: Fax:

Vendor Code Address ID (e.g. “AD001”): AD .

(Note: The Address ID must be set up for EFT payments.)

MMARS Doc ID(s):

RFR/Procurement or Other ID Number:

___ NEW CONTRACT

PROCUREMENT OR EXCEPTION TYPE: (Check one option only) __ Statewide Contract (OSD or an OSD-designated Department) __ Collective Purchase (Attach OSD approval, scope, budget) __ Department Procurement (includes all Grants - 815 CMR 2.00) (Solicitation

Notice or RFR, and Response or other procurement supporting documentation) __ Emergency Contract (Attach justification for emergency, scope, budget) __ Contract Employee (Attach Employment Status Form, scope, budget) __ Other Procurement Exception (Attach authorizing language, legislation with specific exemption or earmark, and exception justification, scope and budget)

___ CONTRACT AMENDMENT

Enter Current Contract End Date Prior to Amendment: , 20 .

Enter Amendment Amount: $ . (or “no change”) AMENDMENT TYPE: (Check one option only. Attach details of amendment changes.)

__ Amendment to Date, Scope or Budget (Attach updated scope and budget) __ Interim Contract (Attach justification for Interim Contract and updated scope/budget) __ Contract Employee (Attach any updates to scope or budget) __ Other Procurement Exception (Attach authorizing language/justification and updated scope and budget) The Standard Contract Form Instructions, Contractor Certifications and the following Commonwealth Terms and Conditions document is incorporated by reference into this Contract and are legally binding: (Check ONE option): __ Commonwealth Terms and Conditions __ Commonwealth Terms and Conditions For Human and Social Services COMPENSATION: (Check ONE option): The Department certifies that payments for authorized performance accepted in accordance with the terms of this Contract will be supported in the state accounting system by sufficient appropriations or other non-appropriated funds, subject to intercept for Commonwealth owed debts under 815 CMR 9.00.

__ Rate Contract. (No Maximum Obligation) Attach details of all rates, units, calculations, conditions or terms and any changes if rates or terms are being amended.)

__ Maximum Obligation Contract. Enter total maximum obligation for total duration of this contract (or new total if Contract is being amended). $ .

PROMPT PAYMENT DISCOUNTS (PPD): Commonwealth payments are issued through EFT 45 days from invoice receipt. Contractors requesting accelerated payments must identify a PPD as follows: Payment issued within 10 days __% PPD; Payment issued within 15 days __ % PPD; Payment issued within 20 days __ % PPD; Payment issued within 30 days __% PPD. If PPD percentages are left blank, identify reason: __agree to standard 45 day cycle __ statutory/legal or Ready Payments (M.G.L. c. 29, § 23A); __ only initial payment (subsequent payments scheduled to support standard EFT 45 day payment cycle. See Prompt Pay Discounts Policy.)

BRIEF DESCRIPTION OF CONTRACT PERFORMANCE or REASON FOR AMENDMENT: (Enter the Contract title, purpose, fiscal year(s) and a detailed description of the scope of performance or what is being amended for a Contract Amendment. Attach all supporting documentation and justifications.)

ANTICIPATED START DATE: (Complete ONE option only) The Department and Contractor certify for this Contract, or Contract Amendment, that Contract obligations:

__ 1. may be incurred as of the Effective Date (latest signature date below) and no obligations have been incurred prior to the Effective Date.

__ 2. may be incurred as of , 20 , a date LATER than the Effective Date below and no obligations have been incurred prior to the Effective Date.

__ 3. were incurred as of , 20 , a date PRIOR to the Effective Date below, and the parties agree that payments for any obligations incurred prior to the Effective Date are authorized to be made either as settlement payments or as authorized reimbursement payments, and that the details and circumstances of all obligations under this Contract are attached and incorporated into this Contract. Acceptance of payments forever releases the Commonwealth from further claims related to these obligations.

CONTRACT END DATE: Contract performance shall terminate as of , 20 , with no new obligations being incurred after this date unless the Contract is properly amended, provided that the terms of this Contract and performance expectations and obligations shall survive its termination for the purpose of resolving any claim or dispute, for completing any negotiated terms and warranties, to allow any close out or transition performance, reporting, invoicing or final payments, or during any lapse between amendments.

