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2. Contract Number Request Form
4. Type of Request*
   -- Select One --Sound Business Practices (SBP)Confirmatory Agreement (Please Complete Section II as Well)Invitation for Bid (IFB)Project Using a Master AgreementRequest for Proposals (RFP)Seeking Written QuotesEmergency ProcurementOther (Must Explain in Additional Information)
6. Contract Type*
   -- Select One --Equipment Only (Chapter 30B)Goods, Materials, or Supplies (Chapter 30B)Services (Chapter 30B)Technology Services (Software or Technical Support)Architect, Designer, or Engineering Services for a Public Building (Chapter 7)Engineering Services NOT for a Public BuildingBuilding Construction or Repair ServicesNon-Building Construction or Repair Services (Public Works)Sale of Surplus Equipment Revenue ContractOther (Explain)
8. Title for the Contract*
10. Term*
    -- Select One --Stand Alone (one time)One Year or LessMulti-Year
12. Starting Date for the Contract*
14. Estimated Total Value*
    -- Select One --Less than $5,000More than $5,000 but less than $9,999More than $9,999 but less than $49,999More than $49,999 but less than $99,999More than $99,999 but less than $1,000,000More than $1,000,000
16. Requesting Department*
    -- Select One --Building DepartmentCommission on DisabilitiesCommunity Preservation Committee (CPC)DPW - AdministrationDPW – Building MaintenanceDPW – DrainsDPW – EngineeringDPW – FleetDPW – HighwayDPW – Parks & ForestryDPW – Recycling & Solid WasteDPW – SewerDPW – WaterFinance DepartmentFire DepartmentHealth & Human Services - Public HealthHealth & Human Services - Senior ServicesHealth & Human Services - Veterans ServicesHealth & Human Services - Youth & Family ServicesTown CounselLibraryMunicipal ParkingPark & RecreationPlanning & Community DevelopmentPolice DepartmentBuilding Design & ConstructionTown ClerkTown ManagerHuman ResourcesSchool DepartmentOther (explain in the description box)
18. Funding Source*
    -- Select One --Capital Project AppropriationDepartment Operating Budget Financial Warrant ArticleGrant – Federal (explain)Grant – State (explain)Grant – Local (explain)No Cost ContractOther Source (explain)
20. State Funding*
    -- Select One --Yes, all of this contract will be funded by state fundsYes, a portion of this contract will be funded by state funds.No, none of this contract will be funded by state funds.

    State funds include any funds issued by the state. 

22. Primary Category *
    -- Select One --Other (explain)Construction ServicesDesign Services for a BuildingEngineering Services for a Non-Building ProjectEquipment PurchaseBuilding RepairsEquipment RepairsInfrastructure Repairs (Roads, Sewers, Water systems)Parks and Fields RepairsServices - Professional or TechnicalServices - Other Services not Professional or TechnicalServices - SoftwareServices - TrainingEnergy Related (Fuel, Oil, Natural Gas, Electric)Supplies and Materials Only
24. Additional Information*
26. Authorization Code*
28. Section II
    Required for All Contracts Drafted by Procurement

    If you are requesting a confirmatory agreement (SCCA), sole source contract, or sound business practice contract from Procurement, all of the below questions must be answered in order for a contract number to be assigned. 

30. Does Procurement Need to Draft a Contract?*

    1. Yes
    2. No
    3. This is for a bid or a quote solicitation.
32. Have You Forwarded the Vendor's Quote to Procurement*
    -- Select One --YesNoNO, this is NOT a request for a confirmatory agreementNO, I will be drafting an agreement for this.
34. Which Purchasing Group Does This Contract Relate
    -- Select One --State Contract (COMMBUYS)Greater Boston Police Council, Inc. (GBPC)Metropolitan Area Planning Council (MAPC)Savvik Buying Group (SBG)Sourcewell (SW) Cooperative PurchasingMassachusetts Higher Education Consortium (MHEC)OMNIA Partners (OP) New 12-07-2022THIS is not a cooperative contract purchase
36. Name of the Primary Contact for Town
38. Vendor Name
40. State or Cooperative Contract #*
42. State or Cooperative Contract Title
44. State or Cooperative Contract Expires
46. Vendor Street Address
48. Vendor Address (City/Town, State, Zip Code)
50. Vendor Telephone
52. Primary Contact Person/Title
54. Primary Contact Telephone Number
56. Primary Contact Email Address
58. Name of the Individual Authorized to Sign the Agreement on behalf of the Vendor
60. Position Title of the Individual Authorized to Sign the Agreement
62. Email Address of the Individual Authorized to Sign the Agreement
64. Account Number and Amount to be Encumbered
66. Expiration of the Agreement
68. Is This a Request for a Confirmatory Agreement?*
    -- Select One --BlankYesNo
70. 06/29/2013 rev 06/11/2014 rev 11/10/2014 rev 09/24/2015 rev 11/12/2015 rev 03/08/2016 rev 06/30/2016 rev 08/25/2017 rev 01/03/2018 rev 01/26/2019; rev 12/17/2019; rev 05/29/2020; rev 07/06/2020; rev 06/01/2022; rev 06/29/2022; rev 09/13/2022; rev 10/08/2022; rev 05/02/2023; rev 06/17/2023; rev 02/25/2024
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72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

* indicates a required field