CERTIFICATIONS: Notwithstanding verbal or other representations by the parties, the “Effective Date” of this Contract or Amendment shall be the latest date that this Contract or Amendment has been executed by an authorized signatory of the Contractor, the Department, or a later Contract or Amendment Start Date specified above, subject to any required approvals. The Contractor certifies that they have accessed and reviewed all documents incorporated by reference as electronically published and the Contractor makes all certifications required under the Standard Contract Form Instructions and Contractor Certifications under the pains and penalties of perjury, and further agrees to provide any required documentation upon request to support compliance, and agrees that all terms governing performance of this Contract and doing business in Massachusetts are attached or incorporated by reference herein according to the following hierarchy of document precedence, this Standard Contract Form, the Standard Contract Form Instructions, Contractor Certifications, the applicable Commonwealth Terms and Conditions, the Request for Response (RFR) or other solicitation, the Contractor’s Response, and additional negotiated terms, provided that additional negotiated terms will take precedence over the relevant terms in the RFR and the Contractor’s Response only if made using the process outlined in 801 CMR 21.07, incorporated herein, provided that any amended RFR or Response terms result in best value, lower costs, or a more cost effective Contract.

AUTHORIZING SIGNATURE FOR THE CONTRACTOR:

X: . Date: .

(Signature and Date Must Be Handwritten At Time of Signature)

Print Name: .

Print Title: .

AUTHORIZING SIGNATURE FOR THE COMMONWEALTH:

X: . Date: .

(Signature and Date Must Be Handwritten At Time of Signature)

Print Name: .

Print Title: .

Massachusetts State Lottery Commission

LOT

150 Mount Vernon Street Suite 300 Dorchester, Ma 02125

Matthew DiFrancesco 781-849-5545

MDiFrancesco@MassLottery.com

RFR LOT# 2009

To provide Instant Ticket Acrylic Dispensers.

Didier Bertola

CFO

http://www.macomptroller.info/comptroller/docs/forms/contracts/standard-contract-frm.doc http://www.macomptroller.info/comptroller/docs/forms/contracts/standard-contract-frm.doc http://www.macomptroller.info/comptroller/docs/forms/contracts/2007-19-exec-order-481-cert.doc http://www.macomptroller.info/comptroller/docs/forms/contracts/comm-termsconditions.doc https://www.macomptroller.org/forms https://www.mass.gov/lists/osd-forms https://www.mass.gov/law-library/815-cmr http://www.macomptroller.info/comptroller/docs/forms/contracts/CommonwealthTermsAndConditions.pdf http://www.macomptroller.info/comptroller/docs/forms/contracts/CommonwealthTermsAndConditionsForHumanAndSocialServices.pdf https://www.mass.gov/law-library/815-cmr https://malegislature.gov/Laws/GeneralLaws/PartI/TitleIII/Chapter29/Section23A https://www.mass.gov/law-library/801-cmr

STANDARD CONTRACT FORM INSTRUCTIONS

CONTRACTOR CERTIFICATIONS

COMMONWEALTH TERMS AND CONDITIONS

Page 1 of 7 Issued 10/25/19

INSTRUCTIONS

The following Instructions, Contractor Certifications and the applicable Commonwealth Terms and Conditions are incorporated by reference into an executed Standard Contract Form. Instructions are provided to assist with completion of the Standard Contract Form. Additional terms are incorporated by reference. Links to legal citations are to unofficial versions and Departments and Contractors should consult with their legal counsel to ensure compliance with all legal requirements. Please note that not all applicable laws have been cited.

Contractor Legal Name (and D/B/A): Enter the Full Legal Name of the Contractor's business as it appears on the Contractor’s W-9 or W-4 Form (Contract Employees only) and the applicable Commonwealth Terms and Conditions. If Contractor also has a “doing business as” (d/b/a) name, BOTH the legal name and the “d/b/a” name must appear in this section.

Contractor Legal Address: Enter the Legal Address of the Contractor as it appears on the Contractor’s W-9 or W-4 Form (Contract Employees only) which must match the legal address on the 1099I table in MMARS (or the Legal Address in HR/CMS for a Contract Employee).

Contractor Contract Manager: Enter the authorized Contract Manager who will be responsible for managing the Contract. The Contract Manager should be an Authorized Signatory or, at a minimum, a person designated by the Contractor to represent the Contractor, receive legal notices and negotiate ongoing Contract issues. The Contract Manager is considered “Key Personnel” and may not be changed without the prior written approval of the Department. If the Contract is posted on COMMBUYS, the name of the Contract Manager must be included in the Contract on COMMBUYS.

Contractor E-Mail Address/Phone/Fax: Enter the electronic mail (e-mail) address, phone and fax number of the Contractor Contract Manager. This information must be kept current by the Contractor to ensure that the Department can contact the Contractor and provide any required legal notices. Notice received by the Contract Manager (with confirmation of actual receipt) through the listed address, fax number(s) or e-mail address will meet any written legal notice requirements.

Contractor Vendor Code: The Department must enter the MMARS Vendor Code assigned by the Commonwealth. If a Vendor Code has not yet been assigned, leave this space blank and the Department will complete this section when a Vendor Code has been assigned. The Department is responsible under the Vendor File and W-9s Policy for verifying with authorized signatories of the Contractor, as part of contract execution, that the legal name, address and Federal Tax Identification Number (TIN) in the Contract documents match the state accounting system.

Vendor Code Address ID: (e.g., “AD001”) The Department must enter the MMARS Vendor Code Address ID identifying the payment remittance address for Contract payments, which MUST be set up for EFT payments PRIOR to the first payment under the Contract in accordance with the Bill Paying and Vendor File and W-9 policies.

Commonwealth Department Name: Enter the full Department name with the authority to obligate funds encumbered for the Contract.

Commonwealth MMARS Alpha Department Code: Enter the three (3) letter MMARS Code assigned to this Commonwealth Department in the state accounting system.

Department Business Mailing Address: Enter the address where all formal correspondence to the Department must be sent. Unless otherwise specified in the Contract, legal notice sent or received by the Department’s Contract Manager

(with confirmation of actual receipt) through the listed address, fax number(s) or e-mail address for the Contract Manager will meet any requirements for legal notice.

Department Billing Address: Enter the Billing Address or e-mail address if invoices must be sent to a different location. Billing, confirmation of delivery or performance issues should be resolved through the listed Contract Managers.

Department Contract Manager: Identify the authorized Contract Manager who will be responsible for managing the Contract, who should be an authorized signatory or an employee designated by the Department to represent the Department to receive legal notices and negotiate ongoing Contract issues.

Department E-Mail Address/Phone/Fax: Enter the e-mail address, phone and fax number of the Department Contract Manager. Unless otherwise specified in the Contract, legal notice sent or received by the Contract Manager (with confirmation of actual receipt) through the listed address, fax number(s) or e-mail address will meet any requirements for written notice under the Contract.

MMARS Document ID(s): Enter the MMARS 20-character encumbrance transaction number associated with this Contract, which must remain the same for the life of the Contract. If multiple numbers exist for this Contract, identify all Document IDs.

RFR/Procurement or Other ID Number or Name: Enter the Request for Response (RFR) or other Procurement Reference number, Contract ID Number or other reference or tracking number for this Contract or Amendment which will be entered into the Board Award Field in the MMARS encumbrance transaction for this Contract.

NEW CONTRACTS (left side of Form):

Complete this section ONLY if this Contract is brand new. (Complete the CONTRACT AMENDMENT section for any material changes to an existing or an expired Contract, and for exercising options to renew or annual contracts under a multi-year procurement or grant program.)

Procurement Or Exception Type: Check the appropriate type of procurement or exception for this Contract. Only one option can be selected. See the Office of the Comptroller Guidance for Vendors Policies (State Finance Law and General Requirements, Acquisition Policy and Fixed Assets) and the Operational Services Division Conducting Best Value Procurements Handbook for details.

Statewide Contract (OSD or an OSD-designated Department). Check this option for a Statewide Contract under OSD, or by an OSD-designated Department.

Collective Purchase approved by OSD. Check this option for Contracts approved by OSD for collective purchases through federal, state, local government or other entities.

Department Procurement. Check this option for a Department contract procurement including state grants and federal sub-grants under 815 CMR 2.00 and State Grants and Federal Subgrants Policy, Departmental Master Agreements (MA). If this is a multi-Department user Contract, state that multi- Department use is allowable in the section labeled “Brief Description.”

Emergency Contract. Check this option when the Department has determined that an unforeseen crisis or incident has arisen which requires or mandates immediate purchases to avoid substantial harm to the functioning of government, the provision of necessary or mandated services, or where the health, welfare or safety of clients or other persons or serious damage to property is threatened.

Contract Employee. Check this option when the Department requires the performance of an Individual Contractor, and when the planned Contract performance with an Individual has been classified using the Employment Status https://www.mass.gov/regulations/815-CMR-2-state-grants-federal-grant-awards-federal-subgrants-and-subsidies

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Form (prior to the Contractor's selection) as work of a Contract Employee and not that of an Independent Contractor.

Other Procurement Exception. Check this option when another procurement exception exists, such as legislation with specific language naming the Contractor as a recipient of a grant or contract, an existing legal obligation, a prohibition or other circumstance that exempts or prohibits a Contract from being competitively procured, or identify any other procurement exception not already listed. Legislative “earmarks” exempt the Contract solely from procurement requirements, and all other Contract and state finance laws and policies apply.

Supporting documentation must be attached to explain and justify the exemption.

CONTRACT AMENDMENT (Right Side of Form)

Complete this section for any Contract being renewed, amended, or to continue a lapsed Contract. All Contracts with available options to renew must be amended referencing the original procurement and Contract Document IDs, since all continuing contracts must be maintained in the same Contract file (even if the underlying appropriation changes each fiscal year.) See “Amendments, Suspensions, and Termination Policy.”

Enter Current Contract End Date: Enter the termination date of the Current Contract being amended, even if this date has already passed. (Note: Current Start Date is not requested since this date does not change and is already recorded in MMARS.)

Enter Amendment Amount: Enter the amount of the Amendment increase or decrease to a Maximum Obligation Contract. Enter “no change” for Rate Contracts or if there is no change.

Amendment Type: Identify the type of Amendment being made.

Documentation supporting the updates to performance and budget must be attached.

Amendment to Date, Scope or Budget. Check this option when renewing a Contract or executing an Amendment (“material change” in Contract terms) even if the Contract has lapsed. The parties may negotiate a change in any element of Contract performance or cost identified in the RFR or the Contractor’s response which results in lower costs, or a more cost-effective or better value performance than was presented in the original selected response, provided the negotiation results in a better value within the scope of the RFR than what was proposed by the Contractor in the original selected response. Any “material” change in the Contract terms must be memorialized in a formal Amendment even if a corresponding MMARS transaction is not needed to support the change.

Additional negotiated terms will take precedence over the relevant terms in the RFR and the Contractor’s Response only if made using the process outlined in 801 CMR 21.07, incorporated herein, provided that any amended RFR or Response terms result in best value, lower costs, or a more cost effective Contract.

Interim Contracts. Check this option for an Interim Contract to prevent a lapse of Contract performance whenever an existing Contract is being re-procured but the new procurement has not been completed, to bridge the gap during implementation between an expiring and a new procurement, or to contract with an interim Contractor when a current Contractor is unable to complete full performance under a Contract.

Contract Employee. Check this option when the Department requires a renewal or other amendment to the performance of a Contract Employee.

Other Procurement Exception. Check this option when another procurement exception exists, such as legislation with specific language naming the Contractor as a recipient of a grant or contract; an existing legal obligation; a prohibition or other circumstance that exempts or prohibits a Contract from being competitively procured, or identify any other procurement exception not already listed. Legislative “earmarks” exempt the Contract solely from procurement requirements, and all other Contract and state finance laws and policies apply.

Attach Supporting documentation to explain and justify the exemption and whether Contractor selection has been publically posted.

Identify which version of the Commonwealth Terms and Conditions is incorporated by reference into this Contract: the Commonwealth Terms and Conditions (TC) or the Commonwealth Terms and Conditions for Human and Social Services (TC-HHS). The Comptroller Expenditure Classification Handbook identifies the applicable Commonwealth Terms and Conditions based upon the object code for the contract.

COMPENSATION

Identify if the Contract is a Rate Contract (with no stated Maximum Obligation) or a Maximum Obligation Contract (with a stated Maximum Obligation) and identify the Maximum Obligation. If the Contract is being amended, enter the new Maximum Obligation based upon the increase or decreasing Amendment.

The Total Maximum Obligation must reflect the total funding for the dates of service under the contract, including the Amendment amount if the Contract is being amended. The Maximum Obligation must match the MMARS encumbrance. Funding and allotments must be verified as available and encumbered prior to incurring obligations. If a Contract includes both a Maximum Obligation component and Rate Contract component, check off both.

Specific Maximum Obligation amounts or amended amounts and Attachments must clearly outline the Contract breakdown to match the encumbrance.

PROMPT PAY DISCOUNTS

Payments are processed within a 45 day payment cycle through EFT, in accordance with the Commonwealth Bill Paying Policy for investment and cash flow purposes. Departments may NOT negotiate accelerated payments and Payees are NOT entitled to accelerated payments UNLESS a prompt payment discount (PPD) is provided to support the Commonwealth’s loss of investment earnings…